Indiana Parental Perceptions of the Acceptability of General and HPV-Specific State Vaccine Requirements.

State vaccine requirements are a tool for improving child and adolescent vaccination immunization coverage, but to be effective, parental buy-in is needed. The objective of this study was to assess the demographic, healthcare characteristics, and health beliefs associated with parental acceptance of general and HPV-specific state vaccine requirements. Indiana parents (N = 601) with children ages 11-17 years old completed a survey during March 2020.Results showed that 47.2% and 43.1% of parents believed there should always be general and HPV-specific state vaccine requirements, respectively. In multivariable analysis, higher odds of parental support for general state vaccine requirements were associated with being unsure whether HPV-associated cancer is a problem in the participant's county and having higher perceived benefits of HPV vaccines. Lower odds were associated with private insurance, having less than a bachelor's degree, and having less confidence in vaccines. In comparison, parents had higher odds of agreeing with HPV-specific state vaccine requirements if they reported higher interpersonal altruism and higher perceived benefits of HPV vaccines; they had lower odds if they were non-Hispanic White. Findings indicate that while similar percentages of parents agreed with general and HPV-specific state vaccine requirements, there were different characteristics associated with acceptance of each. Results can inform the development of tailored interventions for improving parental support for general and HPV-specific state vaccine requirements.

The association between maternal human papillomavirus (HPV) experiences and HPV vaccination of their children.

HPV vaccination prevents most HPV-related cancers yet vaccination rates remain low. In this cross-sectional study, we examined the association between maternal HPV experiences and HPV vaccination uptake among children and whether this association may be explained by perceived benefits of vaccination. We used logistic regression models to estimate the effect of (1) maternal history of abnormal Pap smear, (2), family/friend history of cervical cancer, and (3) maternal history of cervical cancer on HPV vaccination uptake among children. Separate mediation analyses were conducted to determine if perceived benefits mediated the relationship between each maternal HPV experience and HPV vaccination uptake. History of abnormal Pap smear (OR = 1.50, 95% CI = 1.15, 1.97), family history of cervical cancer (OR = 1.72, CI = 1.26, 2.35), and personal history of cervical cancer (OR = 3.00, CI = 1.82, 4.95) predicted HPV vaccination of children. Perceived benefits mediated the relationship between history of abnormal Pap smear (indirect effect =.146, SE =.069, 95% CI =.014, .289), family history of cervical cancer (indirect effect =.228, SE =.079, CI =.080, .387), and personal history of cervical cancer (indirect effect =.298, SE =.116, CI =.082, .533) on HPV vaccination. Our results suggest that personal experiences with HPV-related disease may influence maternal HPV vaccine decision-making.

A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States.

The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.

Provider Communication and Mothers' Willingness to Vaccinate Against Human Papillomavirus and Influenza: A Randomized Health Messaging Trial.

OBJECTIVE: To understand the effect of a health messaging intervention focused on provider communication about vaccination on mothers' willingness to vaccinate children against human papillomavirus (HPV) and seasonal influenza. METHODS: A total of 2476 mothers of 9- to 13-year-olds in the United States completed a Web-based survey in August 2014. Mothers were randomized to 1 of 2 groups targeting HPV or influenza vaccine. Mothers whose child had not received the target vaccine (ie, zero doses of HPV vaccine/no prior-year administration of influenza vaccine) were randomized to the intervention. The study used a 3 × 2 between-subjects design; illustrated vignettes depicted 1 of 3 levels of provider recommendation strength (brief mention of vaccination, strong recommendation of vaccination, or personal disclosure of vaccination of own children), and presence or absence of information comparing safety of vaccination to the safety of a common daily activity. Outcome was mothers' willingness to have their child receive the target vaccine. Perceived benefits of vaccination were assessed before viewing the intervention and were included as a covariate in analyses, along with child gender. RESULTS: For HPV vaccine, there was a main effect of safety information (F(1,684) = 7.99, P = .005) and perceived benefits of vaccination (F(1,684) = 221.64, P < .001) on mothers' willingness to vaccinate. For influenza, perceived benefits of vaccination significantly related to willingness to vaccinate (F(1,462) = 105.78, P < .001). Child gender was not associated with willingness. CONCLUSIONS: Provider communication about vaccination may need to be tailored to the vaccine in question. A next step to increasing coverage for both HPV and influenza vaccines may be an intervention aimed at increasing mothers' perceived benefits of vaccination.

Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings.

PURPOSE: We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits. METHODS: Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians. RESULTS: Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32-34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72-415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children. CONCLUSIONS: Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.

Human Papillomavirus Vaccine Initiation among 9-13-Year-Olds in the United States.

OBJECTIVE: The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9-26-year-old males and females, with routine vaccination recommended for 11-12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13-17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9-13-year-olds in the United States. METHODS: A national sample of mothers of 9-13-year-olds in the United States (N=2,446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). RESULTS: Approximately 35% of the full sample and 27.5% of the 9-10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. CONCLUSIONS: Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage.

Effectiveness of asking anticipated regret in increasing HPV vaccination intention in mothers.

OBJECTIVE: To determine the effectiveness of asking Anticipated Regret Questions (ARQ) and risk presentation format on enhancing attitudes and behavioral intentions of mothers to have their daughters receive the HPV vaccine. DESIGN: The study used a 2 × 2 between-subjects factorial design with a no message control, involving 2 anticipated regret conditions (asked or not asked) and HPV risk presentation format (text only or graphical presentation of risk). Data were collected from a national sample of 320 mothers of girls ages 11-16. MAIN OUTCOME VARIABLES: The primary outcome variable was mothers' intention to vaccinate their daughters with all 3 doses of the HPV shots. Message involvement, perceived ease of message comprehension, and health beliefs regarding HPV infection and the HPV vaccine were also measured. RESULTS AND CONCLUSIONS: Results indicated there was a significant interactive effect of asking anticipated regret and risk presentation format on message involvement and behavioral intention. ARQ positively influenced behavioral intention only among mothers exposed to the graphical presentation of HPV-related statistics. This effect was mediated by message involvement. Thus, the combined effect of the graphical message and anticipated-regret questions on behavioral intentions was mediated by increased emotional involvement with the information concerning cervical cancer and HPV vaccination. These findings are consistent with the view that the formation of health-behavior intentions often involves the interplay of both affective and cognitive processing.

Adult women's attitudes toward the HPV vaccine.

AIMS: Two human papillomavirus (HPV) vaccines have demonstrated efficacy in preventing HPV infection and are currently being administered to adolescent girls in several countries. Although the most efficient HPV prevention strategy is immunizing adolescents before there is any risk of exposure, adult women also may benefit from vaccination. This study aimed to explore the attitudes of women aged 27-55 years toward the HPV vaccine. METHODS: Thirty-eight women were recruited from a university-based gynecological practice, completed a demographic questionnaire, and then were interviewed. RESULTS: Most participants had heard about the vaccine and were positive about the HPV vaccine for adult women. Women advocated universal access to this vaccine, indicating that all women should have the option. They assessed their risk level in several ways, including level of monogamy, relationship status, previous sexual risk behaviors, history of an abnormal Pap smear, and family history. All but 2 woman described barriers to vaccination, including cost, side effects, and hassle factors. Most women did not believe the vaccine would change risk behaviors. CONCLUSIONS: The women from this convenience sample knew the HPV vaccine existed and in general found it acceptable. If an HPV vaccine becomes available to adult women, healthcare professionals will be faced with the challenge of providing accurate information, being sensitive and willing to help each individual woman make a decision, and being creative when developing new ways to eliminate barriers to getting the vaccine.

Behavioral interventions to increase HPV vaccination acceptability among mothers of young girls.

OBJECTIVE: To determine the most effective ways to present human papillomavirus (HPV) vaccine risk and benefit information to mothers in Hispanic, African American, and White communities, to increase mothers' intentions to vaccinate their daughters against HPV. DESIGN: The study used a 3 x 2 between-subjects factorial design, involving 3 different risk presentation formats (graphical HPV statistics, nongraphical HPV statistics, or no-statistics control) and the presence or absence of rhetorical questions (RQ). Data were collected from a national sample of 471 mothers of girls ages 11-16. MAIN OUTCOME VARIABLES: The primary outcome variable was mothers' intention to vaccinate their daughters against HPV. Secondary outcomes included mothers' self-reported message comprehension and perceptions of daughters' vulnerability to HPV infection, infection severity, vaccine efficacy, and obstacles to immunization. RESULTS AND CONCLUSION: Results showed that both risk presentation format and RQs had an overall positive effect on mothers' intention to vaccinate their daughters. However, the interventions appear to be more effective when used separately than when used in combination. Each of these interventions is brief and could easily be implemented by health care providers as well as in patient health communication literature.

Literature review of human papillomavirus vaccine acceptability among women over 26 years.

Vaccines for the human papillomavirus (HPV) are currently licensed for females, ages 9 through 26 years old in the U.S., and for adult women up to 45 years in some countries such as Australia. As licensure for adult women, over 26 years, is sought in other countries, it will be important to determine the acceptability to them. We reviewed the available articles on adult opinions and acceptability of vaccinating women against HPV. Predictors of acceptability included barriers, knowledge, risk, age, and marital status. Overall, acceptability rates were high, if adequate information was given and the cost was affordable.

Acceptability of the human papillomavirus vaccine among Latina mothers.

STUDY OBJECTIVE: To describe Latina mothers' acceptance of the human papillomavirus (HPV) vaccine for their daughters and explore their knowledge base regarding HPV-related issues. DESIGN: Individual interviews were conducted with a convenience sample of 40 Latina mothers of daughters 7-14 years old, from an urban, pediatric primary care clinic. Preliminary questions were asked regarding HPV knowledge and then information was verbally provided before exploring vaccine acceptance. RESULTS: Thirty-one of the Latina mothers had not heard of HPV and 34 were not aware of the connection between HPV and cervical cancer. Thirty-two mothers reported that they would allow their daughters to receive the HPV vaccine. Two overarching themes were identified as reasons for accepting the vaccine. The main theme for vaccine acceptance provided by 26 mothers was "to prevent disease." The other theme was "to protect" their child. Four mothers were undecided and 4 reported they would not vaccinate their daughter. The two themes identified from this group of mothers include not having sufficient information regarding the vaccine, and that their daughters are too young. CONCLUSION: Acceptance of the HPV vaccine was high in this sample of Latina mothers. The prevention of disease and the protection of their child were the motivating factors for vaccinating their daughters. Reasons for not accepting include lack of information and young age of daughter. The provision of information will be key to ensuring Latina mothers understand the rationale for vaccinating at a young age.

Parental perspectives on vaccinating children against sexually transmitted infections.

Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents' risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies. This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents.