Human Papillomavirus Vaccination and Age at First Sexual Activity, National Health and Nutrition Examination Survey

Abstract

The National Health and Nutrition Examination Survey (NHANES) collects information on human papillomavirus (HPV) vaccination history as well as sexual activity. We evaluated data from NHANES to assess report of HPV vaccination with ≥1 dose and 3 doses among females and males aged 11 to 26 years during 2007–2014. We also examined age at first vaccine dose and age at first sexual activity among females aged 14 to 26 years. Vaccination significantly increased in females aged 13 to 26 years, but not among 11- to 12-year-old girls, and remained low for both females and males. In NHANES 2011–2014, among females with known age at first vaccine dose, 43.1% reported having had sex before or in the same year they received their first HPV vaccine, and this varied by race/ethnicity. Clinicians should provide strong recommendations consistent with guidelines, including routine vaccination of girls and boys at age 11 or 12 years.

Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18–26 year olds in the United States

“…4,5 The Advisory Committee on Immunization Practices (ACIP) recommends routine HPV vaccination for adolescents between 11 and 12 years of age. 6 Catch-up vaccination is also recommended for females aged 13-26 years, for males aged 13-21 years who may have missed the initial vaccine window, and up to 26 years for males immunocompromised or men who have sex with men. 6,7 Despite the availability, safety, and efficacy of HPV vaccines, uptake has been suboptimal compared to other routine vaccinations in adolescents.…”

Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors

“…A study conducted in the NHANES found that 43% of girls with at least 1 dose of the HPV vaccine had sex before or during the same year as their first HPV vaccination. 28 Ensuring that adolescents receive the HPV vaccination before their first sexual experience is important to helping prevent the negative health effects of HPV infections. Policies to educate adolescents and their families about the benefits of vaccination and increase access will likely be an important part of the policy response to improve vaccination rates.…”

Reaching 80% human papillomavirus vaccination prevalence by 2026: How many adolescents need to be vaccinated and what are their characteristics?

“…19,34,35 Several provider-and system-focused interventions have been shown to be effective at increasing HPVV rates in the clinical setting. 18,46,47 For privately insured adolescents, the current Affordable Care Act requires that most insurers cover HPVV without cost sharing; the influence of this provision on HPVV rates among adolescents has not been examined, although it may be related to recent vaccination increases in rates among women aged 18 to 25 years. 39 In addition, parental text-message and mailed reminders as well as in-clinic provider electronic reminders may boost vaccination rates, and repeated physician recommendations may be needed to convince parents who initially refuse.…”

“…45 Approximately 50% of children younger than 19 years are eligible to receive vaccines through Vaccines for Children, and this program likely contributes to the counterintuitive higher HPVV utilization rate in Medicaid-insured adolescents versus privately insured adolescents in our study as well as others. 18,46,47 For privately insured adolescents, the current Affordable Care Act requires that most insurers cover HPVV without cost sharing; the influence of this provision on HPVV rates among adolescents has not been examined, although it may be related to recent vaccination increases in rates among women aged 18 to 25 years. 48 State-based school-entry requirements for other vaccines (eg, diphtheria and varicella) have been effective in achieving high (~95%) vaccination rates for these respective diseases, although such requirements for HPVV are controversial; parental support is ambiguous, and a positive impact on HPVV utilization has yet to be seen.…”