HPV Vaccination and Sexual Behaviors Among Middle‐Aged United States Adults

OBJECTIVE: This study aims to identify factors associated with HPV vaccination among adults aged 27 to 45 in the United States, emphasizing the relationship between vaccination rates and sexual behaviors. STUDY DESIGN: Retrospective cross-sectional cohort study. SETTING: National Survey of Family Growth (NSFG), 2022 to 2023. METHODS: We analyzed data from 6014 adults aged 27 to 45 years, representing approximately 82.8 million US adults. The primary outcome was HPV vaccination status. The primary independent variable was the presence of multiple sexual partners in the past year. Multivariable logistic regression analyses evaluated associations between demographic characteristics, sexual behaviors, and HPV vaccination. RESULTS: HPV vaccination rates were low overall in adults aged 27 to 45. Individuals with multiple sexual partners in the past year were significantly more likely to receive HPV vaccination aged 27 and older if previously unvaccinated (OR: 1.89, 95% CI: 1.08-3.31). However, an increased number of sexual partners did not demonstrate a linear relationship with vaccination likelihood. Female sex, higher educational attainment, private or public insurance coverage, recent healthcare access, and higher income levels were independently associated with greater vaccination rates. Race/ethnicity and age had variable influences, with younger adults significantly more likely to be vaccinated. CONCLUSION: HPV vaccination rates remain low among middle-aged adults despite expanded eligibility. Sexual activity, specifically having multiple partners, moderately increased vaccination likelihood. More robust predictors of vaccination include healthcare access, educational status, and socioeconomic factors, highlighting the importance of targeted educational initiatives and improved healthcare access to enhance vaccination uptake.