Barriers to Human Papillomavirus Vaccination Initiation and Completion among Adults Aged 18–26 Years in a Large Healthcare System

Abstract

Human papillomavirus (HPV) is a common sexually transmitted infection, with over 40% prevalence in the US. Oropharyngeal cancers (OPCs) driven by high-risk HPV are increasing (up to 90%), with HPV vaccination being the only prevention available. The aim of this study was to investigate HPV vaccination among patients aged between 18 and 26 years old with at least one encounter at a large healthcare system and identify sociodemographic factors associated with vaccine initiation and completion. A cross-sectional retrospective study was conducted between 2018 and 2021, including 265,554 patients identified from the Clinical Data Warehouse. HPV vaccination status by age, sex, race/ethnicity, insurance type, primary care (PCP) visits in the past year, alcohol, tobacco, illicit drug use, and age at vaccination was examined. Overall, 33.6% of females and 25.4% of males have completed the HPV vaccine. Black Americans were 35% more likely to initiate the vaccine than White Americans but were less likely to complete the entire course. Overall, HPV vaccination prevalence was far below the Health People 2030 goal of 80%, especially in young males. This low rate is troubling, since many patients had a PCP visit and remained unvaccinated, which serves as a missed opportunity for vaccination.

Editorial: Special Issue on the Epidemiology of Human Papilloma Virus-Associated Oropharyngeal Squamous Cell Carcinoma

“…The HPV vaccination has been shown to be highly effective in reducing the development of cervical precancers in women [ 20 ], and it has been shown to reduce the rates of HPV-positive infections in those already testing positive [ 21 ]. While the vaccination remains the only primary prevention for HPV-associated oropharyngeal squamous cell carcinoma, there is a remarkably low rate of the population that receive the full vaccination series, with significant disparities existing among men and Black Americans (Khalil et al) [ 22 ]. Perhaps the most urgent goal moving forward would be to encourage vaccination, through strengthening the patient–provider relationship and community education on the risks of HPV, and subsequently, HPV-associated oropharyngeal squamous cell carcinoma.…”