Examining Structural and Social Drivers of Human Papillomavirus Vaccination Rates Across Clinical Settings for Youth

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and a leading cause of cervical, anal, and oropharyngeal cancers. Despite its effectiveness in cancer prevention, HPV vaccination rates remain suboptimal. This study examines HPV vaccination initiation and completion among adolescents and young adults across clinic types, demographics, and social determinants of health (SDOH) to identify barriers and inform interventions.

We conducted a retrospective cross-sectional analysis using electronic health record data from adolescent medicine, pediatric infectious diseases, internal medicine-pediatrics, and family medicine clinics in the University of South Florida health system and an affiliated community youth sexual health clinic. The study included 456 patients aged 16-24 seen from January to March 2025. HPV vaccination initiation and completion were assessed across clinic types, demographics, and SDOH using descriptive, univariate, bivariate, and multivariate analyses.

Overall, 390 patients initiated and 354 completed the HPV vaccination series across 20 clinics. Initiation rates were comparable across clinic types, but completion differed significantly by setting. Completion was independently associated with having insurance, an established primary care provider, completion of other routine vaccines, comorbidities, and female gender. Clinic type was not an independent predictor after adjusting for patient-level factors.

HPV vaccination rates in this cohort exceeded national averages, with strong initiation but lower completion, particularly among uninsured patients and those without primary care access. These findings underscore that vaccination outcomes are shaped more by patients' social and structural circumstances than by clinic setting alone, highlighting the importance of contextualizing completion rates accordingly. Targeted system-level interventions are needed to improve series completion and reduce future HPV-related cancer disparities.