UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Socioeconomic and racial-ethnic inequalities in human papillomavirus vaccination : empirically testing fundamental cause, health lifestyle, and prosocial mechanisms of health disparities Polonijo, Andrea Nicole


Socioeconomic and racial-ethnic inequalities in health are well documented, but the pathways underlying this relationship are not fully understood. To elucidate these pathways, I generate and test hypotheses about three facets of adolescent human papillomavirus (HPV) vaccination. Fundamental cause theory contends health inequalities will shrink when policies support the equal distribution of interventions across populations. Using a triple-difference design, I analyzed the 2008–2009 and 2011–2013 National Immunization Survey–Teen (N=4,579 parents) to examine whether vaccine mandates shape provider recommendation and adolescent uptake of HPV vaccines, by socioeconomic status (SES) and race-ethnicity. I find mandates are associated with (a) improvements in provider recommendation for some SES and racial-ethnic groups (but not corresponding patterns of uptake) and (b) declining HPV vaccine uptake in the overall population. Health lifestyle theory suggests that social groups engage in patterns of health behaviors that are reproduced within families. Analyzing the 2009 University of North Carolina (UNC) Mother–Daughter Communication Survey (N=951 mothers), I used multinomial logistic regression models to test whether mother–daughter communication about vaccines is associated with SES, race-ethnicity, and vaccine uptake. I find (a) Black (versus White) mothers are less likely to initiate conversations about HPV vaccination with their daughters and (b) mother–daughter communication increases the likelihood of HPV vaccination. Research on prosocial behavior suggests that having fewer material resources may result in more positive attitudes toward and greater willingness to partake in health interventions that benefit others. Analyzing the 2010 UNC HPV Immunization in Sons Study (N=919 adolescent boys and parents), I used seemingly unrelated regression models to test whether SES and race-ethnicity are associated with prosocial attitudes toward and willingness to vaccinate against HPV. I find (a) lower (versus Higher) educated parents and (b) Black and Hispanic (versus White) parents and adolescent boys report greater prosocial vaccination attitudes—some of which are associated with greater willingness to vaccinate. These findings inform three important knowledge gaps for understanding health inequalities: the potential impact of adolescent-focused policy for mitigating health inequalities, the intergenerational reproduction of health inequalities within families, and the salience of prosocial attitudes for motivating health behaviors.

Item Citations and Data


Attribution-NonCommercial-NoDerivatives 4.0 International