Inequalities in human papillomavirus vaccination for female adolescents in the United States

The dissertation has the purpose of providing a comprehensive analysis of Human Papillomavirus vaccination for female adolescents in the United States. Built on the premise that vaccination is a long process that starts before the obtaining the vaccine it sheds light as to race/ethnic differences in HPV vaccine related outcomes at multiple stages starting with access to information and culminating with the completion of the series. Grounded in the Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) to justify the multiple stages approach and supported with multiple public health frameworks that drove the construction of the empirical models this dissertation aims to understand the role of race/ethnicity during each stage. This dissertation found race/ethnic disparities exist with regards to awareness about the HPV vaccine, where NH-Black and Hispanics are at lower probability of knowing about the vaccine. In this stage, differences are found for the effect of education and income level between race/ethnic groups. In the stages after awareness, the disparities transform with persons in race/ethnic minorities being more likely to accept and initiate the HPV vaccine series when compared to Non-Hispanic Whites. At the final stage (completion), the race/ethnic disparities are reduced to a marginal level, with Non-Hispanic Blacks having lower odds of completion. The results are discussed by comparing and contrasting the effects at the different stages. Eliminating race/ethnic differences in vaccination will require more than making the vaccine available. It will require addressing the fears towards the vaccine, by educating the parents about the benefits of it.