Structural Sexism and HPV vaccination among US adolescents

There is a gender gap across states in adolescent HPV vaccination. Although state contexts are important factors in individual-level behavior, no studies have considered whether structural sexism may play a role in the propensity for parents to vaccinate their sons and daughters against HPV.

We analyzed 2022-2023 data from the National Immunization Survey - Teen, with a sample of 13- to 17-year-old respondents with medically verified immunization records (N = 32,611). We used random-intercept multilevel logistic regression models to examine the relationship between state-level structural sexism and two measures of HPV vaccination: initiation and being up to date.

Adolescents in states with higher levels of sexism are less likely to initiate or be up to date on the HPV vaccination compared to those in states with lower levels of sexism. A one standard deviation increase in the structural sexism index was associated with 10% lower odds of HPV initiation, and 13% lower odds of being up to date with HPV vaccination among adolescent males. Similar reductions were found for adolescent females.

Structural sexism can negatively impact the HPV vaccination of adolescent males and females. Policy must consider how systematic sexism affects all adolescents to ensure equitable access to preventive healthcare.