Abstract
Barriers to childhood vaccination against vaccine-preventable diseases, such as those due to human papillomavirus (HPV), are well known. However, the role of salience bias-the change in perception of risk due to increased familiarity with the outcome-in decisions to vaccinate children has not been explicitly studied. To assess for salience bias in parental decisions to vaccinate children. This retrospective cohort study used a time-to-event (survival) analysis to compare vaccination rates of children whose mothers had a history of cervical cancer or a cervical biopsy, who have experienced adverse vaccine-preventable outcomes, and for whom vaccination may be more salient, with a control group of children whose mothers had no such history. Participants were accrued from the MarketScan Commercial Database, including US children who turned 11 years old, when HPV vaccination is recommended, from January 1, 2014, to December 31, 2018. Data were analyzed from December 29, 2020, to September 17, 2021. Maternal history of cervical cancer or cervical biopsy. Vaccination against HPV. A total of 757 428 children (370 878 girls [49.0%] and 386 550 boys [51.0%]) were identified, of whom 38 366 had mothers with a history of cervical biopsy alone and 1084 had mothers with a history of cervical cancer. Overall, 54.2% of children (55.7% of girls and 52.7% of boys) received at least 1 vaccination by 16 years of age. In a time-to-event analysis, HPV vaccination did not differ between children whose mothers had cervical cancer vs those whose mothers did not (hazard ratio [HR] for girls, 0.99 [95% CI, 0.86-1.13]; HR for boys, 1.08 [95% CI, 0.94-1.24]). Maternal history of cervical biopsy was associated with a minimally increased hazard of vaccination (HR for girls, 1.06 [95% CI, 1.04-1.09]; HR for boys, 1.04 [95% CI, 1.01-1.06]). There were no clinically meaningful differences between groups for the tetanus/diphtheria/acellular pertussis and meningococcal vaccinations, which are also recommended at 11 years of age. In this analysis of salience bias in childhood vaccination decisions, mothers' personal history of cervical cancer or cervical biopsy was not associated with greater vaccination rates among children against HPV. These findings suggest that salience of vaccine-preventable outcomes may not have a major impact on childhood vaccine hesitancy in HPV; the role of salience should be investigated for other vaccines.
Highlights
Many barriers to vaccinating populations against preventable disease are well known, including affordability, access, and misperceptions about vaccine efficacy and safety.[1,2,3,4,5] hesitancy surrounding the COVID-19 vaccine[3,4,5] has highlighted the need for better understanding of the potential motivators of vaccination decisions. the US Centers for Disease Control and Prevention (CDC) recommends that most adolescents receive several vaccines, vaccination rates often fall short of the goal
In a time-to-event analysis, human papillomavirus (HPV) vaccination did not differ between children whose mothers had cervical cancer vs those whose mothers did not
In this analysis of salience bias in childhood vaccination decisions, mothers’ personal history of cervical cancer or cervical biopsy was not associated with greater vaccination rates among children against HPV
Summary
Many barriers to vaccinating populations against preventable disease are well known, including affordability, access, and misperceptions about vaccine efficacy and safety.[1,2,3,4,5] hesitancy surrounding the COVID-19 vaccine[3,4,5] has highlighted the need for better understanding of the potential motivators of vaccination decisions. the US Centers for Disease Control and Prevention (CDC) recommends that most adolescents receive several vaccines, vaccination rates often fall short of the goal. In 2017, for example, the CDC estimated that only 48.6% of adolescents were up to date on the human papillomavirus (HPV) vaccine, which prevents cervical cancer, 65.5% had received at least 1 dose of the multidose recommended series (current recommendations are to initiate a 2-dose series for children aged 11-12 years; patients who initiate the series at 15 years or older require 3 doses).[6,7] practical considerations—such as affordability and availability of vaccines—can be barriers to vaccination, psychological factors such as complacency about the pathogen and low confidence in the safety and efficacy of the vaccine contribute to vaccine underuse worldwide.[8]. Parents who choose not to vaccinate their young children against diseases such as measles perceive their children as less susceptible to infection and perceive the disease as less severe than parents who fully vaccinate their children.[10]
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