Exploring rural-urban disparities in HPV vaccine initiation: new insights from the 2022 national health interview survey.

As human papillomavirus (HPV)-associated cancers continue rising in rural America, identifying contributors to rural-urban gaps in HPV vaccination could inform public health priorities and targeted interventions. Analyzing nationally representative data from the 2022 National Health Interview Survey (NHIS), we evaluated rural-urban differences in HPV vaccination among individuals aged 9-29 years (all of whom were recommended to receive the HPV vaccine during adolescence since 2006). Generalized structural equation models adjusted for complex survey design, sociodemographic factors, and other vaccine utilization. Even after adjusting for other vaccine utilization, rural participants were 5.4%-points (CI = -9.7, -1.0) less likely to receive the HPV vaccine than urban participants. Rural-urban disparities in HPV vaccination varied by healthcare access barriers and geography, with the largest gap found in participants who were privately insured. Our work suggests that rural-urban disparities in HPV vaccination are driven by factors distinct from those associated with other vaccines and healthcare access.