County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan

Vaccine. 2020 Oct 7;38(43):6730-6734. doi: 10.1016/j.vaccine.2020.08.048. Epub 2020 Sep 3.


Background: The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities.

Methods: The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11-18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing.

Results: The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities.

Conclusions: We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors.

Sources of support: This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.

Keywords: Adolescence; HPV vaccination; Health status; Immunization surveillance; Vaccination.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Health Behavior
  • Humans
  • Indiana
  • Papillomavirus Infections* / prevention & control
  • Papillomavirus Vaccines*
  • Vaccination


  • Papillomavirus Vaccines