Accuracy Of Parental Reports Research Articles

Abstract A066: Inaccuracy in parental reports of adolescent human papillomavirus vaccination: A multilevel analysis of the influences of state-level and individual-level factors

Abstract Background: Accurate reporting of human papillomavirus (HPV) vaccination status is necessary for monitoring coverage and identifying under-vaccinated populations. While parental recall or reports are commonly used to identify adolescent HPV vaccination status, these self-reports may be subjected to bias. The Socioecological Framework suggests that factors at the individual (e.g., education), interpersonal (e.g., interactions with health care provider), community (e.g., state median income), and policy levels (e.g., state-level HPV vaccine policy) can influence the accuracy of parental reports. Objective: We explored potential multilevel correlates of the accuracy of parental reports of adolescent HPV vaccination status. Methods: Data from parents of 19,751 adolescents (2016 National Immunization Survey-Teen) were analyzed using multilevel modeling. We examined the adolescent's age, sex, race/ethnicity, maternal education, and household poverty status (individual-level); the number of health care providers seen (interpersonal-level); state-level median income (community-level); and state policy regarding HPV vaccine (i.e., whether a state has a policy mandating HPV vaccine for school entry or educating residents about HPV vaccine) (policy level). Outcomes included: 1) inaccuracy in reporting vaccine initiation (≥1 dose) and 2) inaccuracy in reporting completion (3 doses). Results: In the sample, 20.6% and 22.2% inaccurately reported initiation and completion, respectively. Compared to parents of White adolescents, parents of those who were Black (OR=1.6 and 1.5), Hispanic (OR=1.4 and 1.7), or of multiple races or other race (OR=1.8 and 1.8) were more likely to inaccurately report initiation and completion, respectively. Households with higher maternal education (OR=0.7 and 0.9) and nonpoverty status (OR=0.5 and 0.6) were less likely to inaccurately report. Compared to those who had seen 0 or 1 provider, those who had seen more providers were less likely to inaccurately report (OR=0.9 and 0.9 for seeing 2 providers, OR=0.8 and 0.9 for 3+ providers). Neither state-level median income nor state HPV vaccine policy was associated with either outcome. Discussion: Parents of racial/ethnic minority adolescents and households with more socioeconomic disadvantages were more likely to inaccurately report HPV vaccine initiation and completion. These results have implications for vaccine estimates drawn from self-reports. Future research can examine and target sources of inaccuracies in these groups, for example, uncertainty in provider communication, low health literacy, or social desirability in reporting. Having seen more providers was associated with higher accuracy, suggesting the importance of increased access to vaccine records. State vaccine policy does not appear to have an impact on the accuracy of parental reports, pointing to a need to further examine differential policy implementation or enforcement. Citation Format: Milkie H. N. Vu, Minh Luu, Regine Haardörfer, Carla J. Berg, Cam Escoffery, Robert A. Bednarczyk. Inaccuracy in parental reports of adolescent human papillomavirus vaccination: A multilevel analysis of the influences of state-level and individual-level factors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A066.

Abstract 2577: A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014

Abstract Introduction: Several studies have examined predictors of HPV vaccine initiation and completion. Two common methods to measure HPV vaccine initiation and completion are parental recall and provider verified vaccine history. Some studies use parental recall because it is cost-effective and time-consuming. Others argue that the provider report should be used because it is the gold standard, although it is more costly and time-consuming. Yet, few studies compare the accuracy of parental report versus provider report for HPV vaccine initiation and completion. Objective: To compare the accuracy of parental reported and provider reported data on HPV vaccine initiation and completion among a national sample of adolescents in the United States. Methods: Data from the 2014 National Immunization Survey-Teen (NIS-Teen) were analyzed for 38,703 adolescents. HPV vaccine initiation and completion were assessed using parental recall (shot cards) and provider verified (medical records) vaccine history. Adjusted, weighted multivariable logistic regression compared the accuracy of parental and provider reported data on HPV vaccine initiation and completion. Results: HPV vaccine initiation (a) and completion (b), by subgroup analysis, is similar for parental recall and provider report. However, subgroup analyses for parental report were slightly lower than provider report, although not statistically significant (Table 1). Conclusion: This study showed that parental report is comparable to provider report when measuring HPV vaccine initiation and completion among adolescents in the US. For more cost-effective and timely assessment of vaccine uptake, an accurate and practical method of measuring HPV vaccine initiation and completion is paramount. Utilizing parental report may be a more cost-effective and timely alternative to provider report for clinical evaluation of vaccine uptake. Table 1:Subgroup analysis of HPV vaccine initiation and completion, Odds Ratios (95% CI)HPV Vaccine Initiation (a)Parental RecallProvider verifiedGender (Ref: Boys)1.98 (1.81, 2.15)2.02 (1.81, 2.26)Race (Ref: Caucasian)African American1.19 (1.03, 1.37)1.31 (1.10, 1.56)Hispanic1.38 (1.20, 1.58)1.51 (1.27, 1.79)Region (Ref: South)Northeast1.31 (1.18, 1.46)1.46 (1.27, 1.67)Midwest1.11 (1.01, 1.22)1.15 (1.02, 1.30)West1.25 (1.09, 1.43)1.42 (1.20, 1.69)HPV Vaccine Completion (b)Parental RecallProvider verifiedGender (Ref: Boys)2.24 (2.02, 2.48)2.37 (2.09, 2.69)Race (Ref: Caucasian)African American0.91 (0.77, 1.07)1.05 (0.87, 1.28)Hispanic1.06 (0.91, 1.23)1.40 (1.17, 1.68)Region (Ref: South)Northeast1.39 (1.23, 1.57)1.55 (1.34, 1.80)Midwest1.14 (1.02, 1.27)1.24 (1.08, 1.41)West1.20 (1.03, 1.40)1.36 (1.12, 1.66) Citation Format: Eric Adjei Boakye, Nosayaba Osazuwa-Peters, Kahee A. Mohammed, Christian J. Geneus, Betelihem B. Tobo. A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2577.

Accuracy of parental reports of children's HPV vaccine status: implications for estimates of disparities, 2009-2010.

Since the introduction of the human papillomavirus (HPV) vaccine in 2006, there have been considerable efforts at the national and state levels to monitor uptake and better understand the individual and system-level factors that predict who gets vaccinated. A common method of measuring the vaccination status of adolescents is through parental recall. We examined how the accuracy of parents' reports of their daughters' HPV vaccination status varied by social characteristics. Data were taken from the 2009-2010 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents' and providers' reports of teens' HPV vaccine initiation (≥1 dose) and completion (≥3 doses). We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic. In bivariate analyses, concordance of parent-reported HPV vaccine initiation was associated with each of the sociodemographic characteristics investigated. In regression models, self-reported nonwhite race, lower household income, and lower education level of the teen's mother were associated with a higher likelihood of having a false-negative parental report than a concordant report. Our results indicate that, while estimates of overall coverage based on parental report may be unbiased, the differences in the accuracy of parental report could result in misleading estimates of disparities in HPV vaccine coverage.

Accuracy of Parental Report and Electronic Health Record Documentation as Measures of Diet and Physical Activity Counseling

ObjectiveTo determine whether parental reports and electronic health record documentation of physician counseling on nutrition and physical activity reflect actual counseling provided. MethodsParticipants were parents of 198 children 2 to 12 years of age seen in a primary care pediatric clinic at an academic medical center for well child care and their 38 physicians. Parents completed a post-visit questionnaire to report discussions on weight, nutrition, and physical activity that occurred during the visit. Electronic health records were reviewed to measure documentation of these topics during the visit. Parental reports and records were compared with actual discussions on the basis of coded audiotapes. Counseling was coded as having occurred if specific topics were mentioned during the encounter, however brief this mention was. ResultsA total of 48% of the children were female, they were a mean age of 5.4 years, and 28% were overweight or obese. Sensitivity of parental report was high (63%–96%), but specificity was low (43%–77%) because of parents’ tendency to overreport counseling. Sensitivity of electronic health record documentation was generally low (40%–53%) except for discussion of screen time (92%) and physical activity (88%); the specificity of these data was also poor (42% and 21%, respectively, for screen time and physical activity). ConclusionsElectronic health record documentation may not be the most valid method of measuring physician counseling on weight, nutrition, and physical activity in pediatric primary care. Parental report via the use of a questionnaire administered immediately after the visit is a better alternative in quality improvement or research studies when resources do not allow for direct observation, with the caveat that parents may overreport whether counseling was provided.

Research with children exposed to disasters

A number of logistical issues complicate the conduct of child disaster research. Like studies of adults, much of the child research has used a single cross-sectional assessment of non-representative samples, it fails to consider pre-disaster contribution to post-disaster problems, and it leaps to unwarranted causal conclusions from results providing mere associations. Despite concern about the accuracy of parental report and concern about children's understanding of certain terms, most child studies have used a single source of information - either the children themselves or their parents. As the field matures, greater attention to the sophistication of research methods and design will increase our understanding of children in the context of disasters.