LAUSR

BACKGROUND HPV vaccination rates remain low in the United States despite efforts to increase them, although rates vary geographically both at the state and regional level within the United States. This study examines differences in teen HPV vaccination rates and associated sociodemographic factors among six regions in Texas to understand potential variation insmaller regions. These differences may inform planning of local public health interventions aimed at increasing vaccination uptake in teens. METHODS We analyzed sociodemographic and vaccination data for a total of 2256 teens 13-17 years old from six regions in Texas using the 2017 National Immunization Survey--Teen (NIS-Teen). We used survey-weighted chi-squared tests to compare demographic characteristics and HPV vaccination initiation and series completion across regions and multivariable robust Poisson regression models to examine the association between region of residence and HPV vaccination outcomes. RESULTS Rates of initiation and completion of the HPV vaccine series varied significantly between six regions in Texas and were both highest in El Paso County and lowest in Dallas County (initiation 82.8% vs52.5%, P < 0.001; completion 51.3% vs 30.2%, P < 0.001). Adjusted multivariable log binomial regression models demonstrated that teens in Dallas county were significantly less likely to initiate the HPV vaccine series than teens in Travis county (RR = 0.79, 95% CI: (0.65, 0.95), P = 0.01). DISCUSSION HPV vaccination uptake varied significantly between six regions in Texas, highlighting the importance of closely examining local regions in public health planning efforts. Intervention efforts should consider the variation in sociodemographic characteristics as well as policy at the regional level to best improve vaccination rates in communities across the nation.