Human Papillomavirus Vaccination Trends, Barriers, and Promotion Methods Among American Indian/Alaska Native and Non-Hispanic White Adolescents in Michigan 2006–2015

  • Beeta M. Kashani
  • Melissa Tibbits
  • Rachel C. Potter
  • Rosa Gofin
  • Li Westman
  • Shinobu Watanabe-GallowayEmail author
Original Paper


Human papillomavirus (HPV) infection, the most common sexually transmitted disease in the US, is a preventable cause of cancer. HPV vaccination has the potential to prevent 90% of HPV-related cancer cases but is underutilized, especially among American Indian/Alaska Native (AI/AN) adolescents. The objectives of this study were to (1) describe trends and identify predictors of HPV vaccination initiation and completion in Michigan’s AI and Non-Hispanic White children age 9 through 18 years and (2) to identify barriers to HPV vaccination and promotion methods at the tribal, state, and local levels in Michigan. Data from Michigan’s immunization information system from 2006 to 2015 were used for analysis. Additionally, semi-structured interviews were conducted with public health professionals across the state to identify barriers to and promoters of HPV vaccination. Predictors for vaccine initiation included being female, AI/AN, and living in high poverty zip code. Predictors of vaccine completion were female gender and younger age at vaccine initiation. Barriers to vaccination included misinformation and weak or inconsistent provider recommendations. Strategies used by health professionals to promote HPV vaccination included immunization summaries, vaccine information statements, the Vaccines for Children (VFC) program, and provider training. Findings suggested the need for education of parents to demystify HPV vaccine benefits and risks and provider training for more consistent recommendations.


Human papillomavirus American Indian Michigan Cervical cancer HPV vaccine Vaccine promotion 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health PromotionUniversity of Nebraska Medical Center College of Public HealthOmahaUSA
  2. 2.Michigan Department of Health and Human ServicesLansingUSA
  3. 3.School of Public Health and Community MedicineHadassah and Hebrew University of JerusalemJerusalemIsrael
  4. 4.Department of Epidemiology, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA

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