Influences of sociodemographic characteristics and parental HPV vaccination hesitancy on HPV vaccination coverage in five US states

BackgroundIn the United States (US), half of new human papillomavirus (HPV) infections occur among young people aged 15–24 years. Despite the effectiveness of HPV vaccination in protecting against HPV-associated cancers, its coverage among adolescents remains suboptimal. This study examined the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage in five US states with disproportionately low adolescent coverage rates compared to the national average.MethodsResponses to an online Qualtrics survey from 926 parents of children aged 9–17 years in Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois in July 2021 were analyzed using multivariate logistic regression to estimate the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage.ResultsOf the parents, 78 % were female, 76 % were non-Hispanic White, 61.9 % lived in rural areas, 22 % were classified as HPV vaccine hesitant, and 42 % had vaccinated their oldest child between the ages of 9–17 years against HPV. Children of vaccine hesitant parents were less likely to have received any doses of the HPV vaccine than children of non-vaccine hesitant parents (AOR: 0.17, 95 % CI:0.11–0.27). Male children were less likely to have initiated the HPV vaccine series than female children (AOR: 0.70, 95 % CI:0.50–0.97). Older children (13–17 vs 9–12 years), receiving the meningococcal conjugate or most recent seasonal influenza vaccine were all associated with higher likelihoods of receiving any doses of the HPV vaccine (AOR: 6.01, 95 % CI:3.98–9.08; AOR: 2.24, 95 % CI:1.27–3.95; AOR: 2.41, 95 % CI:1.73–3.36, respectively).ConclusionsAdolescent HPV vaccination coverage remains low in our targeted states. Children’s age, sex, and parental vaccine hesitancy were significantly associated with likelihood of HPV vaccination. These findings offer the opportunity for targeted interventions among parents in regions with low vaccine uptake and underscore the importance of developing and implementing strategies to address parental HPV vaccination hesitancy to improve uptake in the US.     

Predictors of interest in HPV vaccination: A study of British adolescents

Human papillomavirus (HPV) vaccination is now offered to adolescent girls in the UK. Adolescents over 16 years old are likely to make their own decision about the vaccination. The purpose of this cross-sectional study was to assess acceptability of HPV vaccination among female adolescents (16–19 years) and investigate socio-cultural variation in intended acceptance. Participants were recruited through two further-education colleges in England. They read information about HPV before responding to questions assessing acceptability, demographics and attitudes based on the Health Belief Model. There were 367 cases included in analyses. Most participants said they would be likely to accept HPV vaccination (89%). Ethnicity, religion and English as a first language were associated with acceptability (pseudo-R² = 0.11). In multivariate analysis only religion remained significant, with girls from Muslim (OR = 0.20, CI: 0.05–0.90) or Hindu/Sikh (OR = 0.09, CI: 0.01–0.56) backgrounds less likely to accept vaccination. Perceived susceptibility, benefits and barriers were also associated with acceptability (pseudo-R² = 0.25), but did not mediate the effect of the ethnicity-related variables. Interventions based on the health belief model may help encourage HPV vaccine acceptance among adolescents. Future research to understand the issues associated with HPV vaccination in different religious groups is needed.     

A survey of rubella haemagglutination-inhibition testing in the southern states of Australia

The accuracy and reproducibility of rubella haemagglutination—inhibition tests performed in 17 laboratories in the south of Australia were surveyed and showed that only 8 were providing reliable results.     

HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults

Background

Human papillomavirus (HPV) infection and associated cervical disease are common among all women, regardless of sexual identity, yet limited research has examined HPV vaccination among lesbian and bisexual women.

Methods

A national sample of lesbian and bisexual women ages 18–26 (n = 543) completed our online survey during Fall 2013. We used multivariable logistic regression to identify correlates of HPV vaccine initiation (receipt of at least 1 dose) and completion (receipt of all 3 recommended doses among initiators).

Results

Overall, 45% of respondents had initiated HPV vaccine and 70% of initiators reported completing the series. HPV vaccine initiation was higher among respondents who were students, had received a healthcare provider's recommendation, perceived greater positive social vaccination norms, or anticipated greater regret if they did not get vaccinated and later got HPV. Initiation was lower among those who perceived greater HPV vaccine harms or greater barriers to getting the vaccine (all p < .05). HPV vaccine completion was higher among initiators who had a college degree while it was lower among those who perceived a greater likelihood of acquiring HPV or who anticipated greater regret if they got the vaccine and fainted (all p < .05). Among HPV vaccine initiators who had not yet completed the series, about half (47%) intended to get the remaining doses.

Conclusions

Many lesbian and bisexual women are not getting vaccinated against HPV. Healthcare provider recommendations and women's health beliefs may be important leverage points for increasing vaccination among this population.     

Hepatitis A 2004 vaccination in children: methods and findings of a survey in two states

BACKGROUND: Hepatitis A vaccine coverage estimates needed for surveillance and vaccine policy decisions are not readily available for children older than 35 months or for adolescents. This article reports methodology developed for obtaining such estimates by telephone survey with and without provider record verification. METHODS: A random-digit-dial telephone survey with provider verification was conducted in Arizona and Oregon in 2004-2005 to obtain coverage estimates for children aged 2.5 to 15 years based on parental reports from telephone survey data alone, and from multiple logistic regressions using both telephone survey and provider data. Analysis was performed during 2006. RESULTS: Vaccination information was collected from parents of 1266 children, and provider verification from 488. Telephone survey and provider record-based hepatitis A vaccine coverage (one or more doses) was 60% and 65%, respectively, in Arizona, and 39% and 26%, respectively, in Oregon. Children who were younger, lived in metropolitan areas, or were Hispanic or nonwhite had significantly higher coverage; parents with immunization records provided more-accurate information. While a logistic model-based estimator developed using both parent and provider data performed slightly better than the estimator based on parent data alone, they differed mostly in the subgroups that had small sample sizes. CONCLUSIONS: These are the first statewide provider-verified hepatitis A vaccine coverage estimates for children older than 35 months and indicate that telephone survey estimates as developed using this methodology could prove useful for immunization surveillance activities if interpreted cautiously.     

Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales

BackgroundSchool-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages.MethodsWe carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided.ResultsAmong 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine.ConclusionsOur findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate.     

Perceptions and acceptability of HPV vaccination among parents of young adolescents: A multicenter national survey in China

Prophylactic HPV vaccines target young adolescents to prevent related cervical lesions and even genital warts prior to onset of sexual activity. Parental consent is often essential for success of vaccination program for this age group. We conducted a national multicenter study to explore the acceptability of HPV vaccination among parents of young adolescents and associated factors in relevant parent decision making in China. A total of 2899 parents of young adolescents (11–17 years) participated in the survey between November 28, 2011 and May 9, 2012, but four were excluded from analysis because of inconsistencies in their given information in the questionnaire. Mothers accounted for 62.8% of the parent participants. The mean age of the parents was 40.40 (standard deviation, 4.68) years. Only 36.2% of the parents accepted the vaccine for their children. Knowledge about HPV and HPV vaccine was a positive correlate with HPV vaccination acceptability (P_trend = 0.003). Grade of child (P_trend = 0.015), prior vaccination experience outside the National Expanded Program on Immunization (OR: 1.43; 95%CI: 1.19–1.72), fear of cervical cancer and/or genital warts (OR: 2.47; 95%CI: 2.00–3.05), and prior consultation regarding HPV vaccine information (OR: 2.35; 95%CI: 1.57–3.52) were also positively associated with higher HPV vaccine acceptability. The acceptability was lower in mothers (OR: 0.45; 95%CI: 0.37–0.54) and who had better education (P_trend = 0.009). 57.3% of the parents agreed that the most appropriate venue for HPV vaccination was the local center for disease prevention and control. In conclusion, our study indicates a low acceptability of HPV vaccination among parents of young adolescents in China. We understand there are many challenges in implementing HPV vaccination program. Our findings will serve as valuable references for future HPV vaccination policies and campaigns after HPV vaccines are approved in China.     

Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: A survey of mothers and adolescents

Background

Organized population-based HPV vaccination programs can be effective in reducing the burden of cervical cancer, especially in the absence of a comprehensive cervical screening program (e.g. Hong Kong). Assessment of vaccine acceptability is important when evaluating the feasibility and cost-effectiveness of such vaccination programs.

Methods

To provide a more representative and updated assessment on the acceptability of female adolescent HPV vaccination in Hong Kong, we conducted surveys in 2008 among 1022 mothers with daughters aged ≤18 years through random digit-dialing telephone interviewing and 2167 schoolgirls aged 11–18 years using two-stage stratified cluster sampling. We conducted the maternal survey again in 2012 with an independent group of 1005 mothers.

Results

In 2008, 2.4% (95% confidence interval [CI] = 1.8–3.2%) of the recruited schoolgirls reported having received HPV vaccination. In 2012, the mothers reported that 9.1% (7.0–11.6%) of their daughters who were in the same age range (11–18 years) as the schoolgirls had been vaccinated (p < 0.01). Regarding acceptability, 27.5% (24.8–30.4%) and 37.6% (34.5–40.8%) of the mothers were willing to have their daughters vaccinated at market price in 2008 and 2012 (p < 0.01), respectively. 27.1% (25.2–29.1%) of the schoolgirls were willing to receive HPV vaccination at market price in 2008. The willingness to pay for full-course vaccination among mothers had a median of US$128/HK$1000 (50% central range = US$64–192/HK$500–1500), i.e. substantially lower than the current market price.

Conclusions

The gap between acceptability and actual uptake of HPV vaccination among adolescent girls suggested that coverage is likely to be low without an organized HPV vaccination program, although the difference might be partially attributed to the possibility that at the time of the interview female adolescents who were willing to be vaccinated had not yet taken action. Policymakers should devise tailored, targeted and efficient vaccination strategies to achieve universal coverage for an effectively organized HPV vaccination program.     

Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: Evidence from a large survey of Nordic women

Objective

To assess whether recipients and non-recipients of the human papillomavirus (HPV) vaccine subsequently differ in terms of sexual risk taking behaviour.

Design

Cross-sectional survey. Sequential analyses constructed from self-reported age at vaccination, age at first intercourse and age at response.

Setting

A random selection of women aged 18–46 years living in Denmark, Norway and Sweden in 2011–2012, eligible for opportunistic or organized catch-up HPV vaccination.

Participants

A total of 3805 women reported to have received the HPV vaccine and 40,247 reported not to have received it. Among vaccinees, 1539 received the HPV vaccine before or at the same age as sexual debut, of which 476 and 1063 were eligible for organized catch-up and opportunistic vaccination, respectively.

Main outcome measures

Self-reported sexual behaviour, compared by hazard ratios and odds ratios for women who received the HPV vaccine before or at the same age as sexual debut versus women who did not receive the HPV vaccine.

Results

HPV vaccination did not result in younger age at first intercourse. Women who received the HPV vaccine before or at the same age as sexual debut did not have more sexual partners than did non-vaccinees. Non-use of contraception during first intercourse was more common among non-vaccinees than among HPV vaccinees. The results were similar for organized catch-up and opportunistic vaccinees.

Conclusion

Women who received the HPV vaccine before or at the same age as sexual debut did not subsequently engage more in sexual risk taking behaviour than women who did not receive the HPV vaccine.     

HPV vaccination among adolescent males: Results from the National Immunization Survey-Teen

US guidelines provided a permissive recommendation for HPV vaccine for males in 2009, with an updated recommendation for routine vaccination in 2011. Data on vaccine uptake among males, however, remain sparse. We analyzed 2010–2011 data (collected mostly prior to the recommendation for routine vaccination) from the National Immunization Survey-Teen for a nationally representative sample of adolescent males ages 13–17 (n = 22,365). We examined HPV vaccine initiation (receipt of at least one dose based on healthcare provider records) as the primary outcome. Analyses used weighted logistic regression. HPV vaccine initiation increased from 1.4% in 2010 to 8.3% in 2011. Parents who reported receiving a healthcare provider recommendation to get their sons HPV vaccine were much more likely to have vaccinated sons (OR = 19.02, 95% CI: 14.36–25.19). Initiation was also higher among sons who were Hispanic (OR = 1.83, 95% CI: 1.24–2.71) or who were eligible for the Vaccines for Children program (OR = 1.53, 95% CI: 1.01–2.31). Only 31.0% of parents with unvaccinated sons indicated their sons were “somewhat likely” or “very likely” to receive HPV vaccine in the next year. The most common main reasons for parents not intending to vaccinate were believing vaccination is not needed or not necessary (24.5%), not having received a provider recommendation (22.1%), and lack of knowledge (15.9%). HPV vaccination is low among adolescent males in the US, and provider recommendation for vaccination is likely key to improving vaccine uptake. Given the updated recommendation for routine vaccination and the changes in health insurance coverage that are likely to follow, continued efforts are needed to monitor HPV vaccination among males.     

Predictors of anxiety in family caregivers*

The present study builds on the foundation laid in caring for family caregivers of dependent elderly persons through psycho-educational support. After briefly tracing the development of the programme and its associated evaluation research, an investigation of sociodemographic variables as predictors of caregivers' anxiety is described. In line with previous literature on caregiver stress, it was found that 461 caregivers' pretreatment negative emotional responses were closely related to high levels of anxiety in their particular situations. Less expected were the findings that length of caregiving, relationship to caregiver of care-recipient, residential arrangements, age of caregiver and disability of care-recipient did not contribute significantly to the regression analysis. Even more remarkable was the finding that the strongest predictors of anxiety were the combined factors of masculine gender, unemployment and involvement in fewer than the median number of caregiving responsibilities. Implications and recommendations for research and practice are drawn.     

Estimating effectiveness of HPV vaccination against HPV infection from post-vaccination data in the absence of baseline data

BackgroundHPV vaccination programs have been introduced in large parts of the world, but monitoring of effectiveness is not routinely performed. Many countries introduced vaccination programs without establishing the baseline of HPV prevalences. We developed and validated methods to estimate protective effectiveness (PE) of vaccination from the post-vaccination data alone using references, which are invariant under HPV vaccination.MethodsType-specific HPV prevalence data for 15–39 year-old women were collected from the pre- and post-vaccination era in a region in southern Sweden. In a region in middle Sweden, where no baseline data had been collected, only post-vaccination data was collected. The age-specific baseline prevalence of vaccine HPV types (vtHPV, HPV 6, 11, 16, 18) were reconstructed as Beta distributions from post-vaccination data by applying the reference odds ratios between the target HPV type and non-vaccine-type HPV (nvtHPV) prevalences. Older non-vaccinated age cohorts and the southern Sweden region were used as the references. The methods for baseline reconstructions were validated by computing the Bhattacharyya coefficient (BC), a measure for divergence, between reconstructed and actual observed prevalences for vaccine HPV types in Southern Sweden, and in addition, for non-vaccine types in both regions. The PE estimates among 18–21 year-old women were validated by comparing the PE estimates that were based on the reconstructed baseline prevalences against the PE estimates based on the actual baseline prevalences.ResultsIn Southern Sweden the PEs against vtHPV were 52.2% (95% CI: 44.9–58.5) using the reconstructed baseline and 49.6% (43.2–55.5) using the actual baseline, with high BC 82.7% between the reconstructed and actual baseline. In the middle Sweden region where baseline data was missing, the PE was estimated at 40.5% (31.6–48.5).ConclusionsProtective effectiveness of HPV vaccination can be estimated from post-vaccination data alone via reconstructing the baseline using non-vaccine HPV type data.     

Support groups for dementia caregivers - Predictors for utilisation and expected quality from a family caregiver's point of view: A questionnaire survey PART I*

Background  

Support groups have proved to be effective in reducing the burden on family caregivers of dementia patients. Nevertheless, little is known about the factors that influence utilisation or quality expectations of family caregivers. These questions are addressed in the following paper.     

Chapter 13: Current findings from prophylactic HPV vaccine trials

Early data from randomized controlled trials consistently show that prophylactic human papillomavirus virus-like particle (HPV VLP) vaccines are effective in preventing infection and lesions caused by the targeted HPV type(s). Two vaccines, a bivalent HPV-16/18 VLP vaccine and a quadrivalent HPV-6/11/16/18 VLP vaccine, are currently undergoing evaluation in phase III trials with anticipation of receiving regulatory approval for use in immunization programs worldwide. Both vaccines have the potential to substantially reduce HPV-related morbidity and mortality. This review focuses on published data from clinical trials of these two vaccines.     

Optimising HPV vaccination communication to adolescents: A discrete choice experiment

BackgroundHuman Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics.MethodsGirls and boys enrolled in the last two years of five middle schools in three French regions (aged 13–15 years) participated in an in-class cross-sectional self-administered internet-based study. In ten hypothetical scenarios, participants decided for or against signing up for a school-based vaccination campaign against an unnamed disease. Scenarios included different levels of four attributes: the type of vaccine-preventable disease, communication on vaccine safety, potential for indirect protection, and information on vaccine uptake among peers. One scenario was repeated with an added mention of sexual transmission.ResultsThe 1,458 participating adolescents (estimated response rate: 89.4%) theoretically accepted vaccination in 80.1% of scenarios. All attributes significantly impacted theoretical vaccine acceptance. Compared to a febrile respiratory disease, protection against cancer was motivating (odds ratio (OR) 1.29 [95%-CI 1.09–1.52]), but not against genital warts (OR 0.91 [0.78–1.06]). Compared to risk negation (“vaccine does not provoke serious side effects”), a reference to a positive benefit-risk balance despite a confirmed side effect was strongly dissuasive (OR 0.30 [0.24–0.36]), while reference to ongoing international pharmacovigilance without any scientifically confirmed effect was not significantly dissuasive (OR 0.86 [0.71–1.04]). The potential for indirect protection motivated acceptance among girls but not boys (potential for eliminating the disease compared to no indirect protection, OR 1.57 [1.25–1.96]). Compared to mentioning “insufficient coverage”, reporting that “>80% of young people in other countries got vaccinated” motivated vaccine acceptance (OR 1.94 [1.61–2.35]). The notion of sexual transmission did not influence acceptance.ConclusionHPV vaccine communication to adolescents can be tailored to optimise the impact of promotion efforts.     

Girls’ preferences for HPV vaccination: A discrete choice experiment

A discrete choice experiment was developed to investigate if girls aged 12–16 years make trade-offs between various aspects of human papillomavirus (HPV) vaccination, and to elicit the relative weight that girls’ place on these characteristics. Degree of protection against cervical cancer, protection duration, risk of side-effects, and age of vaccination, all proved to influence girls’ preferences for HPV vaccination. We found that girls were willing to trade-off 38% protection against cervical cancer to obtain a lifetime protection instead of a protection duration of 6 years, or 17% to obtain an HPV vaccination with a 1 per 750,000 instead of 1 per 150,000 risk of serious side-effects. We conclude that girls indeed made a trade-off between degree of protection and other vaccine characteristics, and that uptake of HPV vaccination may change considerably if girls are supplied with new evidence-based information about the degree of protection against cervical cancer, the protection duration, and the risk of serious side-effects.     

Prophylactic HPV vaccination after conization: A systematic review and meta-analysis

IntroductionHuman papillomavirus (HPV) vaccination is essential for cervical cancer prevention. However, the value of HPV vaccination in the context excisional treatment of high-grade cervical intraepithelial neoplasia (CIN 3) remains unclear.MethodsIn this meta-analysis, three retrospective and three prospective studies, three post-hoc analyses of RCTs and one cancer registry study analysing the effect of pre- or post-conization vaccination (bi- or quadrivalent vaccine) against HPV were included after a systematic review of literature. Random-effect models were prepared to evaluate the influence of vaccination on recurrent CIN 2+.ResultsPrimary end point was CIN2+ in every study. The overall study population included 21,059 patients (3,939 vaccinations vs. 17,150 controls). The results showed a significant risk reduction for the development of new high-grade intraepithelial lesions after HPV vaccination (relative risk (RR) 0.41; 95% CI [0.27; 0.64]), independent from HPV type. Due to the heterogeneous study population multiple sub analyses regarding HPV type, age of patients, time of vaccination and follow-up were performed. Age-dependent analysis showed no differences between women under 25 years (RR 0.47 (95%-CI [0.28; 0.80]) and women of higher age (RR 0.52 (95%-CI [0.41; 0.65]). Results for HPV 16/18 positive CIN2+ showed a RR of 0.37 (95% CI [0.17; 0.80]). Overall, the number of women that would have to be vaccinated before or after conization to prevent one case of recurrent CIN 2+ (NNV) is 45.5.ConclusionMeta-analysis showed a significant risk reduction of developing recurrent cervical intraepithelial neoplasia after surgical excision and HPV vaccination compared to surgical excision only.