Date of Conferral





Public Health


Jacqueline Fraser


A high number of Hispanic youth in Bexar County, Texas, face morbidity and mortality related to human papillomavirus (HPV) infection due to inadequate vaccination coverage youth. A better understanding of the factors that influence vaccination might help public health authorities to increase coverage. The aim of this quantitative, cross-sectional study, which was based on the socioecological model and involved analysis of weighted survey data from the 2016 to 2018 National Immunization Survey-Teen, was to better understand the multilevel factors influencing HPV vaccine use among Hispanic youth. The weighted sample was representative of the study population in terms of survey characteristics (e.g., response rate) and sociodemographics (i.e., maternal education, teen gender, race/ethnicity, and age). The association of parents’ annual income with vaccination intent (n = 816), initiation (n = 632), completion (n = 1,040), and perceived barriers (n = 364) to vaccination was measured using the chi-square test and prevalence ratio. The association of income level with perceived reasons for lack of intent to vaccinate was tested based on five domains of concerns or barriers. In the pooled average of the study years, low-income families (<$40,000/year) had about 1.3 times higher prevalence of vaccination intention, initiation, and completion than their high-income counterparts (>$40,000/year). Low-income families generally had a higher prevalence of lack of knowledge of HPV and the vaccine, systemic barriers, and sociocultural barriers, but a lower prevalence of safety/effectiveness concerns and misinformation. Public health authorities could use these results to tailor and prioritize interventions to increase HPV vaccination at the local level, and, in turn, mitigate the adverse effects of HPV infection.

Available for download on Wednesday, August 30, 2023