Paul L. Reiter

Parents' health beliefs and HPV vaccination of their adolescent daughters ☆

Though many studies have documented correlates of HPV vaccine acceptability, our study is one of the first to examine correlates of vaccine initiation. The current study aimed to identify modifiable correlates of HPV vaccine initiation among adolescent girls in high risk communities and whether correlates varied by race and urban/rural status. In 2007, we conducted a cross-sectional survey of 889 parents of adolescent girls aged 10-18 living in areas of North Carolina, USA with high cervical cancer rates. We analyzed data using logistic regression. Health Belief Model constructs were associated with HPV vaccine initiation in multivariate analyses, including doctors recommendation to get HPV vaccine, perceived barriers to obtaining HPV vaccine, and perceived potential vaccine harms. While exploratory stratified analyses suggested that many of the same parent beliefs were important correlates of HPV vaccine initiation regardless of racial group or urban/rural status, a few differences did exist. These potentially modifiable beliefs offer well-defined targets for future interventions designed to increase HPV vaccine coverage. However, the beliefs relative importance may differ between racial groups and regions.

Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area.

Background: Human papillomavirus (HPV) vaccine uptake is low among adolescent girls in the United States. We sought to identify longitudinal predictors of HPV vaccine initiation in populations at elevated risk for cervical cancer. Methods: We interviewed a population-based sample of parents of 10- to 18-year-old girls in areas of North Carolina with elevated cervical cancer rates. Baseline interviews occurred in summer 2007 and follow-up interviews in fall 2008. Measures included health belief model constructs. Results: Parents reported that 27% (149/567) of their daughters had initiated HPV vaccine between baseline and follow-up. Of parents who at baseline intended to get their daughters the vaccine in the next year, only 38% (126/348) had done so by follow-up. Of parents of daughters who remained unvaccinated at follow-up but had seen a doctor since baseline, only 37% (122/388) received an HPV vaccine recommendation. Rates of HPV vaccine initiation were higher among parents who at baseline perceived lower barriers to getting HPV vaccine, anticipated greater regret if their daughters got HPV because they were unvaccinated, did not report “needing more information” as the main reason they had not already vaccinated, intended to get their daughters the vaccine, or were not born-again Christians. Conclusions: Missed opportunities to increase HPV vaccine uptake included unrealized parent intentions and absent doctor recommendations. While several health belief model constructs identified in early acceptability studies (e.g., perceived risk, perceived vaccine effectiveness) were not longitudinally associated with HPV vaccine initiation, our findings suggest correlates of uptake (e.g., anticipated regret) that offer novel opportunities for intervention.

HPV vaccine and adolescent males

In 2009, the United States approved quadrivalent HPV vaccine for males 9-26 years old, but data on vaccine uptake are lacking. We determined HPV vaccine uptake among adolescent males, as well as stage of adoption and vaccine acceptability to parents and their sons. A national sample of parents of adolescent males ages 11-17 years (n=547) and their sons (n=421) completed online surveys during August and September 2010. Analyses used multivariate linear regression. Few sons (2%) had received any doses of HPV vaccine, and most parents and sons were unaware the vaccine can be given to males. Parents with unvaccinated sons were moderately willing to get their sons free HPV vaccine (mean=3.37, SD=1.21, possible range 1-5). Parents were more willing to get their sons vaccinated if they perceived higher levels of HPV vaccine effectiveness (β=0.20) or if they anticipated higher regret about their sons not getting vaccinated and later developing an HPV infection (β=0.32). Vaccine acceptability was also modest among unvaccinated sons (mean=2.98, SD=1.13, possible range 1-5). Sons were more willing to get vaccinated if they perceived higher peer acceptance of HPV vaccine (β=0.39) or anticipated higher regret about not getting vaccinated and later developing an HPV infection (β=0.22). HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males. Vaccine acceptability was moderate among both parents and sons. Efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.

Acceptability of HPV Vaccine Among a National Sample of Gay and Bisexual Men

Objective: Due to higher rates of human papillomavirus (HPV) infection and anal cancer among gay and bisexual men, we aimed to characterize their willingness to get HPV vaccine and identify correlates of vaccine acceptability. Methods: We surveyed a national sample of men aged 18 to 59 who self-identified as either gay (n = 236) or bisexual (n = 70) during January 2009. We analyzed data using multivariate logistic regression. Results: Most men had heard of HPV vaccine (73%, 224/306) and were willing to get it (74%, 225/306). HPV vaccine acceptability was higher among men who believed their doctor would recommend getting the vaccine (OR = 12.87, 95% CI: 4.63–35.79) and those who were unsure (OR = 3.15, 95% CI: 1.47–6.76), as compared to men who believed their doctor would not recommend it. Acceptability was also higher among men who reported 5 or more lifetime sexual partners (OR = 3.39, 95% CI: 1.34–8.55), perceived greater severity of HPV-related disease (OR = 1.92, 95% CI: 1.18–3.14), perceived higher levels of HPV vaccine effectiveness (OR = 1.97, 95% CI: 1.27–3.06), or reported higher levels of anticipated regret if they did not get vaccinated and later developed an HPV infection (OR = 2.39, 95% CI: 1.57–3.61). Conclusions: HPV vaccine acceptability was high among gay and bisexual men. These findings identify potentially important beliefs and attitudes for future communication efforts about HPV and HPV vaccine among gay and bisexual men.

The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): Scale Development and Associations With Intentions to Vaccinate

Background: No standardized instruments, to our knowledge, exist to assess attitudes and beliefs about human papillomavirus (HPV) vaccination. Methods: We developed the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS), using data collected on 783 parents who had not yet vaccinated their daughters against HPV. We conducted a principal components analysis of 16 HPV vaccine attitude and belief items, assessed the scales psychometric properties, and used linear regression to examine the relationship of CHIAS factors and parents vaccination intentions. Results: Analyses identified 4 CHIAS factors, all of which had acceptable scale alphas and 1-year test-retest reliability. In multivariate models, higher vaccination intentions were associated with: believing HPV vaccine is effective (&bgr; = 0.06) or has less harmful effects (&bgr; = −0.47), perceiving more barriers to access (&bgr; = 0.18), and having less uncertainty about the vaccine (&bgr; = −0.23) (all P < 0.05). Conclusions: Findings suggest that parent attitudes about HPV vaccine are important to their intentions to vaccinate their adolescent daughters against HPV. The CHIAS offers researchers a compact, standardized measure of important HPV vaccine attitudes and beliefs.

Human papillomavirus knowledge and vaccine acceptability among a national sample of heterosexual men

Objectives If approved for use in young males in the United States, prophylactic human papillomavirus (HPV) vaccine may reduce the incidence of HPV-related disease in vaccinated males and their sexual partners. We aimed to characterise heterosexual mens willingness to get HPV vaccine and identify correlates of vaccine acceptability. Methods Participants were from a national sample of heterosexual men (n=297) aged 18–59 y from the United States who were interviewed in January 2009. We analysed data using multivariate logistic regression. Results Most men had not heard of HPV prior to the study or had low HPV knowledge (81%; 239/296). Most men had heard of HPV vaccine prior to the study (63%; 186/296) and 37% (109/296) were willing to get HPV vaccine. Men were more willing to get vaccinated if they reported higher perceived likelihood of getting HPV-related disease (OR 1.80, 95% CI 1.02 to 3.17), perceived HPV vaccine effectiveness (OR 1.86, 95% CI 1.22 to 2.83) or anticipated regret if they did not get vaccinated and an HPV infection later developed (OR 2.01, 95% CI 1.40 to 2.89). Acceptability was also higher among men who thought (OR 9.02, 95% CI 3.45 to 23.60) or who were unsure (OR 2.67, 95% CI 1.30 to 5.47) if their doctor would recommend they get HPV vaccine if licenced for males. Conclusions Men had low HPV knowledge and were moderately willing to get HPV vaccine. These findings underscore the need for HPV educational efforts for men and provide insight into some of the factors that may affect the HPV vaccination decision making process among men.

HPV vaccine for adolescent males: acceptability to parents post-vaccine licensure.

We examined mothers willingness to get their adolescent sons HPV vaccine. In December 2009, 2 months after approval of HPV vaccine for males, we surveyed a national sample of mothers with sons aged 9-18 (n=406). More mothers were definitely or probably willing to get their sons HPV vaccine if the vaccine were free (47%) than if it cost

How parents hear about human papillomavirus vaccine: implications for uptake.

400 out of pocket (11%). The importance of HPV vaccine possibly protecting their sons future female partners from HPV-related disease was the strongest correlate of willingness. These findings are important to increasing acceptability to parents of HPV vaccine for their sons.

Meta-analysis of human papillomavirus infection concordance

PURPOSEnTo examine correlates of human papillomavirus (HPV) vaccine awareness and information sources in a state requiring schools to inform parents about HPV vaccine.nnnMETHODSnTelephone 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.nnnRESULTSnOverall, 91% of parents had heard of HPV vaccine. Parents were more likely to be aware if they had household incomes of

HPV Vaccine Acceptability in Heterosexual, Gay, and Bisexual Men

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 childrens healthcare providers were more likely to initiate HPV vaccine for their daughters.nnnCONCLUSIONSnParents had rarely heard of the vaccine through schools. The only source associated with vaccine initiation was hearing from a healthcare provider.