Social Determinants of HPV Vaccine Completion among Adolescents

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The human papillomavirus (HPV) is a causative factor for many genital and oral cancers in the U.S. HPV-associated cancer are preventable through vaccination. The HPV vaccine is routinely administered to adolescents’ ages 11 to 12 to prevent HPV infection before sexual debut. However, HPV vaccination rates among adolescents are low, with approximately half of U.S. adolescents completing the vaccine series. In 2016, the number of required doses for vaccine completion were reduced to two doses for adolescents ages 11 to 14. Despite this reduction, the HPV vaccine remains a multi-dose series, requiring adolescents to return to the clinic to complete the series. Social determinants of health across several socioecological levels may play a role in vaccine completion among adolescents.

The purpose of this dissertation was to explore and describe determinants of HPV vaccine completion among adolescents. A systematic literature was conducted using a socioecological approach to explore barriers and facilitators to HPV vaccine initiation and completion among U.S. adolescents (Chapter 2). Chapter 3 highlights the quantitative findings from this study that examined the individual- and community-level determinants of health for adolescent HPV vaccine completion within a 14-month period. Chapter 4 details the convergent mixed-method findings from this study which integrated qualitative interviews and quantitative electronic health record data to examine the influence of individual-, relationship-, and community-level determinants of HPV vaccine completion within 14 months, and to describe barriers and facilitators to vaccine completion among parents and adolescents, ages 11 to 14 years. Findings across from these three chapters are synthesized in Chapter 5 and implications for future research and practice are discussed.

Individual-, relationship-, and community-level determinants are associated with HPV vaccine completion among adolescents ages 11 to 14 years and serve as barriers to completing the vaccine series. Barriers across levels interacted with one another, highlighting that multi-level influences play a role in adolescent HPV vaccine completion. Future research designing multi-level interventions for parents, adolescents, and healthcare providers are needed to reduce barriers to HPV vaccine completion. Reducing these barriers may improve HPV vaccine completion rates among adolescents thereby decreasing their risks for HPV-associated cancers in the future.






Mansfield, Lisa Nicole (2020). Social Determinants of HPV Vaccine Completion among Adolescents. Dissertation, Duke University. Retrieved from


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