Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US

Factors associated with HPV vaccine hesitancy among college students: A cross-sectional survey based on 3Cs and structural equation model in China

Despite the high effectiveness of HPV vaccines in preventing infection, vaccine hesitancy remains a concern, particularly in China. This study aimed to explore college students' attitudes toward HPV vaccination and identify associated factors. Data was collected through a cross-sectional survey using self-administered questionnaires in four cities from May to June 2022. Chi-square tests and logistic regression analyses were conducted to identify factors. Additionally, an integrated structural equation model (SEM) based on the 3Cs (confidence, convenience, complacency) was developed to understand underlying factors contributing to hesitancy. The results from 2261 valid questionnaires were enlightening. A significant 89.47% (59.4% for females) considered HPV vaccination necessary, with 9.82% remaining neutral and only 0.71% deeming it unnecessary. Factors like higher education, being a medical student, residing in urban areas, having medical insurance, more extraordinary living expenses, a family history of tumors, and a solid understanding of HPV played a role in perceiving the vaccine as necessary. Among the 1438 female respondents, 84.36% had no hesitancy toward HPV vaccination, 13.53% expressed hesitancy, and 2.11% refused vaccination. Factors like age, understanding of HPV, medical staff recommendations, living expenses, and family history influenced hesitancy levels. SEM revealed that the 3Cs significantly affected vaccine hesitancy. Factors like price, booking process, vaccination times, trust in vaccines, medical staff recommendations, efficiency, and risk perception collectively influenced hesitancy. In conclusion, this study found high acceptance of HPV vaccination but acknowledged the complexity of hesitancy factors. It recommends medical staff disseminate scientific knowledge, offer recommendations, simplify booking procedures, and expand vaccination sites to address vaccine hesitancy effectively.

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.

Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings

PURPOSE

Parental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County.

METHODS

Parents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9-17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV.

RESULTS

A total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information.

DISCUSSION

Our findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.

Message framing's limited efficacy in counteracting parental hesitancy towards human papillomavirus vaccination for female adolescents: Insights from a randomized trial

BACKGROUND

Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV.

METHODS

A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non-narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses.

RESULTS

Of 4012 participants, the majority were women with low VH. Only loss-framing exerted a direct effect on advocacy (p = .036). Initial VH negatively moderated this effect (p = .027). Except for narrative evidence (p = .068), message framings showed significant small effects in low-hesitant participants (p = .032). An incentive policy negatively moderated the initial VH's effect on advocacy (p = .042). Persuasion was evident only among low-hesitant participants not receiving incentives (p = .002). In contrast, for highly hesitant individuals without incentive policies, loss-framing (p = .024) and collectivism perspective (p = .033) produced counterintuitive effects.

CONCLUSIONS

Message framing is effective among low-hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non-narrative evidence and loss-framing messages should be prioritized over narrative evidence and gain-framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents.

Human papillomavirus vaccine beliefs and intentions Post-COVID-19 vaccine release among mothers in Alabama

PURPOSE

The current study sought to determine if the release of COVID-19 vaccines influenced Alabama mothers' attitudes and behaviors regarding HPV vaccination of their adolescent children.

METHODS

A social media survey was conducted August - September 2022 among mothers of adolescents ages 9-18, who self-identified as Alabama residents and their child(ren)'s primary medical decision maker. The survey assessed demographics, vaccine knowledge and opinions, vaccination history, influences on vaccination decisions, and how COVID-19 vaccine release affected vaccine opinions. Univariable and multivariable analyses were conducted.

RESULTS

Of 241 responses, most participants were white (82.0 %, n = 196), non-Hispanic (96.6 %, n = 230), and privately insured (64.5 %, n = 151), with annual household incomes ≥$61,000 (45.4 %, n = 103). The majority (60.8 %) reported that their child either had or planned to receive the HPV vaccine. The release of COVID-19 vaccines did not change the majority of parental opinions towards HPV, with 78.5 % (n = 161) reporting no change. Among those who experienced a change, 25 % (n = 5) reported an increased likelihood of having their child vaccinated for HPV and 75 % (n = 15) reported a decrease in likelihood. Moderate and high HPV knowledge scores were associated in multivariable analysis with increased likelihood of having their child vaccinated for HPV ("moderate" knowledge AOR: 12.4, 95 % CI: 1.98-78.1; "high" knowledge AOR: 12.8, 95 % CI: 2.00-82.1). Positive HPV opinion scores in the univariable analysis similarly showed increased odds (AOR = 1.5).

CONCLUSIONS

These findings indicate that, in this population, COVID-19 vaccine release did not significantly impact subsequent HPV vaccination decision making. Parental perceptions regarding vaccination are critical to informing future interventions.

Perceived Effects of COVID-19 on Vaccine Hesitancy and Clinician Discussion: A Qualitative Study

BACKGROUND AND OBJECTIVES

Studies note a high prevalence of pediatric coronavirus disease 2019 (COVID-19)-specific vaccine hesitancy in the United States. Our objective was to assess whether clinicians perceive a spillover effect of COVID-19 vaccine hesitancy onto other vaccines, and the impact of this spillover on their general recommendation behavior.

METHODS

We conducted semistructured interviews with pediatricians in California and Colorado pediatric practices (January-March 2023). We transcribed, coded, and analyzed interviews using content analysis.

RESULTS

We interviewed 21 pediatricians (10 in California, 11 in Colorado). Clinicians observed some spillover effect of vaccine-favorable changes among some parents and greater hesitancy among others regarding the risks and benefits of childhood vaccination in general. This spillover was informed by 2 divergent patterns of parental trust in health systems and individual clinicians caused by the COVID-19 pandemic. Factors driving perceived changes included media coverage, greater knowledge about vaccination, and misinformation. Some clinicians felt that their approach to vaccine recommendations became more patient-centered, whereas others reported declining engagement in persuading hesitant parents about vaccination.

CONCLUSIONS

Clinicians described a hardening of parental views toward vaccines in both directions, which impacted their recommendation behavior. There is a need for vaccine hesitancy monitoring and better training and support for clinicians facing vaccine hesitant parents.

COVID-19 Vaccination in Historically Marginalized Communities: Examining Barriers and Facilitators in a Pediatric Population

Introduction

COVID-19 hospitalization rates among unvaccinated children are double of that of vaccinated children, and this difference is greater among racial and ethnic minority children. Vaccination rates among children remain suboptimal. Few studies have characterized barriers to COVID-19 vaccination among historically marginalized communities.

Methods

From January 2022 to May 2022, parents and guardians of children aged 12 months to 18 years presenting for pediatric care at a hospital-based primary care clinic were surveyed about perceptions of COVID-19 vaccines, intentions to vaccinate their child, and trusted sources of information.

Results

A total of 113 parents/guardians participated, with 92% self-identifying with a historically marginalized racial/ethnic group. A total of 54% of respondents either did not plan to vaccinate their child against COVID-19 or were unsure. The obstacles to vaccination most frequently cited were related to (1) unknown side effects, (2) the rapid development of the vaccine, and (3) unsafe ingredients. Worries about being used as experimental subjects and potential impacts on fertility were also reported. Parents who planned to vaccinate their child reported higher rates of trust in doctors, local clinics, hospitals, and health departments.

Conclusions

High rates of COVID-19 vaccination hesitancy exist among parents/guardians from historically marginalized groups. Barriers to vaccination were frequently related to side effects, whereas a high level of trust in healthcare providers as sources of information may be a facilitator. Strategies to improve health outcomes and boost vaccination rates should focus on equipping pediatric healthcare providers with the knowledge and skills necessary to address these known barriers to COVID-19 vaccination.

Validation of the Chinese version of the vaccine conspiracy beliefs scale during COVID-19 pandemic and its correlates

OBJECTIVE

To validate the Chinese version of the vaccine conspiracy beliefs scale (VCBS) and to investigate and compare its correlates among healthcare workers and non-healthcare workers during COVID-19 pandemic.

METHODS

From March 19 to April 05, 2021, a nationwide cross-sectional online survey was administered to Chinese individuals aged 16 and above. The study aimed to assess the reliability and validity of the Chinese version of the VCBS. A binary logistic or linear regression model, along with mediation analysis, was employed to explore the relationship between vaccine conspiracy beliefs and its correlates among healthcare workers.

RESULTS

The VCBS demonstrated robust psychometric properties, showing satisfactory results from both exploratory and confirmatory factor analyses, strong internal consistency (KR-20 = 0.947), and calibration validity. Measurement invariance (MI) was also observed. Additionally, individuals' vaccine conspiracy beliefs, as measured by the VCBS, mediate the relationship between occupation and COVID-19 vaccine hesitancy (95 % CI [-2.229, -1.060]), as well as COVID-19 (95 % CI [0.096, 0.304]), influenza (95 % CI [0.075, 0.304]), and HPV (95 % CI [0.009, 0.236]) vaccination uptakes.

CONCLUSION

The Chinese adaptation of the VCBS proves adept at assessing vaccine conspiracy beliefs among Chinese individuals aged 16 and above. Notably, the healthcare workers are less likely to exhibit COVID-19 vaccine hesitancy and are more likely to receive COVID-19, influenza, and HPV vaccines. This tendency is partly related to their weaker conspiracy beliefs about vaccination.

Vaccine hesitancy as indecision: Creation and evaluation of the Unidimensional Vaccine Hesitancy Scale

BACKGROUND

Several authors have argued that vaccine hesitancy should be conceptualized as indecision in the vaccination decision-making process, but no established measure with support for its psychometric properties and validity has been created from this operational definition.

AIMS

To resolve this tension, this article undergoes a four-study scale development process to create the 4-item Unidimensional Vaccine Hesitancy Scale (UVHS).

MATERIALS AND METHODS

We conduct four survey studies utilizing a total sample size of 884.

RESULTS

In Studies 1 (n = 297) and 2 (n = 298), we provide psychometric support for the measure via exploratory and confirmatory factor analysis. In Studies 3 (n = 193) and 4 (n = 106), we support the concurrent and discriminant validity of the measure by assessing its relations with relevant constructs, such as vaccination readiness and acceptance, and we also provide initial indicators of the scale's possible predictive qualities by testing its time-separated effects with vaccination willingness, receipt and word-of-mouth.

DISCUSSION

We leverage these results to provide a number of theoretical insights and suggestions for future practice. Of note, we highlight that different conceptualizations and operationalizations for the same construct can produce notably differing empirical findings, and vaccine hesitancy is no different.

CONCLUSION

Our cumulative efforts indicate that the UVHS is an appropriate measure to assess vaccine hesitancy as indecision.

VaxBot-HPV: A GPT-based Chatbot for Answering HPV Vaccine-related Questions

Background

HPV vaccine is an effective measure to prevent and control the diseases caused by Human Papillomavirus (HPV). This study addresses the development of VaxBot-HPV, a chatbot aimed at improving health literacy and promoting vaccination uptake by providing information and answering questions about the HPV vaccine.

Methods

We constructed the knowledge base (KB) for VaxBot-HPV, which consists of 451 documents from biomedical literature and web sources on the HPV vaccine. We extracted 202 question-answer pairs from the KB and 39 questions generated by GPT-4 for training and testing purposes. To comprehensively understand the capabilities and potential of GPT-based chatbots, three models were involved in this study : GPT-3.5, VaxBot-HPV, and GPT-4. The evaluation criteria included answer relevancy and faithfulness.

Results

VaxBot-HPV demonstrated superior performance in answer relevancy and faithfulness compared to baselines (Answer relevancy: 0.85; Faithfulness: 0.97) for the test questions in KB, (Answer relevancy: 0.85; Faithfulness: 0.96) for GPT generated questions.

Conclusions

This study underscores the importance of leveraging advanced language models and fine-tuning techniques in the development of chatbots for healthcare applications, with implications for improving medical education and public health communication.

HPV Vaccination Information Access, Needs, and Preferences Among Black and Hispanic Mothers

HPV-associated cancer disparities disproportionately affect Black/African American and Hispanic individuals in the U.S. HPV vaccination, which can prevent many HPV-associated cancers, should be clearly recommended by pediatricians to parents of adolescents aged 9-12, yet uptake and completion remain lower than other adolescent vaccinations. We used the Structural Influence Model of Health Communication to explore communication inequalities from interviews with 19 Black and Hispanic mothers of adolescents. We identified HPV vaccination information seeking behaviors, media use, and preferred channels to address information needs. This study provides insights into how mothers' nativity and ethno-racial identity influenced how they accessed and processed information from various sources. Preferences for digital and community-based strategies to address information gaps and hesitancy concerns are also presented. Findings suggest future prevention strategies must increase access to accurate information that resonates with NH-Black and Hispanic communities' needs and is disseminated via preferred communication channels to maximize the effects of multi-level interventions promoting HPV vaccination among communities experiencing disparities.

Update on Pathologic Conditions, Imaging Findings, Prevention, and Management of Human Papillomavirus-related Neoplasms

Human papillomavirus (HPV) is the most common sexually transmitted infection that proliferates in the squamous epithelium and is the most common source of viral-related neoplasms. Low-risk subtypes (HPV-6 and -11) cause respiratory papillomas (laryngeal, tracheal, and bronchial) and condyloma acuminata of the penis, anus, and perineal region (anogenital warts). High-risk subtypes (HPV-16, -18, -31, and -33) are responsible for oropharyngeal squamous cell carcinoma (SCC) that involves the tongue base, tonsils, posterior pharyngeal wall, and larynx and malignancies of the anogenital region (cancers of the cervix, vagina, vulva, penis, and anal canal). Recent studies have increasingly shown a favorable treatment response and substantial differences in the overall prognosis associated with HPV-associated oropharyngeal cancers. Given this fact, oropharyngeal, cervical, and penile SCCs are classified as HPV-associated and HPV-independent cancers in the current World Health Organization classification. Imaging is essential in the early detection, diagnosis, and staging of HPV-associated cancers. Imaging also helps assess treatment response and postoperative complications and is used for long-term surveillance. HPV-associated oropharyngeal SCCs have well-defined borders and solid and cystic nodal metastases at imaging. Updated screening and vaccination guidelines are currently available that have great potential to decrease the overall disease burden and help control this worldwide public health concern. Novel therapeutic strategies, such as immunotherapies, are being explored, and imaging biomarkers that can predict treatment response and prognosis are being investigated; radiologists play a pivotal role in these efforts. ©RSNA, 2024 Supplemental material is available for this article.

What Influences Parents on Their Decision to Vaccinate Their Daughters Against HPV?

STUDY OBJECTIVE

To investigate and compare the attitudes of parents who initiated their daughters' HPV vaccination with parents who did not.

METHODS

Data were collected through telephone interviews with a close-end questionnaire on parents' knowledge, attitudes towards the vaccine, and the reasons for vaccinating or not their daughters against HPV. The sample was random, stratified by geographic region and urbanization level, national, and representative of the general population of parents of girls aged 11-18 in Greece. Statistical analysis consisted of descriptives, an inferential analysis with hypothesis testing, and a logistic regression model.

RESULTS

Overall, 996 parents were included in the analysis, 99.0% of which were women. Forty-seven percent of them initiated their daughters' HPV vaccination, with physician recommendation stated as the most important reason for this decision (50.2%). For those who had not initiated their daughters' HPV vaccination (53%), lack of information was the most important reason (25.6%). In the hypothesis testing, parents with unvaccinated daughters agreed more with the statements "I do not have enough information for the HPV vaccine to decide," and "My child is very young to be vaccinated for an STD" (P < .05), but no significant difference found for the statement "It's more possible for a vaccinated girl to begin sexual activities" (P > .05).

CONCLUSIONS

Lack of information, young age of the daughter, and perceived effectiveness of the vaccine are the most important hesitation factors. Physician recommendation is the most important reason to initiate vaccination.

No more than "half prevention": A qualitative study on psychosocial determinants of Covid-19 vaccination acceptance

Vaccine hesitancy represents a major barrier to achieving Covid-19 vaccination coverage, including in Italy, where the vaccination rates suggest that Covid-19 vaccination has not been fully integrated into people's routine immunization schedules. While quantitative studies have generated ample data on factors influencing vaccination decisions, rarely was an overall picture of people's actual views and experiences with Covid-19 vaccines provided. To address this gap, this qualitative study aimed to explore, from a psychosocial perspective, the relationships between perceptions of Covid-19 vaccines, traditional vaccines, and general approaches to prevention. Following a Grounded Theory approach, we interviewed 25 Italian adults from different socioeconomic and working backgrounds. Findings revealed that, despite a generally positive attitude towards Covid-19 vaccines, they were often regarded as providing only partial protection-a "half prevention"-against the disease rather than a definitive preventive measure. In this sense, a gap emerged between the overall notion of prevention and the specific representations associated with Covid-19 vaccines. Therefore, to increase vaccination acceptance, interventions should prioritize the reduction of such a gap by promoting the idea that vaccination against Covid is, in all respects, a safe and effective preventive tool. This requires fostering a credible knowledge system and building trustful relationships among community members and stakeholders involved in the vaccination campaign, including general practitioners, healthcare professionals, and political authorities.

The Role of Healthcare Leaders in Promoting Vaccine Acceptance in Saudi Arabia

Background

Several vaccines have been recommended by the health authorities in recent years and have been opposed by debates, lack of public trust, and variable levels of hesitance that resulted in increased anti-vaccination advocacy and a subsequent reduction in vaccination rates worldwide.

Purpose

This study aimed to explore the community's perceptions of the role of healthcare leadership in promoting vaccine acceptance.

Methods

This cross-sectional study used a validated questionnaire designed according to the study's objectives for a heterogeneous purposive sample of individuals over 18 years old in Saudi Arabia. Participants completed the questionnaire online via a link provided by multiple social media platforms.

Results

The study included 7159 participants with various demographical features. On a five-point Likert scale, the average level of agreement on the role of healthcare executives in promoting vaccines was 3.76. The average level of agreement about the role of healthcare leaders in promoting vaccines was 3.76 out of five. Men were more likely than women to agree on healthcare worker's influence, 63.6% and 58.6%, respectively (P < 0.001). The ages of participants showed a favorable correlation with their level of agreement on the role of healthcare leaders in promoting vaccines (P < 0.001). The level of agreement on healthcare leader's role in promoting vaccines was inversely proportional to the education level (P < 0.001). The retired group reported the highest score, followed by the employed ones (P < 0.001).

Conclusion

Unlike other political and religious leaders, this study indicates that healthcare professionals significantly impact vaccine hesitancy and uptake. Despite rising vaccine hesitancy, healthcare leaders remain more trustworthy providers of guidance and influence over vaccination decisions than others. In addition, the health leader's factual message boosts people's self-esteem and helps them decide to be vaccinated.

Effect of vaccine hesitancy on female college students' willingness to receive the HPV vaccine in China: a multicenter cross-sectional study

OBJECTIVE

To analyse the influencing factors of vaccine hesitancy on HPV vaccination willingness of female college students in order to promote the promotion of HPV vaccine in female college student population.

METHODS

From September-October 2022, a convenience sampling method was used to conduct a questionnaire survey among freshman female students from four higher vocational colleges in Henan Province, China. The survey comprised a general information questionnaire, as well as inquiries regarding vaccine hesitancy and willingness to receive the human papillomavirus (HPV) vaccine. In PSM analyses, vaccine-hesitant students were matched with non-vaccine-hesitant students at a 1:1 ratio; subsequently, both univariate and multivariatble logistic regression analyses were applied to assess the impact of vaccine hesitancy on female university students' willingness to receive the HPV vaccine.

RESULTS

The results revealed a vaccine hesitancy rate of 44.75% among female university students, with 82.9% expressing willingness to receive the HPV vaccine. The results of the multivariable ordinal logistic regression analysis indicated vaccine hesitancy is a risk factor for HPV vaccination intentions among female university students [OR = 4.38, 95% CI (2.74, 6.99), P < 0.001]. Furthermore, the field of study (P = 0.01) and independently seeking information about the HPV vaccine (P = 0.04) were identified as factors influencing female university students' willingness to receive the HPV vaccine.

CONCLUSIONS

Non-vaccine-hesitant students were more likely to be willing to receive the HPV vaccine than vaccine-hesitant students. Healthcare providers and educators should focus on vaccine attitudes among female college students to reduce vaccine hesitancy and enhance community education on cervical cancer, HPV infection and prevention through multichannel campaigns.

Influences on male college students' patient-provider communications and uptake behaviors related to the human papillomavirus vaccine

OBJECTIVE

We assessed the psychosocial influences on college males' human papillomavirus (HPV) vaccine patient-provider communication and their uptake of one or more HPV vaccine doses.

METHODS

We conducted a cross-sectional survey with college males attending one large southwestern university. We used logistic regressions to explore the relationships between psychosocial and demographic variables on patient-provider communication and HPV vaccine uptake.

RESULTS

Patient-provider communication had the most significant influence on HPV vaccine uptake. However, most college males reported never discussing the HPV vaccine with their healthcare providers. HPV vaccine awareness, perceived subjective norms to vaccinate, and behavioral control to talk to healthcare providers about the vaccine significantly influenced college males' patient-provider communication and vaccine uptake.

CONCLUSION

HPV vaccine awareness, perceived behavioral control to communicate about the vaccine, and subjective norms to vaccinate are all addressable factors that influence HPV vaccine communication and uptake. Future intervention work should specifically target these factors for college men.

Understanding HPV Vaccine Hesitancy and What Helped Hesitant Adopter Parents Have Their Children Vaccinated Despite Their Hesitancy

INTRODUCTION

One out of four parents reported HPV vaccine hesitancy; however, little is known about HPV vaccine-hesitant parents who vaccinate their children (e.g., hesitant adopters).

METHOD

We use individual interviews (n = 8) to explore hesitancy and facilitators for overcoming hesitancy among hesitant adopter parents. We drew a priori codes from the Increasing Vaccination Model domains and identified seven emergent secondary themes.

RESULTS

Understandable information about safety, side effects, and effectiveness could address HPV vaccine hesitancy. Health care professionals, family, friends, and coworkers were trusted vaccine and vaccination information sources. The study documents the lack of access to HPV vaccines with established health care providers as a barrier to vaccination.

DISCUSSION

This is the first study of hesitant adopter parents that expands our understanding of factors driving HPV vaccination among them. Study insights can inform future efforts to increase HPV vaccine uptake among the hesitant.

Determinants of Parental Intention to Vaccinate Young Adolescent Girls against the Human Papillomavirus in Taiwan: An Online Survey Study

Since 2018, Taiwan has included the human papillomavirus (HPV) vaccination into its national immunization program for junior high school girls. However, the reports of side effects following vaccination have increased parental concerns. This study investigated parental intentions regarding the HPV vaccination for their daughters and related factors in Taiwan. A total of 213 parents of girls aged between 12 and 15 years participated in an online survey. The survey collected data on various factors, including the parental intention to vaccinate their daughters against HPV; the motivation behind the vaccinations, as measured using the Motors of Human Papillomavirus Vaccination Acceptance Scale; an understanding of the reasons behind the government's promotion of HPV vaccinations; concerns regarding the side effects of vaccinations for their daughters; an awareness of the reported side effects of HPV vaccines experienced by some individuals; the exposure to information on HPV vaccines from social media; and mental health status, measured using the Brief Symptom Rating Scale. The associations between these variables and the parental intention to vaccinate their daughters against HPV were examined using a multivariable linear regression analysis model. The findings revealed a moderate to high level of intention among participants to vaccinate their daughters against HPV. Parents who perceived a greater value in HPV vaccination for their daughters' health (B = 0.524, standard error [se] = 0.039, p < 0.001) and had greater autonomy in decision-making regarding vaccination (B = 0.086, se = 0.038, p = 0.026) exhibited a higher intention to vaccinate their daughters against HPV. Conversely, parents who expressed greater concern regarding the side effects of HPV vaccines for their daughters had a lower intention to vaccinate (B = -0.762, se = 0.203, p < 0.001). Based on these findings, this study recommends integrating these factors into the design of intervention programs aimed at enhancing parental intentions to vaccinate their daughters against HPV.

Human papillomavirus circulating tumor DNA assays as a mechanism for head and neck cancer equity in rural regions of the United States

The rates of human papillomavirus-positive oropharyngeal cancer (HPV-OPC) are rising worldwide and in the United States, particularly in rural regions including Appalachia. Rural areas face unique health challenges resulting in higher cancer incidence and mortality rates, and this includes HPV-OPC. The recent advent of highly sensitive liquid biopsies for the non-invasive detection of HPV-OPC recurrence (circulating tumor HPV DNA, HPV ctDNA) has been swiftly adopted as part of surveillance paradigms. Though knowledge gaps persist regarding its use and clinical trials are ongoing, the ease of collection and cost-effectiveness of HPV ctDNA make it more accessible for HPV-OPC survivors than usual surveillance methods of frequent exams and imaging. Herein, we discuss how implementing HPV ctDNA assays in rural regions of the United States provide one poignant example of how liquid biopsies can improve cancer care equity.

Graduate and Health Professional Student Knowledge, Attitudes, Beliefs, and Behavior Related to Human Papillomavirus and Human Papillomavirus Vaccination: A Scoping Review of the Literature

Human papillomavirus (HPV) is a common sexually transmitted infection. Despite a safe and effective vaccine, uptake continues to be suboptimal. Recently, focus has moved to college campuses in an effort to increase vaccination rates. Little is known about the extent of efforts to reach graduate students on college campuses in the United States and the vaccination rates within this subpopulation. This scoping review assessed the literature on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination among graduate and post-baccalaureate professional students in the United States. This review also aims to identify areas for further research to improve institutions' abilities to create health programming to increase HPV awareness and HPV vaccination coverage on their campuses. Publications focusing on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination in post-baccalaureate students were included. The systematic review of PubMed, CINAHL, and Embase identified 2562 articles, and 56 articles met all inclusion criteria and were included in this scoping review. A majority of the reviewed studies investigated some combination of knowledge, attitudes, behaviors, and beliefs about HPV and the HPV vaccine in students in professional programs such as medicine. Study design approaches were primarily cross-sectional, utilizing web-based survey distribution methods. HPV vaccination status and HPV screening behaviors were primarily measured through participant self-report. There is limited research investigating post-baccalaureate student knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination. There is a need for researchers to further investigate the needs of graduate students to create informative and effective HPV programming.

Willingness and hesitancy towards the governmental free human papillomavirus vaccination among parents of eligible adolescent girls in Shenzhen, Southern China

BACKGROUND

Since 2020, China has actively promoted HPV vaccination for eligible adolescent girls through various pilot programmes. This study investigated parental willingness and hesitancy towards the government-sponsored, free human papillomavirus (HPV) vaccination for eligible adolescent girls in Shenzhen, Southern China.

METHODS

From June to August 2022, a cross-sectional survey was conducted with parents of girls entering Grade 7, employing an adapted Vaccine Hesitancy Scale to assess vaccine hesitancy and logistic regression to identify factors influencing willingness to accept the free domestic vaccines.

RESULTS

Although only 3.4% of the 2856 respondents had their daughters vaccinated against HPV prior to the survey, 91.7% were willing to utilise the governmental vaccination services. Parents with children in public schools (χ2 = 20.08, p < 0.001), those with more secure medical insurance (χ2 = 4.97, p = 0.026), and parents who had received an HPV vaccine themselves (χ2 = 28.829, p < 0.001) showed more reluctance towards the free vaccines. Vaccine hesitancy was presented in a mere 2.1% but was a significant predictor of vaccine refusal, even after adjusting for multiple factors (adjusted OR = 15.98, 95% CI: 9.06, 28.20). Notably, about four-fifths of parents of unvaccinated daughters harboured concerns about the safety and efficacy of the domestic vaccine.

CONCLUSIONS

Although parents show a strong inclination to utilise the government vaccination services, their vaccine hesitancy, driven by safety concerns and a preference for imported vaccines, remains a significant barrier for rolling out vaccination coverage. This study highlights the need for multifaceted intervention strategies that address these issues to enhance HPV vaccine uptake effectively.

Pandemic antecedents - Exploring predictivity and relationships between COVID-19 vaccine uptake and influenza, shingles, and HPV vaccination

BACKGROUND

A wealth of extant research focuses on identifying barriers to, and predictors of, COVID-19 vaccination. In addition to treating COVID-19 vaccination and related experiences as antecedents, this study analyzes the relationships between COVID-19 vaccination experiences and intent to receive the flu, shingles, and HPV vaccines.

METHOD

Analyses were performed on the responses from U.S. survey panel of 1,024 participants (n = 1,024), 530 (51.8 %) who received at least a dose of the COVID-19 vaccine and 494 (48.2 %) who had not. Descriptive and inferential statistics identify participant demographic characteristics, prior vaccination behavior, vaccination intentions, risk behavior assessment, vaccination attitudes and beliefs, and the predictivity of COVID-19 vaccination, when treated as an antecedent.

RESULTS

Receiving a first dose of the COVID-19 vaccine interacted with receiving a past influenza vaccine, predicting the future intention to receive a COVID-19 vaccine or booster. Vaccine hesitancy in parents is significantly related to vaccination behaviors for themselves and their children. Analyses also showed differences between the vaccinated group (VG) and the unvaccinated group (UVG) on hesitancy, beliefs, and attitudes toward the COVID-19 vaccine.

CONCLUSION

Experience with COVID-19 vaccination and the relationship of those experiences with other vaccinations provide useful insight on leveraging vaccine uptake. Healthcare professionals should improve the COVID-19 vaccination experience and use vaccination appointments to promote other vaccinations. Research should continue to compare vaccination experiences and how they may persuade or dissuade vaccination intent for other vaccinations.

"You Don't Know If It's the Truth or a Lie": Exploring Human Papillomavirus (HPV) Vaccine Hesitancy among Communities with Low HPV Vaccine Uptake in Northern California

BACKGROUND

Vaccine hesitancy, delaying or refusing to vaccinate despite the availability of vaccines, impedes the progress of achieving optimal HPV vaccine coverage. Little is known about the sources of human papillomavirus (HPV) vaccine hesitancy among racially/ethnically and geographically diverse communities. The purpose of this paper is to explore HPV vaccine hesitancy among rural, Slavic, and Latino communities that reside in counties with low HPV vaccine uptake rates.

METHODS

Key informant interviews and focus groups were conducted with rural, Slavic, and Latino communities that reside within counties in California that have low HPV vaccine up to date rates (16-25%). Qualitative data were transcribed verbatim and analyzed using inductive and deductive thematic analysis.

RESULTS

A total of seven focus groups and 14 key informant interviews were conducted with 39 individuals from seven California counties. Salient themes that contributed to HPV vaccine hesitancy included the following: social media and the anti-vaccination movement; a strong belief in acquiring immunity naturally; prior vaccine experiences; and vaccine timing concerns. Participants suggested the provision of culturally appropriate, in-language, in-person easy to understand HPV vaccine education to mitigate HPV vaccine hesitancy.

CONCLUSIONS

Our findings can inform future interventions to increase HPV vaccine uptake among hesitant communities.

Did the COVID-19 experience change U.S. parents' attitudes towards HPV vaccination? Results from a national survey

BACKGROUND

In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine.

METHODS

In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9-14 years. Respondents completed a 20-minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change.

RESULTS

Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention.

CONCLUSIONS

Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents.

Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study

OBJECTIVES

Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months.

METHODS

The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time.

RESULTS

A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up.

CONCLUSION

The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.

Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states

BACKGROUND

We assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child.

METHODS

An online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9-17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level.

RESULTS

Analyses were conducted using responses from 926 parents about their oldest child in the target age range (9-17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children.

CONCLUSIONS

The results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.

Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy

OBJECTIVE

This study evaluated the impact of the COVID-19 pandemic and vaccine perceptions on Human Papillomavirus (HPV) vaccine hesitancy. Secondary endpoints included comparing COVID-19 and HPV vaccination trends regarding time, community of residence, and unmet social needs.

METHODS

This was a survey-based, cross-sectional study that included 101 participants who were recruited through the Wyandotte County Public Health Department. Participants were eligible for inclusion in this study if they were a parent/guardian of one or more children aged 13 to 17; English- or Spanish-speaking. This study took place in Wyandotte County, Kansas. Descriptive statistics and chi-square analyses were utilized.

RESULTS

There was no difference in completion of COVID-19 and HPV vaccines (p = 0.0975). Significantly more individuals started and did not finish the HPV vaccine series compared to the COVID-19 vaccine series (p = 0.0004). Most participants indicated their opinion on the HPV vaccine had not changed due to the pandemic (71.3 %). Participants who felt familiar with HPV had higher rates of HPV vaccine completion. While 77 % of participants felt extremely or moderately familiar with HPV, 61.4 % were unaware of its association with oropharyngeal cancer.

CONCLUSION

There was minimal change in parents' perception of the HPV vaccine due to the COVID-19 pandemic despite decreased rates of vaccination during this time. HPV vaccine series completion was significantly lower than COVID-19 vaccine series completion, highlighting a need to improve HPV vaccine completion counseling. Additionally, patient education should address the knowledge gap discovered regarding the link between HPV infection and oropharyngeal cancer.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

Building knowledge using a novel web-based intervention to promote HPV vaccination in a diverse, low-income population

OBJECTIVES

HPV vaccination rates remain suboptimal despite proven efficacy. Data suggest misconceptions or lack of knowledge are leading barriers. Our study aimed to develop and pilot a novel interactive education resource designed to educate parents and patients about HPV vaccines.

METHODS

This is a prospective pilot study conducted in an urban teaching hospital pediatric clinic. The Patient Activated Learning System (PALS) intervention included 3 web-based videos with HPV vaccine-related educational content. Participants were parents of adolescent patients, aged 11-17 years, and young adult patients, aged 18-26 years. Enrolled participants completed an HPV vaccine knowledge survey before and after watching PALS; paired scores were evaluated. Acceptability and participant-reported impact of PALS modules were measured via Likert-scale surveys.

RESULTS

132 individuals were approached; 101 (76%) enrolled and completed the study. Participants self-identified as Hispanic (50%), non-Hispanic Black (23%), non-Hispanic White (7%), Asian (6%), American/Alaskan/Hawaiian Native or Pacific Islander (5%). Half reported earning ≤$40,000 annually; 57% had only a high school education. Post-intervention knowledge scores were increased compared to baseline (9.87/27 points vs 17.53/27 points, p < 0.01). PALS modules were reported as enjoyable to use and understandable (89% and 93%, respectively), and improved participants' understanding of the importance of HPV vaccination (90%). Of the 18 patients unvaccinated at baseline, 39% received 1 shot of the HPV vaccine within one month.

CONCLUSION

The PALS HPV vaccine educational intervention was feasible, acceptable, and improved knowledge among a diverse, underserved population. Our intervention may positively influence HPV vaccination rates, with potential to overcome HPV vaccine hesitancy.

Vaccine Hesitancy among European Parents-Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis

BACKGROUND

Due to low adherence to HPV vaccination programs, the European region struggles with vaccination rates lower than 30% among the targeted population. The present report investigated various socio-demographic and psychological factors influencing European parents' hesitancy towards vaccinating their children.

METHODS

As of September 2023, four databases were searched. After applying inclusion criteria, all articles comparing psychological and socio-demographic factors in parents who vaccinate or do not vaccinate their children were included.

RESULTS

Twenty-five primary publications met the criteria, totaling 385,460 responders, of which 311,803 want to or have already vaccinated their child, and 73,555 do not wish to do so. Immigrant and employment status, religion, age of parents and the child's gender seemed to influence their decision to vaccinate their child. Previous experience with vaccines, perceived safety and efficacy and the mother's previous abnormal CCS results also impacted their decision. The caregivers' education, gender, civil status, number of children, family history of neoplasia or mother's CCS attendance did not influence their hesitancy to vaccine.

CONCLUSION

Multiple demographic, social, economic and psychological barriers involved in the parents' hesitancy to vaccinate their children against the HPV virus were highlighted. Specific at-risk categories that need to be targeted with information, education and vaccination campaigns were identified.

Relationship between vaccine hesitancy and vaccination behaviors: Systematic review and meta-analysis of observational studies

BACKGROUND

Vaccination is crucial for prevention of infectious diseases, and identification of the impact of vaccine hesitancy on vaccination programs is crucial for early intervention and formulation of policies to alleviate vaccine hesitancy. The aim of this systematic review was to explore the relationship between vaccine hesitancy and negative vaccination behavior globally.

METHODS

We searched for observational studies in various databases. We conducted a meta-analysis using pooled odds ratios (OR) and 95 % confidence intervals (CI), performed meta regression and subgroup analysis to explore the role factors such as location and individual characteristics on the association between vaccine hesitancy and vaccination behavior.

RESULTS

A total of 46 articles were included in systematic analysis and 34 articles were included in the meta-analysis. The systematic analysis comprised 162,601 samples, whereas the meta-analysis included 147,554 samples. The meta-analysis showed that a higher rate of vaccine hesitancy was associated with an increased likelihood of adverse vaccination behaviors (all adverse behaviors: OR = 1.50, 95 % CI, 1.33-1.70, P < 0.001; unvaccinated: OR = 1.48, 95 % CI, 1.29-1.70, P < 0.001; vaccine delay: OR = 2.61, 95 % CI, 1.97-3.44, P < 0.001). The meta-regression results indicated that the heterogeneity observed was mainly from sample selection methods, age of vaccinees and the health status of participants. The results showed that parents of minor vaccinees or without high-risk health status had a higher association between vaccine hesitancy and vaccine uptake compared with populations exposed to higher health risks or adult vaccinees.

CONCLUSION

The findings provide evidence on the association between vaccine hesitancy and adverse vaccination behaviors. The results showed that these population-specific factors should be considered in future research, and during formulation of interventions and implementation of policies to improve vaccination uptake.

Using Gaming to Promote Vaccination Among Youth: A Systematic Review

Introduction

While vaccines are crucial for disease prevention, disparities in vaccination coverage persist among youths aged 10 to 29 years, including within the United States. Serious games are emerging as a new strategy to address vaccine hesitancy. This systematic review aimed to aggregate and assess the current evidence on game-based interventions to improve youth vaccination rates, evaluating their impact and identifying factors influencing their effectiveness.

Methods

This systematic review was conducted through a meticulous search and evaluation of literature from databases including PubMed, Cumulative Index to Nursing and Allied Health Literature database, ProQuest platform, Cochrane Library, and Google Scholar. Studies were included if they (a) were designed with the purpose of improving youth vaccination rates; (b) were published in English; (c) were published between January 2011 and June 2023; and (d) evaluated the effect of game-based interventions. Search terms included Medical Subject Headings terms and keywords of the eligible articles.

Results

Out of 269 studies, 11 were included in the final analysis of this review. The earliest study dated back to 2013, with 5 being randomized controlled trial and 6 studies incorporating theoretical models in their design or outcome measures. The findings indicated a generally positive effect of game-based interventions on vaccine-related knowledge. However, the impact on actual vaccine uptake was limited. In-game avatar customization and collaboration games were found as effective tools for player engagement.

Conclusion

The review findings indicated that serious games boost vaccine knowledge but lack strong evidence for influencing youth vaccine uptake. More rigorous research and tailored game designs are needed to determine the effectiveness of game-based interventions and effectively address the diverse needs of youth in vaccine decision-making.

Psychological variables linked to hesitation toward vaccination against COVID-19 among late adolescents and young adults: The role of magical thinking and right-wing authoritarianism

INTRODUCTION

Several studies on the predisposition to be subjected to vaccination have shown that vaccine hesitation is a global phenomenon influenced by a lack of knowledge and awareness, as well as perceived risks and benefits. The purpose of this study was to investigate the mediating role of right-wing authoritarianism in the relationship between magical thinking and positive attitudes toward COVID-19 vaccines (i.e. trust of vaccine benefits, worries over unforeseen future effects, concerns about commercial profits, preference for natural immunity).

METHOD

The sample consisted of 201 Italian young adults, 49 males (24.4%), and 152 females (75.6%), aged between 18 and 25. Data were collected during 2022.

RESULTS

The results confirmed the role of right-wing authoritarianism as a mediator for magical thinking on positive vaccine attitudes. Findings indicated a positive association between right-wing authoritarianism and magical thinking and a negative relationship of both the aforementioned variables on positive vaccine attitudes. SEM analyses showed a direct positive association from magical thinking to right-wing authoritarianism and a direct negative association from right-wing authoritarianism to trust of vaccine benefits, to low worries over unforeseen future effects, to lack of concerns about commercial profits and to low preference for natural immunity.

CONCLUSIONS

The findings highlight that common contribution of odd or magical beliefs and right-wing authoritarianism may slow the spread of vaccines among late adolescents and young adults. Our findings provide insight on what effective communication with vaccine-resistant individuals should look like in order to increase the chances of reaching vaccine-hesitant individuals.

Mothers' perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers' hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Acceptability of a hypothetical dengue vaccine and the potential impact of dengue vaccination on personal vector control behavior: a qualitative study in Fortaleza, Brazil

BACKGROUND

Dengue is the most rapidly spreading viral vector-borne disease in the world. Promising new dengue vaccines have contributed to a growing consensus that effective dengue control will require integrated strategies of vaccination and vector control. In this qualitative study, we explored the perspectives of residents of Fortaleza, Brazil on acceptability of a hypothetical safe and effective dengue vaccine, specific drivers of dengue vaccine acceptance or hesitance, and the expected impact of dengue vaccination on their personal vector control practices.

METHODS

A total of 43 in-depth interviews were conducted from April to June 2022 with Fortaleza residents from a diverse range of educational and professional backgrounds, with and without recent personal experiences of symptomatic dengue infections. Data were analyzed using the principles of inductive grounded theory methodology.

RESULTS

Our findings indicate that knowledge of dengue transmission, symptoms, and prevention methods was strong across respondents. Respondents described willingness to accept a hypothetical dengue vaccine for themselves and their children, while emphasizing that the vaccine must be demonstrably safe and effective. Respondents expressed diverse perspectives on how receiving a safe and effective dengue vaccine might influence their personal vector control behaviors, relating these behaviors to their perception of risk from other Aedes mosquito-carried infections and beliefs about the role of vector control in maintaining household cleanliness.

CONCLUSIONS

Our study findings provide community-level perspectives on dengue vaccination and its potential impact on personal vector control behavior for policymakers and program managers in Fortaleza to consider as new dengue vaccines become available. With the introduction of any new dengue vaccine, community perspectives and emerging concerns that may drive vaccine hesitancy should be continuously sought out. Improved urban infrastructure and efforts to engage individuals and communities in vector control may be needed to optimize the impact of future dengue vaccinations and prevent rising cases of other arboviruses such as Zika and chikungunya.

The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review

BACKGROUND

The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine's proven efficacy, the vaccination rate among US youth remains below the recommended 80% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden.

OBJECTIVE

This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth's vaccine uptake.

METHODS

We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus.

RESULTS

Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82%), used a randomized controlled trial design (12/17, 71%), and adopted behavior change theories or a culture-centric approach (10/17, 59%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information.

CONCLUSIONS

This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations.

Factors for hesitancy towards vaccination against COVID-19 among the adult population in Puducherry, India - a cross sectional study

BACKGROUND

Vaccine hesitancy is a complex phenomenon that threatens global health. Present-day communication technology has paved the way for self-education but also contributed to the infodemic surrounding vaccination. This has resulted in pockets of people who are reluctant, refuse recommended vaccinations, or choose to delay being vaccinated. The present study was designed to estimate the magnitude of hesitancy towards the COVID-19 vaccination and determine its associated factors in the community.

METHODS

This cross-sectional study was conducted among 776 adults aged ≥ 18 years in 15 clusters in Puducherry district, India, between March 2022 and May 2022. Face-to-face interviews were conducted using a validated, structured questionnaire. Socio-demographic variables, co-morbidities, attitudes towards vaccination, etc., were expressed as frequencies and percentages. Vaccine hesitancy was dichotomized with the median score as the cut-off and reported as a proportion with a 95% confidence interval. Univariate and multivariate analyses were carried out to determine the factors associated with vaccine hesitancy.

RESULTS

The mean age of participants was 43.3 ± 14.8 years, with the majority being female (67.0%). Nearly 92.4%, 74.4%, and 0.5% of participants received their first, second, and precautionary doses, respectively, during the study period. Among the unvaccinated, 93.2% were unwilling to receive any dose of vaccination. More than half of the participants were hesitant towards vaccination, according to the vaccine hesitancy scale. Participants aged above 45 years were less hesitant, while those educated up to school level, belonging to the upper socio-economic class, never tested for COVID-19 in the past, and having a negative attitude towards vaccination were significantly associated with higher vaccine hesitancy.

CONCLUSIONS

It is imperative to address vaccine hesitancy by alleviating existing fears and misconceptions in the community through efficient communication strategies to win the fight against current as well as future public health emergencies.

Moral foundations and HPV vaccine acceptance in the United States: State, parental, and individual factors

RATIONALE

Appeals to intuitive morality may present a novel approach to addressing vaccine hesitancy.

OBJECTIVE

To better understand the relationship between morality and vaccination by employing Moral Foundations Theory to studies surrounding the HPV vaccination at multiple different levels of decision making.

METHOD

We employed three different study modalities which examined moralities link to vaccination by employing Moral Foundations Theory. A state-wide ecological study aimed to understand population level trends. Two randomized control interventional studies were then created to understand the effects of Moral Foundations Theory based interventions on both parents of children and individual decision makers.

RESULTS

We demonstrated a negative association at the state level between the purity moral foundations and HPV vaccination rates (β = -.75, SE 0.23; p < .01) and a positive association between loyalty and HPV vaccination rates (β = 0.62 SE 0.24; p < .05). The parental study built upon this by demonstrating negative association between higher moral purity scores and attitudes towards the HPV vaccine and intention to vaccinate their children (β = -0.27 SE 0.07; p < .001). Our final study demonstrated a Moral Foundations Theory based intervention was associated with an increase in the odds of indicating an intention to receive the HPV vaccination (adjusted Odds Ratio (aOR) 2.59, 95% Confidence Interval (CI) 1.62-4.14). This equates to a 20% increase in the predicted probability of the intention to receive an HPV vaccine (39% CI (36%-42%) vs 60% CI (57%-63%).

CONCLUSIONS

Together, these studies demonstrate that moral foundations, specifically the purity foundation, appear to have a strong and consistent relationship with HPV vaccination. They also demonstrate the how moral values-based interventions may serve as a novel approach to increase HPV vaccine uptake with potential to be employed to target vaccine hesitancy more broadly.

Navigating Vaccine Uncertainty: Anxiety and Fourth Dose Hesitancy Among Saudi Adults

Background The continuous evolution of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and early evidence of declining effectiveness of the third dose over time have generated anxiety and hesitancy regarding vaccinations. The current study aimed to assess anxiety levels and the willingness to receive a fourth dose of the SARS-CoV-2 vaccine. Potential factors leading to this reluctance were also assessed. Methodology This was a cross-sectional cohort study conducted among the adult Saudi population. A questionnaire including demographic data, questions regarding Generalized Anxiety Disorder (GAD-7) assessment, and questions related to accepting the vaccine and reasons for hesitancy was employed. Results Of the 1,924 participants who responded, 1,033 were males, and 891 were females. Among the respondents, a significant level of anxiety toward receiving the fourth dose of the SARS-CoV-2 vaccine was reported in 1,097 cases, representing 57% of the total, with varying degrees of anxiety. Both gender and age were identified as co-factors contributing to this anxiety. A substantial portion of the participants, 1,369 individuals, accounting for 71.2%, exhibited vaccine hesitancy and reluctance to receive the fourth dose. Conclusions Our findings underscore the pressing need for targeted interventions to combat vaccine hesitancy and alleviate associated anxieties, particularly among the adult Saudi population. As we persist in confronting the ongoing challenges brought about by the evolving pandemic, it is crucial that we customize our vaccination campaigns and communication strategies to tackle the apprehensions and hesitations of the Saudi population directly.

Implementing the free HPV vaccination for adolescent girls aged below 14 in Shenzhen, Guangdong Province of China: experience, challenges, and lessons

Cervical cancer is a major public health concern in China, accounting for almost one-fifth of the global incidence and mortality. The recently prequalified domestic bivalent human papillomavirus (HPV) vaccine offers a practical and feasible preventive measure. In response to the global call for action, the National Health Commission issued an Action Plan to eliminate cervical cancer by 2030, with promotion of the HPV vaccination for school-aged girls as a critical step. Despite this, implementation of the vaccination has been patchy, with very low coverage among eligible girls. To address this, from December 2021 to December 2022, a demonstration project was launched in Shenzhen, Guangdong Province, to promote the inclusion of HPV vaccine in local immunisation programme and to address existing barriers to implementation. Using multiple sources of data, this article presents a case study of the demonstration project, analysing its impact on rolling out HPV vaccination among eligible girls and identifying any challenges encountered during implementation. The demonstration project has shown promising results in increasing the HPV vaccination rate, promoting public awareness and acceptance of the domestic HPV vaccine, and establishing a model for quickly scaling up the vaccination at the municipal level. The success of the project can be attributed to several factors, including strong governmental commitment, sufficient funding, multi-sectoral collaboration, ensured vaccine accessibility and affordability, improved vaccination services, and effective health education and communication strategies. Lessons learned from Shenzhen can provide valuable insights for future advocacy and implementation of the vaccination in other areas of China, but challenges must be addressed to achieve universal coverage. These include addressing vaccine hesitancy, expanding the programme to cover a broader age range, and ensuring consistent quality of vaccination services in primary care facilities. Overcoming these challenges will require innovative strategies, public-private partnerships, and sustained funding and resources. Future research should focus on evaluating the long-term effectiveness of the vaccination programme and identifying contextual factors that may impact its implementation in different settings. Overall, the effective control of cervical cancer in China will rely on the "political will" to ensure the incorporation of preventive interventions into policies and universal programme coverage.

Longitudinal assessment of COVID-19 vaccine uptake: A two-wave survey of a nationally representative U.S. sample

Understanding factors that influence those who are initially COVID-19 vaccine hesitant to accept vaccination is valuable for the development of vaccine promotion strategies. Using Ipsos KnowledgePanel®, we conducted a national survey of adults aged 18 and older in the United States. We created a questionnaire to examine factors associated with COVID-19 vaccine uptake over a longitudinal period ("Wave 1" in April 2021 and "Wave 2" in February 2022), and utilized weighted data provided by Ipsos to make the data nationally representative. Overall, 1189 individuals participated in the Wave 1 survey, and 843 participants completed the Wave 2 survey (71.6% retention rate). Those who intended to be vaccinated as soon as possible ("ASAP") were overwhelmingly vaccinated by Wave 2 (96%, 95% CI: 92% to 100%). Of those who initially wished to delay vaccination until there was more experience with it ("Wait and See"), 57% (95% CI: 47% to 67%) were vaccinated at Wave 2. Within the "Wait and See" cohort, those with income <$50,000 and those who had never received the influenza vaccine were significantly less likely to be vaccinated at Wave 2. Among those who initially indicated that they would not receive a COVID-19 vaccine ("Non-Acceptors"), 28% (95% CI: 21% to 36%) were vaccinated at Wave 2. Those who believed COVID-19 was not a major problem in their community were significantly less likely to be vaccinated, while those with more favorable attitudes toward vaccines in general and public health strategies to decrease the impact of COVID-19 were significantly more likely to be vaccinated. Overall, barriers to vaccine uptake for the "Wait and See" cohort appear to be more practical, whereas barriers for the "Non-Acceptor" cohort seem to be more ideological. These findings will help target interventions to improve uptake of COVID-19 boosters and future novel vaccines.

Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review

Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.

Missed Opportunities for Adolescent Immunizations at Well-Care Visits During the COVID-19 Pandemic

PURPOSE

The Coronavirus Disease 2019 pandemic disrupted healthcare, but the impact on vaccination missed opportunities (MOs, vaccine-eligible visits without vaccination) is unknown. We evaluated pandemic-related trends in MOs at adolescent well-care visits for three vaccines: human papillomavirus; quadrivalent meningococcal conjugate; and tetanus, diphtheria, and acellular pertussis (Tdap).

METHODS

We analyzed electronic health record data from 24 pediatric primary care practices in 13 states from 1/1/2018 to 12/31/2021. Segmented logistic regression estimated risk differences for MOs during the pandemic relative to prepandemic trends.

RESULTS

Among 106,605 well-care visits, we observed decreases in MOs prepandemic followed by an increase in MOs during the pandemic for all three vaccines. Relative to prepandemic, MOs increased for human papillomavirus (+15.9%, 95% confidence interval [CI]: 11.7%, 20.1%), meningococcal conjugate (+9.4%, 95% CI: 5.2%, 13.7%), and tetanus, diphtheria, and acellular pertussis (Tdap) (+ 8.2%, 95% CI: 4.3%, 12.1%).

DISCUSSION

Increases in vaccine MOs during the pandemic equaled or exceeded pre-pandemic decreases. Reducing MOs in adolescent well-care could raise vaccine coverage.

Challenges of hesitancy in human papillomavirus vaccination: Bibliometric and visual analysis

BACKGROUND

Human papillomavirus (HPV) vaccine has immense research value in the prevention of related tumours. A huge body of work has been published in this field, which may pose difficulties for researchers aiming to investigate all the available information. However, bibliometrics can provide deep insights into this research field.

OBJECTIVE

We aimed to study HPV vaccine development, visually analyse the development status, trends, research hotspots, and frontiers of this field, and provide a reference for research on it.

METHODS

Articles were acquired from the Web of Science Core Collection. VOS viewer and CiteSpace software were used to analyse publication growth, country/region, institution, journal distribution, author, reference, and keywords, and collected burst keyword words to display research hotspots.

RESULTS

A total of 4831 references were obtained, and the annual number of publications increased fluctuating over the past decade. The United States of America ranked at the top in terms of percentage of articles. The institution with the highest number of research publications in this field was the Centers for Disease Control and Prevention. The most productive and frequently cited authors was Lauri E Markowitz. The journal with the most publications in this field was Vaccine, and the most influential journal was Paediatrics. The most frequently cited reference was 'A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women'. Burst detection analysis of top keywords showed that 'national immunisation survey', 'social media', and 'hesitancy' are the current research frontiers in this field.

CONCLUSION

This study provides useful information for acquiring knowledge on HPV vaccine. Research on solving the hesitation of HPV vaccination will become an academic trend in this field, which can offer guidance for more extensive and in-depth studies in the future.

Barriers to Human Papillomavirus Vaccination Initiation and Completion among Adults Aged 18-26 Years in a Large Healthcare System

Human papillomavirus (HPV) is a common sexually transmitted infection, with over 40% prevalence in the US. Oropharyngeal cancers (OPCs) driven by high-risk HPV are increasing (up to 90%), with HPV vaccination being the only prevention available. The aim of this study was to investigate HPV vaccination among patients aged between 18 and 26 years old with at least one encounter at a large healthcare system and identify sociodemographic factors associated with vaccine initiation and completion. A cross-sectional retrospective study was conducted between 2018 and 2021, including 265,554 patients identified from the Clinical Data Warehouse. HPV vaccination status by age, sex, race/ethnicity, insurance type, primary care (PCP) visits in the past year, alcohol, tobacco, illicit drug use, and age at vaccination was examined. Overall, 33.6% of females and 25.4% of males have completed the HPV vaccine. Black Americans were 35% more likely to initiate the vaccine than White Americans but were less likely to complete the entire course. Overall, HPV vaccination prevalence was far below the Health People 2030 goal of 80%, especially in young males. This low rate is troubling, since many patients had a PCP visit and remained unvaccinated, which serves as a missed opportunity for vaccination.

Parental Vaccine Hesitancy in a COVID-19 World: A Qualitative Study of Midwestern Parents' Decisions Regarding COVID-19 Vaccination for Their Children

Introduction

With the launch of the SARS-CoV-2 (COVID-19) vaccines, a new cohort of people exists who do not consider themselves to be completely vaccine-hesitant, but are specifically COVID-19 vaccine hesitant (CVH). There is a need to learn from CVH parents, to ensure their concerns are addressed, and allow them to comfortably vaccinate their children against the COVID-19 virus.

Methods

Surveys were used to identify CVH parents. Using semistructured interviews, we assessed the attitudes of CVH parents toward COVID-19 vaccination in children. An inductive coding method was used to analyze transcripts and develop themes.

Results

Fourteen parents were interviewed. Seven (50%) had received the COVID-19 vaccine even though they had doubts. Six reported that education about mRNA vaccine production was helpful in deciding to get vaccinated. Parents were reluctant regarding pediatric vaccination due to lack of long-term studies and concerns about adverse impact on childhood development. Personal physicians were the most trusted source of information and direct conversations with them were the most influential, as opposed to public health leaders like the U.S. Centers for Disease Control and Prevention and the National Institutes of Health.

Conclusions

Our findings suggested that physicians are among the most trusted sources of information regarding the COVID-19 vaccine for CVH parents. Rather than use broad public health messaging and advertising to increase rates of vaccination, further investigation into training health professionals on how to counsel CVH patients effectively may be a higher impact area of opportunity to improve vaccine response rates.

Pediatricians' perspectives on COVID-19 and HPV vaccine hesitancy

Rises in parental vaccine hesitancy, observed during the COVID-19 pandemic, threaten public health. This is especially concerning for vaccines not typically required for school-entry, such as the vaccines for COVID-19 and human papillomavirus (HPV), both of which also have much lower rates of completion compared to other adolescent vaccines. Pediatricians are well-positioned to address vaccine hesitancy and can offer insights into parents' perspectives in this area. There is evidence that pediatricians' sharing their own vaccine stories may help to address parents' concerns; yet we have little information on pediatricians' or their children's COVID-19 vaccine uptake. To address these gaps, we conducted a cross-sectional survey about Massachusetts pediatricians' behaviors and perspectives on vaccines that face significant resistance: HPV and COVID-19 vaccines. A total of 144 people initiated the survey, and 109 participants were eligible and completed the survey. Participants reported high levels of COVID-19 vaccine uptake for themselves (97%) and their children (98%). Similarities in parents' resistance toward both vaccines were identified: fear of side effects; general vaccine resistance. Pediatricians reported a rise in vaccine hesitancy since the beginning of the COVID-19 pandemic. Future research should focus on identifying strategies to build overall vaccine confidence and streamline these efforts for pediatricians.

Parent-reported Barriers and Parental Beliefs Associated with Intentions to Obtain HPV Vaccination for Children in a Primary care Patient Population in Minnesota, USA

Human papillomavirus (HPV) vaccine uptake among adolescents remains suboptimal in the US. The COVID-19 pandemic posed new challenges to increase HPV vaccination rates. To characterize parent-reported barriers to obtain HPV vaccination for their children and to identify psychosocial factors associated with parents' intention to vaccinate their children for HPV, we administered parent surveys between April 2020 and January 2022 during a randomized pragmatic trial assessing the impact of evidence-based implementation strategies on HPV vaccination rates for adolescent patients at six Mayo Clinic primary care practices in Southeast Minnesota. A total of 342 surveys were completed (response rate 34.1%). Analyses were focused on parents of unvaccinated children (n = 133). The survey assessed the main reason the child did not receive the HPV vaccine, parental beliefs about the vaccine, and the parent's intention to vaccinate the child for HPV in the next 12 months. Frequently reported awareness and access barriers to HPV vaccination included not knowing the child was due (17.8%) and COVID-19 related delay (11.6%). Frequently reported attitudinal barriers include the belief that the child was too young for the vaccine (17.8%) and that the vaccine is not proven to be safe (16.3%). Injunctive social norm (Adjusted-OR = 3.15, 95%CI: 1.94, 5.41) and perceived harm beliefs (Adjusted-OR = 0.58, 95%CI: 0.35, 0.94) about the HPV vaccine were positively and negatively associated with HPV vaccination intention, respectively. Our findings suggest that continued efforts to overcome parental awareness, access, and attitudinal barriers to HPV vaccination are needed and underscore the importance of utilizing evidence-based health system-level interventions.

Parent-Child Vaccination Concordance and Its Relationship to Child Age, Parent Age and Education, and Perceived Social Norms

Researchers established that parental vaccination status often predicts that of their children, but a limited number of studies have examined factors influencing dyadic concordance or discordance (i.e., same or different vaccination status or intent for both members). We investigated how child versus parent age as well as parents' perceptions of their respective friends' immunization behavior impacted un/vaccinated parents' decisions regarding vaccinating their child. An online survey obtained the COVID-19 vaccination status and views of 762 parents of 5-17-year-old children. More than three-quarters of all dyads were concordant; 24.1% of vaccinated parents would not vaccinate their child, with greater hesitancy for younger children and among younger or less educated parents. Children of vaccinated parents and of parents who thought most of their child's friends were vaccinated were 4.7 and 1.9 times, respectively, more likely to be vaccinated; unvaccinated parents were 3.2 times more likely to accept the vaccine for their child if they believed most of their friends would vaccinate their children. Further, parents who reported that most of their friends were vaccinated were 1.9 times more likely to have obtained the vaccine themselves, illustrating the influence of social norms. Regardless of their own vaccination status, parents of unvaccinated children were more likely to be politically conservative. If communities or circles of friends could achieve or convey a vaccinated norm, this might persuade undecided or reluctant parents to vaccinate their children. Future research should examine the effects of community behavior and messages highlighting social norms on pediatric vaccine uptake.