U.S. state-level variation in caregiver-reported provider recommendation of HPV vaccination to 13-to-17-year-old adolescents

Introduction Although regional differences in provider recommendation of human papillomavirus (HPV) vaccine have been documented, limited research has examined variation at the state level. Therefore, this study examined state-level differences in caregiver-reported health care provider recommendation of HPV vaccines among 13-to-17-year-old adolescents in the United States. Method Using a cross-sectional design to examine data from the National Immunization Survey–Teen (2023), multivariable logistic regression was used to model state-specific variations in provider recommendation of HPV vaccine. Proportion estimation was used to examine state-specific prevalence. Result Provider recommendation varied considerably across states. For example, the odds of reporting a recommendation were lower among caregivers of adolescents in Arkansas (adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.33 to 0.96), Georgia (AOR = 0.49, 95% CI = 0.26 to 0.93), and Mississippi (AOR = 0.42, 95% CI = 0.24 to 0.74), and higher among caregivers in New Hampshire (AOR = 2.40, 95% CI = 1.23 to 4.68) compared with adolescents in California. Greater heterogeneity was observed in the South compared with other regions. For example, the prevalence of not receiving a recommendation was 16% in Maryland and 41% in Mississippi. Conclusion The findings underscore the need to improve HPV vaccine recommendation in some states in the United States. In particular, states with low rates should be targeted for focused interventions.