# Understanding and Addressing the Disparity in Vaccination Coverage Among U.S. Adolescents Living in Rural Versus Urban Areas

> **NIH ALLCDC U01** · MARSHFIELD CLINIC, INC. · 2020 · $350,000

## Abstract

PROJECT SUMMARY
Three vaccines introduced between 2005 and 2007, meningococcal conjugate vaccine
(MenACWY); tetanus, diphtheria, and acellular pertussis vaccine (Tdap); and human
papillomavirus (HPV) vaccine, are currently recommended for all adolescents aged 11-12 years.
National data indicate important differences in HPV and MenACWY vaccine coverage between
adolescents living in rural areas and urban central cities with no disparities in coverage for
Tdap. Reasons for this geographic disparity are not clear. Better understanding of the factors
contributing to the observed differences in rural and urban areas will inform strategies to
address the rural-urban disparity in vaccine coverage by increasing vaccine uptake among
adolescents living in rural areas. The aims of this project are 1) identify factors contributing to
disparities in recommended vaccine coverage between adolescents living in rural areas and
those living in urban areas, 2) develop and implement an intervention to improve vaccination
coverage among adolescents living in rural area, and 3) evaluate the intervention effectiveness
and identify strategies that may be effective in improving vaccination coverage among
adolescents living in rural areas. We will administer surveys to parents and guardians of
adolescents and primary care providers serving adolescents who live in rural and urban areas of
Minnesota and Wisconsin in Year 1. The surveys will be designed to identify provider and
parental factors associated with the rural-urban disparities. Survey results and qualitative in-
depth interviews with providers and clinical staff will inform the intervention that will take place in
Years 2 and 3. The intervention to increase rural adolescent vaccine uptake will be implemented
and evaluated in a health system that serves a largely rural population. Evaluation of the
intervention may consist of assessing changes in adolescent vaccination coverage, pre- and
post- surveys of providers and parents of adolescents to assess changes in knowledge,
attitudes, beliefs, vaccine counseling, and participation in intervention activities. Findings
regarding potentially modifiable factors will inform strategies/interventions increase routine
vaccination coverage of HPV and MenACWY among adolescents living in rural areas of the
country, reducing the disparity between rural and urban areas.

## Key facts

- **NIH application ID:** 9948519
- **Project number:** 5U01IP001093-03
- **Recipient organization:** MARSHFIELD CLINIC, INC.
- **Principal Investigator:** Huong Q Nguyen
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $350,000
- **Award type:** 5
- **Project period:** 2018-09-01 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9948519

## Citation

> US National Institutes of Health, RePORTER application 9948519, Understanding and Addressing the Disparity in Vaccination Coverage Among U.S. Adolescents Living in Rural Versus Urban Areas (5U01IP001093-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9948519. Licensed CC0.

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