Human Papillomavirus Vaccination Among Young Adults Before and During the COVID-19 Pandemic

This cross-sectional survey study assesses the self-reported human papillomavirus vaccination rate by sociodemographic characteristics in adults aged 18 to 26 years from 2018 to 2022.


Introduction
In the US, the human papillomavirus (HPV) vaccine is routinely recommended as catch-up vaccination for adults aged 18 to 26 years who were not adequately vaccinated at a younger age. 1 Before the COVID-19 pandemic started in March 2020, a steady increase in HPV vaccination coverage in this population was reported. 2However, coverage during the pandemic remains unknown.We compared national HPV vaccination coverage among young adults before and during the pandemic and assessed recent vaccination rates among racial, ethnic, and sexual minority groups and other sociodemographic subgroups.

Methods
We analyzed data for participants aged 18 to 26 years in the 2018, 2019, and 2022 National Health Interview Survey (NHIS), a nationally representative survey of a civilian noninstitutionalized population. 3Trained interviewers administered the survey after obtaining participants' informed consent.Sociodemographic information and HPV vaccination status were self-reported; vaccination status was not collected in 2020 and 2021.The Medical University of South Carolina Institutional Review Board deemed this cross-sectional survey study exempt from review and informed consent because it used deidentified publicly available data.We followed the AAPOR reporting guideline. 4 defined coverage as receipt of 1 or more doses of HPV vaccine before age 27 years.
Proportions and representative population counts were estimated using NHIS sampling weights.
Multivariable models estimated prevalence ratios.Statistical significance was tested at P < .05.All analyses were performed with SAS 9.4, specifically SURVEY procedures to incorporate sampling weights and adjust for the complex survey design.

+ Supplemental content
Author affiliations and article information are listed at the end of this article.
Open Access.This is an open access article distributed under the terms of the CC-BY License.No significant differences were detected by region or urbanicity.Findings were consistent in multivariable analyses.Error bars represent 95% CIs.P values were calculated using survey design-adjusted Wald F test.Participants who responded yes to the question "Have you ever received the HPV vaccine?" were identified as vaccinated with 1 or more HPV vaccine doses.Sex was not reported for 1 participant in 2022.a The HPV vaccination status was ascertained using this question in the National Health Interview Survey (NHIS): "Have you ever received the HPV vaccine?" Participants who responded yes were identified as vaccinated with 1 or more HPV vaccine doses.
c Participants were combined into a single LGB+ category due to small sample sizes.
Nonbinary and transgender individuals could not be identified in the NHIS dataset.
d Race and ethnicity were collected separately.A combined recoded variable on race and ethnicity was provided by the NHIS and included imputed data when race and Hispanic origin were unknown.We used the race and ethnicity variable provided in the NHIS dataset.

Figure .
Figure.Human Papillomavirus (HPV) Vaccination Coverage Among US Adults Aged 18 to 26 Years for 2018, 2019, and 2022 100 Coverage was higher among females and males with associate or bachelor's degrees (68.2% and 45.4%; P < .001)vs those with high school or lower educational level (43.7% and 29.5%; P < .001).

Table . HPV
Vaccination Coverage in 2022 Among Adults Aged 18 to 26 Years by Sociodemographic Characteristics a