The 2016 and 2017 National Immunization Surveys-Teen (NIS-Teen) revealed disparities in HPV vaccination coverage based on metropolitan statistical area (MSA) status. Teens in suburban and mostly rural areas had significantly lower coverage with one dose of HPV vaccine than those in mostly urban areas. The reasons for this disparity are unknown; this study sought to identify sociodemographic factors associated with not starting the HPV vaccine series and to see if these factors differed by MSA status. Multivariate logistic regression was used to assess associations between various sociodemographic factors and non-initiation of the HPV vaccine series by MSA status in a sample of 41,424 adolescents, using NIS-Teen data. The adjusted prevalence ratios and 95% confidence intervals are given. A secondary analysis looked at missed opportunities for HPV vaccination based on MSA status and estimated what coverage could have been achieved if these missed opportunities had occurred.

The majority of factors associated with not receiving HPV vaccine were similar across all three MSAs, including living in the South, having a mother with some college education, missing an 11–12-year-old well-child visit, and failing to receive a provider recommendation for vaccination. Others were linked to non-initiation of the HPV vaccine series in only a subset of MSAs. Teens in suburban areas were more likely than those in urban areas to miss out on HPV vaccination opportunities. If these missed opportunities had been eliminated, coverage with one dose of HPV vaccine would have been significantly higher in all three MSAs.