FACTORS ASSOCIATED WITH MISSED OPPORTUNITIES FOR HPV VACCINATION AMONG VACCINE-ACCEPTING ADOLESCENT BOYS AND GIRLS IN THE NATIONAL IMMUNIZATION SURVEY – TEEN 2011 – 2012

Background: Vaccines against human papillomavirus (HPV) were approved in 2006, but uptake has been low compared to other adolescent vaccines. Methods: We used data from the National Immunization Survey – Teen 2011-2012 to assess factors associated with an HPV vaccine missed opportunity among vaccine-accepting adolescents. The outcome was defined as missing HPV vaccine initiation while being up-to-date on other recommended adolescent vaccines (Meningococcal and Tdap booster). The sample included 14,238 girls and boys who had both of these provider-verified adolescent vaccines. Multivariate Poisson regression with robust variance estimation was used to estimate prevalence ratios while accounting for complex survey design to elucidate factors associated with the outcome. Results: The prevalence of an HPV vaccine missed opportunity was 54.9% among these vaccine-accepting adolescents. Lack of provider recommendation for HPV vaccination was strongly associated with the outcome (aPR 1.74, 95% CI 1.64-1.85). Compared to public insurance, adolescents with private insurance were more likely to have a missed opportunity for the HPV vaccine (PR 1.32, 95% CI 1.22-1.43). Other factors significantly associated with the outcome were: male sex, white race, other insurance, lack of annual influenza shot, being above the poverty line, maternal education above a high school diploma and not receiving an annual wellness checkup (p