Human Papillomavirus Vaccination: What Are the Reasons for Nonvaccination Among U.S. Adolescents?

Erika L. Thompson, Brittany L. Rosen, Cheryl A. Vamos, Mika Kadono, Ellen M. Daley

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Purpose Human papillomavirus (HPV) vaccination is recommended for 11- to 12-year-old U.S. adolescents. Unfortunately, HPV vaccine rates have been suboptimal. Parents are key decision agents regarding their adolescents’ health; thus, it is necessary to understand their reasons for not vaccinating their adolescents. The purpose of this study was to compare parents’ primary reasons for non-HPV vaccination by calendar year, sex of the child, and level of vaccine hesitancy. Methods The National Immunization Survey-Teen 2012–2015 was subset to parents who did not intend for their adolescent to receive the HPV vaccine in the next 12 months (N = 59,897). Survey-weighted logistic regression models assessed the impact of year, sex, and level of hesitancy on main reasons for nonvaccination. Results Not receiving a recommendation and lack of knowledge were significantly more likely to be the reasons for nonvaccination in 2012 and 2013 compared with 2015. The following reasons were significantly less likely to be reported for females compared with males: not recommended (odds ratio [OR] =.63, 95% confidence interval [CI],.58–.69) and lack of knowledge (OR =.86, 95% CI,.79–.94). In contrast, parents of females were more likely to state they were concerned about safety and side effects (OR = 2.19, 95% CI, 1.98–2.41). Differences in reasons for nonvaccination were observed between those who were unlikely and unsure regarding receiving the HPV vaccine. Conclusions Findings indicate that U.S. parental attitudes about HPV vaccination have changed over time and reasons for nonvaccination vary based on the sex of the adolescent and the level of hesitancy of the parent. This information can shape how providers respond to parental concerns and HPV vaccine hesitancy.

Original languageEnglish
Pages (from-to)288-293
Number of pages6
JournalJournal of Adolescent Health
Issue number3
StatePublished - Sep 2017


  • Adolescents
  • HPV vaccination
  • Hesitancy


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