Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006–2008 National Survey of Family Growth
Highlights
► In this study we examine intent to get HPV vaccine among unvaccinated 15–24 year old women. ► A majority (57.5%) of respondents were unlikely to receive HPV vaccination in the next 12 months. ► Among those unlikely to get HPV vaccine, we report the main reason for not getting vaccinated. ► Not being at risk and institutional barriers were the most common reasons for forgoing HPV vaccine. ► Sexually experienced women were more likely than sexually inexperienced ones to want HPV vaccine.
Introduction
Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States and is associated with most cervical and other cancers including vaginal, vulvar, anal, penile, and oropharyngeal, as well as genital warts [1], [2]. The Food and Drug Administration licensed a quadrivalent HPV vaccine that protects against four HPV types associated with most cases of genital warts and cervical cancers in 2006 and a bivalent HPV vaccine in 2009 that protects against two types associated with most cases of cervical cancers [3], [4]. The Advisory Committee on Immunization Practices (ACIP) recommends using either vaccine for the routine vaccination of girls aged 11 or 12 years with catch-up vaccination for females aged 13–26 years [3].
Since availability of the initial HPV vaccine, coverage has increased in the U.S. from 25.1% of 13–17 year old females initiating the HPV vaccine series (≥1 dose) in 2007 to 48.7% in 2010 [5], [6], [7]. Although rising, HPV coverage among adolescent females is considerably lower than other routinely recommended adolescent vaccinations and the increase in uptake between 2009 and 2010 was less than half that seen for Tdap and meningococcal conjugate vaccines [7]. Several challenges to achieving high HPV vaccine coverage in the U.S. have been cited, including the vaccine cost, lack of support for HPV immunization mandates, and absence of school-based vaccination programs [8]. Further, several recent studies have found that HPV vaccine uptake varies significantly by individuals’ socio-demographic background, awareness and knowledge of HPV, vaccination history, utilization of health care services, insurance status, and belief that one's parents and physician would endorse HPV vaccination [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18].
In light of these considerations, it is important to understand the unvaccinated population of eligible vaccine recipients and to identify any differences between those likely and unlikely to get vaccinated, which may suggest barriers of some type. Using data from a nationally representative survey conducted post-licensure of the first HPV vaccine, this study analyzes a sub-sample of unvaccinated women age 15–24 years. As a means to inform strategies to improve HPV vaccine uptake as well as develop lessons-learned for future vaccine programs to consider in the early months of availability, we explore correlates of intention to receive HPV vaccine by age and describe reasons for refusing HPV vaccine.
Section snippets
Study design and population
The National Survey of Family Growth (NSFG) is a continuously administered nationally representative survey of 15–44 year olds in the United States. The 2006–2008 data set was used for this analysis but was limited to the time frame for which HPV questions were on the survey (July 2007 to December 2008). NSFG is a household survey that uses multistage sampling techniques and over-samples for adolescents (15–19 years), black/African Americans and Hispanic/Latinos. The survey includes a
Sample description
Previous analyses found that 76.9% (n = 955) of the 15–24 year old sample was unvaccinated [20]. More young adult women were not vaccinated and thus answered the “intent” question (n = 522) compared to the adolescent women (n = 433). Young adults were statistically significantly more likely to have insurance than adolescents (88% vs. 72%, chi square = 24.19, p < 0.001). There were no other significant differences in demographics by age.
Intent to receive HPV vaccine among unvaccinated women
A minority (42.5%) of respondents said they intended to get the HPV
Discussion
These nationally representative data collected immediately post-HPV licensure provide insight into the intentions of unvaccinated females at that time to receive HPV vaccine and factors associated with intending to get vaccinated. Overall, the majority of young, unvaccinated women in this sample (57.5%) indicated that they did not intend to receive HPV vaccine in the following year. Although somewhat dated, these analyses identify correlates that may continue to impact HPV vaccination behaviors
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2021, Journal of PediatricsCitation Excerpt :Many previous studies have shown parental perception of HPV risk and the benefits of vaccination influence vaccination decisions for their sons and daughters.8,26,27 A belief of not being at risk for HPV was also a reason for forgoing vaccination among adolescent women aged 15-24 years.28 Lack of awareness about HPV and associated cancers has been identified as a barrier since HPV vaccine was first introduced; our survey results suggest that this remains a parental barrier to vaccination.
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