logistic regression was conducted to examine the odds of initiating the HPV vaccine series, after adjusting for age, race/ethnicity, insurance coverage, and belief that is acceptable for 16 year olds to have sex. Results: Among 235 sexually active US adolescent females surveyed, 62% initiated the HPV vaccine series after sexual debut. Compared with adolescent females who initiated the HPV vaccine series before sexual debut, those initiating the HPV vaccine series after sexual debut were significantly more likely to have a younger age at sexual debut (15 years old vs. ! 16 years old; P<.01) and visited a usual source of care in the last 12 months (93% vs.76%; P<.01); and less likely to have had formal education about sexually transmitted infections prior to sexual activity (49% vs. 98%; P<.01), to have had formal education on where to get birth control prior to sexual activity (68% vs. 95%; P¼.02), and to have had formal education on contraception prior to sexual activity (46% vs. 96%; P<.01). In multivariable analyses, older age (adjusted odds ratio [aOR], 1.7; 95% CI, 1.2-2.4) and believing that is was acceptable for 16 year-olds to have sex (aOR, 1.9; 95% CI, 1.1-3.1) were associated with almost double the odds of initiating the HPV vaccine series after sexual debut. Having public insurance was associated with over nine times the odds (aOR, 9.2; 95% CI, 1.5-55.4) of initiating the HPV vaccine series after sexual debut. American Indian, Asian-Pacific Islander, and multiracial race/ethnicity was associated with reduced odds (aOR, 0.1; 95% CI, 0.02-0.97) of initiating the HPV vaccine series after sexual debut. Conclusions: Almost two-thirds of sexually active US adolescent females initiated the HPV vaccine series after sexual debut. Adolescent females who are older, believe that it is acceptable for 16 year-olds to have sex, and are publicly insured have significantly higher odds of initiating the HPV vaccine series after sexual debut. The study findings suggest that targeting these at-risk populations for more focused HPV-vaccine education and counseling may prove useful in increasing the number of adolescent females who initiate the HPV vaccine series prior to sexual debut, and ultimately could reduce the number of HPV infections and future cervical cancer cases in the US.

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