Barriers to HPV Vaccine Uptake: Role of State Religiosity and Providers' Participation in State Vaccine Program.

BACKGROUND: Despite the known benefits of preventing HPV-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro- (state) and meso-level (organization) factors associated with HPV vaccine initiation and up to date (UTD).

METHODS: Data from NIS-Teen 2020 was used to study a sample of 20,163 U.S. adolescents (ages 13-17). The data was collected from the teen's parents/guardians and their healthcare providers. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted.

RESULTS: The prevalence of HPV vaccine initiation was 75.1%, and UTD was 58.6%. At the macro-level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity AOR: 0.63 [95% C.I.:0.50-0.78]; moderate religiosity (AOR: 0.68 [95% CI : 0.55-0.85]) and UTD (high religiosity AOR: 0.69 [95% CI : 0.56-0.85]; moderate religiosity (AOR: 0.74 [95% CI : 0.61-0.91]) than states with low religiosity. Additionally, at the meso-level, when none of the teens' healthcare providers ordered a vaccine from the state, teens had lower odds of initiation (AOR: 0.68 [95% CI : 0.53-0.87]) and UTD (AOR: 0.76 [95% CI : 0.60-0.95]) compared to teens all of whose healthcare providers ordered vaccine from the state. In addition, race and ethnicity, age, mother's education, household income, well-child examination, and doctor's recommendation were also significantly associated with HPV vaccine uptake.

CONCLUSION: A multipronged approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare providers' access and enrolment in state vaccine initiatives such as the Vaccine for Children program.