Parental Refusal of Human Papillomavirus Vaccine: Multisite Study

Exploring mother-daughter communication and social media influence on HPV vaccine refusal for daughters aged 9-17 years in a cross-sectional survey of 11,728 mothers in China

This study investigated the influences of mother-daughter communication and social media on mothers' HPV vaccine refusal for their daughters aged 9-17. A cross-sectional online survey among 11,728 mothers of girls aged 9-17 in Shenzhen, China was implemented between July and October 2023. Multi-level logistic regression models were fitted. Among 11,728 participants, 43.2% refused to have their daughters receive an HPV vaccination. In multivariate analysis, more openness in the mother-daughter communication (AOR: 0.99, 95%CI: 0.98, 0.99), perceived more positive outcomes of mother-daughter communication (AOR: 0.77, 95%CI: 0.75, 0.79), higher frequency of exposure to testimonials about daughters' HPV vaccination (AOR: 0.81, 95%CI: 0.78, 0.85) and information encouraging parents to vaccinate their daughters against HPV on social media (AOR: 0.76, 95%CI: 0.73, 0.79), and thoughtful consideration of the veracity of the information specific to HPV vaccines (AOR: 0.80, 95%CI: 0.77, 0.83) were associated with lower vaccine refusal. Mothers who were not the main decision-makers of daughters' HPV vaccination (AOR: 1.28 to 1.46), negative outcome expectancies of mother-daughter communication (AOR: 1.06, 95%CI: 1.04, 1.08), and mothers' HPV vaccine refusal (AOR: 2.81, 95%CI: 2.58, 3.06) were associated with higher vaccine refusal for their daughters. The level of mothers' HPV vaccine refusal for their daughters was high in China. Openness and outcome expectancies of mother-daughter communication and information exposure on social media were considered key determinants of HPV vaccine refusal for daughters. Future HPV vaccination programs should consider these interpersonal factors.

A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.

Associations of Maternal Age, Education, and Marital Status with HPV Vaccine Uptake and Hesitancy among United States Youth: A Cross-Sectional Analysis of the 2020 National Immunization Survey

STUDY OBJECTIVE

Human papillomavirus (HPV) vaccination is proven to reduce the risk of HPV-associated cancers and lesions. Factors associated with HPV vaccine receipt or rejection have been studied, but specific maternal characteristics driving uptake among teens requires further investigation. The aim of this study was to examine maternal characteristics influencing teen vaccine uptake and intent to vaccinate.

STUDY DESIGN

Cross-sectional analysis METHODS: We analyzed data on 27,320 teens aged 13-17 using the 2020 National Immunization Survey-Teen. We constructed regression models to determine the associations, via relative risk, between child vaccination status and maternal characteristics.

RESULTS

Compared with mothers with less education, those with a college degree were significantly more likely to have their children receive HPV vaccination (RR = 1.18; 95% CI, 1.11-1.26). Compared to mothers under 35 years, those aged 35-44 (RR 1.07; 95% CI 1.01-1.14) and over 45 (RR = 1.13; 95% CI, 1.07-1.21) were more likely to provide HPV vaccination to their child. Among children not previously vaccinated (n = 12,098; N = 5,752,355), educated mothers were significantly less likely to report intent to vaccinate their child in the next year. There was no significant difference in vaccination rates in mothers who were married compared with never married (RR = 0.99; 95% CI, 0.97-1.02).

CONCLUSION

Maternal education was the strongest predictor of teens receiving the HPV vaccine. Among mothers with teens not previously vaccinated, intent to obtain the HPV vaccine for their child was higher among mothers with less education compared with college-level educated mothers. Understanding maternal characteristics driving HPV vaccine hesitancy can inform targeted approaches to improve vaccine uptake in children. Additionally, adequate and consistent health messaging on the safety, efficacy, and benefits of HPV vaccination from health providers and public health agencies could increase uptake among adolescents and teens of vaccine-hesitant mothers.

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.

Resources for assessing parents' vaccine hesitancy: a systematic review of the literature

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.