Attitudes about human papillomavirus vaccine in young women

College women's HPV vaccine decision narratives

Drawing on 38 in-depth qualitative interviews with college women and college health clinicians, we collected human papillomavirus (HPV) vaccine decision narratives to identify the implicit and explicit values underlying HPV vaccine decision making. Narratives of vaccine acceptance and resistance were identified. Vaccine acceptance narratives consisted of four themes: supportive family messages, explicit health care provider endorsement, peer descriptive norms reducing stigma of vaccination, and disease framing (e.g., cancer, HPV) shaping vaccine benefit perceptions. Vaccine resistance narratives consisted of five themes: skepticism of vaccine safety, invoking alternative prevention strategies, articulating stigmatizing HPV messages, overcoming self-efficacy barriers (e.g., cost, availability, time, and fear of parental disclosure), and delay strategies. Common to all decision narratives was that relationship status framed college women's perceptions of HPV susceptibility. Theoretical and practical implications for designing HPV vaccine messages aimed at college-aged women are discussed.

Women's knowledge of Pap smear test and human papillomavirus: acceptance of HPV vaccination to themselves and their daughters in an Islamic society

OBJECTIVE

Cancer of cervix uteri is the second most common cancer among women, and it has been shown to be caused by human papillomavirus (HPV) infection in more than 99% of cases. We surveyed Muslim Turkish women, who mostly accept talking about sex as a taboo, to examine their knowledge about Papanicolaou (Pap) smear test, HPV, HPV vaccine, and their attitude toward vaccination to themselves and their daughters.

METHODS

We surveyed 525 women aged between 19 and 53 years to examine their knowledge about cervical cancer screening Pap smear test, HPV, HPV vaccine, and their attitude toward vaccination to themselves and their daughters with a questionnaire that is consisted of 5 parts with a total of 31 items.

RESULTS

The knowledge of cervical screening was high (70%), and 51% of the subjects were at least once had a Pap smear test, but most respondents (56%) had never heard of HPV. For most women, recommendations from health workers (67%) were the major influences in deciding to get vaccinated.

CONCLUSIONS

The importance of successful introduction on the vaccine by the drug providers and health care professionals in Turkey was shown in this present study with a high rate of awareness of cervical cancer vaccine. "Early-age vaccination knowledge" before any sexual contact is probably due to the correct education of mothers by health care professionals. The professionals should be educated and trained about HPV, vaccination, and its relation with cervical cancer to increase the knowledge about it.

Reasons for non-vaccination against HPV and future vaccination intentions among 19-26 year-old women

Background

Despite CDC recommendations regarding universal catch-up vaccination against human papillomavirus (HPV), only about ten percent of young adult women in the United States have been vaccinated. The purpose of this study was to better understand reasons for non-vaccination among insured 19-26 year-old women and to evaluate future vaccination intentions.

Methods

We used an administrative claims database from a large US managed care plan to identify women aged 19-26 for receipt of a mailed survey. From a sample of 1,375 women with no evidence of HPV vaccination from June 1, 2006 through April 30, 2007, 222 completed surveys were received, of which 185 were eligible for this analysis. The main outcome measures were unvaccinated women's attitudes and vaccine awareness, likelihood of future action regarding the vaccine, and reasons for inaction.

Results

Among the 185 non-vaccinees, 25.4% were married, 83.2% were white, and 89.2% had a college or higher level education. The vaccine was described as very important by 32.4% of subjects, and 30.1% had discussed the vaccine with a doctor and received a doctor's recommendation. Half or fewer of respondents were "very" or "extremely" likely to discuss the vaccine with their doctor (50.0%), do additional research on the vaccine (42.6%), ask a doctor to get the vaccine (37.5%), or make an appointment to get the vaccine (27.8%), while 48.0% were "somewhat", "very", or "extremely" likely to do nothing to get the vaccine. Among the latter, reasons for taking no action included being married or in a monogamous relationship (54.9%), belief that the vaccine is too new (35.4%), not having enough information about the vaccine (31.7%), concerns about side effects (24.4%), and uncertainty about insurance coverage (24.4%).

Conclusions

Educational interventions may be needed to enhance HPV vaccination rates among 19-26 year-old women, particularly regarding information about vaccine safety, vaccine efficacy, insurance coverage, and the value of vaccination to women in monogamous relationships.

Attitudes and perceptions of the HPV vaccine in Caribbean and African-American adolescent girls and their parents

OBJECTIVE

To describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors.

DESIGN

Questionnaire survey.

SETTING

An adolescent medicine clinic.

PARTICIPANTS

A convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic.

INTERVENTION

Participants completed an anonymous confidential 10-minute questionnaire.

MAIN OUTCOME MEASURES

Data on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine.

RESULTS

Responses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13-4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV (P < 0.001) and with interest in receiving HPV vaccination (P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents. There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC.

CONCLUSIONS

Although controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.

Assessment of parental acceptance of a potential cytomegalovirus vaccine for adolescent females

The development of a vaccine against cytomegalovirus (CMV) has been designated as a high priority and adolescent females are a likely target population for CMV vaccination. A self-administered, internet-based survey was developed using constructs from the Health Belief Model to identify factors that may be associated with parental acceptance of a CMV vaccine for their adolescent daughters. Data from 516 parents were analyzed, the majority of whom were female, white, and college educated. Parental acceptance of a CMV vaccine was generally high. Perceived benefits of vaccine were independently associated with vaccine acceptance while history of previous vaccine refusal, concerns about safety and cost of the vaccine were negatively associated. These findings provide initial data on factors that are likely to influence parental acceptance of a CMV vaccine for adolescent girls.

Communication skills in HPV prevention: an audit among Italian healthcare workers

This study aims to investigate the knowledge, the attitudes and practices on HPV vaccination of health professionals of Mother and Child Service of Puglia Region (Italy). The study was conducted through a standardized questionnaire. Of 455 respondents, 74.2% judged HPV vaccine very important for immunization calendar. 88.9% did not believe that the administration of HPV vaccine implies consent to the initiation of sexual activity but 34.2% sustained that vaccine can give a false sense of protection against sexually transmitted diseases. 62.2% believed that boys should also be vaccinated. Skills necessary in the implementation of strategies in the promotion of health are partially inadequate and appropriate ongoing education should be carried out for health care workers.

Mother-daughter communication and human papillomavirus vaccine uptake by college students

OBJECTIVES

Although a human papillomavirus(HPV) vaccine has been available for more than 3 years, little research has documented the uptake and predictors of vaccination among older adolescents and young adult women. The purpose of this cross-sectional study was to examine the prevalence of HPV vaccination among college women across time and to explore the effect of mother-daughter communication on vaccination.

METHODS

During the period of fall 2007 through fall 2009, a convenience sample of 972 female undergraduate students (aged 18-25) at a large Midwestern state university (89% white) completed a paper-and-pencil or online anonymous questionnaire that assessed their sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

RESULTS

Sixty-five percent of the women reported being sexually active, and 49% reported having received at least the first of the 3-shot vaccine series. The mother's approval of HPV vaccination, mother-daughter communication about sex, and daughter's perceptions of vulnerability to HPV were positively associated with vaccination status. Among the women who had not received any of the HPV shots, the mother's approval of HPV vaccination, perceived vulnerability to HPV, and risky sexual behavior were predictive of interest in receiving the vaccine. Mother-daughter communication about values related to sex was negatively associated with interest.

CONCLUSIONS

Although many of these young women were old enough to receive the vaccine without their parents' consent, perception of their mother's approval and mother-daughter communication about sex were important predictors of vaccination.

Geographic disparity, area poverty, and human papillomavirus vaccination

BACKGROUND

A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.

PURPOSE

The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.

METHODS

Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.

RESULTS

Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance=0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.

CONCLUSIONS

The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls.

A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability

BACKGROUND

The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.

METHODS

A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.

RESULTS

The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one's daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.

CONCLUSIONS

Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.

"Is cancer contagious?": Australian adolescent girls and their parents: making the most of limited information about HPV and HPV vaccination

INTRODUCTION

Australia has implemented a nation-wide program providing HPV vaccination to girls at school. To date, there are no published studies that explore knowledge about HPV and HPV vaccine post-implementation of the national school-based HPV vaccination program.

METHODS

A purposive sample of schools was selected to reflect a range of vaccination coverage (high versus lower uptake), and different school types (Catholic, Independent or Government). Semi-structured focus groups and interviews were conducted with girls and their parents respectively, until saturation was reached. Transcripts were analysed, letting themes emerge from the data.

RESULTS

A core theme from both girls and parents was lack of knowledge. Supporting themes were lack of knowledge of HPV, lack of knowledge of vaccine, and realisation of their lack of knowledge. Their lack of knowledge was common in three areas: what HPV is, how HPV is transmitted, and the HPV and cervical cancer connection. The lack of knowledge about HPV vaccination was reflected in what the vaccine protects against, how the vaccine works, HPV vaccination recommendations, the vaccine and Pap smear connection, and myths about HPV vaccination. Both girls and parents wanted more information, had a tendency to defer responsibility, and parents expressed judgment of themselves as parents.

DISCUSSION

Low levels of knowledge and understanding about HPV vaccination among adolescents and parents have implications for adolescents' future health practices, including sexual risk behaviour, condom usage, and cervical screening. Reasons for the low levels of knowledge are explored, as are implications for school-based educational interventions.

Drivers and barriers to acceptance of human-papillomavirus vaccination among young women: a qualitative and quantitative study

Background

Human papillomavirus (HPV) is a necessary cause of cervical dysplasia and cancer, and of genital warts. Few studies have examined attitudes to HPV vaccination since the introduction of HPV vaccines. We aimed to investigate the reasons for young women's acceptance or rejection of the quadrivalent HPV vaccine after its general availability in Denmark.

Method

A literature review assessed attitudes towards HPV vaccination and the information was used to identify relevant questions for telephone and focus group interviews with women aged 16-26 who had decided to receive or reject HPV vaccination. 435 women across Denmark were interviewed by telephone. Qualitative interviews were undertaken in focus groups with 33 women living in Odense who had completed the telephone survey. Four focus groups were set up according to age (16-20 and 21-26 years of age) and acceptance/rejection of the vaccine.

Results

Of 839 women initially contacted by telephone, 794 were included, 411 (49%) said they accepted vaccination but only 201 (24%) had actually received the vaccine and these latter were interviewed. 242 women said they refused vaccination of which 234 were interviewed. Women who were undecided were excluded from the study. Prevention of cervical cancer was the main driver for acceptance of the vaccine, followed by parental encouragement and financial support, personal experience of someone with cancer and recommendation by health-care professionals. The greatest barrier to vaccination was its cost. A lack of information about the benefits of vaccination for sexually active women was also an important barrier and the older participants in particular considered that they were too old to be vaccinated. Knowledge about HPV and its role in the development of cervical cancer and genital warts was poor.

Conclusions

The difference between intention to be vaccinated and starting vaccination was considerable, and a large proportion of women aged 16-26 did not wish to be vaccinated. If the most important barriers to vaccination were addressed (cost and a lack of information about vaccination benefits), it is likely that the uptake of vaccination in Denmark would increase substantially.

Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination

OBJECTIVE

To describe human papillomavirus (HPV) vaccine uptake, predictors of vaccination, and barriers to vaccination in young women.

METHODS

Participants were 13-26-year-old girls and women recruited from an urban, hospital-based clinic. Between June and December 2007, 6 months after they had completed a baseline survey, they were recontacted to assess receipt of at least one HPV vaccine dose and barriers to receiving the vaccine. We assessed whether demographic factors, gynecological history, and attitudes measured at baseline were associated with vaccination at follow-up using logistic regression.

RESULTS

Of the 262 women who completed the baseline study, 189 (72%) participated in this follow-up study. At follow-up, 68 of 189 (36%) had received >or=1 HPV vaccine dose. Factors measured at baseline that predicted vaccination 6 months later included insurance coverage for HPV vaccination (odds ratio [OR] 5.31, 95% confidence interval [CI] 1.61-17.49) and the belief that one's parents, partners, and clinicians endorsed HPV vaccination (OR 2.21, 95% CI 1.29-3.79); those with a history of an abnormal Pap test were less likely to have received the vaccine (OR 0.30, CI 0.10-0.92). Of the 121 who were unvaccinated, 54 (45%) had not returned to the clinic since the baseline study, 51 (42%) had returned but were not offered vaccine, and 15 (12%) had declined vaccination.

CONCLUSIONS

Interventions to increase HPV vaccination rates in women in the catch-up age group for vaccination should ensure that vaccine costs are covered, promote HPV vaccination as normative, and establish clinic-based systems to prevent missed opportunities for vaccination.

Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation

Among insured women, aged 19-26 years, those who discussed the HPV vaccine with their physician and received a recommendation were overwhelmingly more likely to be vaccinated. Student status and perception of the personal importance of vaccination were also predictive of vaccination. The strength of the physician's recommendation played a significant role in the decision to be vaccinated, resulting in a 4-fold greater likelihood of vaccination when women received a strong recommendation versus one that was not strong. Health care providers should be well-informed about HPV vaccination and recognize that the strength of their recommendation to patients will foster appropriate uptake.

Integrating clinical, community, and policy perspectives on human papillomavirus vaccination

Infection with genital human papillomavirus (HPV) may cause anogenital cancers, oropharyngeal cancers, anogenital warts, and respiratory papillomas. Two prophylactic vaccines (a bivalent and a quadrivalent vaccine) are now licensed and currently in use in a number of countries. Both vaccines prevent infection with HPV-16 and HPV-18, which together cause approximately 70% of cervical cancers, and clinical trials have demonstrated 90%-100% efficacy in preventing precancerous cervical lesions attributable to HPV-16 and HPV-18. One vaccine also prevents HPV-6 and HPV-11, which cause 90% of genital warts. A growing literature describes psychosocial, interpersonal, organizational, and societal factors that influence HPV vaccination acceptability. This review summarizes the current literature and presents an integrated perspective, taking into account these diverse influences. The resulting integrated framework can be used as a heuristic tool for organizing factors at multiple levels to guide intervention development and future research.

Factors influencing familial decision-making regarding human papillomavirus vaccination

OBJECTIVE

The purpose of this review is to summarize the research regarding Human Papillomavirus (HPV) vaccination uptake among families with adolescent/preadolescent daughters.

METHODS

Literature searches (utilizing PubMed and PsychInfo databases) were conducted and research examining psychological and environmental factors which relate to HPV vaccine uptake and intentions was reviewed.

RESULTS

Factors such as physician recommendations, perceptions of the beliefs of peers and significant others, history of childhood immunizations, and communication with adolescents regarding sexual topics appear to influence HPV vaccination outcomes.

CONCLUSIONS

Although primary prevention of cervical and other cancers is available for preadolescent and adolescent girls, rates of HPV vaccine uptake are low. Future interventions should target vaccine intent and physician/family communication as a means to increasing HPV vaccination.

UK health professionals' attitudes and knowledge regarding Human Papillomavirus (HPV) vaccination: a West Yorkshire Study

AIM

To investigate the willingness of clinicians to recommend human papillomavirus (HPV) vaccination, the strength of support for a national HPV vaccine programme and to determine which factors, if any, affected these.

METHODS

An online, invitation-only questionnaire was developed and distributed to three medical professional groups in the West Yorkshire Region, United Kingdom.

RESULTS

Two hundred twenty-two responders were included in the final analysis, from the following specialties: general practice (62), paediatrics (103) and obstetrics and gynaecology (57). The majority of doctors were in favour of an National Health Service-funded national vaccination programme. Over 90% supported vaccination of girls as early as ages 11-13. Fewer doctors felt comfortable recommending vaccination to parents of girls under 16 than to young women. Latent class analysis demonstrated that doctors' self-rated knowledge of the HPV vaccine was an important determinant of willingness to recommend vaccination. Younger, more recently qualified doctors were less likely to be willing to recommend vaccination.

CONCLUSIONS

There is widespread support for vaccination. Information provision to doctors will be important in maximising clinician confidence in recommending vaccination, and may be most beneficial when targeted at more junior doctors.

Vaccine adherence in adolescents

Although a number of routine and catch-up vaccinations are currently recommended for adolescents, coverage rates of these vaccines are currently suboptimal. Routine recommended immunizations for this cohort include vaccines for influenza, human papillomavirus, and meningococcal disease, as well as a booster for tetanus, diphtheria, and acellular pertussis. Adolescence is also a critical period for administration of catch-up vaccines for those not fully immunized during childhood. Adolescents who do not seek appropriate preventive healthcare are at risk for significant morbidity and possible mortality. Increasing adolescent adherence to recommended vaccine schedules presents a challenge and opportunity for pediatricians and public health advocates. This article outlines barriers to vaccine compliance among adolescents and discusses strategies to increase vaccine uptake.

Hear all about it: nightly television news coverage of cervical cancer vaccination in the United States

OBJECTIVE

To examine the content of human papillomavirus (HPV)-related vaccination information presented during nightly national television news broadcasts in the United States.

MATERIALS AND METHODS

A retrospective content analysis of HPV vaccination coverage on 5 major nightly US television networks from 2002 to 2007. The Vanderbilt Television News Archive was searched for keywords "Gardasil," "cervical cancer vaccination," "human papillomavirus vaccine," and "HPV vaccination." Each television news broadcast was categorized as follows: segment length (in seconds), network (American Broadcasting Company, Columbia Broadcasting Company, National Broadcasting Company, Cable News Network, or Fox Broadcasting Company), year of broadcast (2002-2007), and (4) presentation type. Air dates were plotted on a timeline to depict trends and linkages to 5 seminal events surrounding the development, efficacy, and controversy regarding HPV vaccination.

RESULTS

During the 6-year period, a total of 27 HPV-related vaccination news broadcasts aired. News broadcasts ranged from 10 to 250 seconds, lasting an average of close to 2 minutes (mean +/- SD, 127.0 +/- 66.1 seconds). Most broadcasts presented information pertaining to HPV and cervical cancer, information on vaccine labeling, impact of the vaccine, and raised issues or concerns about the vaccine. More than half (66.7%) of news broadcasts were directly related to 5 seminal events surrounding the development, efficacy, and controversy regarding HPV vaccination.

CONCLUSION

All 5 networks included within the Vanderbilt Television News Archive aired HPV vaccination content, with National Broadcasting Company and Columbia Broadcasting Company broadcasting most of the news stories during this time period. As compared with other medical-related information presented on national nightly television news during this time period, HPV vaccination received a modest amount of coverage.

Effects of information framing on human papillomavirus vaccination

BACKGROUND

In June 2006, the first vaccine to prevent human papillomavirus (HPV) transmission was approved for use in females in the United States. Because the vaccine was approved for females as young as 9, its success depends on parents' and individuals' willingness to accept vaccination. Little is known about how attitudes toward this vaccine will be influenced by the way the vaccine is portrayed in the media or in public debate.

METHODS

To assess the effects of information framing on intentions to vaccinate self or female children, if appropriate, 635 adults read one of three short descriptive paragraphs about the vaccine, each of which emphasized a different aspect of the vaccine. Participants were then asked about their intentions to vaccinate under cost or no-cost conditions.

RESULTS

Women who read that the vaccine protects only against cervical cancer had significantly higher intentions to vaccinate themselves when the vaccine was available at little or no cost compared with women who read alternate versions of the descriptive paragraph, F(2,325) = 5.74, p = 0.004.

CONCLUSIONS

How the HPV vaccine is framed may affect vaccination intentions under certain conditions. Women may be more receptive to the vaccine if it is framed as a cervical cancer prevention tool rather than a sexually transmitted infection (STI) prevention tool.

Mothers' intention for their daughters and themselves to receive the human papillomavirus vaccine: a national study of nurses

OBJECTIVES

The aims of this study were to examine mothers' intention to vaccinate their daughters and themselves against human papillomavirus and to determine which demographic, behavioral, and attitudinal factors were associated with intention to vaccinate daughters.

METHODS

We surveyed 10,521 US mothers, all nurses, between June 2006 and February 2007. Multivariable logistic regression models were used to determine which of the following factors were associated with a mother's intention to vaccinate a 9- to 12-year-old daughter: demographic factors, gynecologic history, belief that one's daughter should have regular Papanicolaou testing, beliefs about Papanicolaou testing outcomes (3-item scale), and beliefs about human papillomavirus vaccines (7-item scale measuring beliefs about human papillomavirus vaccine efficacy, impact of vaccination on sexual and Papanicolaou screening behaviors, severity of and susceptibility to human papillomavirus, and anticipated clinician recommendations).

RESULTS

Of the 8832 mothers who completed a survey (84% response rate), 7207 had a daughter. Among mothers with a daughter, 48% intended to vaccinate a daughter if she were 9 to 12 years of age, 68% if she were 13 to 15 years of age, and 86% if she were 16 to 18 years of age. Forty-eight percent intended to receive the vaccine themselves if recommended. In multivariable regression models, variables significantly associated with intention to vaccinate a 9- to 12-year-old daughter included belief that one's daughter should have regular Papanicolaou testing and beliefs about human papillomavirus vaccines.

CONCLUSIONS

In this first national study of mothers' attitudes about human papillomavirus vaccines, mothers' intention to vaccinate a daughter <13 years of age was lower than intention to vaccinate an older daughter, contrasting with national recommendations to target 11- to 12-year-old girls for vaccination. Educational interventions designed to affect mothers' willingness to vaccinate daughters should focus on human papillomavirus vaccine efficacy, behavioral impact of vaccination, perceived risk of human papillomavirus, and clinician support for vaccination.

Stage of adoption of the human papillomavirus vaccine among college women

BACKGROUND

Certain types of human papillomavirus (HPV) can cause cervical and other cancers. A vaccine that protects against HPV types responsible for 70% of cervical cancers is available to females ages 9-26.

OBJECTIVE

To examine correlates of stage of vaccine adoption among women ages 18-22.

METHODS

In 2007, female students (n=4774) at a New England University in the U.S. were invited to complete an on-line survey that assessed knowledge of HPV, perceived susceptibility, severity, vaccine benefits/barriers, social and subjective norms, and stage of vaccine adoption

RESULTS

1897 women (40%) responded; complete data were available for 1401. About half (53%) were planning to be vaccinated, 12% had received the vaccine, 15% were undecided, and 7% had decided against vaccination. HPV knowledge was low (mean 58%). In multivariate analyses, social norms was the strongest correlate of stage; each standard deviation increase in social norms score was associated with more than four times the odds of intending to be vaccinated within the next 30 days, compared with those who had decided against vaccination (OR=4.15; 95% CI 2.17-6.36).

CONCLUSIONS

Acceptance of the vaccine was high, although misconceptions about viral transmission, availability of treatment, and the role of Pap tests were common. Perceived norms were strongly associated with intentions. Interventions on college campuses should stress vaccination as a normative behavior, provide information about viral transmission, and stress the role of continued Pap screening.

Acceptance of the HPV vaccine for adolescent girls: analysis of state-added questions from the BRFSS

PURPOSE

Previous research regarding human papillomavirus (HPV) awareness and vaccine acceptance has relied on convenience or other selected samples of the population. To assess the prevalence of HPV awareness and vaccine acceptance in Kentucky we added questions to the 2006 Kentucky Behavioral Risk Factor Survey System (BRFSS), a population-based survey of health behaviors.

METHODS

Women who participated in the statewide BRFSS were asked two HPV-related questions: one assessed previous awareness of HPV, and another assessed vaccine acceptance for girls 10 to 15 years old. We used crosstabulations and multivariate logistic regression to determine which factors were associated with HPV awareness and vaccine acceptance. Because the HPV vaccine Gardasil was approved in June 2006, we conducted an analysis of pre- and postapproval HPV awareness and vaccine acceptance. We also compared results across Appalachian and non-Appalachian counties, two distinct regions of Kentucky.

RESULTS

Overall, 57.6% of women had heard of HPV, and 70.2% accepted vaccination for girls. HPV awareness increased after Gardasil's approval, but the increase was much smaller among Appalachian women. Prevalence of vaccine acceptance was unchanged in both regions. Awareness of HPV was not associated with vaccine acceptance, and factors significantly associated with vaccine acceptance in multivariate analysis differed by Appalachian status.

CONCLUSIONS

This population-based survey of Kentucky women found relatively high vaccine acceptance for girls. Also, many respondents reported not knowing whether they accept vaccination, and factors associated with vaccine acceptance varied by Appalachian status. These findings suggest that acceptance of the HPV vaccine for girls may improve with targeted interventions.

Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls

OBJECTIVES

We investigated whether maternal attitude toward prevention, as indicated by history of seeking Papanicolaou (Pap) tests and contracting sexually transmitted infections, influenced human papillomavirus (HPV) vaccine uptake among their adolescent daughters.

METHODS

We linked the electronic health records of girls aged 9 to 17 years with their mothers at Kaiser Permanente Southern California (n = 148 350 mother-daughter pairs). Personal identifying information was removed from the data set after the matching of daughters and mothers was completed. We used logistic regression models to detect associations between mothers' history of Pap tests and abnormal results, genital or anal warts, and other sexually transmitted infections and daughters' HPV vaccine initiation and 3-dose regimen completion.

RESULTS

Mothers' testing history was associated with daughters' likelihood for vaccination across ethnic and neighborhood socioeconomic strata (overall odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.43, 1.52). Mothers' history of sexually transmitted infections was only modestly associated with daughters' vaccination. Mothers' testing history was positively associated with daughters' regimen completion (overall OR = 1.42; 95% CI = 1.31, 1.54).

CONCLUSIONS

Mothers' attitude toward prevention may influence HPV vaccine uptake among adolescent girls. The impacts of targeting mothers should be considered by HPV vaccination programs and investigated by further research.

Adolescent girls' attitudes on human papillomavirus vaccination

STUDY OBJECTIVE

The objective of the study was to assess the attitudes of adolescent girls on Human papillomavirus (HPV) vaccination and the impact of an information pamphlet on their attitude. Other factors that may affect their attitude were also studied.

DESIGN

Questionnaire survey.

SETTING

Pediatric and adolescent gynecology clinic.

PARTICIPANTS

250 adolescents aged 12 to 19 years.

INTERVENTIONS

Participants completed a questionnaire regarding their knowledge and attitudes towards HPV vaccination. Immediately following this, they read an information pamphlet on HPV vaccination. They then completed the same questionnaire again.

MAIN OUTCOME MEASURES

The attitude of the adolescents towards HPV vaccination.

RESULTS

Initially, 35% intended to receive the vaccination but after reading the information pamphlet, it rose to 69%. Their intention was positively correlated with their knowledge (P = 0.003), health belief (P < 0.001) and belief in who should receive the vaccine (P < 0.001) but negatively correlated with their belief that other people would approve of their vaccination (normative belief) (P < 0.001). There was a significant increase in their knowledge score (P < 0.001) after reading the pamphlet. Their health belief and belief in who should receive vaccine became more positive (P < 0.001), but the normative belief was more negative (P = 0.002) after reading.

CONCLUSION

69% of adolescent girls intended to receive HPV vaccination and their intention was improved by reading an information pamphlet. It was positively correlated with their knowledge, health belief, and belief in who should receive the vaccine, but negatively correlated with their normative belief.

Men's attitudes toward receiving the human papillomavirus vaccine

OBJECTIVES

To determine men's attitudes toward receiving the human papillomavirus (HPV) vaccine.

MATERIALS AND METHODS

Five hundred seventy-one men read a 1-page informational sheet about HPV and the HPV vaccine before completing a 29-item questionnaire. Descriptive statistics were calculated on all variables.

RESULTS

Of these men, 33% wanted to receive the HPV vaccine, 27% did not, and 40% were undecided. The main reasons for wanting the vaccine included a desire to stay healthy (67.4%); prevention of cancer in my sexual partner(s) (52.9%); prevention of anal, penile, and head and neck cancer (41.0%); fear of cancer (33.4%); and prevention of genital warts (32.8%). Being in a monogamous relationship and not at risk (18.9%), not interested (13.8%), and not enough evidence yet to prove that it will help men (8.2%) were the main reasons for not wanting to be vaccinated.

CONCLUSIONS

Although many men want to receive the HPV vaccine, more remain undecided. Pending favorable safety and efficacy results from a clinical trial for men, substantial factual education will likely convince many ambivalent men to receive the HPV vaccine.

Human papillomavirus vaccine acceptability among young adult men

BACKGROUND

For human papillomavirus (HPV) vaccination to have maximum benefit to public health, both men and women should be vaccinated. Although efficacy trials in men are still ongoing, the HPV vaccine will likely be licensed for men in the near future. Little is known about men's interest in HPV vaccination. This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone. Predictors of HPV vaccine acceptability were also identified.

METHODS

Heterosexual male college students (n = 356) were randomly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine. Participants provided demographic and sexual history information, HPV-related awareness and knowledge, health beliefs, and HPV vaccination intentions.

RESULTS

: Men reported moderate interest in the HPV vaccine; vaccine acceptability did not differ by experimental condition. A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity, perceived susceptibility to HPV, perceived benefits of the vaccine, perceived hassle and cost of vaccination, self-efficacy for vaccination, and perceived norms for vaccination.

CONCLUSION

Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men's interest in the vaccine. Correlates of vaccine acceptability among men were generally consistent with those identified for women. Findings have important implications for future HPV vaccination campaigns targeting young adult men.

Acceptance of human papillomavirus vaccination among first year female university students in Hong Kong

The present study assessed sexual behaviour, knowledge and attitudes among first year university students in order to identify factors that may affect their acceptance of human papillomavirus (HPV) vaccination. A cross-sectional survey was conducted at the Chinese University of Hong Kong in August 2006. The survey was a self-administered questionnaire comprising questions regarding general health, sexual behaviour, knowledge about HPV and cervical cancer, and attitudes towards vaccination. χ2, anova and logistic regression tests were used to identify associations between categories. Of 992 students, 63 (6.5%) reported having had sexual intercourse, 22.4% of whom had had more than one sexual partner and 36.5% had had unprotected sexual intercourse. A total of 70.8% of participants were willing to accept the HPV vaccine, with ‘willingness’ independently associated with age, having had sexual intercourse and beliefs regarding the effectiveness of vaccination (P < 0.05). Understanding the role of these influences can aid in the design of successful HPV education, prevention and vaccination programs.

Physicians' experiences with HPV vaccine delivery: evidence from developing country with multiethnic populations

Physicians' experiences in providing human papillomavirus (HPV) immunization were assessed by mailed questionnaire. Response rate of 41.4% was achieved. Malay Muslim physicians were more likely to agree that cultural sensitivity is an issue when recommending HPV vaccines. Pediatricians and family physicians were more likely to agree that acceptance is better if vaccines were recommended to prevent cervical cancer than to prevent a sexually transmitted disease. Near 70% rated success of HPV vaccines recommendation in their practice as very poor with the majority patients preferred to postpone immunization. Physicians reported cultural disparities in vaccine uptake and perceived high vaccination cost limits its use.

Acceptability of the human papillomavirus vaccine among Latina mothers

STUDY OBJECTIVE

To describe Latina mothers' acceptance of the human papillomavirus (HPV) vaccine for their daughters and explore their knowledge base regarding HPV-related issues.

DESIGN

Individual interviews were conducted with a convenience sample of 40 Latina mothers of daughters 7-14 years old, from an urban, pediatric primary care clinic. Preliminary questions were asked regarding HPV knowledge and then information was verbally provided before exploring vaccine acceptance.

RESULTS

Thirty-one of the Latina mothers had not heard of HPV and 34 were not aware of the connection between HPV and cervical cancer. Thirty-two mothers reported that they would allow their daughters to receive the HPV vaccine. Two overarching themes were identified as reasons for accepting the vaccine. The main theme for vaccine acceptance provided by 26 mothers was "to prevent disease." The other theme was "to protect" their child. Four mothers were undecided and 4 reported they would not vaccinate their daughter. The two themes identified from this group of mothers include not having sufficient information regarding the vaccine, and that their daughters are too young.

CONCLUSION

Acceptance of the HPV vaccine was high in this sample of Latina mothers. The prevention of disease and the protection of their child were the motivating factors for vaccinating their daughters. Reasons for not accepting include lack of information and young age of daughter. The provision of information will be key to ensuring Latina mothers understand the rationale for vaccinating at a young age.

Recommendations for primary care physicians to improve HPV vaccination rates during clinical encounters

The availability of the human papillomavirus (HPV) vaccine has positioned primary care physicians to play an active role in ensuring its successful implementation. However, physicians must be aware of common knowledge, attitudes, and belief barriers associated with HPV and the vaccine that are often encountered during clinical visits. This editorial provides primary care physicians an overview of these barriers and realistic recommendations utilizing the "5A's" - Awareness, Assess, Address, Acceptability, and Activate. This mnemonic can help facilitate a physician's systematic approach to increasing HPV vaccination rates during the clinical encounter.

Chapter 24: Psychosocial aspects of vaccine acceptability

In this chapter we identify psychosocial issues that have been raised with respect to human papillomavirus (HPV) vaccination and review the research literature on HPV vaccine acceptability. Many women and physicians have relatively poor knowledge about HPV, but despite this, most healthcare providers are willing to recommend HPV vaccination and parents are interested in having their children vaccinated. Concerns about post-vaccination sexual behavior change do not appear to be justified, but can certainly be addressed through anticipatory guidance. Most research studies have come out of the United States and other English-speaking industrialized countries. More psychosocial research regarding HPV vaccination is therefore needed from developing countries.

Young multiethnic women's attitudes toward the HPV vaccine and HPV vaccination

OBJECTIVE

To investigate the acceptability of the HPV vaccine among a multiethnic sample of young women in Malaysia.

METHODS

A qualitative study of 40 young women aged between 13 and 27 years recruited into 7 focus groups to discuss their knowledge of HPV infection, and their attitudes toward and acceptance of the HPV vaccine. The women were divided into Malay, Chinese, and Indian groups to allow for comparison among ethnicities.

RESULTS

Poor knowledge about HPV did not influence the HPV vaccine's acceptability. Although participants were in favor of the vaccine, the majority preferred to delay vaccination because it is newly introduced, they did not perceive themselves to be at risk of HPV infection, or because of cost factors. Concerns were raised regarding the vaccine's safety, the potential to be perceived as promiscuous and sexually active, and whether the vaccine was halal.

CONCLUSION

Promotion of the HPV vaccine should take account of social and cultural acceptability. The findings will help develop strategies for effective vaccination initiatives in a multiethnic and multireligious Asian society.

Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes

PURPOSE

To examine the relationships of demographics, parenting, and vaccine attitudes with the acceptance of the human papillomavirus (HPV) vaccine or to the intent to vaccinate in the next 12 months.

METHODS

Mothers (n = 153) with daughters ages 11 to 17 years were recruited through the pediatric clinic waiting room/announcements to complete a questionnaire.

RESULTS

Eighteen percent of the daughters had not received the vaccine, although it had been offered; 34% had not been offered the vaccine and did not intend to get it in the next 12 months; 22% had not been offered the vaccine but intended to get it in the next 12 months; 26% had started vaccination or completed the series. In a multinomial, multivariable logistic regression model, those mothers who had less than a high school degree, had a history of a sexually transmitted infection, supervised their daughter more when she was with peers, and whose daughter would not mind three shots were more likely to be favorable about their daughter being vaccinated. The following variables were not related to their attitudes about getting the vaccine: mothers' and daughters' ages, race/ethnicity, mothers' self-reported history of HPV disease and age of sexual initiation, daughters' dating status and anticipated age of sexual initiation, the number of sexual topics discussed and level of comfort, mother's sexual values, and the family environment.

CONCLUSIONS

Mothers' decisions about the HPV vaccine were not related to their sexual values or their daughters' sexual behavior, but rather their parenting, sense of vulnerability, and vaccine attitudes. Mothers who were not planning to vaccinate did not appear to not feel an urgency given the newness of the vaccine, and many planned to vaccinate eventually.

Human papillomavirus and vaccination: knowledge, attitudes, and behavioural intention in adolescents and young women in Italy

This study assesses knowledge, attitudes, and behavioural intention towards human papillomavirus (HPV) infection and vaccination in a random sample of 1348 adolescents and young women aged 14–24 years in Italy. A self-administered anonymous questionnaire covered demographics; knowledge about HPV infection, cervical cancer, and HPV vaccine; the perceived risk for contracting HPV infection and/or for developing cervical cancer, the perceived benefits of a vaccination to prevent cervical cancer, and willingness to receive an HPV vaccine. Only 23.3% have heard that HPV is an infection of the genital mucosa and about cervical cancer. Those older, with at least one parent who is a health care professional, with personal, familiar, or friendly history of cervical cancer, and having underwent a health checkup in the last year with information about HPV vaccination were significantly more knowledgeable. Risk perception scores (range: 1–10) of contracting HPV infection and of developing cervical cancer were 5.8 and 6.5. Older age, not having a parent who is a health care professional, having had a personal, familiar, or friendly history of cervical cancer, and need of additional information were predictors of the perceived susceptibility of developing cervical cancer. The vast majority professed intent to receive an HPV vaccine and the significant predictors were having at least one parent who is a health care professional, a high perceived risk of contracting HPV infection and of developing cervical cancer, and a high belief towards the utility of a vaccination for preventing cervical cancer. Knowledge about HPV infection and cervical cancer should be improved with more attention to the benefit of HPV vaccination.

Young adults and acceptance of the human papillomavirus vaccine

OBJECTIVES

To determine whether young Dutch adults had ever heard of human papillomavirus (HPV) and whether they would accept vaccination, and to assess the factors influencing their decision.

STUDY DESIGN

Cross-sectional survey.

METHODS

Six hundred participants aged 18-25 years were recruited from two university departments and one non-university technical college.

RESULTS

One hundred and six (17.7%) participants had heard of HPV and 536 (94%) had heard of cervical carcinoma. Women had significantly more knowledge of cervical carcinoma than men. A medical education, knowledge of HPV, knowledge of cervical cancer and knowledge of the cervical screening programme were not significantly associated with acceptance of HPV vaccination, whereas gender and age did show a significant relationship. In total, 61% of the female participants and 48% of the male participants were willing to accept a 'catch-up' HPV vaccination.

CONCLUSIONS

This study found that average knowledge levels of HPV and cervical cancer were low. Despite this lack of knowledge, a small majority of the study population would accept a 'catch-up' HPV vaccination. Women and younger participants were significantly more willing to accept HPV vaccination. However, in these subgroups, acceptance of HPV vaccination seems to be affected by other, still unidentified, factors. These factors could be evaluated in a more qualitative orientated study. An educational campaign is needed to cover knowledge about HPV and cervical carcinoma, and beliefs and behaviours associated with the acceptance of vaccination.

Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women

OBJECTIVE

To estimate rates of human papillomavirus (HPV) vaccination, factors associated with intention and belief in one's ability (self-efficacy) to receive the vaccine, and prevalence of vaccine-type HPV during the first year after an HPV-6, HPV-11, HPV-16, HPV-18 vaccine was licensed.

METHODS

Sexually experienced females 13-26 years of age (N=409) were recruited from three primary care clinics, completed a questionnaire, and underwent cervicovaginal HPV DNA testing. Outcome measures were HPV vaccination, intention and belief in one's ability to receive the HPV vaccine in the next year, and prevalence of vaccine-type HPV. Factors independently associated with intention and belief in one's ability to receive the HPV vaccine were determined by logistic regression.

RESULTS

Five percent of participants had received at least one HPV vaccine dose, 66% intended to receive the vaccine, 65% were confident they could find the time to get vaccinated, 54% believed that they could receive all three shots, and 42% believed that they could afford vaccination. Sixty-eight percent of women were HPV-positive: 9% for HPV-6, 3% for HPV-11, 17% for HPV-16, and 12% for HPV-18. Factors independently associated with intention included believing that influential people would approve of vaccination, higher perceived severity of cervical cancer or genital warts, fewer safety barriers, and pregnancy history. Factors associated with a high belief in one's ability to receive the vaccine included perceived severity of HPV, sexually transmitted disease history, insurance coverage, and fewer practical barriers to vaccination.

CONCLUSION

Interventions that aim to increase intention and belief in one's ability to receive HPV vaccines, which may lead to higher vaccination rates, should address personal beliefs about vaccination as well as systemic barriers to vaccination.

LEVEL OF EVIDENCE

III.

Acceptability to Latino parents of sexually transmitted infection vaccination

OBJECTIVE

To evaluate the acceptability to Latino parents of having their adolescent children vaccinated against sexually transmitted infections, and to identify potential demographic correlates of acceptability.

METHODS

We applied established methodology to a sample of 119 Latino parents who accompanied their children (51% female, aged 12-17 years) to medical appointments. The parents used computer-based questionnaires to rate 9 hypothetical vaccine scenarios. The scenarios had 4 dimensions: mode of transmission (sexually transmitted or not sexually transmitted), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Willingness by parents to vaccinate their adolescents under each vaccine scenario was assessed on a scale (range, 0-100). Conjoint analysis was used to determine the relative contribution of each dimension to the ratings.

RESULTS

The study sample consisted of predominantly Mexican immigrant parents, 94% of whom chose to complete the Spanish version of the computerized interview. The mean value of the parents' willingness to accept vaccination for their adolescent children was exceptionally high. For example, the mean score of the Latino parents for the 6 sexually transmitted infection (STI) vaccine scenarios (score 86.2; SD 21.1) was far higher than the mean score in previous studies (81.3, SD 21.1). Conjoint analysis revealed that the dimensions of vaccine efficacy and severity of infection were equal in terms of their influence on vaccine ratings for the Latino parents. The next most influential dimension on vaccine ratings was the availability of behavioral prevention, followed by the sexual transmissibility of the infection.

CONCLUSIONS

Our sample of predominantly Mexican parents was accepting of the concept of STI vaccination for their adolescent children. Important issues for parents include vaccine efficacy and severity of infection, followed by vaccines for infections that had no method of behavioral prevention available. Overall, there is little difference in the relative preference of a STI versus non-STI vaccine for their adolescent children.