Human papillomavirus vaccination among adolescents in Georgia

Abstract

Human papillomavirus (HPV) vaccination coverage for adolescent females and males remains low in the United States. We conducted a 3-arm randomized controlled trial (RCT) conducted in middle and high schools in eastern Georgia from 2011-2013 to determine the effect of 2 educational interventions used to increase adolescent vaccination coverage for the 4 recommended adolescent vaccines: Tdap, MCV4, HPV and influenza. As part of this RCT, this article focuses on: 1) describing initiation and completion of HPV vaccine series among a diverse population of male and female adolescents; 2) assessing parental attitudes toward HPV vaccine; and 3) examining correlates of HPV vaccine series initiation and completion. Parental attitude score was the strongest predictor of HPV vaccine initiation among adolescents (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.80, 2.39). Other correlates that significantly predicted HPV series initiation were gender, study year, and intervention arm. Parental attitudes remained a significant predictor of receipt of 3 doses of HPV vaccine along with gender, race, school type and insurance type. This study demonstrates that positive parental attitudes are important predictors of HPV vaccination and critical to increasing coverage rates. Our findings suggest that more research is needed to understand how parental attitudes are developed and evolve over time.

Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border

“…Few studies have specifically assessed parent predictors of HPV vaccine initiation 30–34 and completion 33, 34 for their adolescent girl children. Brewer and colleagues 30 found increased HPV vaccine initiation among parents when few barriers to vaccination were perceived.…”

“…Tsui and colleagues 32 reported that neighborhood sociodemographic factors (e.g., the percentage of census tract residents living below poverty level, the percentage of unemployed census tract residents older than age 16, the percentage of census tract residents belonging to a minority race/ethnicity, and the percentage of census tract residents without access to a private vehicle) were not significantly associated with HPV vaccine initiation after controlling for individual-level factors (e.g., the daughter’s age, insurance type, usual source of care; and the mother’s race/ethnicity, age and level of HPV awareness). According to Underwood and colleagues 33 , parents with more positive attitudes about the vaccine and with a female child were more likely to initiate and complete the series. The age of the female child and the type of insurance were also factors: having a high school age child and private insurance were associated with completing the series compared to having a middle school child and Medicaid.…”

“…The age of the female child and the type of insurance were also factors: having a high school age child and private insurance were associated with completing the series compared to having a middle school child and Medicaid. 33 …”

“…The aforementioned studies focused on rural and urban African American, 30, 33, 34 Haitian, 34 mixed urban Latino and African American, 31 and mixed urban Latino and Asian American 32 populations. Few of these studies controlled for individual level factors such as HPV and HPV vaccine knowledge, which are recognized by health promotion theories 35, 36 as contributing to the adoption and/or maintenance of HPV vaccination.…”

Parent HPV vaccine perspectives and the likelihood of HPV vaccination of adolescent males

“…6 Other research has shown that parents' beliefs about the general benefits of vaccines and perceived benefits of HPV vaccine were associated with initiation of HPV vaccine for their sons, 7 and that positive attitudes toward HPV vaccine among parents were the strongest predictor of HPV vaccine initiation and completion. 8 Given the importance of a provider recommendation and awareness of HPV vaccine for males, one objective of this study was to explore in more depth parents' experiences with discussing HPV vaccine with physicians. In addition, we sought to explore attitudes related to HPV vaccination among parents with adolescent sons, with a focus on comparing the perspective of parents who do not intend to initiate HPV vaccine to that of parents who are likely to initiate or continue HPV vaccination.…”