Rural residents of the United States have higher HPV-associated cancer incidence and mortality, and suboptimal HPV vaccine uptake compared to urban residents. This study aimed to assess differences in knowledge and awareness of HPV, the HPV vaccine, and HPV-associated cancers among rural and urban residents. We analyzed data from the Health Information National Trends Survey 2013-2017 on 10,147 respondents ages ≥18 years. Multivariable logistic regression analyses compared urban/rural differences in knowledge and awareness of HPV, associated cancers, and HPV vaccine. Models were adjusted for sex, age, race/ethnicity, education, household income, census region, health insurance, regular provider, internet use, and personal history of cancer. Overall, 67.2% and 65.8% of urban residents were aware of HPV and HPV vaccine, respectively, compared to only 55.8% and 58.6% of rural residents. Adjusted models illustrated that compared to urban residents, rural residents were less likely to be aware of HPV (OR = 0.68, 95% CI = 0.53-0.86) and HPV vaccine (OR = 0.78, 95% CI = 0.63-0.97). Among those who were aware of HPV, rural residents were less likely to know that HPV causes cervical cancer (OR = 0.62, 95% CI = 0.46-0.84) and that HPV can be transmitted through sexual contact (OR = 0.72, 95% CI = 0.56-0.94). No significant differences between rural and urban residents were noted for knowledge that HPV is transmitted sexually and that it causes oral, anal, and penile cancers. This study highlights significant rural health disparities in knowledge and awareness of HPV and the HPV vaccine compared to urban counterparts.
Preventive medicine. 2018 Jan 26 [Epub ahead of print]
Kahee A Mohammed, Divya S Subramaniam, Christian J Geneus, Emmett R Henderson, Caress A Dean, Dipti P Subramaniam, Thomas E Burroughs
Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA; Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA. Electronic address: ., Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA., Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA., Saint Louis University College of Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA., Master of Public Health Program, School of Health Sciences, Oakland University, Rochester, MI, USA., Division of Health Services Research, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA., Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA; Saint Louis University College of Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.