The top reasons for not initiating human papillomavirus (HPV) vaccination are necessity, safety, and knowledge, rather than a lack of discussions on sexuality, according to a study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology.1

A major reason clinicians fail to recommend HPV vaccination to teenagers is their perception that they need to discuss sex and sexuality prior. Because clinician recommendation influences whether parents vaccinate their children, researchers sought to examine if concerns regarding sexuality discussions are consistent with parental reasons for lack of vaccine initiation.

For the study, investigators analyzed provider-verified data from the National Immunization Survey-Teen 2010-2014 to calculate estimates of HPV vaccine initiation and provider recommendation among girls aged 13 to 17 years. They also estimated annual prevalence rates for parent-reported reasons for lack of initiation.

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Results showed that HPV vaccine initiation in girls significantly rose nationwide from 47% in 2010 to 60% in 2014 (P <.001). Among those who received a recommendation from their clinician, the rate of vaccine initiation increased from 62% to 69% (P <.001).

From 2010 to 2014, the researchers found that the proportion of girls who received a provider recommendation increased from 51% to 74% (P <.001); however, sexuality discussions as a reason for not initiating HPV vaccination dropped from 18% in 2010 to 9% in 2014 (P <.001).

The 3 most common reasons for not initiating HPV vaccination in girls in 2014 were the belief that the vaccine is unnecessary, concerns about vaccine safety, and lack of knowledge. The study demonstrated that reasons related to necessity and safety decreased slightly over the 5-year period, but the prevalence of reasons associated with a lack of knowledge remained unchanged. 

Notably, less than 1% of parents reported religious beliefs, antivaccination sentiment, and concerns about increased sexual activity after vaccination as reasons for not initiating the vaccination series, and these reasons remained unchanged over time.

Given that sexuality discussions may not be a barrier to HPV vaccine recommendation, the findings suggest that clinicians need to focus discussions on education and awareness to improve rates of HPV vaccination.


1. Beavis AL, Krakow M, Levinson K, Rositch AF. Reasons for persistent suboptimal rates of HPV vaccination in the US: shifting the focus from sexuality to education and awareness. Paper presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.