Abstract
Background: Human papillomavirus (HPV) remains the most prevalent sexually transmitted infection in the United States (U.S.). By the age of 45, over 80% of Americans will contract HPV, which creates a significant public health concern. Despite the availability of effective vaccines, low vaccination uptake continues to be a challenge, particularly in Tennessee. Additionally, the Advisory Committee on Immunization Practices (ACIP) recently expanded recommendations for HPV vaccine usage to include adults aged 27-45, suggesting a population with the potential to experience a gap in preventative care. To understand the underlying factors that may hinder Tennesseans from receiving the HPV vaccine, we conducted a cross-sectional survey from 29 June to 17 August 2023 among adults aged 18 to 45 in Tennessee. The survey was developed and informed by a scoping review regarding the various constructs and frameworks used in vaccine hesitancy and our previous qualitative work. Using theory-based instruments and previous qualitative data, this study aimed to determine the underlying factors that may hinder Tennesseans from receiving the HPV vaccine, focusing on those adults within the recently approved age range of 27-45 years old. Methods: An Exploratory Factor Analysis of 2011 participants ultimately included five factors, which explain 70.3% of the variability. These were Benefits/Trust, Perceived Susceptibility, Attitude/Behavioral Control, Perceived Barriers, and Perceived Severity. All Cronbach alphas were greater than 0.80, indicating that each factor was reliable. Results: When stratifying by various demographics, our analysis found that race emerged as a significant factor (p = 0.002), while the interaction of race and vaccination status was not significant (p = 0.753). Black respondents had significantly lower levels of Benefits/Trust than White (p < 0.001) and Asian respondents (p = 0.030), with no significant differences between White and Asian respondents. Conclusions: These findings underscore the importance of researchers, healthcare professionals, public health officials, and policymakers in addressing these demographic differences to effectively increase vaccination rates and reduce HPV-associated cancer risks in Tennessee. Further studies are needed for targeted interventions to address these disparities.