The investigation used data from the 2021 to 2022 Cancer Community Health Resources and Needs Assessment, an effort organized by the NYU Langone Health Perlmutter Cancer Center together with 23 community partner organizations. This collaborative design allowed the researchers to reach a genuinely multiethnic adult population across the city. The analytic sample included 1,278 adults between the ages of 18 and 45, a demographic window that matters because the HPV vaccine is licensed and recommended for catch-up vaccination in young adults even though routine recommendation begins in adolescence.

What distinguishes this study methodologically is its refusal to collapse racial and ethnic groups into broad, aggregated categories. Instead of treating Asian, Black, Hispanic, or White residents as monolithic blocks, the team analyzed six distinct groups: White, Hispanic, Black, Southwest Asian and North African (often abbreviated SWANA), Asian, and an Other category that included American Indian and Alaskan Native, Central Asian, mixed-race, Native Hawaiian and Pacific Islander, and unknown responses. This disaggregation is critical because national surveys frequently lump together populations with vastly different migration histories, languages, healthcare access patterns, and cultural attitudes toward vaccination.

The statistical approach centered on multinomial logistic regression, a technique suited to outcomes with more than two unordered categories. Here the outcome had four levels: receiving no doses of the HPV vaccine, receiving one dose, receiving more than one dose, or having an unknown vaccination status. The researchers tested an interaction term between race and ethnicity on one side and nativity, meaning US-born versus foreign-born status, on the other. That interaction term was statistically significant at a threshold of p less than 0.01 and was retained in the final models, which were additionally adjusted for sociodemographic covariates. In practical terms, the interaction means the effect of being foreign-born on vaccination differed depending on a person’s racial and ethnic group, and vice versa.

The descriptive picture of the sample already tells a striking story. Respondents were predominantly female, at 61 percent, and a substantial majority, 65 percent, were born outside the United States. About 73 percent reported having health insurance, leaving more than a quarter uninsured. Most sobering was the vaccination picture: over half of respondents, 53 percent, had never received any dose of the HPV vaccine, and another 23 percent did not know their own vaccination status. Taken together, fewer than one in four participants could be confidently counted as having initiated the vaccine series, a figure that underscores how much work remains even in a city with dense healthcare infrastructure.

The regression results sharpened the pattern around nativity. Compared with US-born White individuals, the reference category in the models, foreign-born SWANA individuals had markedly lower odds of having received one dose versus no doses, with an odds ratio of 0.21 and a 95 percent confidence interval of 0.06 to 0.74. Foreign-born White individuals also showed reduced odds of a single dose, with an odds ratio of 0.35 and a confidence interval of 0.12 to 0.96. Because these confidence intervals exclude one, the findings are statistically significant, and the magnitude of the SWANA estimate, roughly a 79 percent reduction in odds, is substantial by any epidemiological standard.

For the more demanding outcome of receiving more than one dose, which reflects series initiation beyond a first injection, the disparities widened. Foreign-born Asian individuals had an odds ratio of 0.34 (95 percent CI: 0.17 to 0.71) relative to US-born White individuals, and foreign-born Black individuals had an odds ratio of 0.39 (95 percent CI: 0.16 to 0.95). The steepest deficits appeared among foreign-born SWANA respondents, with an odds ratio of 0.07 (95 percent CI: 0.02 to 0.34), and foreign-born White respondents, with an odds ratio of 0.08 (95 percent CI: 0.02 to 0.30). These estimates indicate that, after adjustment, being born outside the United States was associated with dramatically lower completion of multiple doses across several groups, including among White residents, a finding that would have been masked entirely if nativity had not been modeled separately.

One of the most intriguing results concerns uncertainty itself. Foreign-born Asian individuals had higher odds of reporting unknown vaccination status rather than no doses, with an odds ratio of 2.82 (95 percent CI: 1.16 to 6.83) compared with US-born White individuals. This is more than a data-quality footnote. Unknown status may reflect fragmented medical records across countries, vaccination received abroad that is not documented in US systems, language barriers during clinical encounters, or lower familiarity with one’s own immunization history. From a surveillance standpoint, a quarter of the entire sample not knowing their status means that measured uptake gaps could be either underestimated or overestimated, and that interventions to consolidate vaccination records could meaningfully improve both care and measurement.

The biological rationale for closing these gaps is well established. HPV is a sexually transmitted virus whose persistent infection with high-risk genotypes drives cervical, anal, oropharyngeal, penile, vaginal, and vulvar cancers. The vaccine targets the most oncogenic types, and vaccination at a young age produces the strongest immune responses and greatest protection because it precedes any exposure. Adults in the 18 to 45 range represent a catch-up population in whom even partial series initiation confers benefit, which is why the distinction between one dose and more than one dose in this study carries real clinical weight rather than being a mere statistical convenience.

The authors conclude that their findings highlight the importance of disaggregated data for developing effective programs to improve HPV vaccination uptake. The implication for public health practice is concrete: city-level vaccination campaigns that target race and ethnicity alone will miss the foreign-born residents within nearly every group who face the largest deficits, and outreach that treats all immigrants as a single category will miss the especially low uptake among SWANA populations, a group rarely broken out in US health statistics. Community-partnered data collection of the kind used here, built through organizations embedded in the neighborhoods they serve, offers a template for identifying precisely where the gaps lie. The research was supported by the National Cancer Institute, the Centers for Disease Control and Prevention, and the Dune Road Foundation, and it was approved by the NYU Langone Health Institutional Review Board, with informed consent obtained from all participants.

Subject of Research: HPV vaccine uptake by race, ethnicity, and nativity among adults in New York City

Article Title: HPV vaccination in New York City: variation by population characteristics and nativity

Article References: Chebli, P., Nakra, N. M., Wyatt, L., Kwon, S. C., Trinh-Shevrin, C., & LeCroy, M. N. (2026). HPV vaccination in New York City: variation by population characteristics and nativity. BMC Cancer. https://doi.org/10.1186/s12885-026-16819-0

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16819-0

Keywords: HPV vaccination, New York City, nativity, immigrants, health disparities, cancer prevention, SWANA, data disaggregation, multinomial logistic regression, public health, immunization, community health