- Although most sexually active adolescents within a large primary care network had received human papillomavirus (HPV) vaccination before sexual debut, 12% had not received any doses of the vaccine, and 9% had not completed the series.
- Young people who had not been vaccinated were disproportionately non-Hispanic white (49%) and commercially insured (59%).
- Factors at play might have included vaccine hesitancy and delayed decision-making rather than lack of access.
More than 1 in 5 adolescents within one large primary care network weren’t fully vaccinated against human papillomavirus (HPV) before sexual debut, representing a “critical missed opportunity for cancer prevention,” researchers reported.
Among 9,491 teens ages 13 to 18 who reported sexual activity, 12% had not received any HPV vaccine before sexual debut, and 9% had initiated but not completed the vaccine series, Brian Jenssen, MD, MSHP, of the Children’s Hospital of Philadelphia, and colleagues found in a cross-sectional analysis.
Young people who had not been vaccinated were disproportionately non-white (49%) and commercially insured (59%), the research team reported in JAMA Pediatrics.
“The pattern was backwards from typical healthcare disparities,” Jenssen told MedPage Today in an email. “This suggests vaccine hesitancy and delayed decision-making, not lack of access, are the main barriers,” he added.
The research team said their study is the first to link adolescent sexual activity with vaccination records across a large primary care network, “identifying missed preexposure vaccination opportunities.”
“Even high-performing networks can improve in the timeliness of HPV vaccination,” they wrote.
The study comes at a time when the CDC has made drastic changes to the U.S. childhood vaccination schedule. Though the HPV vaccine remains among those universally recommended for young people (typically at age 11 or 12 years, but as early as age 9 and through age 26 for catch-up vaccination), the CDC did reduce the previously recommended two doses to one, with experts expressing concern there isn’t enough evidence to support doing so just yet.
HPV vaccination is “safe, effective, and provides long-lasting protection against cancers caused by HPV,” Jenssen and colleagues noted. “Vaccination before sexual debut maximizes effectiveness,” they continued, “yet rates of timely vaccination remain unknown.”
To help fill the research gap left by a lack of adolescent-reported sexual activity data in prior studies, Jenssen and colleagues used confidential adolescent surveys linked to vaccination records in a large primary care network. They examined demographic, clinician, and practice-level factors associated with not receiving HPV vaccination before sexual debut.
Sexual debut was defined by an affirmative response to the Adolescent Health Questionnaire item: “Sex or sexual intercourse can mean different things to different people and people can have sex with others of the same or different gender. In your entire life, have you had any kind of sexual contact with anyone?”
Among the 1,907 adolescents who had not completed the HPV vaccine series prior to their first sexual activity, 765 (70%) were never vaccinated, while 248 (23%) subsequently initiated the series, and 74 (7%) completed the series after sexual debut.
Practice-level variation was “substantial,” Jenssen and colleagues also noted. Rates of teens not vaccinated before sexual debut ranged from 5% to 47% across practices.
Factors associated with increased likelihood of not being vaccinated before sexual debut included higher neighborhood opportunity, commercial insurance coverage, and greater distance from the network’s main hospital.
Furthermore, practices that more frequently initiated HPV vaccination at age 9 had lower rates of unvaccinated teens (−0.89%, 95% CI −1.02 to −0.76).
The studied adolescents ranged in age from 13 to 18, with an average age of 17. Slightly more than half of the cohort was male. About 40% were non-Hispanic Black, 40% non-Hispanic white, 11% other race and ethnicity, and 9% Hispanic. Some 44% of adolescents were Medicaid-insured, and 33% were from very low Child Opportunity Index neighborhoods.
The primary care network examined in the study comprised 31 practices serving a total of some 90,000 adolescents, Jenssen and colleagues noted. Data spanned from September 2023 to September 2025.
Teens were included in the study if they had a primary care visit and self-reported sexual activity on an Adolescent Health Questionnaire (a confidential pre-visit survey) at any time point.
Limitations included that adolescents’ first report of sexual activity was captured rather than all sexual activity since age 13, that the study’s cross-sectional design could not fully distinguish between vaccine completion patterns and barriers to timely receipt, and that findings from a single-region primary care network might not generalize to other settings, Jenssen and colleagues noted.
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Source link : https://www.medpagetoday.com/pediatrics/vaccines/120317
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Publish date : 2026-03-16 16:49:00
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