Predictors of HPV vaccination coverage among adolescents in Tennessee during the COVID-19 pandemic: A cross-sectional study

Geographical disparities exist in human papillomavirus (HPV) vaccination rates with Southern states having the lowest rates. Parental attitudes remain understudied in different Southern locations. We assessed factors related to HPV vaccination receipt among children aged 9-17 years in Tennessee, and if those factors differed by child's age and gender. A cross-sectional survey of 506 parents was performed via random digit dial from May to August 2022. A multivariable logistic regression model was used to estimate adjusted odds ratios and 95 % confidence intervals to predict sociodemographic and overall vaccine-related factors associated with HPV vaccine receipt or non-receipt (referent) for their child, and exploratory analyses to determine if those factors differed by child's age and gender. In adjusted logistic regression models, HPV vaccine receipt was significantly positively associated with the child's age (13-17 years) and the parent and child having had the influenza vaccine this season and the COVID-19 vaccine, and negatively associated with children who were male and had a parent employed parttime/unemployed/retired/student/disabled. Significant associations for HPV vaccine receipt were with increased levels of agreement of the parent having enough information for decision-making, belief the vaccine was beneficial, and increased levels of trust and perceived effectiveness of the vaccine. Increased levels of hesitancy and increased levels of agreement that the vaccine might cause infertility issues in the child, was unsafe, and natural immunity is better than vaccine immunity had negative associations with HPV vaccine receipt. All associations were more pronounced among older than younger children, and all but one association (overall vaccine trust) was more pronounced among males compared with females. Strategies to improve HPV vaccine uptake should be targeted to and/or include males and parents with children aged 9-12 years, and include education on the importance and process of protecting the body through HPV vaccination and vaccines in general.