Maternal and Child Health Journal

, Volume 17, Issue 5, pp 879–885 | Cite as

A National Study of HPV Vaccination of Adolescent Girls: Rates, Predictors, and Reasons for Non-Vaccination

  • Laura M. Kester
  • Gregory D. Zimet
  • J. Dennis Fortenberry
  • Jessica A. Kahn
  • Marcia L. Shew


Despite recommendations in the U.S. for routine HPV vaccination of adolescent girls since 2006, rates of vaccination continue to be low. This study reports vaccination uptake, factors associated with vaccine uptake and reasons for non-vaccination within a national sample of adolescent females during 2010. Using a computer administered survey of a national sample of 501 mothers of daughters 14–17 years old we assessed maternal reports of HPV vaccination as well as socio-demographical factors, maternal HPV exposures and reasons chosen for non-vaccination. Reported HPV vaccination rates were slightly over 50 % (51.1 %), with 38.3 % reporting completion of all 3 doses. Socioeconomic and demographic factors were not associated with vaccination initiation; however, Blacks and Hispanics were less likely to complete vaccination. The most common reasons for non-vaccination were concerns about vaccine safety, danger to daughter, and provider non-recommendation. Relatively poor HPV vaccine initiation and only modest 3-dose completion continues to be a major public health concern that requires continued efforts to address identified predictors and reasons for non-vaccination.


HPV Vaccination rates Adolescent health behaviors Sexually transmitted infections 



Funding support for this research was provided by NIH R56 A1079090-01A1.

Conflict of interest

Kester, Laura: Has no financial disclosures. Zimet, Gregory: Investigator on grants funded through Merck’s Investigator Initiated Studies Program. In the past year served as a consultant to Sanofi Pasteur regarding attitudes about herpes vaccination. Shew, Marcia: Investigator for Merck and Co. related HPV vaccine trials. Kahn, Jessica: Co-PI of two clinical trials of HPV vaccine in HIV-infected individuals; vaccine and immunogenicity testing were provided by Merck. Fortenberry, J Dennis: Receives compensation from American Social Health Association for continuing lectures related to HPV vaccines.


  1. 1.
    Morbidity and Mortality Weekly Report (MMWR). (2007). Quadrivalent human papillomavirus vaccine. CDC, 56(RR02), 1–24.
  2. 2.
    Morbidity and Mortality Weekly Report (MMWR). (2010). FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). CDC, 59(20), 626–629.
  3. 3.
    Morbidity and Mortality Weekly Report (MMWR). (2007). QuickStats: Prevalence of HPV infection among sexually active females aged 14–59 years by age group. National Health and Nutrition Examination Survey, United States 2003–2004. CDC.
  4. 4.
    Weaver, B., Shew, M., Qadadri, B., et al. (2011). Natural history of multiple human papillomavirus infections in female adolescents with prolonged follow-up. Journal of Adolescent Health, 48(5), 473–480.PubMedCrossRefGoogle Scholar
  5. 5.
    Morbidity and Mortality Weekly Report (MMWR). (2010). National, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2009. CDC, 59(32):1018–1023.
  6. 6.
    Morbidity and Mortality Weekly Report (MMWR). (2011). National and state vaccination coverage among adolescents aged 13 through 17 years—United States, 2010. CDC, 60(33).
  7. 7.
    Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45(2–3), 107–114.PubMedCrossRefGoogle Scholar
  8. 8.
    Guerry, S. L., De Rosa, C. J., Markowitz, L. E., et al. (2011). Human papillomavirus vaccine initiation among adolescent girls in high-risk communities. Vaccine, 29(12), 2235–2241.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith, L., Brassard, P., Kwong, J., Deeks, S., Ellis, A., & Levesque, L. (2011). Factors associated with initiation and completion of the quadrivalent human papillomavirus vaccine series in an Ontario cohort of Grade 8 girls. BMC Public Health, 11(1), 645.PubMedCrossRefGoogle Scholar
  10. 10.
    Fernández, M. E., Allen, J. D., Mistry, R., & Kahn, J. A. (2010). Integrating clinical, community, and policy perspectives on HPV vaccination. Annual Review of Public Health, 31, 235–252.PubMedCrossRefGoogle Scholar
  11. 11.
    Dorell, C. G., Yankey, D., Santibanez, T. A., & Markowitz, L. E. (2011). Human papillomavirus vaccination series initiation and completion, 2008–2009. Pediatrics, 128(5), 830–839.PubMedCrossRefGoogle Scholar
  12. 12.
    Barnack, J. L., Reddy, D. M., & Swain, C. (2010). Predictors of parents’ willingness to vaccinate for human papillomavirus and physicians’ intentions to recommend the vaccine. Women’s Health Issues, 20(1), 28–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Allen, J. D., Othus, M. K. D., Shelton, R. C., et al. (2010). Parental decision making about the HPV vaccine. Cancer Epidemiology, Biomarkers and Prevention, 19(9), 2187–2198.PubMedCrossRefGoogle Scholar
  14. 14.
    Brewer, N. T., Gottlieb, S. L., Reiter, P. L., et al. (2011). Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area. Sexually Transmitted Diseases, 38(3), 197–204.PubMedCrossRefGoogle Scholar
  15. 15.
    Pruitt, S. L., & Schootman, M. (2010). Geographic disparity, area poverty, and human papillomavirus vaccination. American Journal of Preventive Medicine, 38(5), 525–533.PubMedCrossRefGoogle Scholar
  16. 16.
    Widdice, L. E., Bernstein, D. I., Leonard, A. C., Marsolo, K. A., & Kahn, J. A. (2011). Adherence to the HPV vaccine dosing intervals and factors associated with completion of 3 doses. Pediatrics, 127(1), 77–84.PubMedCrossRefGoogle Scholar
  17. 17.
    Schluterman, N., Terplan, M. S., Lydecker, A. D., & Tracy, J. K. (2011). Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital. Vaccine, 29(21), 3767–3772.PubMedCrossRefGoogle Scholar
  18. 18.
    Gold, R., Naleway, A. L., Jenkins, L. L., et al. (2011). Completion and timing of the three-dose human papillomavirus vaccine series among adolescents attending school-based health centers in oregon. Preventive Medicine, 52(6), 456–458.PubMedCrossRefGoogle Scholar
  19. 19.
    Chou, B., Krill, L. S., Horton, B. B., Barat, C. E., & Trimble, C. L. (2011). Disparities in human papillomavirus vaccine completion among vaccine initiators. Obstetrics & Gynecology, 118(1), 14–20.CrossRefGoogle Scholar
  20. 20.
    Niccolai, L. M., Mehta, N. R., & Hadler, J. L. (2011). Racial/ethnic and poverty disparities in human papillomavirus vaccination completion. American Journal of Preventive Medicine, 41(4), 428–433.PubMedCrossRefGoogle Scholar
  21. 21.
    Society, A. C. (2010). Cancer facts and figures 2010. Alanta: American Cancer Society.Google Scholar
  22. 22.
    Bingham, A., Drake, J. K., & LaMontagne, D. S. (2009). Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings. Archives of Pediatrics & Adolescent Medicine, 163(5), 455–461.Google Scholar
  23. 23.
    Kahn, J. A., Lan, D., & Kahn, R. S. (2007). Sociodemographic factors associated with high-risk human papillomavirus infection. Obstetrics & Gynecology, 110(1), 87–95.CrossRefGoogle Scholar
  24. 24.
    Caskey, R., Lindau, S. T., & Alexander, G. C. (2009). Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey. Journal of Adolescent Health, 45(5), 453–462.PubMedCrossRefGoogle Scholar
  25. 25.
    Chao, C., Slezak, J. M., Coleman, K. J., & Jacobsen, S. J. (2009). Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls. American Journal of Public Health, 99(6), 1137–1142.PubMedCrossRefGoogle Scholar
  26. 26.
    Gerend, M. A., Weibley, E., & Bland, H. (2009). Parental response to human papillomavirus vaccine availability: Uptake and intentions. Journal of Adolescent Health, 45(5), 528–531.PubMedCrossRefGoogle Scholar
  27. 27.
    Dorell, C., Yankey, D., & Strasser, S. (2011). Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, National Immunization Survey—Teen, 2009. Clinical Pediatrics, 50(12), 1116–1124.PubMedCrossRefGoogle Scholar
  28. 28.
    Daley, M. F., Crane, L. A., Markowitz, L. E., et al. (2010). Human papillomavirus vaccination practices: A survey of US physicians 18 months after licensure. Pediatrics, 126(3), 425–433.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Laura M. Kester
    • 1
  • Gregory D. Zimet
    • 1
  • J. Dennis Fortenberry
    • 1
  • Jessica A. Kahn
    • 2
  • Marcia L. Shew
    • 1
  1. 1.Department of PediatricsIndiana UniversityIndianapolisUSA
  2. 2.Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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