Year of Award


Document Type


Degree Type

Master of Arts (MA)

Degree Name


Department or School/College


Committee Chair

Katrina Mullan, PhD

Commitee Members

Amanda Dawsey PhD, Sophia Newcomer PhD, Ethan Walker PhD


HPV, vaccination, health economics, public health, economics


University of Montana


Human papillomavirus (HPV) is a common sexually transmitted infection that causes at least 37,300 new cases of cancer every year in the United States. While effective vaccines to prevent HPV infection have been approved and available since 2006, 23.1% of US adolescents aged 13- 17 continue to miss out on the opportunity for immunization (Pingali 2022). This study examines missed opportunities (MOs) for HPV vaccination among US teens, where the teen receives either Tetanus, diphtheria, and acellular pertussis (Tdap) and/or Meningococcal vaccines, but the recommended HPV dose is not administered. This study uses a health economics framework and multinomial logistic regression to analyze data from a nationally representative sample of US teens using the public use files from the National Immunization Survey – Teen from 2018, 2019, and 2020. The dataset includes information on vaccination history, healthcare facility types, and patient and household demographics. By using this nationally representative dataset, this study provides a broad picture of the issue of MOs to vaccinate against HPV among US teens with a narrow analysis of the effect of facility type. Results show that MOs for HPV vaccination are more prevalent in public facilities compared to private facilities, and that girls are at a higher risk of missing out on HPV vaccination opportunities when visiting only public facilities for immunizations. The results of the study provide new insights into the factors associated with MOs for HPV immunization, including healthcare facility type and structural characteristics associated with facility type. The findings have important implications for policymakers and healthcare providers in the fight to prevent HPV-related cancers, highlighting the need for targeted interventions in public facilities to improve HPV vaccine uptake among US teens and to reduce disparities in HPV vaccination coverage.



© Copyright 2023 Patrick E. Boise