Elsevier

Journal of Adolescent Health

Volume 61, Issue 3, September 2017, Pages 288-293
Journal of Adolescent Health

Original article
Human Papillomavirus Vaccination: What Are the Reasons for Nonvaccination Among U.S. Adolescents?

https://doi.org/10.1016/j.jadohealth.2017.05.015Get rights and content

Abstract

Purpose

Human papillomavirus (HPV) vaccination is recommended for 11- to 12-year-old U.S. adolescents. Unfortunately, HPV vaccine rates have been suboptimal. Parents are key decision agents regarding their adolescents' health; thus, it is necessary to understand their reasons for not vaccinating their adolescents. The purpose of this study was to compare parents' primary reasons for non-HPV vaccination by calendar year, sex of the child, and level of vaccine hesitancy.

Methods

The National Immunization Survey-Teen 2012–2015 was subset to parents who did not intend for their adolescent to receive the HPV vaccine in the next 12 months (N = 59,897). Survey-weighted logistic regression models assessed the impact of year, sex, and level of hesitancy on main reasons for nonvaccination.

Results

Not receiving a recommendation and lack of knowledge were significantly more likely to be the reasons for nonvaccination in 2012 and 2013 compared with 2015. The following reasons were significantly less likely to be reported for females compared with males: not recommended (odds ratio [OR] = .63, 95% confidence interval [CI], .58–.69) and lack of knowledge (OR = .86, 95% CI, .79–.94). In contrast, parents of females were more likely to state they were concerned about safety and side effects (OR = 2.19, 95% CI, 1.98–2.41). Differences in reasons for nonvaccination were observed between those who were unlikely and unsure regarding receiving the HPV vaccine.

Conclusions

Findings indicate that U.S. parental attitudes about HPV vaccination have changed over time and reasons for nonvaccination vary based on the sex of the adolescent and the level of hesitancy of the parent. This information can shape how providers respond to parental concerns and HPV vaccine hesitancy.

Section snippets

Sample

The National Immunization Survey-Teen (NIS-Teen) is the primary U.S. surveillance database for adolescent vaccination. Specifically, it is an add-on survey to the National Immunization Survey, which targets noninstitutionalized households with 19- to 35-month-old children. The National Immunization Survey uses a dual-sampling frame with random digit dialing. Those households contacted by this survey were then screened for the presence of one randomly selected 13- to 17-year-old adolescent for

Results

Approximately, a quarter of the sample is represented by each survey year, respectively. The sample reported on 58.8% male and 41.2% female adolescents aged 13–17 years. Among the respondents in the sample, 31.6% were not too likely to receive the HPV vaccine, 51.9% were not likely at all to receive the HPV vaccine, and 16.5% were not sure or did not know. Respondents in this sample included 68.0% mothers or female guardian, 25.6% fathers or male guardian, 3.0% grandparents, and the remaining

Discussion

The suboptimal HPV vaccination rates in the United States warrant an investigation of reasons for vaccine hesitancy over time. Moreover, differences by sex of the child and level of vaccine hesitancy were assessed to see how these were associated with primary reasons for nonvaccination.

First, reasons for nonvaccination differed over time. Specifically, the HPV vaccine being not recommended, the adolescent reported as not sexually active and having a lack of knowledge were more likely to be

Acknowledgments

A portion of this publication was presented as an abstract at the International Papillomavirus Conference, 2017. The authors would like to acknowledge the data source, which made this analysis possible. U.S. Department of Health and Human Services (DHHS), National Center for Health Statistics. The 2012–2015 National Immunization Survey-Teen, Hyattsville, Maryland: Centers for Disease Control and Prevention, 2013–2016.

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      Citation Excerpt :

      While there is some disagreement around the definition of “hesitancy” in the literature [38–40], reminding parents may not be effective if parents have significant underlying concerns about the vaccine. Studies have shown that the reasons for HPV vaccine hesitancy include lack of a provider recommendation, misinformation about the vaccine, and concerns over vaccine safety or efficacy [41–44]. A recent survey in a nationally representative sample of US parents demonstrated an overall hesitancy rate of about 23% for HPV, with safety being a major source of concern.

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    Conflicts of interest: E.M.D. has served on the U.S. HPV Vaccine Advisory Board for Merck Pharmaceuticals. The other authors have no conflicts of interest to disclose.

    Clinical Trial Registry: Not applicable.

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