Mother-daughter communication about HPV vaccine

Indonesian Mothers' Experience of Their Daughter's HPV Vaccination, and Factors Associated with Their Willingness to Recommend HPV Vaccination for Girls

In Indonesia, knowledge of parents' experiences of their daughters' HPV vaccination in school settings is limited. As Indonesia seeks to scale up its HPV vaccination program nationwide, parents' perspectives hold important insights into how elements of the vaccination model can be sustained and improved. This study explored mothers' experiences of their daughters' HPV vaccination experiences, their knowledge of HPV risks and prevention, and factors associated with willingness to recommend HPV vaccination for girls. A cross-sectional online survey was conducted with 143 mothers of schoolgirls who had received HPV vaccination at schools in Yogyakarta and Jakarta. Multivariate logistic regression was used to assess factors associated with willingness to recommend HPV vaccination. Chi-square and independent t-tests were performed to assess relationships between variables. One-way ANOVA was used to test mean differences in knowledge scores among mothers with different education levels. Many respondents (62.4%) received key health information before their daughters' HPV vaccination. Mothers' average knowledge score was 6.07/10 (SD 2.35). Receiving satisfactory information was significantly associated with willingness to recommend HPV vaccination for girls to others. A significant association was found between mothers' willingness to recommend HPV vaccination and having ever participated in cervical cancer screening themselves. Providing consistent health information that addresses the knowledge gaps and affirms the benefits and safety of HPV vaccines can improve the likelihood of mothers recommending HPV vaccination to others. The benefit of a synchronized approach to promoting primary and secondary prevention was supported by the findings.

HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

Social media promotion, risk perception, and parental support for adolescent girls' HPV vaccination: Taking consideration of future consequences and sexual attitudes as moderators

HPV vaccine hesitancy in Asia is unique compared to western countries. Concerning whether social media promotion about HPV vaccine will be related with parental support for Chinese adolescent girls, we investigated the correlation among social media promotion, risk perception of HPV vaccine and parental support. Through the theoretical lens of Health Action Process Approach model (HAPA), we found that social media promotion could reduce the risk perception of HPV vaccine and promoted parental supportive decision, and risk perception played a mediation role between social media information exposure to vaccine and parental support. Consideration of future consequences has been found to play a moderating role between social media promotion and risk perception, and parents' sexual attitudes moderated the effect of social media promotion on parental support. Implications of the findings are discussed.

Recommending Breast Cancer Screening to My Mum: Examining the Interplay of Threat, Efficacy, and Virality on Recommendation Intention in the Chinese Context

The burgeoning eHealth campaigns and the emerging daughter-to-mother health communication necessitate a close examination of the intricate mechanism behind recommending preventive behaviors in online settings. The present study addresses existing gaps by investigating how message characteristics and platform-generated virality cues jointly influence younger females' intention to recommend breast cancer screening to their mothers. Drawing on the extended parallel process model (EPPM) as the theoretical basis, a 2 (threat: low vs. high) × 2 (efficacy: low vs. high) × 2 (virality: low vs. high) randomized between-subjects experiment (n = 269) was performed. Results revealed a three-way interaction effect between threat, efficacy, and virality on message involvement. Message involvement was positively associated with recommendation intention and mediated the three-way interaction effect on recommendation intention. This study demonstrates that a high threat can initiate message involvement but fail to trigger recommendation intention. In contrast, a low-threat, high-efficacy, high-virality combination would yield a salutary outcome. Besides, the indispensable role of message involvement in the underlying psychological mechanism behind recommending preventive behaviors was reaffirmed. Theoretical and practical implications are further discussed.

HPV vaccination and cervical screening: the knowledge and attitudes of mothers of adolescent girls

OBJECTIVE

Mothers play a significant role in decision making about human papillomavirus (HPV) vaccination for their daughters and about cervical screening attendance for themselves. This study had three objectives, to explore: (1) mothers' knowledge and attitudes about HPV and HPV vaccination, (2) their knowledge and attitudes about cervical cancer and screening, and (3) whether their daughter's HPV vaccination invitation was an opportunity to nudge mothers to attend screening.

DESIGN

138 women from North Staffordshire completed a cross-sectional survey and 15 took part in follow-up focus groups.

RESULTS

Despite high self-reported engagement with both the cervical screening and HPV vaccination programmes, relatively low levels of knowledge and some uncertainty were evident. There was mixed opinion about the potential of using the vaccination invite as an opportunity to nudge mothers to attend cervical screening.

CONCLUSION

Even amongst women who do engage positively with the programmes, knowledge is not as complete and certain as it could be. Further research is needed with women who are less likely to accept the vaccination for their daughters. Women need to be better informed, which may go some way to reversing the decline in screening and maintaining high levels of vaccination.

Parents' reasoning about HPV vaccination in Sweden

INTRODUCTION

The aim of this study was to describe parents' reasoning in making decisions about vaccinating their daughters against human papilloma virus (HPV), a part of the Swedish vaccination programme.

METHOD

Twenty parents whose daughter had been offered HPV vaccination participated. Semi-structured individual interviews were conducted and analysed using thematic analysis.

RESULTS

The findings reveal that the decision-making process is complex. The parents trusted the vaccination programme and saw it as beneficial to society. They also described using different resources to decide about HPV vaccination, but they did not include their daughters in making the decision.

DISCUSSION

Parents need better vaccine and health literacy to be able to decide, based on evidence and in consultation with their daughters, on HPV vaccination. School nurses can play an important role in evidence-based decision-making about HPV vaccination and introducing children to this health-promoting intervention.

Young African Americans' Communication with Family Members About COVID-19: Impact on Vaccination Intention and Implications for Health Communication Interventions

Communication with family members about the COVID-19 vaccine may play an important role in vaccination decisions, especially among young people. This study examined the association between family communication about the COVID-19 vaccine and vaccination intention. Participants were Black/African Americans aged 18-30 years (N = 312) recruited through an online survey in June 2020. We assessed family communication, vaccine attitudes, perceived norms, outcome expectancies, and vaccination intention. More than half (62%) of the participants had talked to family members about the vaccine. Females were more likely than males to have engaged in family communication (63% vs. 59%) (p. > .05). Family communication, injunctive norms, and descriptive norms were significantly (p. < .01) associated with vaccination intention. Family communication was the strongest predictor of intention.Promoting discussions about vaccinations between young Black adults and their families may increase the likelihood of adopting positive vaccination beliefs and influencing vaccine decision-making.

Easing Human Papillomavirus Vaccine Hesitancy: A Communication Experiment With U.S. Parents

INTRODUCTION

The Announcement Approach using presumptive announcements increases human papillomavirus vaccine uptake. This study seeks to understand the impact of the final Announcement Approach steps-easing parents' vaccine concerns and then encouraging them to get human papillomavirus vaccine for their children-on parents' human papillomavirus vaccine hesitancy and confidence in the vaccine's benefits.

METHODS

In 2017-2018, investigators recruited an online national sample of 1,196 U.S. parents of children aged 9-17 years who had not yet completed the human papillomavirus vaccine series. Following the steps of the Announcement Approach, participants viewed brief videos of a pediatrician announcing that a child was due for human papillomavirus vaccine (shown to all the parents). In the 2 × 2 experiment, parents saw (1) a video of the pediatrician attempting to ease a concern that the parent had raised earlier in the survey (Ease video), (2) a video of the pediatrician encouraging the parent to get their child vaccinated (Encourage video), (3) both videos, or (4) neither of the videos. Data analysis was conducted in spring 2020.

RESULTS

Seeing the Ease video message led to lower human papillomavirus vaccine hesitancy than not seeing it (mean=2.71, SD=1.29 vs mean=2.97, SD=1.33; p<0.001). The beneficial impact of easing concerns on lower vaccine hesitancy was explained by higher confidence (p<0.05). By contrast, the Encourage video had no impact on human papillomavirus vaccine hesitancy or confidence.

CONCLUSIONS

Addressing parents' concerns can decrease human papillomavirus vaccine hesitancy and increase confidence. On the basis of these findings, the Announcement Approach retained its emphasis on announcing that children are due for vaccination and easing parent concerns.

From knowledge to a gendered event and trustful ties: HPV vaccine framings of eligible Finnish girls and school nurses

In the present study, we examine socio-cultural and practical aspects of human papillomavirus vaccination (HPVV) through a multi-sited study of framings. We ask how HPVV is framed in the daily lives of vaccination-aged Finnish girls and in school nurses' everyday work. We then mirror these framings against both each other and Finland's official vaccination campaign. Based on analysis of interviews with 24 nurses and 12 girls and the campaign materials, we argue first that the campaign frames vaccination as an individual, knowledge-based decision reflecting the informed consent principle. Second, however, the vaccination is framed in the everyday lives of eligible girls through gendered social ties and as a gendered and cohort-specific event pivoting around the needle prick. Third, HPVV is not primarily framed in the school nurses' work as preparing the girls for the vaccination decision by sharing official information but through trust-based social relationships with the girls and their parents. We conclude that, as the vaccination is not an issue of individually reflected and knowledge-based decision-making for the two interviewed key groups, the official Finnish HPVV campaign and the undergirding informed consent principle drift into problems in their practical implementation.

Cervical cancer screening among sexual minority women: findings from a national survey

PURPOSE

Sexual minority women (SMW; lesbian, bisexual, and other women who have sex with women) are at risk for cervical cancer but less likely than non-SMW to receive regular cervical cancer screening (Pap- and/or HPV-testing). We examined factors contributing to receipt of guideline-based cervical cancer screening among SMW.

METHODS

During October 2019, we conducted an online survey of self-identified SMW aged 21-45 years living in the United States (n = 435). We estimated risk differences (RD) in women's likelihood of being within current cervical cancer screening guidelines by sociodemographic and health-related characteristics.

RESULTS

Overall, 75% of respondents were within current screening guidelines. Adjusting for other factors, SMW were more likely to be within guidelines if they were insured (aRD 0.26, 95% CI 0.13, 0.39), had a partner (aRD 0.18, 95% CI 0.09, 0.28), and were older (aRD 0.12, 95% CI 0.04, 0.20). Overall, the most common reasons for not being screened recently were lack of insurance/cost (42%) and perceiving it was unnecessary (28%).

CONCLUSION

Many SMW are not being screened for cervical cancer according to guidelines. Findings can inform efforts to improve screening among this population.

Human papillomavirus vaccination uptake: a longitudinal study showing ethnic differences in the influence of the intention-to-vaccinate among parent-daughter dyads

INTRODUCTION

It is unclear what role daughters play in the decision-making process regarding HPV vaccination. Therefore, we explored the impact of HPV vaccination intention among parents and their 12-13 year-old daughters on HPV vaccination uptake.

METHODS

In February 2014 parents/guardians and their 12-13 year-old daughters were invited to complete a questionnaire about socio-psychological determinants of the decision-making process regarding HPV vaccination. Vaccination status of the daughter was retrieved from the national vaccination database after the last possible vaccination date in 2014. The association between HPV vaccination uptake and intention, and determinants of intention, was jointly assessed using a generalized structural equation model, stratified by origin of parents (Dutch versus non-Dutch).

RESULTS

In total, 273 Dutch parent-daughter dyads and 165 non-Dutch dyads were analyzed for this study. HPV vaccination uptake was 90% (246/273) and 84% (139/165) in the Dutch and non-Dutch group, respectively. In the Dutch group, high parental intention (β = 2.3, 95%CI 1.2-3.3) and high daughters' intention (β = 1.5, 95%CI 0.41-2.6) were significantly associated with HPV vaccination uptake. In the non-Dutch group, high daughters' intention (β = 1.2, 95%CI 0.16-2.2) was significantly associated with HPV vaccination, but high parental intention was not (β = 0.52, 95%CI -0.47-1.5). Attitude was the most prominent socio-psychological determinant associated with vaccination intention among all groups.

CONCLUSION

In the non-Dutch group, only daughters' intention was significantly associated with HPV vaccination uptake, whereas in the Dutch group both the parents' and the daughters' intention were significantly associated with uptake. The role of the child in the decision-making process might need to be taken into account when developing new interventions focused on increasing HPV vaccination uptake, especially among individuals of non-Dutch origin.

Awareness, knowledge, social norms, and vaccination intentions among Khmer mother-daughter pairs

Cervical cancer is caused by human papillomavirus (HPV) infection, which can be prevented by vaccination. Mothers play an important role in promoting vaccination and health education. However, Cambodian American mothers reported to have challenges to play a role as primary health educators due to lack of health knowledge and language and cultural gaps. Therefore, this study aims to understand the Cambodian American daughters' and mothers' awareness, knowledge and social norms of HPV vaccination and their health communication and vaccination decision-making. We conducted a pilot randomized clinical trial to promote HPV vaccination. In this study, we have only reported findings from baseline data examining individual, interpersonal and social determinants of HPV vaccination behavior among 19 dyads of Cambodian American mothers and daughters. Both mothers and daughters demonstrated low levels of awareness and knowledge. A significant relationship was found between the daughters' HPV vaccine decisions and their perception of their mothers' intention on HPV vaccination for them. Culturally and linguistically appropriate communication strategies such as storytelling or visual presentation approaches may be more effective than the current practice of using information-based written materials to promote HPV vaccination and health education among Cambodian Americans.

What kind of 'a girls' thing'? Frictions and continuities in the framing and taming of the HPV vaccine in Finland

This article focuses on two different ways of framing and taming the uncertainties of the human papillomavirus (HPV) vaccine in the context of the Finnish welfare state: the bio-medical rationale of population-level cancer reduction based on epidemiological assessments, and the meaning formation of Finnish vaccination-aged girls. Epidemiologists run analyses estimating the cost-effectiveness and public health benefit of vaccinations, while the adolescent girls face the burdensome choice of whether to undergo vaccination. The processes of framing the complexities and actively taming them are analysed utilising a cultural-sociological framework. Firstly, the taming work of the epidemiologists is examined by focusing on the creation of the vaccination campaign. The aetiological complexities between some HPV types and cervical cancer are tamed into a clear campaign message of vaccination as a scientifically proven protection against deadly cancer. Secondly, the girls' own ways of framing the complexities of the HPV vaccine and taming the decision whether to undergo vaccination or not are analysed based on their comments in an Internet discussion forum. Finally, the framings and tamings of both sites are discussed together, and some interesting continuities and disjunctions between the two are revealed.

Human Papillomavirus Risk Perceptions Among Young Adult Sexual Minority Cisgender Women and Nonbinary Individuals Assigned Female at Birth

CONTEXT

Some sexual minority women may be less likely than other women to engage in human papillomavirus (HPV) prevention behaviors. Although risk perceptions have been found to be associated with health behaviors, HPV risk perceptions among U.S. sexual minority women have not been examined.

METHODS

In 2016-2017, in-depth interviews were conducted in Boston with 29 sexual minority individuals aged 18-36 who were assigned female at birth (AFAB) and identified as women or nonbinary. Purposive sampling was used to recruit participants online, through community-based and student organizations, and by word of mouth. Thematic analysis was employed to examine participants' HPV risk perceptions.

RESULTS

Participants incorrectly linked HPV risk to the exchange of genital fluids, and a hierarchy of perceived risk emerged in relation to sexual orientation: Individuals who engage in penile-vaginal sex with partners who were assigned male at birth (AMAB) were perceived to be at highest risk, and lesbians and individuals with only AFAB partners were perceived to be at low risk. Lesbians and participants with only AFAB partners identified sex with bisexual women or AFAB individuals with AMAB partners as a risk factor for HPV infection. Risk perceptions were shaped by health care providers' linking HPV risk to sex with AMAB individuals, a lack of discussion of HPV with parents and peers, and the exclusion of information on HPV and sexual minority women from school-based sex education.

CONCLUSION

Interventions providing sexual minority AFAB individuals with comprehensive, accurate and tailored information about HPV risk are needed.

Questions and Concerns About HPV Vaccine: A Communication Experiment

: media-1vid110.1542/5972295740001PEDS-VA_2018-1872Video Abstract OBJECTIVES: We sought to identify effective responses to parents' questions and concerns about human papillomavirus (HPV) vaccine.

METHODS

In 2017-2018, we surveyed a national sample of 1196 US parents of children aged 9 to 17 years. We recorded brief videos of a pediatrician providing messages that addressed 7 HPV vaccination topics that commonly elicit questions or concerns (eg, recommended age). We randomly assigned parents to 1 of the message topics; parents then viewed 4 videos on that topic in random order and evaluated the messages.

RESULTS

Parents were more confident in HPV vaccine when they were exposed to messages that addressed lack of knowledge about HPV vaccine (b = 0.13; P = .01), messages that included information about cancer prevention (b = 0.11; P < .001), messages that required a higher reading level (b = 0.02; P = .01), and messages that were longer (b = 0.03; P < .001). Parents were less confident in HPV vaccine when exposed to messages in which urgency was expressed (b = -0.06; P = .005). Analyses conducted by using HPV vaccine motivation as an outcome revealed the same pattern of findings.

CONCLUSIONS

We provide research-tested messages that providers can use to address parents' HPV vaccination questions and concerns about 7 common topics. Important principles for increasing message effectiveness are to include information on the benefits of vaccination (including cancer prevention) and avoid expressing urgency to vaccinate when addressing parents' questions or concerns. Additionally, providers may need to be prepared to have longer conversations with parents who express concerns about HPV vaccine, especially regarding safety and side effects.

Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists

We sought to examine whether pharmacy service quality was associated with parents' willingness to have immunizing pharmacists administer human papillomavirus (HPV) vaccine to their adolescent children. Participants were a national sample of 1504 US parents of adolescents ages 11 to 17 who completed an online survey in 2014. Analyses used structural equation modeling. Parents rated service quality and feelings of satisfaction with their pharmacies as moderate to high. Many (44%) were willing to get HPV vaccine from immunizing pharmacists for their adolescent children. Compared with parents who went to chain pharmacies, parents who went to independent pharmacies gave higher ratings of service quality (professionalism, confidentiality, milieu, all p < .001). Parents who went to clinic pharmacies, compared with parents who went to chain pharmacies gave lower ratings for milieu (p < .01). Parents who went to independent pharmacies had lower willingness to get HPV vaccine from pharmacists compared to parents who went to chain pharmacies (p = .001), but there was no difference in willingness for parents who went to clinic versus chain pharmacies. Service quality and satisfaction partially mediated the effect between independent pharmacies compared to chain pharmacies and willingness (p < .05). Parents who knew their pharmacists or expressed more confidence in HPV vaccine also had higher willingness to get their children HPV vaccine from pharmacist. Many parents were willing to go to immunizing pharmacists for their children's HPV vaccination. Pharmacies that are considering offering HPV vaccine may be able to improve vaccine uptake by increasing perception of service quality.

Human Papillomavirus Vaccine Sources of Information and Adolescents' Knowledge and Perceptions

Understanding where adolescents obtain information about human papillomavirus (HPV) vaccines may be helpful in designing public health interventions promoting HPV vaccination. This study assessed the following: (1) exposure to specific sources of information about HPV vaccines, (2) self-reported helpfulness of these sources of information, and (3) whether the specific source of information was associated with knowledge and perceptions about HPV vaccines among adolescent girls. There were 339 adolescent girls (mean age = 16.8 years) recruited into the study. Television advertisements, the Internet, doctors/nurses, and mothers were the most frequently reported sources of vaccine information; more than 90% of participants who received information from these sources reported they were helpful. Adolescents who received information about HPV vaccines from television advertisements, the Internet, clinicians, and mothers had higher knowledge about HPV vaccines and more positive perceptions. Assuring the accuracy of messages from these sources will be essential, given their importance in influencing adolescents' knowledge and perceptions about HPV vaccines.

Human Papillomavirus Vaccination Rates in Young Cancer Survivors

Purpose

Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation.

Methods

Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015).

Results

The mean age at the time of the study was 16.3 ± 4.7 years; the mean time off therapy was 2.7 ± 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6% to 27.0% v 40.5%; 95% CI, 40.2% to 40.7%; P < .001); survivors were more likely to be HPV vaccine-naïve than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P < .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3% to 26.7%), significantly lower than population peers (42.5%; 95% CI, 42.2% to 42.8%; P < .001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95% CI, 6.5 to 18.0; P < .001), survivors' perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P < .001), male sex (OR, 2.9; 95% CI, 1.7 to 4.8; P < .001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P < .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P < .001; comparison, 13 to 17 years).

Conclusion

HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.

Parents' involvement in the human papillomavirus vaccination decision for their sons

OBJECTIVES

Parents are critical to ensure sufficient human papillomavirus (HPV) vaccine coverage. No studies to date have examined how mothers and fathers perceive their own, their partners' and their sons' involvement in HPV vaccination decision-making process.

METHODS

An online survey methodology was used to collect data from a national sample of Canadian parents (33% fathers, 67% mothers, M_age=44) who had a 9-16years old son (n=3117).

MAIN OUTCOME MEASURES

Parent's perception of their self-involvement, partner-involvement and son's involvement in the decision to get their son the HPV vaccine were measured on a Likert scale and were classified as 'no involvement', 'moderate involvement' and 'high involvement'.

RESULTS

Mothers and fathers both perceive that they themselves and their partners should be highly involved in their son's HPV vaccination decision. Son's involvement was reported as moderate and influenced by age. Significant gender differences were found for self and partner involvement, but the effect sizes were small.

CONCLUSION

Mothers and fathers both perceive that they themselves and their partners should be significantly involved in their son's HPV vaccination decision. A dyad decision-making model involving both parents for HPV vaccine decision-making is suggested with a stronger recommendation for a triad decision-making model involving both parents as well as the child/adolescent. Gender stereotypes of females perceiving themselves as the sole decision-maker or fathers not wanting to be involved in their children's health decision were not supported.

Parents' and teachers' views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

Background

To successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.

Methods

In this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach.

Results

We conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents.

Conclusion

In this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.

Communication about sex and HPV among Puerto Rican mothers and daughters

OBJECTIVE

Although opportunities to vaccinate against human papillomavirus (HPV) are available, vaccination rates in Puerto Rico remain low. Communication between parents and adolescents about sexual topics may influence decisions about HPV vaccination uptake, particularly among young women; yet, few studies have addressed this issue. This qualitative study explored Puerto Rican mothers' and daughters' communication on sex-related topics, and HPV, including the HPV vaccine.

DESIGN

Thirty participants, including 9 mothers and 21 daughters, participated in seven focus groups. Participants were divided into groups of mothers and daughters, and further stratified by vaccination status. Transcripts were analyzed using a modified grounded theory approach to identify emergent themes.

RESULTS

Focus group data revealed four main themes: (1) limited parent-daughter communication about sex-related topics; (2) daughters' discomfort discussing sex-related topics with their parents; (3) parental focus on abstinence; and, (4) limited parent-daughter communication about HPV and the HPV vaccine.

CONCLUSION

Although daughters in this study struggled with feelings of embarrassment, invasion of privacy, encouragement of abstinence, and the fear of parents' reaction to them being sexually active prior to marriage, they also recognized the need to increase the parent-daughter communication about sex-related topics including HPV and the HPV vaccine. Educational efforts should target both daughters and parents to increase communication skills and self-efficacy and to enable them to discuss sexual health in open and nonjudgmental conversations.

Using actor-partner interdependence modeling to understand HPV vaccine acceptance

A wealth of scientific literature has been devoted to understanding what factors influence parents and their adolescent children to obtain the HPV vaccine. This literature is relatively uniform in its methodological approach of sampling individuals (i.e., either parents or adolescents) and examining the predictors of uptake for that individual. To improve understanding of HPV vaccination uptake, we sampled low-income, African American parent-child dyads with either a female (n = 93) or a male (n = 116) adolescent who had not been vaccinated. Both parents and children completed self-report measures that tapped intent to receive the vaccine and hypothesized predictors of intent (i.e., self-efficacy, beliefs about the vaccine, beliefs about HPV, knowledge of HPV). Using a dyadic analytic approach (i.e., the Actor-Partner Interdependence Model or APIM) [1], we found that parents and their adolescents have different structures of beliefs regarding HPV vaccination (i.e., they are empirically distinguishable). Consistent with prior research, the majority of predictors of an individual's own intention to vaccinate were individual-level variables; uniquely though, some predictors endorsed by one member of the dyad influenced the intentions held by the other member. Specifically, parents' reports of HPV severity and their self-efficacy were both associated with adolescents' intent to obtain the vaccine. Further, adolescents' beliefs that the vaccine will lead to greater promiscuity or be stigmatizing were associated with parents holding an increased intent to vaccinate. Use APIM improves understanding of HPV vaccination uptake and can be used to guide intervention efforts.

Timing Is Everything: Exploring Parental Decisions to Delay HPV Vaccination

The delayed uptake of the human papillomavirus (HPV) vaccine offers an opportunity to explore how temporality and risk are at work in everyday life. Drawing from a mixed-methods study with parents ( N = 50) in Northern California, this study explored parents' decision to delay HPV vaccination for their children among parents who had not yet vaccinated ( n = 27). At the core of these decisions were temporal assessments of risk whereby parents weighed their child's (perceived) present risk of HPV exposure against the uncertain perceived risks of the vaccine itself. Our findings are promising as they indicate that given time, and the continued growth of evidence regarding the safety and effectiveness of HPV vaccination, completion rates should increase. However, our results also suggest that vaccination delays are not merely a matter of scientific doubt but also based on parents' (potentially inaccurate) perceptions of their child's sexual readiness, and thus potentially more difficult to overcome.

Factors Motivating HPV Vaccine Uptake Among Vaccinated and Nonvaccinated Hispanic Young Adult Women

Introduction:

To identify factors influencing human papillomavirus (HPV) vaccination up taking decision making among vaccinated and nonvaccinated Hispanic college women.

Participants:

Hispanic young women between the ages of 18 and 24 years ( N = 49). In total, 26 had not received the HPV vaccine, and 23 had started/completed the vaccine series.

Method:

Participants registered for the study via a psychology research pool at a large public university in the southeast United States after institutional review board approval. After completing a demographic information and HPV knowledge Web-based survey, participants were individually interviewed.

Results:

Differences in HPV vaccine knowledge emerged between vaccinated and nonvaccinated women. Fear of side effects, perceptions of risk, and sources of encouragement influenced willingness to be vaccinated against HPV. Health care providers played a central role in addressing concerns and promoting vaccination.

Conclusions:

Health care providers must address and integrate unique decision-making processes influencing Hispanic young adult women’s perceptions of HPV vaccination.

Factors affecting HPV vaccine acceptance in west Austria: Do we need to revise the current immunization scheme?

BACKGROUND

Austria introduced a school-based gender-neutral human papillomavirus (HPV) immunization program in February 2014. In order to assure high coverage, factors influencing acceptance of the vaccine need to be identified. In this study we aim to assess parents' attitude and related socio-demographic factors in relation to the newly implemented gender-neutral, school-based HPV Immunization program.

METHODS

Parents of 4th grade school children in 20 randomly selected primary schools were asked to fill out questionnaires on socio-demographic factors and on the level of information and attitude towards HPV infection and HPV vaccine.

RESULTS

A total of 439 parents with 449 vaccine eligible children participated in the study. Fifty nine percent of vaccine eligible girls and 51.8% of eligible boys received the first dose of the vaccine. Fear of side effects and child being too young for the vaccine were the most commonly cited reasons by parents electing not to let child receive the vaccine. Children who had received other school-based vaccines have more than fifteen times higher probability of receiving HPV vaccine. To have received HPV-related information from physicians positively influenced vaccine acceptance (OR (95% CI)=1.60 (1.06-2.43)). Higher paternal (fathers') educational status significantly increased the chances of a male child to be HPV vaccinated (OR (95% CI)=2.45 (1.29-4.78)).

CONCLUSION

Despite the efforts to provide HPV vaccine free-of-costs and as a school-based program, the study found that a significant proportion of vaccine eligible children failed to receive the vaccine. Involvement front line physicians and men with higher educational status may be utilised by public health policy makers in the effort to increase awareness. For a better acceptability of the vaccine, there is a need to consider lifting the age of "eligibility" for the school-based vaccination program.

Factors Associated with HPV Vaccination among Cambodian American Teenagers

OBJECTIVES

Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes.

DESIGN AND SAMPLE

A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used.

RESULTS

CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV.

CONCLUSIONS

The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.

Biopower, Normalization, and HPV: A Foucauldian Analysis of the HPV Vaccine Controversy

This article utilizes the Foucauldian concepts of biopower and normalization to give an analysis of the debate surrounding the controversial administration of the HPV vaccine to adolescents. My intention is not to solve the problem, rather to utilize a Foucauldian framework to bring various facets of the issue to light, specifically the way the vaccine contributes to strategies of power in reference to how young adults develop within relationships of power. To begin, the article provides an overview of the Foucauldian concepts of biopower and normalization, including how these two strategies of power were present in the administration of the smallpox vaccine in the 19th century. Next, information about HPV and the history of the current controversy in the United States is presented. Lastly, the article presents an analysis of the strategies of biopower and normalization present in the debate on HPV, including an emphasis on how the vaccination is similar to, and different from, 19th century smallpox vaccination. It also explores the way that mechanisms of disease control affect and are affected by individual subjects, in this case, adolescents.

Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study

BACKGROUND

Human papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12-13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher. The study's objectives were to explore factors influencing UK based African parents' acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views.

METHODS

A qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing.

RESULTS

HPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it's still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person's disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood.

CONCLUSION

Tailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

OBJECTIVE

To examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30months following vaccination.

METHODS

Participants included 112 sexually experienced girls aged 13-21years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30months and including 30months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.

RESULTS

Mean age was 17.9years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p=0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p=0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.

CONCLUSIONS

The finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.

A qualitative study to assess the potential of the human papillomavirus vaccination programme to encourage under-screened mothers to attend for cervical screening

BACKGROUND

Coverage of the UK National Health Service Cervical Screening Programme is declining. Under-screened women whose daughters participate in the human papillomavirus (HPV) vaccination programme could be stimulated to attend. We investigated whether factors associated with the vaccination programme changed mothers' intentions for future screening.

METHODS

Questionnaires were sent to mothers of girls aged 12-13 years across two North West primary care trusts (n=2387) to assess the effect of the HPV vaccination programme on screening intentions. This identified mothers whose intentions had changed. Consent was sought to contact them for a semi-structured interview to discuss their screening intentions. Key themes were identified using framework analysis.

RESULTS

97/606 women responding to the questionnaire had changed their views about cervical screening. 23 women were interviewed, 10 of whom expressed a positive change and 13 no change. Most had discussed the vaccine information, including cervical screening, with their daughters. Mothers who made a positive change decision recognised their daughters' risk of cervical cancer, the need for future screening, and the importance of their own example. In this way daughters became 'significant others' in reinforcing their mothers' cervical screening motivation.

CONCLUSIONS

A daughter's invitation for HPV vaccination instigates a reassessment of cervical screening intention in some under-screened mothers.

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

PURPOSE

Human papillomavirus (HPV) is a sexually transmitted infection and the cause of cervical and other cancers. Vaccination is available to protect against genital HPV and is recommended for individuals aged 9-26 years. This study aimed to estimate the prevalence of HPV vaccination among childhood cancer survivors and to identify factors associated with vaccine outcomes.

METHODS

Young adult females with (n = 114; M age = 21.18 years, SD = 2.48) and without (n = 98; M age = 20.65 years, SD = 2.29) a childhood cancer history completed surveys querying HPV vaccination initiation/completion, as well as sociodemographic, medical, and health belief factors. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for vaccine outcomes.

RESULTS

Among survivors, 38.6 % (44/114) and 26.3 % (30/114) initiated or completed vaccination compared to 44.9 % (44/98) and 28.6 % (28/98) among controls, respectively. In the combined survivor/control group, physician recommendation (OR = 11.24, 95 % CI 3.15-40.14) and familial HPV communication (OR = 7.28, 95 % CI 1.89-28.05) associated with vaccine initiation. Perceptions of vaccine benefit associated with vaccine completion (OR = 10.55, 95 % CI 1.59-69.92), whereas perceptions of HPV-related severity associated with non-completion (OR = 0.14, 95 % CI 0.03-0.71).

CONCLUSION

Despite their increased risk for HPV-related complication, a minority of childhood cancer survivors have initiated or completed HPV vaccination. Modifiable factors associated with vaccine outcomes were identified.

IMPLICATIONS FOR CANCER SURVIVORS

HPV vaccination is a useful tool for cancer prevention in survivorship, and interventions to increase vaccine uptake are warranted.

HPV vaccine for teen boys: Dyadic analysis of parents' and sons' beliefs and willingness

OBJECTIVE

Parents and adolescents often decide together whether the child should receive human papillomavirus (HPV) vaccine. However, few studies have investigated the dyadic nature of beliefs that affect this process.

METHOD

Data came from the 2010 HPV Immunization in Sons (HIS) Study, a national sample of 412 parents and their adolescent sons. We conducted dyadic multivariate logistic regression to examine the relationships between parents' and sons' HPV vaccine beliefs and their willingness to have the son receive the vaccine.

RESULTS

Less than half of parents and sons were willing to have the sons receive HPV vaccine (43% and 29%, respectively). Willing parents and sons anticipated greater regret if the son did not receive HPV vaccine but later contracted an HPV infection (parent odds ratio [OR]=1.72, 95% confidence interval [CI]=1.24-2.40; son OR=1.51, 95% CI=1.04-2.19) (both p<.05). Lower concerns about side effects, such as pain and fainting, were also associated with willingness.

CONCLUSION

Parents and sons were more willing to have the son receive HPV vaccine if they had higher anticipated regret about potential HPV infection and lower concerns about side effects. Communication campaigns may be able to target these beliefs to increase parents' and sons' willingness to seek HPV vaccination.

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11-12 year-old girls

OBJECTIVES

Among 11-12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls' risk perceptions, attitudes, and behavior.

METHODS

Girls and mothers (n=25dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls' 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis.

RESULTS

Girls' baseline knowledge was poor but often improved with time. Most girls (n=18) developed accurate risk perceptions about HPV but only half (n=12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions.

CONCLUSIONS

Higher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.

Khmer American Mothers' Knowledge about HPV and HBV Infection and Their Perceptions of Parenting: My English Speaking Daughter Knows More

PURPOSE

The purpose of this study is to explore and describe Khmer mothers' understanding of HBV and HPV prevention as well as their perception of parenting on health and health education of their daughters in the US.

METHODS

The qualitative pilot study guided by the revised Network Episode Model and informed by ethnographic analysis and community-based purposive sampling method were used. Face-to-face audiotaped interviews with eight Khmer mothers were conducted by bilingual female middle-aged community health leaders who spoke Khmer.

RESULTS

The findings revealed that Khmer mothers clearly lacked knowledge about HBV and HPV infection prevention and had difficulty understanding and educating their daughters about health behavior, especially on sex-related topics. The findings showed that histo-sociocultural factors are integrated with the individual factor, and these factors influenced the HBV and HPV knowledge and perspective of Khmer mothers' parenting.

CONCLUSIONS

The study suggests that situation-specific conceptual and methodological approaches that take into account the uniqueness of the sociocultural context of CAs is a novel method for identifying factors that are significant in shaping the perception of Khmer mothers' health education related to HBV and HPV prevention among their daughters. The communication between mother and daughter about sex and the risk involved in contracting HBV and HPV has been limited, partly because it is seen as a "taboo subject" and partly because mothers think that schools educate their children regarding sexuality and health.

Partnering with middle school students to design text messages about HPV vaccination

Human papillomavirus (HPV) vaccination is routinely recommended for U.S. adolescents ages 11 to 12 years, yet vaccine coverage remains low. Text message HPV immunization reminders to parents have been effective with increasing uptake, but text messages directly to adolescents in order to increase HPV vaccination uptake are unknown. The purpose of this study was to examine the acceptability of text messages about HPV vaccination and message preferences among adolescents. Middle school students (n = 43) assisted in designing text messages to promote HPV vaccine among their peers. Through seven focus groups and two in-class surveys, we assessed students' knowledge of HPV vaccine, use of texting, and preferences for text messages and sources. The average age of participants was 13 years, and all were White (17 males, 26 females) in this rural setting. More than 70% used text messaging with a cell phone. The text message with the best composite score (M = 2.33, SD = 0.72) for likeability, trustworthiness, and motivation to seek more information was a gain frame emphasizing reduction in HPV infection if vaccinated against HPV. Text messages with lower scores emphasized threats of disease if not vaccinated. Participants (68%) preferred doctors as their information source. Text messaging to adolescents may be a strategy to improve HPV knowledge and vaccination.

Cervical cancer narratives: invoking 'God's will' to re-appropriate reproductive rights in present-day Romania

Drawing from ethnographic fieldwork in contemporary Southern Romania, this paper scrutinises local moralities governing some women's refusal to enrol in free reproductive healthcare initiatives targeting cervical cancer through primary and secondary prevention (human papillomavirus [HPV] vaccination and Papanicolaou [Pap] testing, respectively). Women backed up their rejection of participation in official reproductive care programmes by mentioning 'God's will' as the ultimate trigger of cervical cancer. They withheld their own and their daughters' bodies from biomedical intervention and used discursive references to divine logic to imbue their refusal with moral legitimacy. However, 'God's will' is not a mere rhetorical device, since it has a correlate in many of these women's embodied reproductive experiences. As this paper argues, religious narratives, far from stripping ordinary citizens of their reproductive choices, constitute the medium through which they display individual agency. In fact, invoking 'God's will' empowers Romanian women to challenge state control and it enables them to re-appropriate their bodies by making a counter-intuitive, yet bold, choice.

Breast cancer prevention knowledge, attitudes, and behaviors among college women and mother-daughter communication

Although breast cancer prevention targets mostly women ages 40 and older, little is known about breast cancer prevention for young women and mother's advice. The purpose of this study was to examine breast cancer prevention knowledge, attitudes, and behaviors among college women and mother-daughter communication. Hispanic and non-Hispanic students at a southwestern university completed a breast cancer prevention survey with items for mother's advice, breast self-awareness and risk reduction knowledge, self-efficacy, susceptibility, family history, provider breast self-exam (BSE) recommendation, peer norms, BSE practice, and demographics. An openended item was also used to elicit types of mother's advice. Logistic regression was used to assess predictors for receiving mother's advice for breast cancer prevention and BSE practice. Self-reported data using a survey were obtained from 546 college women with a mean age of 23.3 (SD = 7.75). Nearly 36 % received mothers' advice and 55 % conducted BSE. Predictors for receiving mother's advice were age, self-efficacy, and family history of breast cancer. Predictors for BSE practice were mother's advice, age, self-efficacy, and provider BSE recommendation. Family history of breast cancer and knowledge were not significant predictors for BSE practice. Findings support the need for clinicians, community health educators, and mothers to provide breast cancer prevention education targeting college women.

Predicting human papillomavirus vaccination behaviour among adolescent girls in England: results from a prospective survey

BACKGROUND

To maximise the benefits of human papillomavirus (HPV) vaccination, uptake needs to be high. We examined psychosocial predictors of HPV vaccine uptake and the association between vaccine intention and uptake 1&emsp14;year later in adolescent girls (aged 16-17&emsp14;years) in England.

METHOD

Adolescent girls in the catch-up cohort were recruited from colleges in the South East of England in 2009 and 2010. Participants completed a questionnaire 6&emsp14;months before (n=606) and 6&emsp14;months after (n=214) being offered the vaccine, which assessed vaccine intention, vaccine uptake, demographics and attitudes based on the Health Belief Model and Theory of Planned Behaviour.

RESULTS

A number of demographic and psychological factors, including intention, showed associations with vaccine uptake in uni-variable analyses. In multi-variable analyses, only ethnicity was independently associated with vaccine uptake. Participants from Black or 'Other' ethnic backgrounds were less likely to have received the HPV vaccine than White participants.

CONCLUSIONS

More research is needed to help understand variation in vaccine coverage between ethnic groups.

An opportunity for cancer prevention during preadolescence and adolescence: stopping human papillomavirus (HPV)-related cancer through HPV vaccination

OBJECTIVE

We conducted a descriptive study of the correlates of refusal and acceptance of human papillomavirus (HPV) vaccination by rural parents of preadolescent and adolescent children. We hypothesized that the correlates of parents who allow their children aged 9 to 13 years to get the HPV vaccine and those of parents who do not allow vaccination would differ significantly.

METHODS

This cross-sectional study was implemented during the school years 2009-2011 in the elementary and middle schools of three rural counties in Georgia. Parents were recruited at school functions to complete an anonymous validated survey.

RESULTS

Parents who chose to vaccinate their children or intended to vaccinate were twice as likely to be from a race other than African American and 2.7 times more likely to have a religion other than Baptist. Using stepwise logistic regression and after adjustment for race and religion, we found that parents who had vaccinated or intended to vaccinate had significantly higher scores on perceived barriers (1.02 times more likely to vaccinate) and lower scores on perceived benefits (1.01 times more likely to vaccinate) (model p < .001).

CONCLUSIONS

The results suggest that healthcare providers in rural areas can increase HPV vaccine uptake and reduce HPV-related cancers by using a multifaceted approach to educating their patients within the context of the patients' cultural values, geographic location, and economic situation. Such an approach could dispel misinformation and increase vaccine uptake.

Parental decisional strategies regarding HPV vaccination before media debates: a focus group study

Before the introduction of the human papillomavirus (HPV) vaccine, decisional strategies and factors that could guide HPV vaccination intentions were explored. The authors conducted 4 focus group discussions with 36 parents of children 8-15 years of age. Three groups consisted primarily of Dutch parents and 1 group of only Turkish parents. Discussions followed a semi-structured question route. Results showed that some parents used an approach of systematically seeking information as a way to prepare a decision, whereas others merely relied on trust in the message source. In general, parents believed that it was important to protect their child against negative outcomes that could result from vaccinating or not, and they felt that it is their responsibility to decide about uptake. Perceived susceptibility, vaccine effectiveness, and possibility of serious side effects were most important in the HPV vaccination decision-making process. In conclusion, parents perceived a lack of information and felt insecure about the vaccine's safety and effectiveness. This may result in ambivalent feelings toward HPV vaccination, which, in turn, may lead to postponing decisions about uptake. To facilitate informed decision making, which requires central processing, personally relevant messages about the knowns and unknowns regarding the effects of HPV vaccination should be provided.

Assessing the effectiveness of a community-based sensitization strategy in creating awareness about HPV, cervical cancer and HPV vaccine among parents in North West Cameroon

In 2010, the Cameroon Baptist Convention Health Services (CBCHS) received a donation of HPV vaccine (Gardasil®) to immunize girls of ages 9-13 years in the North West Region of Cameroon. We evaluated the effectiveness of the CBCHS campaign program in sensitizing parents/guardians to encourage HPV vaccine uptake, identified factors that influence parents' decisions to vaccinate girls, and examined the uptake of cervical cancer screening among mothers. We conducted a cross-sectional survey in four healthcare facilities run by CBCHS, churches and other social settings. A total of 350 questionnaires were distributed and 317 were used for the analysis. There were high levels of awareness about cervical cancer, HPV and HPV vaccine. 75.5% understood HPV is sexually transmitted and 90.3% were aware of the use of vaccine as a preventive measure. Effectiveness of the vaccine (31.8%) and side effects/safety (18.4%) were the major barriers for parents to vaccinate their daughters. Bivariate analysis further revealed that the level of education (p = 0.0006), income level (p = 0.0044) and perceived risks (p = 0.0044) are additional factors influencing parents' decisions to vaccinate girls. 35.3% of women had sought a cervical cancer screening, significantly higher than the general estimated rate of screening (<10%) in other parts of Cameroon and sub-Saharan Africa. These results support the viability of a community-tailored sensitization strategy to increase awareness among the targeted audience of parents/guardians, who are critical decision-makers for vaccine delivery to children.

Identifying knowledge-attitude-practice gaps to enhance HPV vaccine diffusion

To examine differences in knowledge, attitudes, and related practices among adopters and nonadopters of the human papillomavirus (HPV) vaccine, the researchers conducted 83 in-depth interviews with 18- to 26-year-old women. The study identified knowledge-attitude-practice gaps in the context of the HPV vaccine to explain why diffusion of a preventive innovation (such as the HPV vaccine) requires targeted risk communication strategies in order to increase demand. Salient findings included similarities between vaccinated and unvaccinated women's lack of knowledge and uncertainties about HPV and cervical cancer. Vaccinated women who had no knowledge of HPV or no-risk/low-risk perceptions of HPV reported receiving vaccination, indicating HPV risk protection behavior could precede knowledge acquisition for vaccinated women. These vaccinated women identified an interpersonal network supportive of vaccination and reported supportive social influences. Among unvaccinated women, unsupportive vaccination attitudes included low perceived personal risk of HPV. In contrast, unvaccinated women often cited erroneous beliefs that HPV could be avoided by abstinence, monogamy, and knowledge of their partners' sexual history as reasons that the vaccine was not personally relevant. Unvaccinated women cited interpersonal influences that activated short- and long-term vaccination safety and efficacy concerns. Different levels of fear regarding the HPV vaccine may underlie (a) attitudinal differences between vaccinated and unvaccinated women in perceived vaccination value and (b) attitude-practice gaps.

Human papillomavirus vaccine in adolescent women: a 2012 update

PURPOSE OF REVIEW

Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents with the human papillomavirus (HPV) vaccine, U.S. coverage among women remains less than 50%, with that of adolescent men below 2%.

RECENT FINDINGS

Ongoing studies document the efficacy and safety of the HPV vaccine. Nevertheless, misconceptions and negative attitudes persist and serve as barriers to vaccine uptake. Additionally, other factors such as age, insurance status, poverty status, and racial or ethnic background have been associated with diminished vaccine uptake and poor completion rates. Internationally, HPV vaccination programs and school-based programs have achieved increased rates of uptake and series completion. HPV vaccination coverage may also be facilitated by improving communication between physicians, parents, and adolescents as well as by addressing common misconceptions about the vaccine.

SUMMARY

This review highlights significant findings of recent literature on HPV vaccination of adolescent women with a special focus on uptake, series completion, communication, disparities in vaccine coverage, and other health outcomes associated with HPV vaccination.

Human papillomavirus vaccine discussions: an opportunity for mothers to talk with their daughters about sexual health

PURPOSE

Mother-daughter communication about sex is associated with healthier behavior during adolescence. We sought to characterize mothers' communication with their daughters about human papillomavirus (HPV) vaccine and the potential for these discussions to provide an opportunity for talking about sexual health.

METHODS

During December 2009, we conducted an online survey with a nationally representative sample of US mothers of girls aged 11 to 14 years (n = 900; response rate = 66%). We used 3 complimentary approaches to assess HPV vaccine as an opportunity for mother-daughter communication about sex. Estimates are weighted.

RESULTS

Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have also talked with their daughters about sex (92% vs. 74%, OR = 3.25, CI = 1.57-6.68, P < 0.05), in multivariate analyses. Among mothers who talked about sex when they talked about HPV vaccine, many felt that HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%).

CONCLUSIONS

HPV vaccine discussions provide a cue to mother-daughter communication about sex that is as important as some more widely recognized cues. Discussions about HPV vaccine are an acceptable opportunity for mothers to talk with their daughters at an age when communication about sex is most influential. It may be possible for parents to capitalize on HPV vaccine discussions already happening in many families to promote sexual health.

Perspectives on decision making about human papillomavirus vaccination among 11- to 12-year-old girls and their mothers

Introduction. The aims of this qualitative study were to explore (a) the factors influencing mothers' decisions to vaccinate 11- to 12-year-old daughters against human papillomavirus (HPV) and (b) the mothers' and daughters' perspectives about HPV vaccine-related decision making. Methods. Participants were girls (N = 33) who had received an HPV vaccine and their mothers (N = 32), recruited from suburban and urban pediatric practices. Semistructured interviews were conducted with girls and mothers separately, and data were analyzed using framework analysis. Results. The primary factors influencing mothers' decisions to vaccinate daughters against HPV were (a) mother's beliefs and experiences; (b) interactions with clinicians, friends, and family members; and (c) exposure to media reports/marketing. Most daughters believed the decision to be vaccinated was a mutual one, although most mothers believed the decision was theirs. Conclusions. This study provides novel insights into perspectives on decision making about HPV vaccination among mothers and 11- to12-year-old daughters, which can be used in interventions to improve vaccination rates.

Evaluating associations between sources of information, knowledge of the human papillomavirus, and human papillomavirus vaccine uptake for adult women in California

OBJECTIVE

Vaccines have the potential to reduce morbidity from HPV infections if age-eligible patients receive and parents know about them. Content analyses have demonstrated significant range in the quality of HPV information obtained from different sources. The purpose of this study was to determine the pattern of associations between information source and level of knowledge about HPV and vaccine receipt/intention.

METHODS

We analyzed the 2007 California Health Interview Survey, a population-based, statewide random digit dial survey, using data on adult females ages 18-65 who had heard about HPV (n=16,806). One-way ANOVA and multivariate logistic regression assessed the associations between source of information (advertisement only, advertisement plus other sources, and non-advertisement sources) and knowledge of HPV (3 or greater correct on a 4-point scale). Multivariate logistic regressions were conducted on a subsample of vaccine-eligible women and parents to assess vaccine uptake or intention.

RESULTS

Less than half of respondents (43%) correctly answered 3 or more of the HPV knowledge questions. Mean knowledge scores were significantly different when comparing women who reported advertisement only, non-advertisement, and advertisement plus other sources of information (p<0.001). In multivariate analysis, women who reported non-advertisement sources (OR 2.44, 95% CI 2.07-2.87) and advertisements plus other sources (OR 3.03, 95% CI 2.57-3.58) were more likely to have knowledge scores above the 75% level than women who relied on advertisements alone. In the subsample of vaccine-eligible women and parents, those who reported advertisements plus other sources (OR 1.85, 95% CI 1.30-2.62) were more likely to have received or intend to receive the vaccine than those who reported advertisements as their sole information source.

CONCLUSION

Advertisements are the most commonly reported source of information about HPV, and while they inform women of the existence of the vaccine, they do not contribute to accurate knowledge about the virus, nor do they appear to influence vaccine uptake. Other sources may play a larger role in refining knowledge and/or improving uptake.

Providing adolescent-friendly HPV education

Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting more than 6.2 million individuals every year. Most new infections occur in adolescents and young adults shortly after the onset of sexual activity. Nurse practitioners play a key role in preventing HPV infection in teens through adolescent-friendly HPV education, prevention, and vaccination.