Vaccinating Adolescents—New Evidence of Challenges and Opportunities

Abstract

See Related Articles pp. 430, 438, 445, 453, 525, 528, 532, and 535An incompletely vaccinated toddler has several well-child care visits to catch up on immunizations, and, failing these annual vaccination opportunities, school immunization laws serve as enforced reminders to become immunized.In contrast, an incompletely vaccinated adolescent will become a young adult and enter a stage of life in which routine preventive visits generally do not occur. Compounding matters, financially vulnerable young adults lose their entitlement to free vaccines once they are 19 years old and cross the age for inclusion to the Vaccines for Children (VFC) program.From a purely programmatic viewpoint, vaccinating at as young an age as possible has the advantage of longer catch-up time before the ages of heightened risk of exposure to vaccine-preventable infections. This is one reason that the adolescent platform for vaccination is recommended for 11- and 12-year-olds. Provided that the duration of protection afforded by vaccination lasts through the ages of greatest risk, it is reasonable to concentrate vaccination at this young age.The adolescent vaccination platform, which was instituted to provide tetanus and diphtheria toxoids at 11–12 years of age, and to check that adolescents had received all recommended vaccines, was strengthened in 2005 with the licensure of meningococcal conjugate vaccine (MCV4), which was followed within a year by the tetanus, diphtheria, and acellular pertussis (TdaP) and human papillomavirus (HPV) vaccines. Beginning this year, annual influenza vaccination is recommended for all children from 6 months through 18 years of age.How is the U.S. system doing? According to the most recent data from the Teen National Immunization Survey (Teen–NIS), the performance has been mixed—good progress with no major disparities along the race or ethnicity lines, but with a long way to go to achieve national objectives. Compared with the 2007 Teen–NIS, the 2008 data show that MCV4 coverage increased by 9% points, first-dose HPV coverage increased by 12% points, and the use of TdaP increased by 10% points [1Centers for Disease Control and PreventionVaccination coverage among adolescents aged 13–17 years—United States, 2007.MMWR Morb Mortal Wkly Rep. 2008; 57: 1100-1103PubMed Google Scholar, 2Centers for Disease Control and PreventionNational, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2008.MMWR Morb Mortal Wkly Rep. 2009; 58: 997-1001PubMed Google Scholar]. Importantly, coverage among teens residing in households below the federal poverty level was 12% points higher than those residing in households that are above the federal poverty level. This is almost certainly a VFC program effect, given the high cost of the vaccine in the private sector and the targeting of VFC to financially vulnerable children.That the United States has a long way to go is also evident from the 2008 Teen–NIS: first HPV dose coverage is 34%; MCV4 coverage is 42%; and Td/TdaP coverage is 72%. The United States generally takes more than 7 years from the date of recommendation to the time that coverage reaches 90%, so these results are consistent with the pace of increase in coverage following the 2005 and 2006 recommendations. The Td/TdaP coverage of only 72%, however, is a potent reminder that longer standing recommendations for adolescents have not achieved what has been achieved for young children's vaccine recommendations. Of vaccines recommended during the first 2 years of life, coverage rates for 19–35-month-old children are generally on the order of 90% or more.Articles in this issue of the journal provide valuable new information on the challenges and opportunities for adolescent vaccination. Almost all articles concern HPV vaccination, which may reflect key differences in HPV vaccine from most other vaccines in that it prevents sexually transmitted infections and that it is currently recommended only for females, the one vaccine in the U.S. immunization schedule with gender-specific recommendations.Some good news is that parents consistently support vaccinating their daughters with HPV. In Minnesota, Bernat et al found that most parents support the use of HPV vaccine, but that this support varies by a variety of sociodemographic and attitude factors [[3]Bernat D.H. Harpin S.B. Eisenberg M.E. Bearinger L.H. Resnick M.D. Parental support for the human papillomavirus vaccine.J Adolesc Health. 2009; 45: 525-527Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar]. Interestingly, they predict lower acceptance among Hispanic teens, but this difference was not borne out in the 2008 national data in which Hispanic teens had the highest coverage of any race or ethnicity. A smaller study in Florida by Gerend et al also demonstrated strong parental support among attendees of four of their clinics, [[4]Gerend M.A. Weibley E. Bland H.. Parental response to human papillomavirus vaccine availability: Uptake and intentions.J Adolesc Health. 2009; 45: 528-531Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar] and interestingly, showed that lower income was correlated with higher intent to vaccinate. This represents programmatic opportunity as VFC is targeted toward financially vulnerable children. Not surprisingly, neither study showed that parents believed that HPV vaccination would cause their daughter to have sex.Gottlieb et al report on an excellent pair of studies set in four counties in North Carolina that have cervical cancer rates that are higher than the national average [5Gottlieb S.L. Brewer N.T.. Sternberg M.R. et al.Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer.J Adolesc Health. 2009; 45: 430-437Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 6Gottlieb S.L. Brewer N.T.. Smith J.S. Keating K.M. Markowitz L.E. Availability of human papillomavirus vaccine at medical practices in an area with elevated rates of cervical cancer.J Adolesc Health. 2009; 45: 438-444Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. Their survey of 71 medical practices showed substantial differences in provision of HPV vaccine by specialty type (few internists were using HPV vaccine in contrast to the majority of pediatricians, family physicians, and obstetricians/gynecologists), and by participation in North Carolina's state vaccination program, which provides free vaccines including HPV vaccine to participating providers for vaccinating uninsured and Medicaid-eligible children. During the time of the survey, the North Carolina program did not provide HPV vaccine to underinsured individuals. The investigators found that only 42% of practices not participating in North Carolina's program provided HPV vaccine to their patients, compared with 81% of participating practices. Having to purchase HPV vaccine up front for private insurance reimbursement was one of the strongest barriers to the use of HPV vaccine.When the parents of children of age 11–18 years in these same four counties were interviewed 6 months after HPV vaccine became available in North Carolina, Gottlieb et al found that only 10% had initiated the HPV series, but that the majority intended to do so. More than 90% of parents reported that their health insurance covered HPV vaccination. However, providers' reticence to make the up-front purchase of vaccine for privately insured patients effectively nullified their private insurance coverage by not making the vaccine available in the medical home.The National Vaccine Advisory Committee recently studied the financing of adolescent immunization and made recommendations to fix some of the problems that impede maintenance of high coverage with conventional vaccines and implementation of new vaccines such as HPV vaccine [[7]National Vaccine Advisory Committee. Children and Adolescents Vaccine Financing Recommendations Adopted by NVAC—September 2008 (with approved editorial changes March 2, 2009). Available at: http://www.hhs.gov/nvpo/nvac/CAVFRecommendationsSept08.html. Accessed August 8, 2009.Google Scholar]. A recommendation that addresses the financing issue highlighted by Gottlieb's two studies is that “Vaccine manufacturers and third-party vaccine distributors should work with providers on an individual basis to reduce the financial burden for initial and ongoing vaccine inventories, particularly for new vaccines.”A major concern with the adolescent platform is the finite capacity of the medical home for primary care—a concern that substantially heightened with the new recommendation for annual influenza vaccination. The National Vaccine Advisory Committee recommends identifying additional vaccination venues [[8]National Vaccine Advisory Committee. Adolescent vaccination: recommendations from the National Vaccine Advisory Committee—Adolescent Working Group. Available at: http://www.hhs.gov/nvpo/nvac/documents/AdolescentVaccinationRecommend.pdf. Accessed August 8, 2009.Google Scholar], and a study conducted by Daley et al on immunization practices of school-located health clinics [[9]Daley M.F. Curtis C.R. Pyrzanowski J. et al.Adolescent immunization delivery in school-based health centers: A national survey.J Adolesc Health. 2009; 45: 445-452Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar] provides important information for immunization programs. The good news from Daley's survey is that the vast majority are fully engaged in routine vaccination of adolescents. They participated in the Vaccines for Children program; they used all the recommended adolescent vaccines including influenza vaccine; they tracked coverage with electronic databases; and they served a financially vulnerable population. The school-located clinics communicated vaccinations given with primary care providers, mainly through electronic record sharing in immunization registries (69%), and also through letters, fax, and telephone.The school-based clinics had some challenges, primarily obtaining records, vaccinating private sector children, and obtaining informed consent. However, most clinics rated these top barriers as minor ones. The downside of school-based clinics is that there are only 2,000 such clinics in the United States. Almost certainly, these 2,000 clinics will be busy this fall protecting children and adolescents from seasonal and 2009 H1N1 influenza.Accurate and effective health communication is important for successful immunization programs. Parents consistently see their child's primary care provider as the most reliable source of information about vaccines. However, doctors and nurses are far from the only source of information. There has been substantial discussion about the inaccurate or misleading information on Internet websites [[10]Wolfe R.M. Sharp L.K. Lipsky M.S. Content and design attributes of antivaccination web sites.J Am Med Assoc. 2002; 287: 3245-3248Crossref Scopus (230) Google Scholar]. The study by Tozzi et al [[11]Tozzi AE, Buonuomo PS, Ciofi degli Atti ML, et al. A comparison of the quality of Internet pages on HPV immunization in Italian and in English. J Adolesc Health (in press).Google Scholar] showed that English and Italian HPV vaccine websites scored in the middle range in terms of content quality, and that English websites scored somewhat better than Italian websites. Academic and government sites were found to be the most accurate and reliable sources of information regardless of language.Psychological responses to HPV education material and knowledge among adolescent girls and young women of HPV infection and vaccine are the topics of two surveys in this issue [12Lloyd G.P. Marlow L.A.V. Waller J. Miles A. Wardle J. An experimental investigation of the emotional and motivational impact of HPV information in adolescents.J Adolesc Health. 2009; 45: 532-534Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 13Caskey R. Lindau S.T. Alexander G.C. Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey.J Adolesc Health. 2009; 45: 453-462Abstract Full Text Full Text PDF PubMed Scopus (215) Google Scholar]. Lloyd et al found that 13–16-year-old girls in the United Kingdom absorbed information on HPV without becoming worried, and that they were receptive to both Papanicolaou (Pap) smears and vaccination. Caskey et al report on a survey of 9–26-year-old U.S. females that showed low awareness of HPV infection. They had a reassuring finding that the interview subjects did not believe that HPV vaccine is protective beyond the true effect of the vaccine. For example, almost none of their subjects believed that Pap smears are not needed if one is vaccinated.Furthermore, looking ahead to the possibility of licensure and recommendation of HPV vaccine for boys and men, this issue offers a study of the quite different knowledge, attitudes, and beliefs regarding HPV infection and vaccination among college-going men [[14]Allen J.D. Fantasia H.C. Fontenot H. Flaherty S. Santana J. College men's knowledge, attitudes, and beliefs about the human papillomavirus infection and vaccine.J Adolesc Health. 2009; 45: 535-537Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar]. The challenges will be many and different, should the vaccine become recommended for boys and men.This issue of the Journal of Adolescent Health highlights numerous challenges for vaccinating adolescents—especially with HPV vaccine. The important new knowledge presented in the journal will help immunization programs, health care providers, schools, and parents protect adolescents from vaccine preventable diseases. A fully functioning adolescent platform is still years away, but as new knowledge is put to use, one can envision a situation in which new vaccines targeting adolescents will be implemented as effectively as is currently done for young children. See Related Articles pp. 430, 438, 445, 453, 525, 528, 532, and 535 See Related Articles pp. 430, 438, 445, 453, 525, 528, 532, and 535 See Related Articles pp. 430, 438, 445, 453, 525, 528, 532, and 535 An incompletely vaccinated toddler has several well-child care visits to catch up on immunizations, and, failing these annual vaccination opportunities, school immunization laws serve as enforced reminders to become immunized. In contrast, an incompletely vaccinated adolescent will become a young adult and enter a stage of life in which routine preventive visits generally do not occur. Compounding matters, financially vulnerable young adults lose their entitlement to free vaccines once they are 19 years old and cross the age for inclusion to the Vaccines for Children (VFC) program. From a purely programmatic viewpoint, vaccinating at as young an age as possible has the advantage of longer catch-up time before the ages of heightened risk of exposure to vaccine-preventable infections. This is one reason that the adolescent platform for vaccination is recommended for 11- and 12-year-olds. Provided that the duration of protection afforded by vaccination lasts through the ages of greatest risk, it is reasonable to concentrate vaccination at this young age. The adolescent vaccination platform, which was instituted to provide tetanus and diphtheria toxoids at 11–12 years of age, and to check that adolescents had received all recommended vaccines, was strengthened in 2005 with the licensure of meningococcal conjugate vaccine (MCV4), which was followed within a year by the tetanus, diphtheria, and acellular pertussis (TdaP) and human papillomavirus (HPV) vaccines. Beginning this year, annual influenza vaccination is recommended for all children from 6 months through 18 years of age. How is the U.S. system doing? According to the most recent data from the Teen National Immunization Survey (Teen–NIS), the performance has been mixed—good progress with no major disparities along the race or ethnicity lines, but with a long way to go to achieve national objectives. Compared with the 2007 Teen–NIS, the 2008 data show that MCV4 coverage increased by 9% points, first-dose HPV coverage increased by 12% points, and the use of TdaP increased by 10% points [1Centers for Disease Control and PreventionVaccination coverage among adolescents aged 13–17 years—United States, 2007.MMWR Morb Mortal Wkly Rep. 2008; 57: 1100-1103PubMed Google Scholar, 2Centers for Disease Control and PreventionNational, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2008.MMWR Morb Mortal Wkly Rep. 2009; 58: 997-1001PubMed Google Scholar]. Importantly, coverage among teens residing in households below the federal poverty level was 12% points higher than those residing in households that are above the federal poverty level. This is almost certainly a VFC program effect, given the high cost of the vaccine in the private sector and the targeting of VFC to financially vulnerable children. That the United States has a long way to go is also evident from the 2008 Teen–NIS: first HPV dose coverage is 34%; MCV4 coverage is 42%; and Td/TdaP coverage is 72%. The United States generally takes more than 7 years from the date of recommendation to the time that coverage reaches 90%, so these results are consistent with the pace of increase in coverage following the 2005 and 2006 recommendations. The Td/TdaP coverage of only 72%, however, is a potent reminder that longer standing recommendations for adolescents have not achieved what has been achieved for young children's vaccine recommendations. Of vaccines recommended during the first 2 years of life, coverage rates for 19–35-month-old children are generally on the order of 90% or more. Articles in this issue of the journal provide valuable new information on the challenges and opportunities for adolescent vaccination. Almost all articles concern HPV vaccination, which may reflect key differences in HPV vaccine from most other vaccines in that it prevents sexually transmitted infections and that it is currently recommended only for females, the one vaccine in the U.S. immunization schedule with gender-specific recommendations. Some good news is that parents consistently support vaccinating their daughters with HPV. In Minnesota, Bernat et al found that most parents support the use of HPV vaccine, but that this support varies by a variety of sociodemographic and attitude factors [[3]Bernat D.H. Harpin S.B. Eisenberg M.E. Bearinger L.H. Resnick M.D. Parental support for the human papillomavirus vaccine.J Adolesc Health. 2009; 45: 525-527Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar]. Interestingly, they predict lower acceptance among Hispanic teens, but this difference was not borne out in the 2008 national data in which Hispanic teens had the highest coverage of any race or ethnicity. A smaller study in Florida by Gerend et al also demonstrated strong parental support among attendees of four of their clinics, [[4]Gerend M.A. Weibley E. Bland H.. Parental response to human papillomavirus vaccine availability: Uptake and intentions.J Adolesc Health. 2009; 45: 528-531Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar] and interestingly, showed that lower income was correlated with higher intent to vaccinate. This represents programmatic opportunity as VFC is targeted toward financially vulnerable children. Not surprisingly, neither study showed that parents believed that HPV vaccination would cause their daughter to have sex. Gottlieb et al report on an excellent pair of studies set in four counties in North Carolina that have cervical cancer rates that are higher than the national average [5Gottlieb S.L. Brewer N.T.. Sternberg M.R. et al.Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer.J Adolesc Health. 2009; 45: 430-437Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 6Gottlieb S.L. Brewer N.T.. Smith J.S. Keating K.M. Markowitz L.E. Availability of human papillomavirus vaccine at medical practices in an area with elevated rates of cervical cancer.J Adolesc Health. 2009; 45: 438-444Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. Their survey of 71 medical practices showed substantial differences in provision of HPV vaccine by specialty type (few internists were using HPV vaccine in contrast to the majority of pediatricians, family physicians, and obstetricians/gynecologists), and by participation in North Carolina's state vaccination program, which provides free vaccines including HPV vaccine to participating providers for vaccinating uninsured and Medicaid-eligible children. During the time of the survey, the North Carolina program did not provide HPV vaccine to underinsured individuals. The investigators found that only 42% of practices not participating in North Carolina's program provided HPV vaccine to their patients, compared with 81% of participating practices. Having to purchase HPV vaccine up front for private insurance reimbursement was one of the strongest barriers to the use of HPV vaccine. When the parents of children of age 11–18 years in these same four counties were interviewed 6 months after HPV vaccine became available in North Carolina, Gottlieb et al found that only 10% had initiated the HPV series, but that the majority intended to do so. More than 90% of parents reported that their health insurance covered HPV vaccination. However, providers' reticence to make the up-front purchase of vaccine for privately insured patients effectively nullified their private insurance coverage by not making the vaccine available in the medical home. The National Vaccine Advisory Committee recently studied the financing of adolescent immunization and made recommendations to fix some of the problems that impede maintenance of high coverage with conventional vaccines and implementation of new vaccines such as HPV vaccine [[7]National Vaccine Advisory Committee. Children and Adolescents Vaccine Financing Recommendations Adopted by NVAC—September 2008 (with approved editorial changes March 2, 2009). Available at: http://www.hhs.gov/nvpo/nvac/CAVFRecommendationsSept08.html. Accessed August 8, 2009.Google Scholar]. A recommendation that addresses the financing issue highlighted by Gottlieb's two studies is that “Vaccine manufacturers and third-party vaccine distributors should work with providers on an individual basis to reduce the financial burden for initial and ongoing vaccine inventories, particularly for new vaccines.” A major concern with the adolescent platform is the finite capacity of the medical home for primary care—a concern that substantially heightened with the new recommendation for annual influenza vaccination. The National Vaccine Advisory Committee recommends identifying additional vaccination venues [[8]National Vaccine Advisory Committee. Adolescent vaccination: recommendations from the National Vaccine Advisory Committee—Adolescent Working Group. Available at: http://www.hhs.gov/nvpo/nvac/documents/AdolescentVaccinationRecommend.pdf. Accessed August 8, 2009.Google Scholar], and a study conducted by Daley et al on immunization practices of school-located health clinics [[9]Daley M.F. Curtis C.R. Pyrzanowski J. et al.Adolescent immunization delivery in school-based health centers: A national survey.J Adolesc Health. 2009; 45: 445-452Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar] provides important information for immunization programs. The good news from Daley's survey is that the vast majority are fully engaged in routine vaccination of adolescents. They participated in the Vaccines for Children program; they used all the recommended adolescent vaccines including influenza vaccine; they tracked coverage with electronic databases; and they served a financially vulnerable population. The school-located clinics communicated vaccinations given with primary care providers, mainly through electronic record sharing in immunization registries (69%), and also through letters, fax, and telephone. The school-based clinics had some challenges, primarily obtaining records, vaccinating private sector children, and obtaining informed consent. However, most clinics rated these top barriers as minor ones. The downside of school-based clinics is that there are only 2,000 such clinics in the United States. Almost certainly, these 2,000 clinics will be busy this fall protecting children and adolescents from seasonal and 2009 H1N1 influenza. Accurate and effective health communication is important for successful immunization programs. Parents consistently see their child's primary care provider as the most reliable source of information about vaccines. However, doctors and nurses are far from the only source of information. There has been substantial discussion about the inaccurate or misleading information on Internet websites [[10]Wolfe R.M. Sharp L.K. Lipsky M.S. Content and design attributes of antivaccination web sites.J Am Med Assoc. 2002; 287: 3245-3248Crossref Scopus (230) Google Scholar]. The study by Tozzi et al [[11]Tozzi AE, Buonuomo PS, Ciofi degli Atti ML, et al. A comparison of the quality of Internet pages on HPV immunization in Italian and in English. J Adolesc Health (in press).Google Scholar] showed that English and Italian HPV vaccine websites scored in the middle range in terms of content quality, and that English websites scored somewhat better than Italian websites. Academic and government sites were found to be the most accurate and reliable sources of information regardless of language. Psychological responses to HPV education material and knowledge among adolescent girls and young women of HPV infection and vaccine are the topics of two surveys in this issue [12Lloyd G.P. Marlow L.A.V. Waller J. Miles A. Wardle J. An experimental investigation of the emotional and motivational impact of HPV information in adolescents.J Adolesc Health. 2009; 45: 532-534Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 13Caskey R. Lindau S.T. Alexander G.C. Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey.J Adolesc Health. 2009; 45: 453-462Abstract Full Text Full Text PDF PubMed Scopus (215) Google Scholar]. Lloyd et al found that 13–16-year-old girls in the United Kingdom absorbed information on HPV without becoming worried, and that they were receptive to both Papanicolaou (Pap) smears and vaccination. Caskey et al report on a survey of 9–26-year-old U.S. females that showed low awareness of HPV infection. They had a reassuring finding that the interview subjects did not believe that HPV vaccine is protective beyond the true effect of the vaccine. For example, almost none of their subjects believed that Pap smears are not needed if one is vaccinated. Furthermore, looking ahead to the possibility of licensure and recommendation of HPV vaccine for boys and men, this issue offers a study of the quite different knowledge, attitudes, and beliefs regarding HPV infection and vaccination among college-going men [[14]Allen J.D. Fantasia H.C. Fontenot H. Flaherty S. Santana J. College men's knowledge, attitudes, and beliefs about the human papillomavirus infection and vaccine.J Adolesc Health. 2009; 45: 535-537Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar]. The challenges will be many and different, should the vaccine become recommended for boys and men. This issue of the Journal of Adolescent Health highlights numerous challenges for vaccinating adolescents—especially with HPV vaccine. The important new knowledge presented in the journal will help immunization programs, health care providers, schools, and parents protect adolescents from vaccine preventable diseases. A fully functioning adolescent platform is still years away, but as new knowledge is put to use, one can envision a situation in which new vaccines targeting adolescents will be implemented as effectively as is currently done for young children. Human Papillomavirus Vaccine Initiation in an Area with Elevated Rates of Cervical CancerJournal of Adolescent HealthVol. 45Issue 5PreviewWe assessed human papillomavirus (HPV) vaccination of adolescent girls living in communities with elevated cervical cancer rates. Full-Text PDF Availability of Human Papillomavirus Vaccine at Medical Practices in an Area with Elevated Rates of Cervical CancerJournal of Adolescent HealthVol. 45Issue 5PreviewTo assess availability of human papillomavirus (HPV) vaccine at medical practices in an area with elevated cervical cancer rates. Full-Text PDF Adolescent Immunization Delivery in School-Based Health Centers: A National SurveyJournal of Adolescent HealthVol. 45Issue 5PreviewVaccinating adolescents in a variety of settings may be needed to achieve high vaccination coverage. School-based health centers (SBHCs) provide a wide range of health services, but little is known about immunization delivery in SBHCs. The objective of this investigation was to assess, in a national random sample of SBHCs, adolescent immunization practices and perceived barriers to vaccination. Full-Text PDF Knowledge and Early Adoption of the HPV Vaccine Among Girls and Young Women: Results of a National SurveyJournal of Adolescent HealthVol. 45Issue 5PreviewIn 2006, universal human papillomavirus (HPV) vaccination of females ages 9 to 26 years became a formal recommendation, yet little is known about knowledge and adoption of this vaccine. Full-Text PDF Parental Support for the Human Papillomavirus VaccineJournal of Adolescent HealthVol. 45Issue 5PreviewThis study examined support for the human papillomavirus (HPV) vaccine among a representative sample of Minnesota parents after approval from the U.S. Food and Drug Administration. Support for the vaccine was high; 87% supported its use. Although individual characteristics predicted support, support was high across subgroups with two-thirds or more of parents supporting the vaccine. Full-Text PDF Parental Response to Human Papillomavirus Vaccine Availability: Uptake and IntentionsJournal of Adolescent HealthVol. 45Issue 5PreviewThis study examined parental responses to the quadrivalent human papillomavirus (HPV) vaccine approximately 2 years post-licensure. Correlates of vaccine uptake included daughter age, physician recommendation, and parental knowledge, beliefs, and attitudes. Correlates of vaccination intentions were consistent with previous research. Findings can inform future efforts aimed at promoting HPV vaccination. Full-Text PDF An Experimental Investigation of the Emotional and Motivational Impact of HPV Information in AdolescentsJournal of Adolescent HealthVol. 45Issue 5PreviewWe examined psychologic responses to information about human papillomavirus (HPV) in young women within the age range of the UK's HPV vaccination “catch-up” program (13–16 years). Respondents absorbed HPV information without becoming worried, were receptive to cervical screening and vaccination, and these attitudes were enhanced by presentation of relevant information. Full-Text PDF College Men's Knowledge, Attitudes, and Beliefs about the Human Papillomavirus Infection and VaccineJournal of Adolescent HealthVol. 45Issue 5PreviewMen enrolled in an urban university participated in focus groups (k=6; n=45) to explore knowledge about human papillomavirus and attitudes toward prophylactic vaccine. Results suggest that regardless of whether vaccines become available to men, educational efforts should include them, as men tend to have many misconceptions and do not perceive themselves to be vulnerable. Full-Text PDF