Predictors of initial uptake of human papillomavirus vaccine uptake among rural Appalachian young women

Baretta R. Casey, Richard A. Crosby, Robin C. Vanderpool, Mark Dignan, Wallace Bates

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Women in Appalachian Kentucky experience a high burden of cervical cancer and have low rates of human papillomavirus (HPV) vaccination. The purpose of this study was to identify normative influences predicting initial HPV vaccine uptake among a sample of young women in southeastern Kentucky. Women (N = 495), ages 18 through 26 years, were recruited from clinics and community colleges. After completing a questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for Dose 1 served as the primary outcome variable. Hierarchical logistic regression was used to estimate the influence of healthcare providers, friends, mothers, and fathers on vaccine uptake. One-quarter of the total sample (25.9 %) received Dose 1. Uptake was higher in the clinic sample (45.1 %) than in the college sample (6.9 %). On multivariate analysis, women indicating that their healthcare provider suggested the vaccine, that their friends would "definitely" want them to be vaccinated, and that their fathers would "definitely" want them to receive the vaccine all were 1.6 times more likely to receive Dose 1. Interaction effects occurred between recruitment site (clinic vs. community college) and all three of the normative influences retaining multivariate significance, indicating that the associations only applied to the clinic sample. HPV vaccine interventions may benefit from highlighting paternal endorsement, healthcare provider recommendation, and peer support.

Original languageEnglish
Pages (from-to)71-80
Number of pages10
JournalJournal of Primary Prevention
Issue number1-2
StatePublished - Apr 2013

Bibliographical note

Funding Information:
Acknowledgments This study was supported by grants from the Centers for Disease Control and Prevention (Cooperative Agreement Number 1U48DP00193201) and Merck Pharmaceuticals. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention or Merck Pharmaceuticals. Note: Merck Pharmaceuticals had no involvement in the study design; collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication. The authors would like to thank Tonya Godsey for her assistance with data collection in this study.


  • Appalachia
  • Cervical cancer
  • Human papillomavirus vaccine
  • Normative influences

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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