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Calo WA, Shah PD, Fogel BN, Ruffin Iv MT, Moss JL, Hausman BL, Segel JE, Francis E, Schaefer E, Bufalini CM, Johnston N, Hogentogler E, Kraschnewski JL. Increasing the adoption of evidence-based communication practices for HPV vaccination in primary care clinics: The HPV ECHO study protocol for a cluster randomized controlled trial. Contemp Clin Trials 2023; 131:107266. [PMID: 37301468 PMCID: PMC10528011 DOI: 10.1016/j.cct.2023.107266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The safe, highly-effective human papillomavirus (HPV) vaccine remains underused in the US. The Announcement Approach Training (AAT) has been shown to effectively increase HPV vaccine uptake by training providers to make strong vaccine recommendations and answer parents' common questions. Systems communications, like recall notices, can further improve HPV vaccination by reducing missed clinical opportunities for vaccination. Never tested in supporting HPV vaccination, the ECHO (Extension for Community Healthcare Outcomes) model is a proven implementation strategy to increase best practices among healthcare providers. This trial uses a hybrid effectiveness-implementation design (type II) to evaluate two ECHO-delivered interventions intended to increase HPV vaccination rates. METHODS This 3-arm cluster randomized controlled trial will be conducted in 36 primary care clinics in Pennsylvania. Aim 1 evaluates the impact of HPV ECHO (AAT to providers) and HPV ECHO+ (AAT to providers plus recall notices to vaccine-declining parents) versus control on HPV vaccination (≥1 dose) among adolescents, ages 11-14, between baseline and 12-month follow-up (primary outcome). Using a convergent mixed-methods approach, Aim 2 evaluates the implementation of the HPV ECHO and HPV ECHO+ interventions. Aim 3 explores exposure to and impact of vaccine information from providers and other sources (e.g., social media) on secondary acceptance among 200 HPV vaccine-declining parents within 12 months. DISCUSSION We expect to demonstrate the effectiveness and evaluate the implementation of two highly scalable interventions to increase HPV vaccination in primary care clinics. Our study seeks to address the communication needs of both providers and parents, increase HPV vaccination, and, eventually, prevent HPV-related cancers. TRIAL REGISTRATION ClinicalTrials.govNCT04587167. Registered on October 14, 2020.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Cancer Institute, Hershey, PA, USA.
| | - Parth D Shah
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin N Fogel
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Mack T Ruffin Iv
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Moss
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Cancer Institute, Hershey, PA, USA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Bernice L Hausman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA; Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Eric Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chelsea M Bufalini
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Ellie Hogentogler
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
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Zhu X, Jacobson RM, MacLaughlin KL, Sauver JS, Griffin JM, Finney Rutten LJ. Parent-reported Barriers and Parental Beliefs Associated with Intentions to Obtain HPV Vaccination for Children in a Primary care Patient Population in Minnesota, USA. J Community Health 2023; 48:678-686. [PMID: 36920709 PMCID: PMC10015522 DOI: 10.1007/s10900-023-01205-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 03/16/2023]
Abstract
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.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA.
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, 55905, Rochester, Rochester, MN, USA
| | - Kathy L MacLaughlin
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, 55905, Rochester, Rochester, MN, USA
| | - Jennifer St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, 55905, Rochester, Rochester, MN, USA
| | - Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street SW, 55905, Rochester, Rochester, MN, USA
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, 55905, Rochester, Rochester, MN, USA
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Han G, Son H. Environmental factors affecting mothers' decision-making about the HPV vaccination for their daughters. Hum Vaccin Immunother 2021; 17:4412-4417. [PMID: 34402397 DOI: 10.1080/21645515.2021.1965808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aimed to investigate environmental factors influencing mothers' decision-making regarding vaccination of the human papillomavirus (HPV) for their daughters. METHODS This was a cross-sectional study, with data collected using online surveys from July to September 2018. Participants were 230 mothers of second-year female middle-school students in South Korea. The proportional stratification sampling method was used to reflect the difference in medical level between regions. Independent variables consisted of individual (demographic characteristics, HPV-related characteristics, knowledge, attitude, and subjective norms) and environmental factors (the influence of healthcare providers, school, and community environments) were examined. The potential factors influencing vaccination uptake were determined using hierarchical logistic regression. RESULTS The factors influencing mothers' decision-making about the HPV vaccine for their daughters were their attitude toward HPV vaccination (OR = 0.78 p < .001), whether a healthcare provider provided HPV-vaccine-related information (OR = 2.42, p = .030), and presenting positive-framed information (OR = 4.21, p = .020). CONCLUSIONS To increase HPV vaccination among the target population, it is necessary to consider environmental factors identified in this study. Healthcare providers should provide accurate information regarding the vaccination. Information emphasizing the vaccination's benefits is particularly important.
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Affiliation(s)
- Gyumin Han
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
| | - Hyunmi Son
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
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Allison WE, Rubin A, Melhado TV, Choi A, Levine DA. Knowledge and Acceptability of Human Papillomavirus Vaccination and Text Message Reminders for Adolescents in Urban Emergency Departments: A Pilot Study. Open Access Emerg Med 2020; 12:145-153. [PMID: 32581603 PMCID: PMC7277577 DOI: 10.2147/oaem.s245221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Cervical, oropharyngeal and anogenital cancers are vaccine-preventable diseases, but human papillomavirus (HPV) vaccination coverage in the US remains poor overall with regional variations in vaccination rates. We explore the acceptability by adolescents and their parents of HPV vaccination and text message reminders in the non-traditional setting of the emergency department (ED). Patients and Methods The modified validated Carolina HPV Attitudes and Beliefs Scale (CHIAS) survey was administered at two urban EDs to adolescents aged 13–18 years and their parents. Demographic information was collected for each participating adolescent. Recruitment occurred with consecutive eligible participants on the ED census list approached within 4-hour blocks from 8am to 8pm. Results Ninety-six adolescents completed the survey. The mean adolescent and parental knowledge scores were 63% (SD=29.7) and 60% (SD=22.1), respectively. The higher the HPV knowledge score among both adolescents and parents, the more likely they were to accept HPV vaccine in ED. Among the 10 cases where the parents disagreed to the HPV vaccine and the adolescents agreed to the HPV vaccine, the mean knowledge score among parents disagreeing was 47 compared to 62 among the remaining parents (p=0.04). Sixty-seven percent of adolescents and 68% of parents were agreeable to the adolescent receiving vaccination in the ED (kappa = 0.24). Seventy-five percent of adolescents and 71% of parents reported being agreeable to receiving text reminders for HPV vaccines (kappa = 0.20). Adolescent agreement with receiving a text message reminder corresponded with an increased willingness to be vaccinated (OR=3.21, 95% CI=1.07–9.57, p-value=0.0368). Sexually active adolescents were older (mean age, 17 years) than those who reported no sexual activity (mean age, 15 years) (p<0.0001). Conclusion Increased knowledge about HPV influences vaccine acceptance. Parents and adolescents may disagree in accepting HPV vaccination. A majority of adolescents and their parents were agreeable to receiving HPV vaccination in the ED and subsequent text message reminders. The ED should be explored further as a non-traditional healthcare setting for HPV vaccination of adolescents.
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Affiliation(s)
- Waridibo E Allison
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Ada Rubin
- New York University, Ronald O. Perelman Department of Emergency Services, New York, NY, USA
| | - Trisha V Melhado
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Aro Choi
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Deborah A Levine
- New York University, Ronald O. Perelman Department of Emergency Services, New York, NY, USA
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Hanson KE, McLean HQ, Belongia EA, Stokley S, McNeil MM, Gee J, VanWormer JJ. Sociodemographic and clinical correlates of human papillomavirus vaccine attitudes and receipt among Wisconsin adolescents. PAPILLOMAVIRUS RESEARCH 2019; 8:100168. [PMID: 31136831 PMCID: PMC6556618 DOI: 10.1016/j.pvr.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Few studies have assessed adolescent human papillomavirus (HPV) vaccine attitudes and whether they are associated with vaccination uptake. This study characterized HPV vaccine attitudes among male and female adolescents, identified factors associated with attitude changes, and examined associations between attitudes and vaccination receipt. Surveys were administered to adolescents aged 15-16 years who had not completed the HPV vaccine series. A modified version of the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) was employed to assess barriers, harms, ineffectiveness, and uncertainties scores. Surveys were available from 108 participants; 63% were male and 33% had initiated the HPV vaccine series at baseline. CHIAS scores significantly decreased (i.e., became more favorable) between baseline and follow-up for barriers (p = 0.01) and uncertainties (p < 0.01). At least one sociodemographic/clinical factor was associated with changes in each score. Attitude changes were not associated with receipt of HPV vaccine, although adolescents with higher baseline harms scores were significantly less likely to receive an HPV vaccine dose (OR = 0.67). Adolescents' HPV vaccine attitudes slightly improved over a one-year period during which an intervention was implemented. More research is needed to learn how parent and adolescent HPV vaccine attitudes form, and how best to address concerns about vaccine harms.
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Affiliation(s)
- Kayla E Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI, 54449, USA.
| | - Huong Q McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI, 54449, USA.
| | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI, 54449, USA.
| | - Shannon Stokley
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-19, Atlanta, GA, 30329, USA.
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA, 30329, USA.
| | - Julianne Gee
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA, 30329, USA.
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI, 54449, USA.
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Finney Rutten LJ, Radecki Breitkopf C, St Sauver JL, Croghan IT, Jacobson DJ, Wilson PM, Herrin J, Jacobson RM. Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial. Implement Sci 2018; 13:96. [PMID: 30001723 PMCID: PMC6043954 DOI: 10.1186/s13012-018-0778-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. Methods Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients. The clusters are six primary care sites providing care to pediatric populations. We will use a stepped-wedge cluster randomized design, including process evaluation, to test the hypothesis that compared with the current course of care and a practice-level intervention using reminder-recall interventions coupled with provider-level audit and feedback with education increases HPV vaccination rates in exposed clusters. The factorial design allows us to use a single trial to test these two interventions and to assess each individually and in combination. Our design has four 12-month steps. The first step will be a baseline period; data collected during it will provide a within-practice control group for each cluster. Second, two clusters will be randomly assigned to receive intervention 1 (reminder and recall), and two clusters will be randomly selected to receive intervention 2 (audit and feedback with education). Third, the other two clusters will be randomly allocated to intervention 1 or 2. Clusters initially with intervention 1 will be randomly allocated to 1 + 2 or 1; clusters initially with intervention 2 will be randomly allocated to 1 + 2 or 2. Fourth, all clusters will receive both interventions. To ensure balance of patient numbers across interventions, we will use block randomization at the first step, with the six clusters grouped into three pairs according to volume. Our primary outcome will be vaccination rates. Discussion Results of our clinical trial and process evaluation will provide evidence showing whether practice- and provider-level interventions improve HPV vaccination rates and will offer insight into contextual factors associated with direction and magnitude of trial outcomes. Trial registration ClinicalTrials.gov, NCT03501992, registered April 18, 2018. Electronic supplementary material The online version of this article (10.1186/s13012-018-0778-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lila J Finney Rutten
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.,Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert M Jacobson
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Damnjanović K, Graeber J, Ilić S, Lam WY, Lep Ž, Morales S, Pulkkinen T, Vingerhoets L. Parental Decision-Making on Childhood Vaccination. Front Psychol 2018; 9:735. [PMID: 29951010 PMCID: PMC6008886 DOI: 10.3389/fpsyg.2018.00735] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
A growing number of parents delay vaccinations or are deciding not to vaccinate their children altogether. This increases the risk of contracting vaccine-preventable diseases and disrupting herd immunity, and also impairs the trust in the capacities of health care systems to protect people. Vaccine hesitancy is related to a range of both psychological and demographic determinants, such as attitudes toward vaccinations, social norms, and trust in science. Our aim is to understand those determinants in parents, because they are a special group in this issue-they act as proxy decision makers for their children, who are unable to decide for themselves. The fact that deciding to vaccinate is a socially forced choice that concerns a child's health makes vaccine-related decisions highly important and involving for parents. This high involvement might lead to parents overemphasizing the potential side effects that they know to be vaccine-related, and by amplifying those, parents are more focused on the potential outcomes of vaccine-related decisions, which can yield specific pattern of the outcome bias. We propose two related studies to investigate factors which promote vaccine hesitancy, protective factors that determine parental vaccination decisions, and outcome bias in parental vaccination intentions. We will explore demographic and psychological factors, and test parental involvement related to vaccine hesitancy using an online battery in a correlation panel design study. The second study is an experimental study, in which we will investigate the moderating role of parents' high involvement in the specific domain of vaccination decision making. We expect that higher involvement among parents, compared to non-parents, will shape the pattern of the proneness to outcome bias. The studies will be conducted across eight countries in Europe and Asia (Finland, Germany, Hong Kong, the Netherlands, Serbia, Slovenia, Spain, and the United Kingdom), rendering findings that will aid with understanding the underlying mechanisms of vaccine hesitancy and paving the way for developing interventions custom-made for parents.
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Affiliation(s)
- Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Johanna Graeber
- Department of Psychology, Faculty of Philosophy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Wing Y. Lam
- Faculty of Social Sciences, School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Žan Lep
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Morales
- Faculty of Psychology, University of Basque Country, Bilbao, Spain
| | - Tero Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Loes Vingerhoets
- Department of Psychology, Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, Netherlands
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Roberts MC, Murphy T, Moss JL, Wheldon CW, Psek W. A Qualitative Comparative Analysis of Combined State Health Policies Related to Human Papillomavirus Vaccine Uptake in the United States. Am J Public Health 2018; 108:493-499. [PMID: 29470122 PMCID: PMC5844399 DOI: 10.2105/ajph.2017.304263] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine how combinations of state policies, rather than single policies, are related to uptake of human papillomavirus (HPV) vaccine. METHODS Using publicly available records and the literature, we characterized policies for each US state and Washington, DC, in 2015 (n = 51), including (1) Medicaid expansion, (2) policies permitting HPV vaccination in pharmacies, (3) school-entry requirements, (4) classroom sex education mandates, and (5) parental education mandates. Using qualitative comparative analysis, we identified which existing combinations of these policies were necessary and sufficient for high HPV vaccine initiation among adolescents, with National Immunization Survey-Teen data. RESULTS No single policy was necessary or sufficient for high HPV vaccine uptake; however, 1 set of policies had consistently high HPV vaccine uptake: adoption of all policies except parental education mandates (girls: consistency = 1.00, coverage = 0.07; boys: consistency = 0.99, coverage = 0.08). CONCLUSIONS We identified a set of polices related to high HPV vaccine uptake. Future studies should examine how these policies and others, individually and in combination, are associated with HPV vaccine uptake. Public Health Implications. This study provides insight into what sets of policies are consistently related to high HPV vaccine uptake.
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Affiliation(s)
- Megan C Roberts
- At the time of this work, Megan C. Roberts, Jennifer L. Moss, and Christopher W. Wheldon were with the National Cancer Institute, Rockville, MD. Taylor Murphy was with George Washington University, Washington, DC. Wayne Psek was with the Milken Institute School of Public Health, George Washington University
| | - Taylor Murphy
- At the time of this work, Megan C. Roberts, Jennifer L. Moss, and Christopher W. Wheldon were with the National Cancer Institute, Rockville, MD. Taylor Murphy was with George Washington University, Washington, DC. Wayne Psek was with the Milken Institute School of Public Health, George Washington University
| | - Jennifer L Moss
- At the time of this work, Megan C. Roberts, Jennifer L. Moss, and Christopher W. Wheldon were with the National Cancer Institute, Rockville, MD. Taylor Murphy was with George Washington University, Washington, DC. Wayne Psek was with the Milken Institute School of Public Health, George Washington University
| | - Christopher W Wheldon
- At the time of this work, Megan C. Roberts, Jennifer L. Moss, and Christopher W. Wheldon were with the National Cancer Institute, Rockville, MD. Taylor Murphy was with George Washington University, Washington, DC. Wayne Psek was with the Milken Institute School of Public Health, George Washington University
| | - Wayne Psek
- At the time of this work, Megan C. Roberts, Jennifer L. Moss, and Christopher W. Wheldon were with the National Cancer Institute, Rockville, MD. Taylor Murphy was with George Washington University, Washington, DC. Wayne Psek was with the Milken Institute School of Public Health, George Washington University
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Exploring Facilitators and Barriers to Initiation and Completion of the Human Papillomavirus (HPV) Vaccine Series among Parents of Girls in a Safety Net System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020185. [PMID: 29360785 PMCID: PMC5858260 DOI: 10.3390/ijerph15020185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/29/2022]
Abstract
Objective: To assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated (NI) or not completed (NC) the HPV vaccine series, attitudes and other factors important in promoting the series, and whether attitudes differed by language preference. Design/Methods: From August 2013–October 2013, we conducted a mail survey among parents of girls aged 12–15 years randomly selected from administrative data in a Denver safety net system; 400 parents from each group (NI and NC) were targeted. Surveys were in English or Spanish. Results: The response rate was 37% (244/660; 140 moved or gone elsewhere; 66% English-speaking, 34% Spanish-speaking). Safety attitudes of NIs and NCs differed, with 40% NIs vs. 14% NCs reporting they thought HPV vaccine was unsafe (p < 0.0001) and 43% NIs vs. 21% NCs that it may cause long-term health problems (p < 0.001). Among NCs, 42% reported they did not know their daughter needed more shots (English-speaking, 20%, Spanish-speaking 52%) and 39% reported that “I wasn’t worried about the safety of the HPV vaccine before, but now I am” (English-speaking, 23%, Spanish-speaking, 50%). Items rated as very important among NIs in the decision regarding vaccination included: more information about safety (74%), more information saying it prevents cancer (70%), and if they knew HPV was spread mainly by sexual contact (61%). Conclusions: Safety concerns, being unaware of the need for multiple doses, and low perceived risk of infection remain significant barriers to HPV vaccination for at-risk adolescents. Some parents’ safety concerns do not appear until initial vaccination.
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Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, Perez S, Rosberger Z. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine 2017; 36:660-667. [PMID: 29289384 DOI: 10.1016/j.vaccine.2017.12.043] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The SAGE Working Group on Vaccine Hesitancy developed a vaccine hesitancy measure, the Vaccine Hesitancy Scale (VHS). This scale has the potential to aid in the advancement of research and immunization policy but has not yet been psychometrically evaluated. METHODS Using a cross-sectional design, we collected self-reported survey data from a large national sample of Canadian parents from August to September 2016. An online questionnaire was completed in English or French. We used exploratory and confirmatory factor analysis to identify latent constructs underlying parents' responses to 10 VHS items (response scale 1-5, with higher scores indicating greater hesitancy). In addition to the VHS, measures included socio-demographics items, vaccine attitudes, parents' human papillomavirus (HPV) vaccine decision-making stage, and vaccine refusal. RESULTS A total of 3779 Canadian parents completed the survey in English (74.1%) or French (25.9%). Exploratory and confirmatory factor analysis revealed a two-factor structure best explained the data, consisting of 'lack of confidence' (M = 1.98, SD = 0.72) and 'risks' (M = 3.07, SD = 0.95). Significant Pearson correlations were found between the scales and related vaccine attitudes. ANOVA analyses found significant differences in the VHS sub-scales by parents' vaccine decision-making stages (p < .001). Independent samples t-tests found that the VHS sub-scales were associated with HPV vaccine refusal and refusing another vaccine (p < .001). Socio-demographic differences in the VHS were found; however, effect sizes were small (η2 < 0.02). CONCLUSIONS The VHS was found to have two factors that have construct and criterion validity in identifying vaccine hesitant parents. A limitation of the VHS was few items that loaded on the 'risks' component and a lack of positively and negatively worded items for both components. Based on these results, we suggest modifying the wording of some items and adding items on risk perceptions.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Eve Dube
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada
| | - Barbel Knauper
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Samara Perez
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Québec, Canada
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Development and Validation of the Human Papillomavirus Attitudes and Beliefs Scale in a National Canadian Sample. Sex Transm Dis 2017; 43:626-32. [PMID: 27631357 DOI: 10.1097/olq.0000000000000506] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parents' human papillomavirus (HPV) vaccination decision-making is strongly influenced by their attitudes and beliefs toward vaccination. To date, psychometrically evaluated HPV vaccination attitudes scales have been narrow in their range of measured beliefs and often limited to attitudes surrounding female HPV vaccination. The study aimed to develop a comprehensive, validated and reliable HPV vaccination attitudes and beliefs scale among parents of boys. METHODS Data were collected from Canadian parents of 9- to 16-year-old boys using an online questionnaire completed in 2 waves with a 7-month interval. Based on existing vaccination attitudes scales, a set of 61 attitude and belief items were developed. Exploratory and confirmatory factor analyses were conducted. Internal consistency was evaluated with Cronbach's α and stability over time with intraclass correlations. RESULTS The HPV Attitudes and Beliefs Scale (HABS) was informed by 3117 responses at time 1 and 1427 at time 2. The HABS contains 46 items organized in 9 factors: Benefits (10 items), Threat (3 items), Influence (8 items), Harms (6 items), Risk (3 items), Affordability (3 items), Communication (5 items), Accessibility (4 items), and General Vaccination Attitudes (4 items). Model fit at time 2 were: χ/df = 3.13, standardized root mean square residual = 0.056, root mean square error approximation (confidence interval) = 0.039 (0.037-0.04), comparative fit index = 0.962 and Tucker-Lewis index = 0.957. Cronbach's αs were greater than 0.8 and intraclass correlations of factors were greater than 0.6. CONCLUSIONS The HABS is the first psychometrically-tested scale of HPV attitude and beliefs among parents of boys available for use in English and French. Further testing among parents of girls and young adults and assessing predictive validity are warranted.
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VanWormer JJ, Bendixsen CG, Vickers ER, Stokley S, McNeil MM, Gee J, Belongia EA, McLean HQ. Association between parent attitudes and receipt of human papillomavirus vaccine in adolescents. BMC Public Health 2017; 17:766. [PMID: 28969653 PMCID: PMC5625818 DOI: 10.1186/s12889-017-4787-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. This study examined the association between changes in parents’ vaccine attitudes and HPV vaccine receipt in their adolescent children. Methods A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11–17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties) from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents’ adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion. Results There were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents’ uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion. Conclusions Reductions in parents’ uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine’s safety profile.
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Affiliation(s)
- Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA.
| | - Casper G Bendixsen
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA
| | - Elizabeth R Vickers
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA
| | | | | | - Julianne Gee
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA
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13
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Clark SJ, Cowan AE, Filipp SL, Fisher AM, Stokley S. Understanding Non-Completion of the Human Papillomavirus Vaccine Series: Parent-Reported Reasons for Why Adolescents Might Not Receive Additional Doses, United States, 2012. Public Health Rep 2017; 131:390-5. [PMID: 27252558 DOI: 10.1177/003335491613100304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Completion rates of the human papillomavirus (HPV) vaccine series among U.S. adolescents are below public health targets. We explored parent-reported reasons for their children's non-completion of the HPV vaccine series using a nationally representative online survey of parents of children aged 9-17 years, fielded in October 2012. Among the 1,653 parents who responded, the proportion reporting that their child would definitely continue with the HPV vaccine series among those who had started the series ranged from 28% to 54%. The most common reason cited by parents for non-completion of the series was their child's fear of needles, followed by lack of awareness about additional doses and safety concerns. These findings demonstrate the need to encourage adoption of strategies addressing needle fears, utilize reminders for parents about subsequent doses, and emphasize recent HPV vaccine safety data in discussions with parents.
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Affiliation(s)
- Sarah J Clark
- University of Michigan, Child Health Evaluation and Research Unit, Ann Arbor, MI
| | - Anne E Cowan
- University of Michigan, Child Health Evaluation and Research Unit, Ann Arbor, MI
| | - Stephanie L Filipp
- University of Michigan, Child Health Evaluation and Research Unit, Ann Arbor, MI
| | - Allison M Fisher
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA
| | - Shannon Stokley
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA
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Perez S, Tatar O, Ostini R, Shapiro GK, Waller J, Zimet G, Rosberger Z. Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys. Prev Med 2016; 91:43-49. [PMID: 27471023 DOI: 10.1016/j.ypmed.2016.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/21/2022]
Abstract
As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, The University of Queensland, West Street, Toowoomba, Qld 4350, Australia
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
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15
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Palmer S, Pudwell J, Smith GN, Reid RL. Optimizing Participation of Pregnant Women in Clinical Trials: Factors Influencing Decisions About Participation in Medication and Vaccine Trials. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:945-954. [PMID: 27720094 DOI: 10.1016/j.jogc.2016.04.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To obtain information on women's attitudes and opinions about participation in vaccine and medication trials during pregnancy. METHODS A quantitative, cross-sectional survey was administered to 110 consenting women over a four-week period in the waiting room of an ambulatory obstetrics and gynaecology clinic in Ontario. RESULTS The final response rate was 74.8%, with the majority of participants agreeing with statements about the importance of obtaining safety data about products in pregnancy and the importance of a woman having the ability to choose whether to participate in such research. Of all participants, 16.3% indicated they would consider participating in vaccine research during pregnancy and 20.0% would consider participating in medication research during pregnancy. Factors relating to maternal or fetal/child health were the most frequently cited factors influencing willingness to participate, with lack of trust in researchers and pharmaceutical companies as factors that would discourage participation. CONCLUSION A minority of pregnant women were willing to consider participating in medication or vaccine research during pregnancy. Optimizing participation requires providing women (and if appropriate, their partners) with detailed, multidisciplinary education about the maternal and fetal benefits and risks of such trials. Education about the principles of research ethics, including the limits of involvement of pharmaceutical companies, would be beneficial.
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Affiliation(s)
- Sophie Palmer
- Queen's School of Medicine, Faculty of Health Sciences, Queen's University, Kingston ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Queen's University, Kingston ON
| | - Graeme N Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Heath Sciences, Queen's University, Kingston ON
| | - Robert L Reid
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University, Kingston ON
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Abdullahi LH, Kagina BM, Cassidy T, Adebayo EF, Wiysonge CS, Hussey GD. Knowledge, attitudes and practices on adolescent vaccination among adolescents, parents and teachers in Africa: A systematic review. Vaccine 2016; 34:3950-60. [PMID: 27289251 DOI: 10.1016/j.vaccine.2016.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/18/2016] [Accepted: 06/03/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Vaccines are the most successful and cost-effective public health interventions available to avert vaccine-preventable diseases and deaths. Despite global progress in adolescent health, many adolescents in Africa still get sick and die from vaccine-preventable diseases due to lack of vaccination. Adolescents, parents and teachers are key players in the development and implementation of adolescent vaccination policies. Optimal knowledge, attitudes and practices towards adolescent vaccination among these key players may improve vaccine uptake among adolescents. We conducted a qualitative and quantitative systematic review on knowledge, attitudes and practices of adolescent vaccination among adolescents, parents and teachers in Africa. METHODS We searched PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, WHOLIS, Africa Wide and CINAHL for eligible quantitative and qualitative primary studies with no time limits. We also checked reference lists of included studies for eligible studies and searched grey literature. Two authors independently screened the search outputs, selected studies and extracted data; resolving discrepancies by consensus and discussion. Qualitative data were analysed using thematic analyses where applicable, while analyses from quantitative studies used different methods based on the type of outcomes. RESULTS We included 18 cross-sectional studies in this review. The included studies were conducted in 10 out of the 54 countries in Africa. The 18 studies focused on a wide range of adolescent vaccines. Thirteen studies evaluated vaccines against Human Papilloma Virus, while each of the remaining 5 studies, evaluated vaccines against rabies, HIV, tetanus toxoid, tuberculosis and adolescent vaccines in general. Among the key players, we found low to moderate levels of knowledge about adolescent vaccination. Positive attitudes and practices towards adolescent vaccination, especially against Human Papilloma Virus were reported. Despite the low knowledge, our results showed high levels of acceptability to adolescent vaccination among adolescents, parents and teachers. CONCLUSIONS It was evident in our review that all key demographics (parents, adolescents and teachers) were receptive towards adolescent vaccines. We propose relevant policy makers in Africa to consider continuous education programs such as those aimed to inform the parents, adolescents and teachers on adolescent vaccination.
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Affiliation(s)
- Leila H Abdullahi
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa
| | - Tali Cassidy
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Esther F Adebayo
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa
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Reiter PL, McRee AL, Katz ML, Paskett ED. Human Papillomavirus Vaccination Among Young Adult Gay and Bisexual Men in the United States. Am J Public Health 2015; 105:96-102. [PMID: 25393178 DOI: 10.2105/ajph.2014.302095] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We examined human papillomavirus (HPV) vaccination among gay and bisexual men, a population with high rates of HPV infection and HPV-related disease. Methods. A national sample of gay and bisexual men aged 18 to 26 years (n = 428) completed online surveys in fall 2013. We identified correlates of HPV vaccination using multivariate logistic regression. Results. Overall, 13% of participants had received any doses of the HPV vaccine. About 83% who had received a health care provider recommendation for vaccination were vaccinated, compared with only 5% without a recommendation (P < .001). Vaccination was lower among participants who perceived greater barriers to getting vaccinated (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.27, 0.78). Vaccination was higher among participants with higher levels of worry about getting HPV-related disease (OR = 1.54; 95% CI = 1.05, 2.27) or perceived positive social norms of HPV vaccination (OR = 1.57; 95% CI = 1.02, 2.43). Conclusions. HPV vaccine coverage is low among gay and bisexual men in the United States. Future efforts should focus on increasing provider recommendation for vaccination and should target other modifiable factors.
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Affiliation(s)
- Paul L Reiter
- Paul L. Reiter and Electra D. Paskett are with the Division of Cancer Prevention and Control, College of Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus. Annie-Laurie McRee and Mira L. Katz are with the Division of Health Behavior and Health Promotion, College of Public Health and the Comprehensive Cancer Center, Ohio State University
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Rickert VI, Rehm SJ, Aalsma MC, Zimet GD. The role of parental attitudes and provider discussions in uptake of adolescent vaccines. Vaccine 2014; 33:642-7. [PMID: 25529293 DOI: 10.1016/j.vaccine.2014.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/24/2014] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine the relationship between parental vaccine attitudes, the number of specific vaccines discussed with a provider, and immunization outcomes including discussing immunization with their teen, knowledge of adolescent vaccine schedule, and their son or daughter being up-to-date on recommended vaccines using a nationally weight sample. Parents completed an internet-based survey between December 2012 and January 2013 and we computed a vaccine attitude scale (higher scores indicating stronger and more positive attitudes toward vaccination of teen) for each parent and categorized them into one of three groups: low (n=76), medium (n=207) or high (n=215). We also constructed a vaccine discussion scale representing the number of vaccines discussed with their adolescent's physician. Parents who were identified as having high vaccine attitudes were significantly more likely to report their physician talked with them about a particular vaccine. Using logistic regression and controlling for respondent's gender and age, income, and teen's gender, we found medium as compared to low-attitude parents had a 6.21 (95%CI=3.08, 12.51) greater odds of reporting that their teen had all recommended vaccines. Similarly, high as compared to low-attitude parents reported a 23.02 (95% CI=11.27, 46.99) greater odds of having a teen who was up-to-date on recommended vaccines. We detected that for each additional vaccine discussed, there was a 1.24 (95%CI=1.11, 1.39) increase in odds of the teen having all recommended vaccines. Parental immunization attitudes and provider discussion about vaccines are key ingredients to improving immunization rates among adolescents. While some parents may be reluctant to immunize their son or daughter with a recommended vaccine, vaccine-specific discussions between physicians and parents represent an important first step to continued discussions with providers regarding vaccination. Moreover, vaccine discussions must occur within the context of ongoing conversations about health and disease prevention.
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Affiliation(s)
- Vaughn I Rickert
- Indiana University School of Medicine, Indianapolis, IN, United States.
| | | | - Matthew C Aalsma
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gregory D Zimet
- Indiana University School of Medicine, Indianapolis, IN, United States
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Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, Taylor VM, Bastani R. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine 2014; 33:289-93. [PMID: 25434792 DOI: 10.1016/j.vaccine.2014.11.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/29/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022]
Abstract
Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Jennifer Tsui
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Rita Singhal
- Office of Women's Health, Los Angeles County Department of Public Health, 3400 Aerojet, 3rd Floor, El Monte, CA 91731-2803, USA.
| | - Leah Sanchez
- Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - L Cindy Chang
- Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, (M3-B232), Seattle, WA 98109-4433, USA.
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Abdullahi LH, Kagina BM, Cassidy T, Adebayo EF, Wiysonge CS, Hussey GD. Knowledge, attitudes and practices on adolescent vaccination among parents, teachers and adolescents in Africa: a systematic review protocol. Syst Rev 2014; 3:100. [PMID: 25200458 PMCID: PMC4161692 DOI: 10.1186/2046-4053-3-100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccines are the most successful and cost-effective public health interventions available to avert vaccine-preventable diseases and deaths. Despite progress in the field of adolescent health, many young people in Africa still get sick and die from vaccine-preventable diseases due to lack of vaccination. Parents, adolescents and teachers are key players with regard to implementation of adolescent vaccination policies. Therefore, understanding their knowledge, attitudes and practices towards adolescent vaccination may provide clues on what can be done to improve vaccine uptake among adolescents. The aim of this study is to conduct a qualitative and quantitative systematic review on knowledge, attitudes and practices on adolescent vaccination among parents, teachers and adolescents in Africa. METHODS We will include both quantitative and qualitative primary studies. Eligible quantitative studies include both intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, in-depth interviews and case ethnographic studies. We will search PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, WHOLIS, Africa Wide and CINAHL for eligible studies with no time and language limits. We will also check reference lists of included studies for other eligible reports. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. We will analyse qualitative data using thematic analysis where applicable, and quantitative studies findings will be presented in a narrative synthesis form based on the outcomes. DISCUSSION The findings from this systematic review will guide the identification of gaps on knowledge, attitudes and practices among the key role players on adolescent vaccination. We anticipate that our findings will guide the development of adolescent-focused vaccination policy in Africa, which is virtually non-existent at present. SYSTEMATIC REVIEW REGISTRATION This review is registered with PROSPERO, registration number CRD42014010395.
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Affiliation(s)
- Leila H Abdullahi
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Tali Cassidy
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Esther F Adebayo
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care and Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7925, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town 7925, South Africa
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Dempsey AF, Fuhrel-Forbis A, Konrath S. Use of the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) in young adult women. PLoS One 2014; 9:e100193. [PMID: 24945630 PMCID: PMC4063751 DOI: 10.1371/journal.pone.0100193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Validated measures that can accurate describe young adults' HPV vaccination attitudes and how these relate to vaccination intention and receipt are needed for developing interventions to improve low HPV vaccination levels. The Carolina HPV Immunization Attitudes Scale (CHIAS) is a validated measure of these outcomes that was originally designed for parents. OBJECTIVE To assess the performance of the CHIAS among young adult women using an exploratory factor analysis. METHODS A convenience sample of 139 young adult women (age 18-26 years) were given the CHIAS measure at baseline. Factor analysis was used to determine attitudinal factor groupings and the association of these factors with HPV vaccination intention. A 6-month follow up assessment examined the stability of the CHIAS over time and the association of baseline vaccine factors with vaccine receipt. RESULTS Five factors loaded on to the CHIAS in young adults - "Barriers," "Harms," "Effectiveness," "Risk Denial" and "Uncertainty," - which was similar to the factor loadings of CHIAS for parents. "Harms" was the factor most consistently associated with vaccination intention at all time points assessed. Only 5 women had received or made an appointment to receive the vaccine at the 6-month follow-up. CONCLUSIONS In terms of categorizing HPV vaccination attitudes, the CHIAS appears to have similar performance among young adults as in parents. However, additional studies are needed to assess the utility of the CHIAS for predicting HPV vaccine receipt among the young adult population.
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Affiliation(s)
- Amanda F. Dempsey
- Children’s Outcomes Research Program, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Andrea Fuhrel-Forbis
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sara Konrath
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
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22
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Patel A, Stern L, Unger Z, Debevec E, Roston A, Hanover R, Morfesis J. Staying on track: a cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion. Vaccine 2014; 32:2428-33. [PMID: 24631099 DOI: 10.1016/j.vaccine.2014.02.095] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate whether automated reminders increase on-time completion of the three-dose human papillomavirus (HPV) vaccine series. METHODS Ten reproductive health centers enrolled 365 women aged 19-26 to receive dose one of the HPV vaccine. Health centers were matched and randomized so that participants received either routine follow-up (control) or automated reminder messages for vaccine doses two and three (intervention). Intervention participants selected their preferred method of reminders - text, e-mail, phone, private Facebook message, or standard mail. We compared vaccine completion rates between groups over a period of 32 weeks. RESULTS The reminder system did not increase completion rates, which overall were low at 17.2% in the intervention group and 18.9% in the control group (p=0.881). Exploratory analyses revealed that participants who completed the series on-time were more likely to be older (OR=1.15, 95% CI 1.01-1.31), report having completed a four-year college degree or more (age-adjusted OR=2.51, 95% CI 1.29-4.90), and report three or more lifetime sexual partners (age-adjusted OR=3.45, 95% CI 1.20-9.92). CONCLUSIONS The study intervention did not increase HPV vaccine series completion. Despite great public health interest in HPV vaccine completion and reminder technologies, completion rates remain low.
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Affiliation(s)
- Ashlesha Patel
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States; Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Lisa Stern
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Zoe Unger
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Elie Debevec
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Alicia Roston
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Rita Hanover
- Westport Compass, 3011 S. Plateau, Salt Lake City, UT 84109, United States.
| | - Johanna Morfesis
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
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23
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Porter CK, Fitamaurice G, Tribble DR, Armstrong AW, Mostafa M, Riddle MS. Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment. Hum Vaccin Immunother 2013; 9:2613-7. [PMID: 23917256 DOI: 10.4161/hv.25910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this population.
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Affiliation(s)
- Chad K Porter
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
| | - Gina Fitamaurice
- George Washington University; School of Public Health and Health Services; Washington, DC USA
| | - David R Tribble
- Infectious Diseases Clinical Research Program; Uniformed Services University; Bethesda, MD USA
| | | | - Manal Mostafa
- United States Naval Medical Research Unit No. 3; Cairo, Egypt
| | - Mark S Riddle
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
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Post Approval Human Papillomavirus Vaccine Uptake Is Higher in Minorities Compared to Whites in Girls Presenting for Well-Child Care. Vaccines (Basel) 2013; 1:250-61. [PMID: 26344111 PMCID: PMC4494229 DOI: 10.3390/vaccines1030250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 06/08/2013] [Accepted: 07/11/2013] [Indexed: 11/17/2022] Open
Abstract
Since introduction of the human papillomavirus (HPV) vaccine, there remains low uptake compared to other adolescent vaccines. There is limited information postapproval about parental attitudes and barriers when presenting for routine care. This study evaluates HPV vaccine uptake and assesses demographics and attitudes correlating with vaccination for girls aged 11–12 years. A prospective cohort study was performed utilizing the University of Virginia (UVA) Clinical Data Repository (CDR). The CDR was used to identify girls aged 11–12 presenting to any UVA practice for a well-child visit between May 2008 and April 2009. Billing data were searched to determine rates of HPV vaccine uptake. The parents of all identified girls were contacted four to seven months after the visit to complete a telephone questionnaire including insurance information, child’s vaccination status, HPV vaccine attitudes, and demographics. Five hundred and fifty girls were identified, 48.2% of whom received at least one HPV vaccine dose. White race and private insurance were negatively associated with HPV vaccine initiation (RR 0.72, 95% CI 0.61–0.85 and RR 0.85, 95% CI 0.72–1.01, respectively). In the follow-up questionnaire, 242 interviews were conducted and included in the final cohort. In the sample, 183 (75.6%) parents reported white race, 38 (15.7%) black race, and 27 (11.2%) reported other race. Overall 85% of parents understood that the HPV vaccine was recommended and 58.9% of parents believed the HPV vaccine was safe. In multivariate logistic regression, patients of black and other minority races were 4.9 and 4.2 times more likely to receive the HPV vaccine compared to their white counterparts. Safety concerns were the strongest barrier to vaccination. To conclude, HPV vaccine uptake was higher among minority girls and girls with public insurance in this cohort.
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Abstract
Parental vaccine hesitancy is a growing problem affecting the health of children and the larger population. This article describes the evolution of the vaccine hesitancy movement and the individual, vaccine-specific and societal factors contributing to this phenomenon. In addition, potential strategies to mitigate the rising tide of parent vaccine reluctance and refusal are discussed.
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Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases; University of Pennsylvania; Philadelphia, PA USA
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26
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Gollust SE, Attanasio L, Dempsey A, Benson AM, Fowler EF. Political and news media factors shaping public awareness of the HPV vaccine. Womens Health Issues 2013; 23:e143-51. [PMID: 23557851 DOI: 10.1016/j.whi.2013.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2006, the U.S. Food and Drug Administration licensed a vaccine for the human papillomavirus (HPV) that prevents the strains of HPV that cause 70% of cervical cancers. Within months, many states introduced legislation requiring the vaccine for girls, prompting controversy and heightened political and media attention to the issue. Previous research has shown differences in HPV vaccine awareness by individual-level characteristics such as race/ethnicity, income, and education levels. We examined how individual political orientation and exposure to media coverage can also shape awareness of the vaccine. METHODS Using data from a 2009 Internet survey of 1,216 nationally representative adult respondents linked to data on state-specific news coverage, we assessed how political orientation, media exposure, and state political context predicted HPV vaccine awareness. RESULTS Younger people, women, and those with more education were significantly more likely to be aware of the vaccine. Even after controlling for these characteristics, we found that exposure to news media was associated with higher HPV vaccine awareness. Whereas liberals and conservatives were both more aware of the vaccine compared with moderates, the data are suggestive that liberals were more sensitive to news coverage. CONCLUSION These findings suggest that individual-level political identities and their interaction with the informational environment may be important factors to consider in evaluating the determinants of individuals' attitudes and behaviors related to politically charged women's health issues.
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Affiliation(s)
- Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota 55455, USA.
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