Peer-reviewed article
Factors Influencing HPV Vaccination Uptake in Adolescents: Evidence to Guide Clinical Practice.
Taylor Mullin, Diane Von Ah ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined factors affecting HPV vaccine uptake among U.S. adolescents aged 9-18 years, synthesizing evidence from 37 studies. Vaccination initiation averaged 47% and completion 40%. Provider recommendation, health insurance, urban residence, older age, and higher parental education were associated with higher uptake. Significant disparities were found among adolescents in rural areas and from minority or low-income backgrounds, with barriers including parental safety concerns and logistical challenges.
Key points
- Average HPV vaccine initiation rate was 47% and completion rate was 40% among U.S. adolescents
- Provider recommendation, health insurance coverage, urban residence, older age, and higher parental education predicted higher vaccine uptake
- Disparities were most evident among adolescents in rural areas and those from minority or low-income backgrounds
- Parental safety concerns and logistical challenges were commonly reported barriers
- Evidence on parental knowledge and attitudes was mixed, with smaller studies showing influence but the largest population-based study showing no significant effect
Limitations
This review focuses only on U.S. adolescents and does not examine HPV vaccination in other countries or age groups. The review synthesizes existing literature and cannot determine causal relationships or test new interventions directly.
Abstract
BACKGROUND: Human papillomavirus (HPV) is a major contributor to several preventable cancers. Although the HPV vaccine is recognized by the Centers for Disease Control and Prevention (CDC) as safe and effective, uptake among U.S. adolescents remains below optimal levels. Disparities in vaccination rates are shaped by both individual characteristics and social determinants of health (SDOH). OBJECTIVE: To systematically review and synthesize the literature examining individual factors and social determinants of health associated with HPV vaccine initiation and completion among adolescents aged 9-18 years in the U.S. METHODS: A systematic search was conducted in accordance with PRISMA guidelines, yielding 37 eligible studies from an initial pool of 2092 articles. The STROBE checklist was used to assess methodological quality, and the Levels of Evidence framework by Melnyk and Fineout-Overholt guided appraisal of study strength. RESULTS: Across included studies, initiation and completion rates averaged 47% and 40%, respectively. Key predictors of higher vaccine uptake included provider recommendation, health insurance coverage, urban residence, older age, and higher parental education. Disparities were most evident among adolescents living in rural areas and those from minority or low-income backgrounds. Barriers reported in several studies included parental safety concerns and logistical challenges. Evidence regarding parental knowledge and attitudes was mixed: smaller studies suggested an influence, whereas the largest population-based study reported no significant effect. CONCLUSION: Addressing HPV vaccination disparities requires a multifaceted approach, including improving healthcare access in underserved regions, strengthening provider-parent communication, and implementing policy interventions such as school-based vaccination programs and state mandates. Normalizing HPV vaccination as part of routine adolescent care is essential for reducing HPV-related cancer morbidity and mortality. These findings also have implications for catch-up vaccination in young adults aged 15-26 and shared clinical decision-making up to age 45, which remain important strategies for increasing protection across the lifespan.