How Parents Hear About Human Papillomavirus Vaccine: Implications for Uptake

doi:10.1016/j.jadohealth.2010.04.003

Journal of Adolescent Health

Volume 47, Issue 3, September 2010, Pages 305-308

https://doi.org/10.1016/j.jadohealth.2010.04.003 Get rights and content

Abstract

Purpose

To examine correlates of human papillomavirus (HPV) vaccine awareness and information sources in a state requiring schools to inform parents about HPV vaccine.

Methods

Telephone survey of a North Carolina population-based sample of 696 parents of females aged 10–17 years about HPV vaccine awareness and information sources (daughters' schools, healthcare provider, drug company advertisements, news stories) was conducted.

Results

Overall, 91% of parents had heard of HPV vaccine. Parents were more likely to be aware if they had household incomes of $50,000 or higher, were women, had non-Hispanic white daughters, or had daughters vaccinated against meningitis. Information sources included drug company advertisements (64%), healthcare providers (50%), news stories (50%), and schools (9%). Only parents who heard from their children's healthcare providers were more likely to initiate HPV vaccine for their daughters.

Conclusions

Parents had rarely heard of the vaccine through schools. The only source associated with vaccine initiation was hearing from a healthcare provider.

Section snippets

Methods

Participants were a population-based sample of 696 parents of 10–17-year-old females in North Carolina. They completed the 2008 Child Health Assessment and Monitoring Program Survey of caregivers for children aged <18 years, a follow-up survey to the Behavioral Risk Factor Surveillance System survey of adults [8].

The survey assessed parents' HPV vaccine awareness with the question, “Have you ever heard of the HPV vaccine?” For parents who had heard of it, questions assessed whether they had

Results

Most parents (91%) reported having heard of HPV vaccine. In multivariate analyses, parents were less likely to be aware of HPV vaccine if they were male, or had daughters who were non-Hispanic African-American or other races/ethnicities than non-Hispanic white (Table 1). Vaccine awareness was higher among parents from households with incomes of $50,000 or higher versus less than $50,000, or who reported having daughters already vaccinated against meningitis.

Of parents who had heard of HPV

Discussion

How parents of adolescent girls heard about HPV vaccine varied substantially in this population-based survey. Although awareness was nearly universal among parents with higher income or white daughters, many parents with lower income or non-white daughters had not heard of HPV vaccine. Differential consumption of news about HPV vaccine is one potential explanation for differences in vaccine awareness [1]. Most parents had heard through drug company advertising, healthcare providers, and news

Acknowledgments

This study was supported by grants from the Centers for Disease Control and Prevention (S3715-25/25), Cancer Control Education Program at Lineberger Comprehensive Cancer Center (R25 CA57726), and American Cancer Society (MSRG-06-259-01-CPPB). The authors thank Donna Miles, James Cassell, Harry Herrick, Bob Woldman, and the staff at the North Carolina State Center for Health Statistics for their assistance.

References (10)

M.A. Gerend et al.
Parental response to human papillomavirus vaccine availability: Uptake and intentions
J Adolesc Health
(2009)
M.L. Katz et al.
Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia
Vaccine
(2009)
A.F. Dempsey et al.
Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus
Ann Epidemiol
(2009)
S.L. Gottlieb et al.
Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer
J Adolesc Health
(2009)
J. Hughes et al.
Disparities in how parents are learning about the human papilloma virus vaccine
Cancer Epidemiol Biomarkers Prev
(2009)

There are more references available in the full text version of this article.

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Provider communication and HPV vaccine uptake: A meta-analysis and systematic review
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Citation Excerpt :
We also stratified the publication bias analyses for variables identified in the moderation analysis. We identified 59 eligible studies that reported provider communication and HPV vaccine uptake (n = 265,083) (Bednarczyk et al., 2011; Bednarczyk et al., 2017; Berenson et al., 2017; Bhatta and Phillips, 2015; Brewer et al., 2011; Buechel and Connelly, 2018; Casey et al., 2013; Caskey et al., 2009; Cates et al., 2010; Cherven et al., 2019; Colón-López et al., 2016; Curtis et al., 2014; Daley et al., 2010; Donahue et al., 2015; Flores et al., 2019; Fu et al., 2017; Gargano et al., 2013; Gerend et al., 2016a; Gerend et al., 2016b; Gerend et al., 2019; Gerend et al., 2009; Gerend et al., 2013; Gilkey et al., 2016; Gorbach et al., 2017; Gottlieb et al., 2009; Guerry et al., 2011; Hoffman et al., 2012; Klosky et al., 2013; Klosky et al., 2015a; Klosky et al., 2017; Klosky et al., 2015b; Kramer and Dunlop, 2012; Krawczyk et al., 2012; Marchand et al., 2012; McRee et al., 2014; Rahman et al., 2015; Reiter et al., 2014; Reiter et al., 2009; Reiter et al., 2013a; Reiter et al., 2013b; Rosenthal et al., 2011; Savas et al., 2012; Sturm et al., 2017; Suryadevara et al., 2016; Vu et al., 2019; Williams et al., 2013; Wilson et al., 2016; The 2008 National Immunization Survey-Teen, 2009; The 2009 National Immunization Survey-Teen, 2010; The 2010 National Immunization Survey-Teen, 2011; The 2011 National Immunization Survey-Teen, 2012; The 2012 National Immunization Survey-Teen, 2013; The 2013 National Immunization Survey-Teen, 2014; The 2014 National Immunization Survey-Teen, 2015; The 2015 National Immunization Survey-Teen, 2016; The 2016 National Immunization Survey-Teen. U.S, 2017; The 2017 National Immunization Survey-Teen, 2018; The 2018 National Immunization Survey-Teen, 2019; Gold et al., 2013). The majority of studies (68%) had less than 2000 participants (Table 1).
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6–13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3–24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China
2021, Vaccine
Human papillomavirus (HPV) vaccine has been increasingly discussed in mainland China since its first approval in 2016. To date, nearly all studies assessing HPV vaccine perceptions and attitudes were implemented during pre-licensure period. Therefore, the nationwide post-marketing survey was conducted to update knowledge, attitudes and practice on HPV vaccine among general population in mainland China.
Participants aged 18–45 years living in mainland China were recruited in April 2019 by multi-stage non-randomized sampling. Sociodemographic factors, HPV and HPV vaccine related awareness, knowledge, attitudes, vaccine uptake and potential obstacles were assessed in questionnaires. Bivariate analysis and multivariate regression were used to identify disparity among subgroups with different sociodemographic characteristics.
4,000 women (32.1 ± 7.81y) and 1,000 men (31.8 ± 7.96y) were included in final analysis. Less than one third of participants had heard of HPV (female: 31%; male: 22%) and HPV vaccine (female: 34%; male: 23%). Knowledge score was also unfavorable on HPV (female: 3 out of 13; male: 1.8 out of 13) and HPV vaccine (female: 3 out of 6; male: 2 out of 5). Only 3% females had been vaccinated three years after HPV licensure in China, although willingness to get vaccinated among those unvaccinated were high (mean willingness score ± SD: female: 3.3 ± 0.97; male: 3.0 ± 0.98). Industry of employment and household income were the major factors related to awareness and knowledge of vaccine, whereas HPV and HPV vaccine awareness were key influential factors for willingness. The main obstacles of vaccination were safety concerns, lack of knowledge, and high price of HPV vaccines.
Findings highlight a lack of vaccine awareness, knowledge, and poor uptake in mainland China and underscore the necessity of health education campaigns. The identified priority groups, contents to be delivered and practical obstacles could furthermore provide insight into health education to reduce disparities and accelerate HPV vaccine roll-out in China.
Parental HPV knowledge and perceptions of HPV vaccines among Korean American parents
2018, Applied Nursing Research
The purpose of this study was to examine Korean-Americans (KA) parents' level of knowledge and perceptions of the HPV vaccination, and to identify the differences in parental knowledge and perceptions of the HPV vaccine between KA parents who have vaccinated their children versus those who have not.
While there are significant concerns about HPV infection, lower immunization rates, and higher cervical cancer risks facing KAs, limited attention has been paid to the specific concerns of KA parents and barriers that underlie parental reluctance to vaccinate their children.
A descriptive comparative design was used in a convenience sample of 74 KA parents. The study questionnaire consisted of demographic items, general knowledge of HPV, and parental perception regarding HPV vaccination.
The level of general knowledge about HPV was very low with a mean score of 3.14 out of 10. Many participants reported negative perception toward HPV vaccination. HPV knowledge scores were not significantly different between parents who did vaccinate their children compared to parents who did not. However, scores for perceived benefits and perceived barriers to vaccination were found to be significantly different between the two groups.
A lack of knowledge about HPV and negative perception of the HPV vaccination play a key role in preventing many KA parents from seeking appropriate information and delaying vaccination. Development of a culturally grounded and sensitive HPV education program is critical to improve and implement preventive measures for HPV in this population.
Factors associated with the human papillomavirus (HPV) vaccination across three countries following vaccination introduction
2017, Preventive Medicine Reports
Direct international comparisons which aim to understand how factors associated with human papillomavirus (HPV) vaccine initiation and attitudes towards the HPV vaccination in parents differ are scarce. Parents (n = 179) of daughters aged 9–17 years in the US, UK and Australia completed an online survey in 2011 with questions measuring daughters' HPV vaccination status, HPV knowledge, HPV vaccination knowledge, and statements assessing attitude towards the HPV vaccine. The strongest factor associated with vaccination status across all countries was parental HPV knowledge (p < 0.001). Parents with both very low and very high knowledge scores were less likely to have vaccinated their daughters. Parents with higher HPV vaccination knowledge scores intended to vaccinate their daughters (if not already vaccinated) for protective reasons (p < 0.001), while those whose daughters were already vaccinated understood that vaccination protection was not 100% and that their daughters may still be at risk of getting HPV (p < 0.05). Compared to the UK and Australia, a higher proportion of parents with unvaccinated daughters from the US were worried about the side-effects of the HPV vaccination (US: 60.5%, UK: 36.4%, AUS: 15.4%; p < 0.05), believed that getting the vaccination might be a hassle (US: 21.1%, UK: 0%, AUS: 7.7%; p < 0.05), and that the vaccine was too new (US: 44.7%, UK: 22.7%, AUS: 7.7%; p < 0.05). This study adds to the understanding of how parents may influence vaccination uptake by demonstrating the effect of knowledge and the parental attitudes towards HPV vaccination across three countries.
Influence of Sources of Information and Parental Attitudes on Human Papillomavirus Vaccine Uptake among Adolescents
2016, Journal of Pediatric and Adolescent Gynecology
The purpose of this study was to: 1) describe parental sources of information about human papillomavirus (HPV) vaccination for adolescents, 2) understand how parental sources of information about HPV vaccine are associated with adolescent HPV vaccine uptake, and 3) understand if the relationship between a greater number of HPV-related information sources and HPV vaccine uptake among adolescents is mediated by parental attitudes.
We conducted a 3-arm randomized controlled trial in middle and high schools in eastern Georgia from 2011 to 2013. As part of the trial, we surveyed parents during the final year to understand their sources of information about HPV vaccine for their adolescent. Data were collected from 360 parents via phone and online surveys.
Parents responded to a survey that asked them to identify demographic information, parental HPV attitudes, sources of information about HPV vaccination, and HPV vaccine uptake.
Most of the sample was African American (74%; n = 267) and 53% of parents (n = 192) reported that their adolescent received at least 1 HPV vaccine dose. The top sources of information about HPV vaccine reported by parents were a doctor or medical professional (80%; n = 287) and television (64%; n = 232). A mediation analysis showed sources of information about HPV vaccine are associated with parental attitudes, and parental attitudes about HPV vaccine are associated with vaccine uptake among adolescents.
These findings highlight the importance of HPV sources of information on parental attitudes.
Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review
2016, Social Science and Medicine
Citation Excerpt :
Reimer et al. (2013) examined HPV vaccine uptake correlates among parents who completed the 2008 Child Health Assessment and Monitoring (CHAMP) survey for North Carolina and found that 31.3% of parents reported that their daughters had received at least 1 dose of the HPV vaccine. Cates et al. (2010) also analyzed the 2008 North Carolina CHAMP survey and found a similar vaccine initiation rate (31%). Importantly, 46% of those who had initiated the HPV vaccine reported to have heard about the HPV vaccine from a healthcare provider and these parents were more likely to vaccinate.
African-Americans and Latinos suffer the highest cervical cancer burden compared to other populations and have sub-optimal HPV vaccination rates.
To condense research findings of studies conducted with African-Americans and Latinos on factors associated with HPV vaccine acceptability and uptake.
Standards for conducting an integrative review were used. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases were searched.
Awareness about HPV and the HPV vaccine varied by demographics of parents. For Latino parents, acculturation and awareness were associated. However, findings were mixed regarding the association between acculturation and knowledge. Among African-Americans, higher socioeconomic status (SES) and awareness were associated. Sexuality-related concerns, concerns about safety and low perceived risk of daughter’s acquiring HPV emerged as barriers to vaccination among Latinos and African-Americans. Among Latinos, vaccine acceptability was associated with the vaccine’s cancer prevention benefits and a provider’s recommendation. Among African-Americans, acceptability was associated with awareness, perceived risk of acquiring HPV, religion, and a provider’s recommendation. Few interventions have been developed to increase HPV vaccine acceptance. Importantly, few studies assessed the influence of culture on vaccine acceptance and uptake.
Future research should be informed by culture-centered theories as this is the first step to inform the development of culturally-grounded interventions.

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Adolescent health briefHow Parents Hear About Human Papillomavirus Vaccine: Implications for Uptake

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

J Adolesc Health

Vaccine

Ann Epidemiol

J Adolesc Health

Disparities in how parents are learning about the human papilloma virus vaccine

Cancer Epidemiol Biomarkers Prev

Adolescent health brief
How Parents Hear About Human Papillomavirus Vaccine: Implications for Uptake