Human Papillomavirus Vaccination Among Low-Income, Underserved Children in the Greater DC and Hackensack, NJ Metropolitan Areas

Abstract

Human Papillomavirus (HPV) is the most common sexually transmitted infection. In 2018, 43 million cases of HPV were recorded in the United States, mostly afflicting young adults in their late teens and early twenties. Gardasil-9, the HPV vaccine currently distributed in the U.S., protects against nine HPV types that cause genital warts and cancers, such as cervical, penile, and oropharyngeal cancer. There is an urgent need for widespread pre-exposure vaccination against HPV among adolescents to prevent the spread of the disease and the future development of associated cancers. This study aims to identify barriers- including lack of knowledge or access, relationship with a provider, and sociocultural factors- to HPV vaccination, to understand the complex motivations behind HPV vaccination and hesitancy to improve vaccine uptake and the health of the community. By identifying these interpersonal and systemic barriers, we can begin to understand what contributes to the lower vaccination rates in low-income, medically underserved communities and what is needed to address them. Data for this analysis was drawn from a quantitative survey and qualitative narratives compiled from key informant interviews (KIIs). Data suggested that receipt of a provider recommendation is associated with vaccine uptake, and greater knowledge of HPV is significantly associated with vaccination. The KIIs revealed that COVID-19 strengthened existing beliefs about vaccination generally, indicating that individuals prone to vaccine hesitancy grew more hesitant while proponents of vaccination pre-pandemic became more supportive after COVID-19. In conclusion, data suggested that increasing the frequency of provider recommendations for HPV vaccination and awareness of HPV would positively impact uptake and result in higher vaccination rates nationwide. Further studies are needed to assess the impact of additional factors, such as medical mistrust, vaccine hesitancy, and stress stemming from COVID-19 on HPV vaccination.