Barriers to Human Papillomavirus (HPV) Vaccination Among Adolescents in the United States

About 14 million people are infected with human papillomavirus (HPV) each year. HPV can cause cervical, vulvar, and vaginal cancers in women and penile cancer in men. It can also cause anal cancer, throat cancer, and genital warts in both men and women. One study estimated that in the United States, about 26,000 cancers per year were attributable to HPV during 2004 to 2008; see the most recent estimates.

HPV vaccines are given as a series of three shots over six months. CDC recommends the HPV vaccine for preteen boys and girls aged 11 or 12 years, so they are protected before being exposed to the virus. Two vaccines (Cervarix and Gardasil) protect against cervical cancers in women. Gardasil also protects against genital warts and cancers of the anus, vagina, and vulva. Both vaccines are available for females; only Gardasil is available for males.

Unfortunately, in the United States, HPV vaccination rates are low compared with other recommended vaccines. We reviewed studies published between 2009 and 2012 to better understand why preteens and teens aren’t vaccinated against HPV at all, or don’t finish the series of three shots. This is the first literature review to include male as well as female adolescents, and to identify the barriers faced by health care providers, parents, and traditionally underserved groups.

Results

• Parents often said they need more information before vaccinating their children. Many parents who got their children vaccinated said they did so because a doctor recommended it.
• Health care providers often said parents’ concerns and the cost of vaccination made it difficult to provide the HPV vaccine.
• Many parents and health care providers didn’t see a need to vaccinate boys.
• Parents whose children start the HPV vaccine series may forget or might not be aware that their children need to receive three separate doses of the vaccine.

Conclusions

By addressing the barriers found in this report, we can increase HPV vaccine use and protect children’s health. For example, doctors should check teens’ and preteens’ vaccination status at every visit, including acute care visits, to make sure they are up-to-date. Doctors and parents need to be educated about the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on how to explain HPV vaccine recommendations to patients and parents. To be most effective, efforts to increase HPV vaccine use need to consider the different concerns of certain groups within the population.

Citation

Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among U.S. adolescents: A systematic review of the literature. JAMA Pediatrics 2014;168(1):76–82.