Missed Opportunities for HPV Vaccination Among Adolescents in a High-Risk Community

Background: Maximizing HPV vaccine uptake is critical for those at highest risk for cervical cancer.

Objectives: To evaluate missed opportunities for HPV vaccination and explore provider messaging associated with successful HPV vaccination of adolescent girls in a high-risk community.

Methods: During October 2008-September 2009, 107 parents of 11-17 year-old girls were interviewed immediately after completing a clinical visit at two urban clinics in Los Angeles serving populations with high cervical cancer rates.

Results: The majority of parent respondents were Hispanic women (89%); daughters’ mean age was 13.9 years.  At the time of their visit, 73 (68%) daughters were eligible to receive HPV vaccine: 50 (68%) had never initiated the vaccine series and 23 (32%) were due for their second or third dose.  Nearly 60% (43/73) of those eligible did not receive HPV vaccine, with the majority having never initiated vaccination (n=33).  Among girls eligible for vaccination, those vaccinated during their visit were older (mean age=14.8 vs. 13.2 years; p=.01); no other demographic differences were noted. A large proportion of parents who vaccinated their daughters noted that the doctor recommended the vaccine (60% vs. 26%; p<.01). Receiving specific vaccine information from the staff was also associated with receipt of vaccine, including information that HPV vaccine works best if received before sex (57% vs. 9%; p<.01), that the vaccine prevents cervical cancer (70% vs. 33%; p<.01) and genital warts (50% vs. 9%; p<.01), and that HPV is a sexually transmitted infection (53% vs. 23%; p<.01). 

Conclusions: A substantial proportion of adolescents eligible for HPV vaccine did not receive it during a clinical visit. Provider recommendation appears to be an influential vaccination motivator as does receiving specific HPV vaccine information. 

Implications for Programs, Policy, and Research: Providers are critical in increasing HPV vaccine uptake and need to limit missed opportunities for vaccination.