Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Peter B. Anderson


Human papillomavirus (HPV) is the most common sexually transmitted virus, and is causally related to several cancers. HPV vaccination rates are far below HealthyPeople 2020 targets and vary across geographic, socioeconomic, and demographic populations. The purpose of this research was to test the relationships among socioeconomic and demographic variables, HPV vaccination, social vulnerability, and physician recommendation within select local areas in the United States. Fundamental cause theory and behavioral economics informed this quantitative secondary analysis of National Immunization Survey-Teen and Social Vulnerability Index data (n = 43,271). Statistical analyses included chi-square and binomial logistic regression. Teens whose mothers had less than a college degree were more likely to initiate the HPV vaccine series (p < .01), while teens living in Hidalgo County and Houston were less likely to initiate the series (p < .001). Younger teens (p < .001), males (p < .001) and teens whose mothers had some college (p < .01) were less likely to complete the series, while older teens (p < .001) and teens living in Philadelphia and Houston (p < .01) were more likely to complete the series. Fewer teens in Bexar County received a physician recommendation (p < .01); there was no difference between vaccine initiation and select local area. These findings highlight the need to consider local sociodemographic influences on underlying disparities in health and physician behavior. Informed interventions may produce positive social change by reducing variance in health care quality, tailoring public health efforts to local needs, and moving persons experiencing disparities in health outcomes toward a healthy future.