The current study identified correlates of HPV vaccine acceptability among a diverse national sample of 1,383 adults with female children in the household. Consistent with prior research (9
), the majority of participants (57.5%) reported being willing to vaccinate an 11–12 year-old daughter, but a significant minority was undecided (24.9%) or reported that they would not do so (17.6%). Despite extensive marketing and media attention, a need for more information was the most commonly cited reason for not being willing to vaccinate. In addition, approximately one in five respondents who were undecided or opposed to vaccination reported concerns about vaccine safety. Thus, the present findings suggest that respondents perceive insufficient knowledge and information about the vaccine, which contributes to the observed hesitancy toward vaccination.
With regard to behavioral correlates, vaccine acceptability was higher among physically active individuals and individuals not reporting CAM use, as hypothesized. These findings are consistent with prior research that suggests that health-promoting behaviors (e.g., physical activity and diet) tend to co-occur (22
) and may be associated with vaccine acceptability (25
). Likewise, the present findings support the notion that parental CAM use may be associated with poorer vaccine uptake among their children (28
). It has been reported that individuals who prefer CAM to conventional approaches are sometimes mistrustful of, or have had negative experiences with, conventional medical approaches and/or public health recommendations (31
). Among parents who requested medical exemptions to required vaccinations for their children, the most common reasons for not vaccinating were concerns about vaccine safety (28
). Recently published data on the post-licensure safety profile of the quadrivalent HPV vaccine should alleviate some parents’ safety concerns given that few serious adverse events have been associated with the vaccine (34
). However, in light of declining incidence and mortality rates of cervical cancer in the U.S., there continues to be debate over whether even the slight risks of vaccination outweigh the possible long-term benefits (35
), and the present findings may reflect ongoing parental consideration of these issues.
Contrary to our hypotheses, smokers reported greater acceptability of the HPV vaccine. It is possible that former and current smokers have a heightened awareness of cancer and/or the cancer-related risks of secondhand smoke (36
), and therefore, they may be more willing to engage in behaviors that offer protection to their daughters. Smoking is also more prevalent in subgroups with lower educational attainment (39
), and some prior studies have reported lower education to be associated with greater HPV vaccine acceptability (13
). However, it should be noted that the association between smoking and vaccine acceptability remained significant even after education level was included in the model.
In addition to behavioral factors, the current analysis also included demographic, medical history, and attitudinal variables that have previously been reported to be associated with HPV vaccine acceptability. Surprisingly, although three behavioral factors were associated with HPV vaccine acceptability in the present study, not one of the demographic variables or medical history variables was associated with vaccine acceptability. Prior studies have also reported inconsistent findings with respect to demographic background and prior medical history (9
), perhaps suggesting that personal health beliefs and behaviors may be more closely related to vaccine acceptability than one’s background or prior experiences. For example, with respect to health beliefs, participants who strongly agreed that cancer can be cured if it is caught early reported greater acceptability of the HPV vaccine. These findings suggest that the assessment of health behaviors and personal beliefs about cancer can help inform our understanding of individuals’ decisions regarding the uptake of cancer prevention strategies for their children.
Strengths of the current study include the use of a diverse national sample and standardized procedures. Although there have been a number of HPV vaccine acceptability studies conducted previously, few have included data from a national sample and thus, the present findings serve as an important barometer of public opinion. Additionally, the majority of prior studies were conducted before the vaccine’s approval for use by the FDA and the subsequent proliferation of vaccine marketing to both adults and children. However, the present findings should be considered in the context of several limitations to the present study. First, the study asked about willingness to vaccinate as opposed to assessing actual vaccine uptake rates. Second, study respondents may not have been the parents or legal guardians of the female children in the household. Third, given the manner in which the sample was selected and how the relevant questions were stated, it is acknowledged that although all study respondents had female children living in the household, some respondents had girls aged 11–12 and some did not. Therefore, for those respondents who did not have a child in that age group, the question to which they were responding was a hypothetical one; whereas for those respondents who did have a child in that age group, the question may have captured “actual” willingness rather than hypothetical willingness. Though our inability to distinguish between actual and hypothetical willingness in this study may limit how we can attribute these findings, the present findings may be informative with respect to actual behavior. Presumably, the respondents with girls aged 11–12 years (or older) will have described their actual willingness very well. Therefore, although a subgroup of respondents will have answered the item according to their hypothetical willingness to vaccinate a daughter, data from the current study may more closely approximate actual behavior than earlier studies, due to the fact that this sample was partially comprised of those who have already made their decisions and were reporting on their actual willingness to engage in this behavior. Finally, the study was limited to items included in the HINTS survey and did not contain other potential correlates, such as items regarding physician recommendations for HPV vaccination. Findings from a recent study suggest that only 50% of physicians always recommend the HPV vaccine for 11–12 year old girls (41
), and therefore, the absence of a physician recommendation may be contributing to the fact that almost half of the study respondents were undecided or not willing to vaccinate an 11–12 year old daughter.
In sum, these results suggest that despite extensive media attention, there is a clear need for additional education and provision of information regarding the potential benefits and risks of the HPV vaccine. In the perceived absence of such information, behavioral factors may influence, to some extent, vaccine acceptability. The present results suggest that individuals who reported past year use of CAM and a lack of physical activity were less willing to adopt this prevention strategy for their daughters. However, the present data also indicate that behavioral patterns are likely to be quite complex, given that former and current smokers were more willing to vaccinate their daughters compared to non-smokers. Therefore, additional research is needed to further our understanding of how existing health habits may contribute to uptake of HPV vaccination and other cancer prevention strategies.