Prevalence and predictors of human papillomavirus vaccination in adolescent girls
Swetha Rao Palli, BSPharm (Hons), MS; Sandhya Mehta, BSPharm, MS; Rajender R. Aparasu, MPharm, PhD
J Am Pharm Assoc (2003) 2012;52:52-58. doi:10.1331/JAPhA.2012.10195


Objectives  To determine the prevalence and predictors of human papillomavirus (HPV) vaccination in adolescent girls who were recommended to receive the vaccine by their health care providers.

Design  Cross-sectional study.

Setting  United States in 2007–08.

Participants  Parents or guardians most knowledgeable about health and health care of adolescent girls aged 12 to 17 years participating in the 2007 National Survey of Children's Health (NSCH).

Intervention  NCSH was a population-based telephone survey using a complex probability sampling design.

Main outcome measures  Prevalence of HPV vaccination in adolescent girls who were recommended to receive the HPV vaccine and predisposing, enabling, and need factors associated with HPV vaccination.

Results  Of 12.38 million adolescent girls aged 12 to 17 years, 3.69 million (29.76%) were recommended to receive the HPV vaccine by their health care provider. The majority who received the HPV vaccine recommendation were 13 to 17 years of age (83%), were white (71%), and had one or more preventive visits (94%). Among those for whom the HPV vaccine was recommended, 48.75% (95% CI 45.37–52.13) received the vaccine. Multivariate logistic regression analysis of those who were recommended revealed that enabling and predisposing factors were significantly associated with the HPV vaccination. Children living at 101% to 200% of the Federal Poverty Level (odds ratio 0.54 [95% CI 0.30–0.98]) and children in households with two or more adults (0.51 [0.33–0.80]) were negatively associated with HPV vaccination, whereas children with any preventive medical care visit(s) (2.28 [1.36–3.84]) in the previous year were positively associated with HPV vaccination.

Conclusion  Nearly one-half of adolescent girls received the HPV vaccine among those who were recommended by their health care provider. The study finding emphasizes the importance of predisposing and enabling factors for HPV vaccination. Policy and education efforts can focus on these factors to improve HPV vaccination rates.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.


Register for a FREE limited account to benefit from personalization features such as alerts.


Markowitz LE, Dunne EF, Saraiya M, et al. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR Recomm Rep. 2007;56:1–24.[PubMed]
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008.  CA Cancer J Clin. 2008;58:71–96.[CrossRef][PubMed]
Trottier H, Franco EL.  The epidemiology of genital human papillomavirus infection.  Vaccine.  2006;24(suppl 1):S4–15.[CrossRef]
Dempsey AF, Zimet GD, Davis RL, Koutsky L.  Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV.  Pediatrics. 2006;117:1486–93.[CrossRef][PubMed]
Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases.  N Engl J Med. 2007;356:1928–43.[CrossRef][PubMed]
 FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions.  N Engl J Med. 2007;356:1915–27.[CrossRef][PubMed]
Villa LL, Costa RL, Petta CA, et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up.  Br J Cancer. 2006;95:1459–66.[CrossRef][PubMed]
Daley MF, Liddon N, Crane LA, et al. A national survey of pediatrician knowledge and attitudes regarding human papillomavirus vaccination.  Pediatrics. 2006;118:2280–9.[CrossRef][PubMed]
Christian WJ, Christian A, Hopenhayn C.  Acceptance of the HPV vaccine for adolescent girls: analysis of state-added questions from the BRFSS.  J Adolesc Health. 2009;44:437–45.[CrossRef][PubMed]
Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States.  JAMA. 2007;297:813–9.[CrossRef][PubMed]
Adams M, Jasani B, Fiander A.  Human papilloma virus (HPV) prophylactic vaccination: challenges for public health and implications for screening.  Vaccine. 2007;25:3007–13.[CrossRef][PubMed]
Kahn JA, Lan D, Kahn RS.  Sociodemographic factors associated with high-risk human papillomavirus infection.  Obstet Gynecol. 2007;110:87–95.[CrossRef][PubMed]
Woodman CB, Collins S, Winter H, et al. Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study.  Lancet. 2001;357:1831–6.[CrossRef][PubMed]
Winer RL, Lee SK, Hughes JP, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students.  Am J Epidemiol. 2003;157:218–26.[CrossRef][PubMed]
Herrero R, Castle PE, Schiffman M, et al. Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica.  J Infect Dis. 2005;191:1796–807.[CrossRef][PubMed]
Stone KM, Karem KL, Sternberg MR, et al. Seroprevalence of human papillomavirus type 16 infection in the United States.  J Infect Dis. 2002;186:1396–402.[CrossRef][PubMed]
Abma JC, Martinez GM, Mosher WD, Dawson BS.  Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002.  Vital Health Stat 23. 2004;Dec:1–48.
Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance: United States, 2005.  J Sch Health. 2006;76:353–72.[CrossRef][PubMed]
Torné A, Alonso I, Puig-Tintoré LM, Pahisa J.  Clinical role of cervical cancer vaccination: when and whom to vaccinate? Gynecol Oncol.  2008;110(3 suppl 2):S15–6.
Zimet GD.  Improving adolescent health: focus on HPV vaccine acceptance.  J Adolesc Health.  2005;37(6 suppl):S17–23.[CrossRef][PubMed]
Ault K, Reisinger K.  Programmatic issues in the implementation of an HPV vaccination program to prevent cervical cancer.  Int J Infect Dis.  2007;11(suppl 2):S26–8.[CrossRef][PubMed]
Caskey R, Lindau ST, Alexander GC.  Knowledge and early adoption of the HPV vaccine among girls and young women: results of a national survey.  J Adolesc Health. 2009;45:453–62.[CrossRef][PubMed]
Kahn JA, Rosenthal SL, Jin Y, et al. Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women.  Obstet Gynecol. 2008;111:1103–10.[CrossRef][PubMed]
Conroy K, Rosenthal SL, Zimet GD, et al. Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination.  J Womens Health. 2009;18:1679–86.[CrossRef]
Marlow LA, Waller J, Wardle J.  Trust and experience as predictors of HPV vaccine acceptance.  Hum Vaccin. 2007;3:171–5.[CrossRef][PubMed]
Zimet GD, Mays RM, Winston Y, et al. Acceptability of human papillomavirus immunization.  J Womens Health Gend Based Med. 2000;9:47–50.[CrossRef][PubMed]
Davis K, Dickman ED, Ferris D, Dias JK.  Human papillomavirus vaccine acceptability among parents of 10-to 15-year-old adolescents.  J Low Genit Tract Dis. 2004;8:188–94.[CrossRef][PubMed]
Brewer NT, Fazekas KI.  Predictors of HPV vaccine acceptability: a theory-informed, systematic review.  Prev Med. 2007;45:107–14.[CrossRef][PubMed]
Zimet GD, Liddon N, Rosenthal SL, et al. Chapter 24: psychosocial aspects of vaccine acceptability.  Vaccine.  2006;24(suppl 3):S201–9.[CrossRef]
Reiter PL, Brewer NT, Gottlieb SL, et al. Parents’ health beliefs and HPV vaccination of their adolescent daughters.  Soc Sci Med. 2009;69:475–80.[CrossRef][PubMed]
Rosenthal SL, Weiss TW, Zimet GD, et al. Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation.  Vaccine. 2011;29:890–5.[CrossRef][PubMed]
Rosenthal SL, Rupp R, Zimet GD, et al. Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes.  J Adolesc Health. 2008;43:239–45.[CrossRef][PubMed]
Jain N, Euler GL, Shefer A, et al. Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey–Adult 2007.  Prev Med. 2009;48:426–31.[CrossRef][PubMed]
 Centers for Disease Control and Prevention.  2007 National Survey of Children's Health. Accessed at www.cdc.gov/nchs/slaits/nsch.htm, November 1,  2010.
Blumberg SJ, Foster EB, Frasier AM, et al. Design and operation of the National Survey of Children's Health, 2007. Accessed at ftp.cdc.gov/pub/health_statistics/nchs/slaits/nsch07/2_Methodology_Report/NSCH_Design_and_Operations_052109.pdf, November 1,  2010.
Andersen R.  A behavioral model of families’ use of health services.  Research series no. 25. Chicago:  Center for Health Administration Studies, University of Chicago;  1968.
Andersen RM.  Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav.  1995;36:1–10.
Mehta S, Nagar S, Aparasu R.  Unmet prescription medication need in US children.  J Am Pharm Assoc. 2009;49:769–76.[CrossRef]
Gaskin DJ, Briesacher BA, Limcangco R, Brigantti BL.  Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries.  Am J Geriatr Pharmacother. 2006;4:96–111.[CrossRef][PubMed]
 American Academy of Pediatrics. The medical home.  Pediatrics. 2002;110:184–6.[CrossRef][PubMed]
Halterman JS, Montes G, Shone LP, Szilagyi PG.  The impact of health insurance gaps on access to care among children with asthma in the United States.  Ambul Pediatr. 2008;8:43–9.[CrossRef][PubMed]
 Centers for Disease Control and Prevention.  Vaccination coverage among adolescents aged 13-17 years: United States, 2007. MMWR Morb Mortal Wkly Rep. 2008;57:1100–3.
 Centers for Disease Control and Prevention. National, state, and local area vaccination coverage among children aged 19-35 months: United States, 2008.  MMWR Morb Mortal Wkly Rep. 2009;58:921–6.[PubMed]
 Centers for Disease Control and Prevention.  Vaccination coverage among adolescents aged 13-17 years: United States, 2008.  MMWR Morb Mortal Wkly Rep. 2009;58:997–1001.
Kahn JA, Cooper HP, Vadaparampil ST, et al. Human papillomavirus vaccine recommendations and agreement with mandated human papillomavirus vaccination for 11-to-12-year-old girls: a statewide survey of Texas physicians.  Cancer Epidemiol Biomarkers Prev. 2009;18:2325–32.[CrossRef][PubMed]
Kahn JA, Zimet GD, Bernstein DI, et al. Pediatricians’ intention to administer human papillomavirus vaccine: the role of practice characteristics, knowledge, and attitudes.  J Adolesc Health. 2005;37:502–10.[CrossRef][PubMed]
Riedesel JM, Rosenthal SL, Zimet GD, et al. Attitudes about human papillomavirus vaccine among family physicians.  J Pediatr Adolesc Gynecol. 2005;18:391–8.[CrossRef][PubMed]
Mays RM, Zimet GD.  Recommending STI vaccination to parents of adolescents: the attitudes of nurse practitioners.  Sex Transm Dis. 2004;31:428–32.[CrossRef][PubMed]
Raley J, Followwill K, Zimet G, Ault K.  Gynecologists attitudes regarding human papilloma virus vaccination: a survey of Fellows of the American College of Obstetricians and Gynecologists.  Infect Dis Obstet Gynecol. 2004;12:127–33.[CrossRef][PubMed]
Olshen E, Woods ER, Austin SB, et al. Parental acceptance of the human papillomavirus vaccine.  J Adolesc Health. 2005;37:248–51.[CrossRef][PubMed]
Chao C, Velicer C, Slezak JM, Jacobsen SJ.  Correlates for human papillomavirus vaccination of adolescent girls and young women in a managed care organization.  Am J Epidemiol. 2010;171:357–67.[CrossRef][PubMed]
Yu SM, Bellamy HA, Schwalberg RH, Drum M.  Factors associated with use of preventive dental and health services among US adolescents.  J Adolesc Health. 2001;29:395–405.[CrossRef][PubMed]
Huang ZJ, Kogan MD, Yu SM, Strickland B.  Delayed or forgone care among children with special health care needs: an analysis of the 2001 National Survey of Children with Special Health Care Needs.  Ambul Pediatr. 2005;5:60–7.[CrossRef][PubMed]
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints