Missed Opportunities for Human Papillomavirus Vaccination by Parental Nativity, Minnesota, 2015-2018

Emily A. Groene, Keith J Horvath, Nicholas Yared, Inari Mohammed, Miriam Muscoplat, Sydney Kuramoto, Tyler Richter, Shalini Kulasingam

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. Methods: We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non–US-born parents and maternal region of birth. Results: Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non–US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). Conclusions: Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity.

Original languageEnglish (US)
Pages (from-to)867-877
Number of pages11
JournalPublic health reports
Issue number5
Early online dateJul 12 2021
StatePublished - Jul 12 2021

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a Healthcare Delivery Research Program grant supplement (principal investigator: S.K.) from the National Cancer Institute (NCI) Division of Cancer Control & Population Sciences (NCI 5P30CA077598-19). Additional funding support was provided by the University of Minnesota National Institutes of Health Clinical and Translational Science Award: TL1R002493 and UL1TR002494.

Publisher Copyright:
© 2021, Association of Schools and Programs of Public Health.


  • adolescents
  • human papillomavirus
  • nativity
  • vaccination


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