Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 31;228(5):615-626.
doi: 10.1093/infdis/jiad055.

Trends in Adolescent Human Papillomavirus Vaccination and Parental Hesitancy in the United States

Jodie L White  1 , M Kate Grabowski  1   2 , Anne F Rositch  2 , Patti E Gravitt  3 , Thomas C Quinn  4 , Aaron A R Tobian  1   2 , Eshan U Patel  1   2
Affiliations

Trends in Adolescent Human Papillomavirus Vaccination and Parental Hesitancy in the United States

Jodie L White et al. J Infect Dis. .

Abstract

Background: Human papillomavirus (HPV) vaccination coverage remains suboptimal in the United States, underscoring the importance of monitoring trends in vaccine hesitancy.

Methods: Cross-sectional data from the 2011-2020 National Immunization Survey-Teen were used to assess trends in HPV vaccination initiation among 13-17-year-olds, parental intent to initiate vaccination, and primary reasons for parental hesitancy.

Results: Among all sex and race and ethnicity groups, the prevalence of HPV vaccination initiation increased over time, but parental intent to vaccinate against HPV for unvaccinated teens remained consistently low (≤45%). Among hesitant parents, "safety concerns" increased in nearly all demographic groups, with the greatest increases observed for non-Hispanic white female and male teens and no change for non-Hispanic black female teens. In 2019-2020, parents of unvaccinated non-Hispanic white teens were least likely to intend on vaccinating their teens, and the most common reason for hesitancy varied by sex and race and ethnicity (eg, "safety concerns" for white teens and "not necessary" for black female teens).

Conclusions: Although HPV vaccination initiation increased over time, a substantial fraction of parents remain hesitant, and trends in their reason varied by sex and race and ethnicity. Health campaigns and clinicians should address vaccine safety and necessity.

Keywords: NIS-Teen; adolescent health; cancer prevention; racial disparities; vaccine hesitancy.

Plain language summary

Adolescent vaccination against human papillomavirus (HPV) is a critical tool for cancer prevention. We analyzed trends in HPV vaccination initiation among adolescents aged 13–17 years and trends in parental hesitancy to initiate HPV vaccination for their teen, using data from a national survey in the United States. Between 2011–2012 and 2019–2020, adolescent HPV vaccination initiation increased over time for both female teens (from 53.4% to 75.2%) and male teens (from 14.5% to 71.5%). However, the majority of parents/guardians of unvaccinated teens did not intend to vaccinate their teen against HPV (ie, were vaccine hesitant), and this was consistent over time in all sex and race and ethnicity groups. Among hesitant parents, the proportion reporting safety concerns as their main reason for being hesitant increased over time in nearly all demographic groups, with the greatest increases in this reasoning observed for white teens. In 2019–2020, parents of unvaccinated white teens were most likely to be vaccine hesitant. The most common reason for being vaccine hesitant also differed by sex and race and ethnicity. Although HPV vaccination has been shown to be safe and effective, HPV vaccination coverage remains suboptimal, and a substantial fraction of parents/guardians continue to be hesitant to adolescent HPV vaccination.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Sample flow for provider-verified and household interview components and eligibility for analytic samples. Abbreviations: HPV, human papillomavirus; NIS-Teen, National Immunization Survey–Teen.
Figure 2.
Figure 2.
Temporal trends in parent-reported and provider-verified human papillomavirus (HPV) vaccination initiation (≥1 dose) among adolescents aged 13–17 years. A, B, Parent-reported prevalence of HPV vaccination initiation for female (A) and male (B) teens (n = 346 850). C, D, Provider-verified prevalence of HPV vaccination initiation for female (C) and male (D) teens (n = 202 804). Numeric estimates of the data shown are provided in Supplementary Table 4.
Figure 3.
Figure 3.
Temporal trends in parental intent to vaccinate against human papillomavirus (HPV) for unvaccinated female adolescents aged 13–17 years.
Figure 4.
Figure 4.
Temporal trends in parental intent to vaccinate against human papillomavirus (HPV) for unvaccinated male adolescents aged 13–17 years.
Figure 5.
Figure 5.
Temporal trends reasons for parental human papillomavirus (HPV) vaccine hesitancy for hesitant parents of unvaccinated female adolescents aged 13–17 years. Error bars indicate Korn-Graubard 95% confidence intervals. Numeric estimates are provided in Supplementary Table 8.
Figure 6.
Figure 6.
Temporal trends reasons for parental human papillomavirus (HPV) vaccine hesitancy for hesitant parents of unvaccinated male adolescents aged 13–17 years. Note: Error bars indicate Korn-Graubard 95% confidence intervals. Numeric estimates are provided in Supplementary Table 8.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kreisel KM, Spicknall IH, Gargano JW, et al. . Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018. Sex Transm Dis 2021; 48:208–14. - PMC - PubMed
    1. Senkomago V, Henley SJ, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human papillomavirus-attributable cancers—United States, 2012–2016. Morb Mortal Wkly Rep 2019; 68:724–8. - PMC - PubMed
    1. McQuillan G, Kruszon-Moran D, Markowitz L, Unger E, Paulose-Ram R. Prevalence of HPV in adults aged 18–69: United States, 2011–2014. NCHS Data Brief 2017; 280:1–8. - PubMed
    1. Chaturvedi AK, Graubard BI, Broutian T, et al. . Prevalence of oral HPV infection in unvaccinated men and women in the United States, 2009–2016. JAMA 2019; 322:977–9. - PMC - PubMed
    1. Han JJ, Beltran TH, Song JW, Klaric J, Choi YS. Prevalence of genital human papillomavirus infection and human papillomavirus vaccination rates among US adult men: National Health and Nutrition Examination Survey (NHANES) 2013–2014. JAMA Oncol 2017; 3:810–6. - PMC - PubMed

Publication types

Substances