County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan

Sharon C. Enujioke, Rivienne Shedd-Steele, Joanne Daggy, Heather Burney, Lisa Robertson, Katharine Head, Gregory Zimet

Research output: Contribution to journalArticle


Background: The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities. Methods: The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11–18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing. Results: The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities. Conclusions: We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors. Sources of support: This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.

Original languageEnglish (US)
Pages (from-to)6730-6734
Number of pages5
Issue number43
StatePublished - Oct 7 2020


  • Adolescence
  • HPV vaccination
  • Health status
  • Immunization surveillance
  • Vaccination

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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