Gregory D. Zimet

Psychometric Characteristics of the Multidimensional Scale of Perceived Social Support

The initial study describing the development of the Multidimensional Scale of Perceived Social Support (MSPSS) indicated that it was a psychometrically sound instrument (Zimet, Dahlem, Zimet, & Farley, 1988). The current study attempted to extend the initial findings by demonstrating the internal reliability, factorial validity, and subscale validity of the MSPSS using three different subject groups: (a) 265 pregnant women, (b) 74 adolescents living in Europe with their families, and (c) 55 pediatric residents. The MSPSS was found to have good internal reliability across subject groups. In addition, strong factorial validity was demonstrated, confirming the three-subscale structure of the MSPSS: Family, Friends, and Significant Other. Finally, strong support was also found for the validity of the Family and Significant Other subscales.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Urban Adolescents

The psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) were investigated in 222 urban, largely African-American adolescents (68%). High internal consistency was demonstrated, and factor analysis confirmed the three subscale structures of the MSPSS: family, friends, and significant other. Correlations with a family caring scale supported the discriminant validity of the Family subscale. These results confirm the reliability, validity, and utility of the MSPSS with an urban, largely African-American adolescent sample. Implications of the findings are discussed.

Factors That Are Associated With Parental Acceptance of Human Papillomavirus Vaccines: A Randomized Intervention Study of Written Information About HPV

OBJECTIVES. Prophylactic vaccines against human papillomavirus (HPV) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children. Parental acceptance of these vaccines will be critical for their success. The objectives of this study were (1) to determine the overall acceptance of HPV vaccines for preadolescent children by parents, (2) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines, and (3) to identify independent predictors associated with HPV vaccine acceptability by parents. METHODS. A randomized intervention study within a cross-sectional survey was conducted. Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios. A self-administered survey on the knowledge, attitudes, and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children. In addition to a baseline paragraph about HPV that was received by all study participants, a random half of the study participants received a detailed “HPV Information Sheet” outlining the epidemiology and potential clinical sequelae of HPV infection. Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models. RESULTS. Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group. However, despite this apparent improvement in knowledge, there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups. CONCLUSIONS. Providing parents with an HPV information sheet did seem to improve knowledge about HPV, but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children. Instead, attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents.

Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation.

Among insured women, aged 19-26 years, those who discussed the HPV vaccine with their physician and received a recommendation were overwhelmingly more likely to be vaccinated. Student status and perception of the personal importance of vaccination were also predictive of vaccination. The strength of the physicians recommendation played a significant role in the decision to be vaccinated, resulting in a 4-fold greater likelihood of vaccination when women received a strong recommendation versus one that was not strong. Health care providers should be well-informed about HPV vaccination and recognize that the strength of their recommendation to patients will foster appropriate uptake.

Human Papillomavirus Vaccine Uptake, Predictors of Vaccination, and Self-Reported Barriers to Vaccination

OBJECTIVE To describe human papillomavirus (HPV) vaccine uptake, predictors of vaccination, and barriers to vaccination in young women. METHODS Participants were 13-26-year-old girls and women recruited from an urban, hospital-based clinic. Between June and December 2007, 6 months after they had completed a baseline survey, they were recontacted to assess receipt of at least one HPV vaccine dose and barriers to receiving the vaccine. We assessed whether demographic factors, gynecological history, and attitudes measured at baseline were associated with vaccination at follow-up using logistic regression. RESULTS Of the 262 women who completed the baseline study, 189 (72%) participated in this follow-up study. At follow-up, 68 of 189 (36%) had received >or=1 HPV vaccine dose. Factors measured at baseline that predicted vaccination 6 months later included insurance coverage for HPV vaccination (odds ratio [OR] 5.31, 95% confidence interval [CI] 1.61-17.49) and the belief that ones parents, partners, and clinicians endorsed HPV vaccination (OR 2.21, 95% CI 1.29-3.79); those with a history of an abnormal Pap test were less likely to have received the vaccine (OR 0.30, CI 0.10-0.92). Of the 121 who were unvaccinated, 54 (45%) had not returned to the clinic since the baseline study, 51 (42%) had returned but were not offered vaccine, and 15 (12%) had declined vaccination. CONCLUSIONS Interventions to increase HPV vaccination rates in women in the catch-up age group for vaccination should ensure that vaccine costs are covered, promote HPV vaccination as normative, and establish clinic-based systems to prevent missed opportunities for vaccination.

Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women.

OBJECTIVE: To estimate rates of human papillomavirus (HPV) vaccination, factors associated with intention and belief in one’s ability (self-efficacy) to receive the vaccine, and prevalence of vaccine-type HPV during the first year after an HPV-6, HPV-11, HPV-16, HPV-18 vaccine was licensed. METHODS: Sexually experienced females 13–26 years of age (N=409) were recruited from three primary care clinics, completed a questionnaire, and underwent cervicovaginal HPV DNA testing. Outcome measures were HPV vaccination, intention and belief in one’s ability to receive the HPV vaccine in the next year, and prevalence of vaccine-type HPV. Factors independently associated with intention and belief in one’s ability to receive the HPV vaccine were determined by logistic regression. RESULTS: Five percent of participants had received at least one HPV vaccine dose, 66% intended to receive the vaccine, 65% were confident they could find the time to get vaccinated, 54% believed that they could receive all three shots, and 42% believed that they could afford vaccination. Sixty-eight percent of women were HPV-positive: 9% for HPV-6, 3% for HPV-11, 17% for HPV-16, and 12% for HPV-18. Factors independently associated with intention included believing that influential people would approve of vaccination, higher perceived severity of cervical cancer or genital warts, fewer safety barriers, and pregnancy history. Factors associated with a high belief in one’s ability to receive the vaccine included perceived severity of HPV, sexually transmitted disease history, insurance coverage, and fewer practical barriers to vaccination. CONCLUSION: Interventions that aim to increase intention and belief in one’s ability to receive HPV vaccines, which may lead to higher vaccination rates, should address personal beliefs about vaccination as well as systemic barriers to vaccination. LEVEL OF EVIDENCE: III

Acceptability of human papillomavirus immunization.

The purpose of this study was to examine the attitudes about hypothetical human papillomavirus (HPV) vaccines in two groups of women in clinical settings. Twenty adolescent women attending an urban community adolescent health clinic and 20 adult women attending a city health department sexually transmitted disease (STD) clinic were recruited to participate in individual interviews. Adolescents were 14-18 years of age (mean 15.6), 75% nonHispanic white, and 75% sexually experienced. Adults were 20-50 years of age (mean 33.6), 95% African American, and all were sexually experienced. As part of the interview, participants ranked nine hypothetical HPV vaccines in order of acceptability. Each vaccine was uniquely defined as a function of cost (

Parental beliefs and decision making about child and adolescent immunization: from polio to sexually transmitted infections.

150,

Human papillomavirus, genital warts, Pap smears, and cervical cancer: Knowledge and beliefs of adolescent and adult women

50, or free), efficacy (50% or 90%), disease targeted (genital warts, cervical cancer, or both), and physician recommendation (not mentioned by a physician or specifically recommended). Rankings by adolescents and adults were highly concordant (Spearman rho = 0.9). Efficacy, physicians recommendation, and cost influenced rankings most strongly. Ranking decisions were often based on complex decision making, in which all characteristics were considered simultaneously. These findings suggest that certain features of an HPV vaccine might significantly affect vaccine acceptability. Vaccine efficacy, physician endorsement, and cost were particularly salient issues.

Partner‐specific relationship characteristics and condom use among young people with sexually transmitted diseases

ABSTRACT. Over the past 150 years, innovations in immunization practices have dramatically improved the health of children, and parents are increasingly asked to consider and accept new childhood vaccines. We present a conceptual model to frame a review of research on the role of parental attitudes and beliefs in decision making about child and adolescent immunization and describe the historical context of vaccine-related decision-making research. This review focuses on theory-based Social-environmental and parent-specific personal factors as potential influences on vaccine decision making. Relevant Social-environmental issues discussed include media coverage of vaccines, perceived social norms, and the persuasive influence of peer groups. Health care provider recommendations are presented as an exemplar of factors related to the familys interface with the health care system. Personal factors addressed include parental health beliefs, attitudes, and knowledge related to vaccine preventable diseases and immunization, as well as cognitive heuristics that are employed in the decision-making process (e.g., omission bias, protected values, framing of information). Last, promising directions for research and suggestions for clinical practice are presented.