The majority of girls in this study had talked to their parents and understood the purpose of vaccination. A substantial minority reported rumours of serious side effects but the main concern of girls was the pain of vaccination. This, and fear of needles, probably explains why many would not advise their peers to be vaccinated. A fundamental stage of adolescent development is the gradual transfer of decision making from parent to child that allows individuals to start taking responsibility for their own health (McCabe, 1996
), and girls in this study were clearly at this stage. In consequence, had the vaccine decision rested only with them, the number of girls who might have initially refused or dropped out of the programme would have outweighed the number who would have opted or stayed in; hence, parental support for vaccination is still required.
Approximately 20% of the total study population of girls completed this questionnaire and their parents may have held more liberal views on adolescent participation in consent than those of nonresponders. Essentially the sample provides a good, but not necessarily typical, example of the mother–daughter interaction promoted by the Department of Health in its social marketing strategy to ‘arm against cancer' (Department of Health, 2009b
). The Department intends the literature to be read by mothers and daughters together, and is in line with previous observations that parents who talk to their daughters are more supportive of HPV vaccination (Brabin et al, 2006
). This study suggests that it also helps girls to prioritise vaccination and think about future health and relationships (). Yet, some parents would like to defer HPV vaccination to a later age and avoid discussing sexual matters (Marlow et al, 2007
; Woodhall et al, 2007
). Having some sexual awareness, 21% of study girls already found the topic embarrassing and older girls would likely prefer to talk more with peers than with parents (Ogle et al, 2008
). More directly worded questions on sexually transmitted infections would have allowed a better understanding of girls' awareness of sexual issues, but we decided against this, given the possibility of a parental veto. The national campaign could place more explicit emphasis on the importance of joint discussions and inform parents of the evidence that communication about sex with young adolescents positively influences their values in late (although not middle) teens (Fisher 1986
). Nearly 80% of girls stated that the vaccine reminded them of the risks of sexual contact, and it would be instructive if future research were to show that HPV vaccination encouraged preventive actions rather than increased sexual risk taking.
Media coverage of reported serious adverse events attributed to HPV vaccination has followed vaccine introduction in several countries. Our report is the first to show that such rumours filter down to girls and become further exaggerated. One consequence is likely to be an increased reluctance to complete the three doses or to recommend the vaccine to younger sisters and friends. Parents also decline vaccination and find it stressful if their daughters dislike needles. (Rosenthal et al, 2008
). In Australia, interim data for the school-based programme showed a fall in Dose 3 coverage in all territories and age groups (Brotherton et al, 2008
). The third-dose uptake figure for the national vaccine programme in England will only be clear once all the missing doses have been followed up in the next academic year
Parents still exert an important influence on girls at this stage of their development by talking to them, encouraging them to think about the importance of vaccination and having begun a vaccine course, to complete it. Without this, vaccine coverage could fall. Health professionals must address the misconceptions held by girls (and by some parents), thereby reducing uninformed discussions and helping girls to come to their own decision about HPV vaccination.