ArticlePublic health reports (Washington, D.C. : 1974)
A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana.
Article in Public health reports (Washington, D.C. : 1974). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Factors that influence caregivers' and adolescents' views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2025Pooled it
- A systematic literature review of human papillomavirus vaccination strategies in delivery systems within national and regional immunization programs.Human vaccines & immunotherapeutics · 2024Pooled it
- A Systematic Review of the Effectiveness of Health Education Programs for Cervical Cancer Prevention in Rural Communities: Implications for Promoting Health Equity.Journal of cancer education : the official journal of the American Association for Cancer Education · 2024Pooled it
- A narrative review of HPV vaccination interventions in rural U.S. communities.Preventive medicine · 2021Pooled it
- Review
- Factors influencing vaccine hesitancy among United Kingdom adolescents in a senior high school environment and actions to address it.Human vaccines & immunotherapeutics · 2025Article
- Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia.BMC cancer · 2024Article
- Nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination: results from a cross-sectional survey in Montana.BMC nursing · 2023Article
- Community Forums to Address Vaccine Hesitancy: A Useful Tool for Meeting the Needs of Diverse Communities.Innovations in pharmacy · 2023Article
- Missed opportunities for human papillomavirus vaccine series initiation in a large, rural U.S. state.Human vaccines & immunotherapeutics · 2022Article
- HPV Vaccine Hesitancy Among Medical Students in China: A Multicenter Survey.Frontiers in public health · 2022Article
- Beyond words: Parental perceptions on human papilloma virus vaccination recommendations and its impact on uptake.Preventive medicine reports · 2021Article
- Development and Implementation of an HPV Vaccination Survey for American Indians in Cherokee Nation.International journal of environmental research and public health · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesHuman papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state.
methodsUsing a mixed-methods design, we integrated quantitative analyses of Montana's National Immunization Survey-Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake.
resultsIn Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers' recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%).
conclusionsHPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents' knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.
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