Editors' ChoiceHuman Papillomavirus

To Vaccinate or Not: Parents Decide

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Science Translational Medicine  13 Oct 2010:
Vol. 2, Issue 53, pp. 53ec160
DOI: 10.1126/scitranslmed.3001769

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with a lifetime prevalence of 80%. Patients with low-risk HPV may develop genital warts; however, high-risk HPV types 16 and 18 cause 70% of cervical cancer cases. The recent introduction of a vaccine against HPV has been an exciting development in disease prevention, yet use of this vaccine remains suboptimal. Despite the availability of two prophylactic HPV vaccines, only 18% of girls between the ages of 9 and 26 years have completed the three-dose series. Because parents are responsible for vaccination decisions for the majority of girls in the targeted HPV vaccination population, the recent cross-sectional study reported by Allen et al. investigated behavioral predictors that influence the decision, among parents, of whether or not to vaccinate eligible girls.

To evaluate parent decision-making, the investigators surveyed knowledge of HPV and vaccines in general, attitudes specific to the HPV vaccine, and social influence on use of an HPV vaccine. The survey targeted White, Black, and Hispanic households with a broad range of household incomes, education levels, and insurance statuses. A significant difference in awareness of HPV and the HPV vaccine was seen across race: 25% of White parents, 48% of Black parents, and 39% of Hispanic parents were unaware of the existence of the HPV vaccine. Despite this lack of awareness, equivalent proportions (10 to 15%) of eligible females in all race/ethnicity categories were vaccinated. Moreover, up to 25% of all parents surveyed had decided against vaccination. Multivariate analysis revealed variables that appeared important in the decision to vaccinate or not to vaccinate, including knowledge of HPV, attitudes regarding vaccination in general, concern of potential side effects, social influence, and barriers such as cost, concerns about the vaccine’s effect on sexual behavior, and trust in the pharmaceutical industry. In summary, despite the advent of two new vaccines targeting HPV, a significant proportion of parents have decided against the vaccine. Further efforts to increase awareness of HPV and its effect on health outcome, with a special emphasis on the Black and Hispanic subpopulations that have the greatest disease burden, are required to improve the incidence of HPV vaccination among eligible girls.

J. D. Allen et al., Parental decision making about the HPV vaccine. Cancer Epidemiol. Biomarkers. Prev. 19, 2187–2198 (2010). [Abstract]

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