Individual-Level and Clinic-Level Factors Associated with HPV Vaccine Initiation Among 11-17 Year Old Adolescents

The human papillomavirus is the most common sexually transmitted infection, and persistent infection with oncogenic types can lead to cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. HPV vaccination can protect against infection. However, vaccine series initiation and completion rates are below national goals. This dissertation aimed to identify individual- and clinic-level factors associated with HPV vaccination among adolescents aged 11-17 years to inform future interventions aimed at increasing vaccination and reducing HPV-related cancers. This dissertation is in the form of three manuscripts each contributing to the overall aim. In manuscript 1, we conducted a systematic review of reviews identifying parental, provider, and clinic-level factors associated with HPV vaccination among adolescents. We synthesized findings from 12 reviews into a multilevel framework of HPV vaccination that can broaden our understanding of HPV vaccination and can inform future interventions by highlighting the relations between factors and potential intervention points. In manuscript 2, we examined correlates of parental intentions to vaccinate and parental psychosocial predictors of HPV vaccination for low income, underinsured Hispanic adolescent females. Findings can inform the development of targeted interventions for this population. In manuscript 3, we identified clinic characteristics and Consolidated Framework for Implementation Science Inner Setting constructs associated with HPV vaccine series initiation rates within a pediatric clinic network. Understanding clinic-level factors associated with vaccination can inform implementation of clinic systems and policies aimed at increasing vaccination rates. Overall, these manuscripts contribute to the literature examining multilevel factors associated with adolescent HPV vaccination. Findings inform future multilevel interventions aimed at increasing HPV vaccination and targeting parent-, provider-, and clinic-levels