The campaign to immunize children to protect against the cancer-causing human papillomavirus (HPV) has never quite gone mainstream.
And new research from University of Utah College of Nursing Assistant Professor and Huntsman Cancer Institute investigator Deanna Kepka, Ph.D., M.P.H., reveals just how difficult it might be to meet national objectives for herd immunity.
In a paper released in , Jan. 14, Kepka and her co-principal investigator, medical geographer Kevin Henry, found that vaccination rates for girls are highest in high-poverty, homogeneous Hispanic communities.
Using data from the Centers for Disease Control and Prevention's (CDC) 2011 and 2012 annual National Immunization Survey-Teen, Kepka and Henry reported 69 percent of Hispanic girls between 13 and 17 years old had initiated the three-dose vaccine. In contrast, girls living in majority white, non-Hispanic communities had the lowest rate of HPV vaccine initiation – 50 percent. Non-Hispanic black communities were only slightly better, with a 54-percent initiation rate.
"We are interested in looking at cultural values that may make certain demographic groups in the 
United States, such as Latinos, more supportive of adolescent vaccination than other demographic groups," Kepka said in a press release from the American Association for Cancer Research.
"HPV vaccine should be recommended right along with Tdap, meningococcal and flu vaccines," she added. "We want to find out what the contextual factors are to these missed opportunities. Why are kids getting all the others but not HPV?"
The research team members – working in a collaboration between the University of Utah, Rutgers University and Temple University – note their findings buck what might be expected.
"Our findings that the rates of HPV vaccine initiation are highest among adolescent girls living in high-poverty communities and majority Hispanic communities, which generally have higher than average poverty rates, are contrary to conventional beliefs that socioeconomic disadvantage is a barrier to health care," said Henry, an assistant professor at Temple University and a member of Fox Chase Cancer Center's Cancer Prevention and Control program.
The federal government's Healthy People 2020 initiative recommends 80-percent HPV vaccination for girls and boys. But in 2013, just 38 percent of U.S. girls and 14 percent of U.S. boys ages 13 to 17 had completed the three-dose series of shots.
On Jan. 1, Henry and Kepka, director of the Intermountain West HPV Vaccination Coalition and a Huntsman Cancer Institute investigator, received a new $163,000 grant from the National Institutes of Health's National Cancer Institute to study community-level geographic factors that might influence HPV vaccination rates. The researchers hope to find possible explanations for the immunization disparity with a detailed analysis of neighborhood-level statistics.
For example, Henry said in the AACR press release, it's possible that "safety-net" immunization services, including state Children's Health Insurance Program (CHIP) coverage, Medicaid health insurance and the Vaccines for Children (VFC) program might contribute to higher rates of HPV immunization in poor and minority communities.
The researchers will bore into individual ZIP code data collected by the CDC's National Center for Health Statistics in Maryland. Over the two-year term of the grant, the team expects to review more than 5 years of information and 50,000 immunization records.
In particular, Kepka says, they want to find out what the HPV immunization patterns are for boys in the same communities, review more recent data and try to determine any regional differences.
"There are 26,000 HPV-related cancers each year in the United States. And we have a cancer-prevention vaccine that has been recommended for over 10 years," Kepka said. "Yet, it is severely underutilized.
"We need to explore how to improve targeted public health messaging to promote this vaccine among sociodemographic groups who are least likely to receive it."