Human Papillomavirus Vaccine Decision-making Research Articles

Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States

ObjectiveThe human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9–26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27–45 years. This study also assessed factors associated with HPV vaccine initiation after age 26. MethodsData were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27–45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27–45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models. ResultsOverall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males. ConclusionsThe ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

The community nurse’s role on the promotion of papillomavirus vaccination among young students: A study protocol

ABSTRACT Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents’ HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents’ vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth’s health promotion.

Relationship between religiosity and HPV vaccine initiation and intention in urban black and hispanic parents

ObjectiveReligion is believed to be an important sociocultural influence in the U.S., but little is known about how religiosity shapes the human papillomavirus (HPV) vaccine decision in racial/ethnic minorities. The purpose of this study was to examine the relationship between religiosity and HPV vaccine initiation and intention among urban, racial/ethnic minority parents of adolescents 11–14 years old.DesignThis study employed a descriptive, cross-sectional design using baseline data from Black and Hispanic parents (N = 175 and 285, respectively) recruited from medically underserved communities. Chi-square tests for independence and independent-samples t-tests were run to assess sociodemographic differences in vaccine initiation and vaccine intention. Binary logistic regression analyses were conducted to determine whether religious attendance and religious salience were associated with parents’ HPV vaccine decisions for their children.ResultsApproximately 47% of Black parents had vaccinated their youth against HPV. Of those who had not initiated the vaccine for their child, 54% did not intend to do so. 54% of Hispanic parents had initiated the HPV vaccine for their youth. Of those who had not initiated the vaccine for their child, 51% did not intend to do so. Frequency of attendance at religious services and the importance of religion in one’s life was not significantly correlated with HPV vaccine decision-making for Black nor Hispanic parents.ConclusionThis study suggests that religiosity does not influence the HPV vaccine decision for urban, Black and Hispanic parents. Future studies using measures that capture the complexity of religion as a social construct are needed to confirm the findings. In addition, studies with representative sampling will enable us to make generalizations about the influence of religion on HPV vaccine decision-making for urban, racial/ethnic minority parents.

Exploring human papillomavirus vaccination decision making through mother and adolescent dyad interviews.

The purpose of our research was to explore how parents and their adolescent children make decisions about the human papillomavirus (HPV) vaccine, and to inform future interventions that aim to facilitate inclusive decision-making processes. Purposive and snowball sampling strategies targeted parents and their adolescent children (ages = 11-13) in a large city in Australia. We conducted separate and joint semistructured interviews in 2013 with six mother-adolescent dyads (50% female adolescents and 50% male). Interviews were analyzed using a grounded theory approach. Factors that both facilitate and impede decision making emerged, including: background knowledge, values, historical experiences, parenting style, and opinion weights. New interventions, strategies, and tools that are informed by these decision-making factors can be used to aid productive, mutual decision making between parents and adolescents and support adolescent autonomy and self-sufficiency in health decision making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived facilitators and barriers to the uptake of the human papillomavirus (HPV) vaccine among adolescents of Arabic-speaking mothers in NSW, Australia: A qualitative study

BackgroundAustralia has a large immigrant population but there is little data regarding whether human papillomavirus (HPV) vaccination coverage in adolescents varies according to parents’ cultural or ethnic background. This work aims to identify facilitators and barriers to HPV vaccination of adolescents as perceived by Arabic-speaking mothers in Western Sydney, South Western Sydney and Wollongong, NSW, Australia. MethodsA purposive sampling approach was applied to recruit mothers of adolescents from Arabic speaking backgrounds who had at least one child eligible for the HPV school-based vaccination program. Face-to-face semi-structured well as online interviews were conducted in Arabic between April 2021 and July 2021. The interviews were audio-recorded, transcribed, and translated into English and examined using thematic analysis. ResultsSixteen mothers of adolescents from Arabic backgrounds described facilitators and barriers to HPV vaccination. A) Facilitators of HPV vaccination included: knowledge of HPV disease, trust in the school vaccination program, opportunistic recommendations from healthcare workers, information from friends. B) Barriers to accessing HPV vaccination included communication gaps: breakdown in school-parent information flow, lack of access to the Arabic language version of the information sheet, mother - GP communication barriers, mother–child communication gap; and health system gaps: missed opportunities for vaccination. C) Mothers’ suggestions to improve HPV vaccination acceptance: to involve religious and cultural leadership, encourage engagement with GPs, and provide school-based education for parents and students. ConclusionParents could benefit from assistance with HPV vaccination decision making. Interventions via schools, health professionals and religious and cultural organisations could play important roles in HPV vaccination acceptance for Arabic speaking immigrant families and in introducing their adolescent children to this vaccine.

Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study.

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.

Factors associated with HPV vaccination decision-making among Korean American women.

Despite a significant reduction of human papillomavirus (HPV) infection in the United States in the past decade, Korean American (KA) women experience a disproportionately high cervical cancer burden due to low HPV vaccination rates. Given associations between parental decision-making and adolescent vaccination, it is crucial to identify and address factors influencing parental HPV vaccination decision-making for their children. The purpose of this study was to examine the sociodemographic characteristics and health literacy factors in relation to KA women's willingness to allow their daughters to receive HPV vaccination. We used baseline data collected from 560 KA women who participated in a cluster-randomized trial designed to promote mammography and Pap test screening. Participants answered study questionnaires measuring individual characteristics, cancer literacy, HPV knowledge, and HPV vaccination decision-making for their daughters. Multivariate logistic regression analysis was conducted to identify the correlates of HPV vaccination decision-making among participants. Over half of the participants (54%) endorsed HPV vaccination for their daughters. Low knowledge, compared to high and medium HPV knowledge (aOR 3.48, CI 2.01-6.04 and aOR 2.14, CI 1.46-3.12, respectively), were significantly associated with higher odds of participants' intention to vaccinate their daughters. Additionally, in comparison to low cancer literacy, middle-range cancer literacy (aOR 1.70, CI 1.08-2.68) was significantly associated with higher odds of participants' intention to vaccinate their daughters. Misperceptions about cancer and low HPV knowledge among KA women should be considered when providing vaccine counseling and developing interventions to promote cervical health in this population.

Exploring HPV vaccine hesitant parents’ perspectives on decision-making and motivators for vaccination

IntroductionThe human papillomavirus (HPV) vaccine is highly effectiveat preventing HPV-associated cancers in bothmales and females, yet vaccination rates remain sub-optimal in part due to vaccine hesitancy. This study sought to assess which strategies vaccine-hesitant parents perceive asmost likely to motivatethem to vaccinate theirchildren againstHPV. MethodsIn 2021, we recruited parents with children ages 10–17 years old who were not vaccinated against HPV and who felt unsure or hesitant about their decision to vaccinate their child. Participants were recruited through an online patient portal within a single institution. A screening survey assessed for vaccine hesitancy. Semi-structured interviews focused on HPV vaccine decision-making, motivators, and potential strategies to improve vaccination rates in hesitant parents. Audio recordings were transcribed and analyzed via a combination of deductive and inductive codes. Results and DiscussionA total of twenty-two vaccine-hesitant parents were interviewed. The major themes identified were a lack of confidence in vaccine decision-making, a desire for more information, and dissatisfaction with provider encounters. Parents reported that their hesitancy was driven by concerns about safety and necessity, often based on negative anecdotal reports. Although pediatricians were the most often cited source of vaccine information, many parents were dissatisfied with the encounters they had regarding the vaccine. Parents expressed a desire for detailed information on both the benefits and risks of the vaccine, and resources that allowed them to actively participate in vaccine discussions with providers. Suggested modes of delivery for this information included in-depth pediatrician discussions, written materials provided by pediatricians, and facilitation tools, such as a list of questions to help parents prepare for pediatrician visits. Thus, strategies that empower parents to feel informed and confident in their decision to vaccinate their children could be useful in motivating vaccine-hesitant parents to vaccinate their children against HPV.

Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey.

BackgroundHuman Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media.ObjectiveThis study aimed to examine the association between parents’ perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child.MethodsParents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group.ResultsOf the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be “undecided/not wanting the vaccine” if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001).ConclusionsInterventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions.

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Human papillomavirus (HPV) vaccination intent and its associated factors: a study of ethnically diverse married women aged 27 to 45 in Malaysia, a Southeast Asian country

ABSTRACT Introduction: This study aimed to investigate HPV vaccination intention among adult married women aged 27 to 45 years and its associated factors, and their spouse/partner’s influence on HPV vaccination decision-making. Methods: This is a cross-sectional, questionnaire-based study. Study participants were recruited through simple random sampling of patients attending obstetrics and gynecology outpatient clinics in a university teaching hospital. Participants were selected based on a computer-generated list of a random list of patients attending the clinic. Results: A total of 794 complete responses were received (response rate 88.2%). The mean age of the respondents was 32.2 years with a standard deviation (SD) of ±3.9 years.The vast majority (85.3%) would communicate with their spouse/partner with regard to HPV vaccination decision-making. Nearly 30% (over half were of the Malay ethnic group) perceived their spouse/partner would not consent to their HPV vaccination. Over half (54.9%) reported joint decision-making, and 9.1% (the majority of whom were Malay) reported that HPV vaccination was dependent on their spouse/partner’s decision. Intention to vaccinate against HPV was high (74.5%). Factors influencing HPV vaccination intention were spouse/partner’s consent to HPV vaccination (odds ratio [OR] = 4.51; 95% confidence interval [CI], 3.08–6.62), being a postgraduate student (OR = 4.55; 95% CI, 2.13–9.72 vs. unemployed/housewife), average household income MYR2000–4000 (OR = 2.09; 95%CI, 1.16–3.78 vs. below MYR2000), and an HPV-related knowledge score of 9–20 (OR = 1.60; 95% CI, 1.10–2.32 vs. score 0–8). Conclusion: Findings highlight the importance of culture-centered interventions to enhance male partner’s awareness and support for the HPV vaccination of married women.

Human papillomavirus vaccination - limatations and opportunities in countries with low vaccine coverage.

Persistent infection with oncogenic Human papillomavirus (HPV) types can lead to neoplasms involving urogenital and laryngeal tumors, which account for approximately 5% of all cancers worldwidely. Effective measures to reduce the morbidity and mortality associated with HPV cancers are regular examinations including the Papanicolaou test and preventive vaccination. However, despite the registration of the first HPV vaccine already in 2006, there is still huge disparity in the vaccination coverage between countries. In Poland, vaccination coverage is still very low in comparison to other European Union countries (only a few percent). Constraints exist on the part of the state and health system organizations, as well as in the attitudes of health professionals and parents. One of the primary factors influencing the decision to vaccinate against HPV is the presence of the vaccine in The National Immunization Program, while often with financial support. Formalization of vaccination also forces physicians to be more attentive to informing and recommending immunization, increasing their level of education. The role of medical workers is crucial from a social point of view. For parents, an adequate discussion with the physician is a vital factor influencing HPV vaccination decisions. At the same time, health care workers express the need to change their work organization due to insufficient time for health promotion and prophylaxis during visits. A thorough understanding of the barriers can allow for the development of effective strategies to increase vaccination coverage.

Disentangling the Role of Religiosity in Human Papillomavirus Vaccination Amidst COVID-19 Pandemic.

Religion is a complex and sociocultural driver of human papillomavirus (HPV) vaccination decisions, but its exact role has been mixed/unclear. We used a cross-sectional study of 342 Christian parents to examine the associations between the three domains of religiosity (organizational, non-organizational, and intrinsic) and the intention to (i) seek HPV information and (ii) receive the HPV vaccine. Organizational religiosity was the only domain that was positively associated with information-seeking intention regardless of the type of covariates included. Mixed findings in the association between religiosity and HPV vaccination decisions may depend on the religiosity domain being assessed.

‘I trust them because my mum trusts them’: Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France

The success of vaccination programmes relies on high uptake and acceptance of vaccines, which is in part influenced by public trust in vaccines, providers, policy-makers and information. France is one of the countries in the world with the lowest confidence in vaccination, with parents expressing particular concerns about the human papillomavirus (HPV) vaccine. This qualitative study explored the role of trust in HPV vaccination decision-making among mothers and adolescent girls in France. Semi-structured interviews and focus groups were conducted with 15–16-year-old adolescent girls and their mothers in Paris. A thematic analysis based on deductive and inductive coding was conducted. HPV vaccination decision-making was described as a complex and uncertain process, a possible consequence of erosion of trust in the vaccine, in healthcare professionals and health authorities, and in information itself. Due to public criticism of the vaccine and conflicting advice received from medical professionals, the vaccine was perceived as controversial. The mothers’ strong trust in doctors did not always increase HPV vaccine acceptance, as doctors themselves failed to recommend or recommended against the vaccine. Furthermore, the perceived mismanagement of previous health events tainted the mothers’ trust in health authorities. Contrastingly, while adolescents expressed trust in doctors and health authorities, their trust in their own mothers was stronger. A lack of exposure to positive sources of information (e.g. from doctors, schools or media) contributed to low awareness about HPV vaccination among adolescent girls. While both mothers and girls discussed the importance of trusting themselves, they also acknowledged being influenced by others around them as well as information, often negative, from the internet. Adolescent girls also expressed mistrust about information in general, explaining that any information can be manipulated. Low confidence in HPV vaccination in France can be explained by broader trust issues, which will require long-term efforts to address.

The role of maturity in adolescent decision-making around HPV vaccination in France

Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents’ involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents’ capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls’ involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents’ lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters’ own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.

Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute’s evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women’s interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women’s online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

Factors Associated With African American Mothers’ Perceptions of Human Papillomavirus Vaccination of Their Daughters: An Integrated Literature Review

African American (AA) women have a higher mortality rate for cervical and other cancers and are less likely to have received the human papillomavirus (HPV) vaccine than White women. Mothers play a significant family role and have a unique relationship with their daughters. Mothers' positive views on HPV vaccination may enhance the HPV vaccination rate among their daughters. The review was conducted by searching literature in PubMed®, CINAHL®, ScienceDirect, Ovid MEDLINE®, and ProQuest databases. The search was limited to studies conducted in the United States and published since the inception of the HPV vaccine in 2006. Of 10,566 publications retrieved, 28 articles were included in the final sample. Factors associated with HPV vaccination were approval and disapproval of HPV vaccination from physicians, family, and friends; HPV knowledge; attitude and belief about HPV vaccination; benefits of vaccination; and challenges of and barriers to HPV vaccination. Understanding factors related to HPV vaccination decisions among AA mothers will inform healthcare providers of the best approach to improving vaccination rates among this high-risk population.

The mediating role of vaccine hesitancy between maternal engagement with anti- and pro-vaccine social media posts and adolescent HPV-vaccine uptake rates in the US: The perspective of loss aversion in emotion-laden decision circumstances

While Human Papillomavirus (HPV) is a prominent cause of cervical cancer and mortality among underserved women, HPV vaccine completion rates remain stagnant (54%) among US adolescents. Our objective is to identify how adolescents' mothers' engagement with anti-vaccine versus pro-vaccine social media content is associated with their children's HPV vaccination rates via increased vaccine hesitancy. We employ the notion of loss aversion escalated in an emotion-laden circumstance in consumer behavior literature given that HPV vaccination decisions directly affect children's well-being. Based on this escalated loss aversion tendency for an emotion-laden decision, we explain why anti-vaccine content disproportionately increases mothers' overarching vaccine hesitancy, while pro-vaccine content does not decrease vaccine hesitancy. We conducted a population-based survey among 426 mothers of US adolescents aged 13–18. Our sample closely mimics the socioeconomic and demographic factors of the population group of mothers of adolescents in the US census. Our results show that anti-vaccine social media posts are associated with increases in mothers' overarching vaccine hesitancy and with decreases in their children's HPV vaccination rates, while pro-vaccine content has no significant association with either.

Human Papillomavirus Vaccine Acceptability and Campaign Message Preferences Among African American Parents: a Qualitative Study.

Human papillomavirus (HPV) vaccination can prevent numerous cancers, yet uptake remains low for adolescents. Given disproportionate burden of cancers among African Americans, it is important to identify factors that influence HPV vaccination decisions among African American parents, specifically the role and preferences of vaccine campaign messages. The objectives of this study were to (1) identify the predictors of parents’ decisions to get their children vaccinated against HPV, (2) assess parents’ evaluation of current HPV vaccination campaign messages, and (3) uncover message strategies or themes parents consider to be effective and motivating to vaccinate their children against HPV. Focus groups were conducted with African American mothers and fathers (n = 18) in person. Several themes emerged regarding HPV vaccine acceptability including the desire to be informed, the unfamiliarity of vaccination, and mistrust toward government, pharmaceutical companies, and healthcare providers. Parental review of existing campaign messages highlighted the importance of clarifying risks and benefits of vaccination, including cancer prevention, and the preference for straightforward language. When brainstorming strategies to craft effective messages, parents highlighted need for the inclusion of diverse groups across race, gender, and age. Additionally, parents recommended clear language on side effects, eligibility, and additional resources for further information. Our findings highlight concerns and potential strategies to promote HPV vaccination tailored to African American parents and their children. Targeted interventions to increase vaccination need to consider the importance of building trust and representation in health promotional materials. Considerations for how messages were shared were also discussed such as physical locations, word of mouth, and social media.

Calling the Shots? Adolescents' Influence on Human Papillomavirus Vaccine Decision-Making During Clinical Encounters

PurposeThe aim of the study was to examine adolescents' influence on human papillomavirus (HPV) vaccine decision-making and receipt during clinical visits. MethodsWe recruited English- and/or Spanish-speaking parents and their adolescent children aged 9–17 years who were eligible for the first HPV vaccine dose and seeking routine care at pediatric and family medicine clinics in the Greater Boston area enrolled in a multilevel intervention to improve HPV vaccination coverage. Parents completed previsit surveys that included parental intention to vaccinate. We coded transcripts of adolescents' clinical encounters to define adolescents' participation in vaccine discussions and cooperation with immunization. Adolescents' influence on vaccine decision-making was determined based on analyses of their participation in discussions and parents' previsit vaccine intentions. ResultsA total of 113 adolescents and their parents participated. Eighty-seven percent of adolescents received their first HPV vaccine dose during the visit. Most reactions were negative (23% mild, 23% moderate, and 10% extreme); nearly all objections were concerns related to the pain of injection rather than specific to HPV vaccination. A minority of reactions were positive (12%), 33% were neutral, and 12% did not participate in vaccine discussions. All adolescents with positive or neutral reactions received vaccination, as did 91% of those with negative reactions. After accounting for parents' previsit vaccine intentions and analyzing discussions during clinical encounters, only 5% of adolescents appeared to influence vaccination either positively (n = 3) or negatively (n = 3). ConclusionsIn this study, adolescents rarely influenced parents' vaccine decision-making, although many exhibited distress over the pain of injections. This suggests that increasing adolescents' involvement in vaccine discussions may have limited effects on vaccination rates.