A Review of Barriers to HPV Vaccination Among Teens

Jennifer Garcia

November 25, 2013

According to a review of recent literature by the Center for Disease Control and Prevention (CDC), barriers to human papilloma virus (HPV) vaccination among adolescents include factors such as lack of recommendation by a healthcare provider, financial concerns, and parental attitudes. These findings were published online November 25 in JAMA Pediatrics.

The researchers, led by Dawn M. Holman, MPH, from the Division of Cancer Prevention and Control at the CDC in Atlanta, Georgia, evaluated data from 55 articles published since 2009 that focused on barriers to HPV vaccination among US adolescents aged 11 to 17 years. Perceived barriers to vaccination were categorized by target populations and included:

  • healthcare professionals: parental attitudes, financial concerns, knowledge gaps;

  • parents and caregivers: lack of knowledge, vaccine cost, low perceived risk for HPV infection, concerns about vaccine safety;

  • underserved or disadvantaged populations: limited knowledge about the vaccine, cultural differences, insurance coverage, immigration status; and

  • males: lack of knowledge about HPV risk in this population.

The authors note that "[a]cross studies, few parents (1%-18%) expressed concern about the effect of vaccination on their child's sexual behavior," although some expressed concern about discussing sexual activity with their adolescents. Among parents overall, receiving a vaccine recommendation from a physician was associated with improved vaccine acceptance and series initiation. The researchers point out that these findings underscore the importance for providing parents with information about the need for HPV vaccination and vaccine safety.

The authors identified systemic barriers to vaccination as well such as lack of exposure to healthcare services among this age group, cultural stigma associated with the vaccine, consent/confidentiality issues, and poor insurance coverage or reimbursement. The authors note that further analyses of these factors and their role in HPV vaccine use is required.

Holman and colleagues acknowledge that HPV vaccine coverage among adolescents has increased since the vaccine was licensed in 2006 but note that it remains low compared with other recommended vaccines for this age group. The authors cite data from the 2011 National Immunization Survey–Teen, which "indicated that 53.0% of US girls aged 13 to 17 years had received at least 1 dose of the HPV vaccine and 34.8% had completed the 3-dose series," they note.

"Barriers faced by health care professionals and parents should be carefully considered when developing strategies to improve HPV vaccine uptake and completion," write Holman and colleagues.

In addition, with regard to addressing system-level barriers to vaccination, "[e]fforts to increase uptake should take into account the specific needs of subgroups within the population," they conclude.

The authors report no relevant financial relationships.

JAMA Pediatrics. Published online November 25, 2013.


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