association of parents attitudes and hpv vaccine.pdf - VanWormer et al BMC Public Health(2017 17:766 DOI 10.1186/s12889-017-4787-5 RESEARCH ARTICLE Open

association of parents attitudes and hpv vaccine.pdf -...

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RESEARCH ARTICLE Open Access Association between parent attitudes and receipt of human papillomavirus vaccine in adolescents Jeffrey J. VanWormer 1* , Casper G. Bendixsen 1 , Elizabeth R. Vickers 1 , Shannon Stokley 2 , Michael M. McNeil 2 , Julianne Gee 2 , Edward A. Belongia 1 and Huong Q. McLean 1 Abstract Background: Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents attitudes impact HPV vaccine uptake. This study examined the association between changes in parents vaccine attitudes and HPV vaccine receipt in their adolescent children. Methods: A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11 17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties) from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion. Results: There were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion. Conclusions: Reductions in parents uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine s safety profile. Keywords: Human, Papillomavirus vaccines, Parents Background The human papillomavirus (HPV) vaccine was introduced in 2006, but coverage has remained lower than for other recommended adolescent vaccines for tetanus, diphtheria, pertussis (Tdap), and meningococcal disease [1]. HPV vaccine series completion, which included three doses in 2015, was recently estimated at 35% in the U.S. Factors contributing to low population-level HPV vaccine cover- age are not well understood. Parents are generally aware of the HPV vaccine [2], but specific knowledge about HPV vaccination (e.g., schedule, benefits) is weakly corre- lated with actual coverage [3]. While multiple causes likely exist, low coverage is hypothesized to be a function of hesitancies, ambivalence, or resistance by many parents who are deciding about their child s healthcare. In considering their adolescent s young age and (presumed) timeline until sexual exposure, parents typically underesti- mate their child s susceptibility to acquiring sexually transmitted infections or cervical cancer [4, 5]. Parents
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