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Factors Contributing to Missed Opportunities for Human Papillomavirus Vaccination Among Adolescents, Ages 11 to 13, in Iowa


Rates of human papillomavirus (HPV) vaccination remain low and missed opportunities for HPV vaccination are widespread. Researchers have identified factors related to HPV vaccination, but less is known about missed opportunities.


We used medical claims data from a large Midwestern insurance provider to explore relationships between adolescent and provider characteristics and missed opportunities for HPV vaccination. We stratified models by initiation status with adolescents who had received one or more HPV vaccinations in one group (n = 6,123) and adolescents with no record of an HPV vaccination in the other (n = 8,107).


There were significant differences in comparisons of all variables between initiators and non-initiators. Notably, non-initiators had lower rates of vaccination for HPV and other adolescent vaccinations, and fewer well-child visits. For all adolescents, birth year, having other recommended vaccines, and number of well-child visits were significantly associated with missed opportunities. Additionally, among initiators, pediatrician as a primary care provider and being in a rural area were significantly associated.


Overall, adolescents with greater healthcare utilization had more missed opportunities, indicating that, despite increased numbers of visits, providers are not taking advantage of these opportunities to vaccinate. Future research should prioritize developing a deeper understanding of why these missed opportunities are occurring and implementing new and existing strategies to prevent them. Reducing missed opportunities will help to prevent future HPV-related cancers and the significant morbidity and mortality that they can cause.


ACIP, Advisory Committee on Immunization Pratices; Adolescent health; EHR, Electronic Health Record; HPV vaccination; HPV, Human Papillomavirus; MO, Missed Opportunity; MSA, Metropolitan Statistical Area; Medical claims data; PCP, Primary Care Provider.

Ryan, G., Perry, S., Charlton, M., Ashida, S., Gilbert, P., & Askelson, N. Factors Contributing to Missed Opportunities for Human Papillomavirus Vaccination Among Adolescents, Ages 11 to 13, in Iowa. 10.1016/j.jvacx.2022.100192.