Parental attitudes to pre-pubertal HPV vaccination
Introduction
Human papillomavirus (HPV) infection of the genital mucosa is a common, sexually transmitted condition and there is now conclusive evidence for its role in the aetiology of cervical cancer [1]. Prophylactic vaccination against HPV has been shown to be highly effective [2], [3]. The quadrivalent vaccine, Gardasil, has recently been licensed by the European Commission [4] and is recommended for girls of 11–12 years by the CDC [5]. It is therefore timely to investigate public attitudes towards HPV vaccination in the UK.
HPV vaccination is expected to reduce lifetime cervical cancer incidence [6], and in countries with cervical screening programmes, may ultimately reduce the required frequency of cytological testing and expose fewer women to the stress of abnormal test results, colposcopy, and treatment. However, for vaccination to be cost-effective, uptake must be high. Mothers of adolescents in the US have been shown to be enthusiastic about HPV vaccination (see Zimet [7] for a review). Qualitative research with British mothers suggests they have concerns about vaccination in early puberty, the sexually transmitted nature of the virus, and possible harm from vaccinations [8]. In contrast, a survey of parents from Manchester schools found more than 70% were positive about HPV vaccination, although this conclusion was tempered by a low survey response rate (22%) [9]. Age of vaccination is an important issue, because for maximum effect the vaccine needs to be given in early puberty and certainly before the onset of sexual activity. However some parents are reluctant to consider their young adolescent daughters to be nearing their sexual debut, and express concern that vaccination could appear to condone early sexual activity [8], [10].
The present study examined vaccine acceptance in mothers of 8–14 year olds to establish: (i) rates of HPV vaccine acceptance, (ii) the age at which mothers believe the HPV vaccine should be administered, (iii) attitudes towards HPV vaccination, and (iv) demographic and attitudinal predictors of vaccine acceptance and earlier vaccination age.
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Participants
Participants were mothers with at least one daughter in school years 4–9 (ages 8–14). Convenience sampling was used to select four locations in England representing inner city, suburban, and rural areas (see Table 1) to ensure a range of parental backgrounds. Lists of all primary and secondary schools in these education authority areas were obtained. The largest secondary school and two primary schools were selected within the three areas (Guildford, Norfolk and Lambeth). In Nottingham, only
Results
The 1255 questionnaires were distributed. Parents were asked to complete and return the questionnaire or return it blank indicating their reason for non-completion. This allowed us to exclude families who received duplicate copies of the questionnaire through two daughters (n = 44) or where no mother lived at the address (n = 6). A potential sample of 1205 received the questionnaires, of which 684 (56.8%) were returned. Response rates varied across schools (Table 1), with lower rates in more
Discussion
Rates of HPV vaccine acceptance were similar to those reported from the United States [12], [13] with 75% of mothers saying they would ‘probably’ or ‘definitely’ accept the HPV vaccination for their daughter. While few mothers said they would not accept the vaccine (only 6%), a significant proportion (19%) were unsure about it. Campaigns to ensure good uptake of the HPV vaccination may benefit from focusing on this undecided group.
HPV vaccination is recommended for 11–12-year-old girls in the
Acknowledgements
The study was funded by Sanofi Pasteur MSD. Jane Wardle and Laura Marlow are supported by Cancer Research UK. Jo Waller has an ESRC/MRC fellowship. We thank the schools involved for their help and the parents who took the time to complete the questionnaires.
Contributors: All authors contributed to the overall conception and design of the study. Laura Marlow and Jane Wardle were responsible for data analysis and all authors contributed to interpretation of the results. The article was drafted by
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Cited by (206)
Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales
2020, VaccineCitation Excerpt :Attitudes to the HPV vaccine: We included nine items assessing attitudes to the HPV vaccine with responses on 5 point Likert scales (see Q8 in https://osf.io/yk2xh/ for the exact wording). These items were developed with reference to the previous literature [15,17,22–24] to include the most commonly reported barriers to HPV vaccination (lack of information, concern about novelty and side-effects, and worry that the vaccine might have an impact on sexual behaviour), social norms, perceived efficacy of the vaccine, perceptions of the health impact of HPV and the child’s future risk, and generally negative attitudes to vaccination. Attitudes were assessed after information exposure.