Our findings indicate that HPV vaccine could provide a new and effective cue to prompt parents to talk with their young adolescent children about sex. In this nationally-representative sample, most mothers reported having talked with their 11–14 year old daughters about HPV vaccine, and many of these mothers included messages about sex in their HPV vaccine discussions, consistent with our previous research on HPV vaccine communication among mothers and daughters in North Carolina.15
In addition to confirming correlates of mother-daughter communication about sex found in previous studies (e.g., daughter’s menarche,18
general communication skills,6
personal experience talking with their own mother21
), our study also identifies a novel correlate — mothers’ discussions with their daughters about HPV vaccine were associated with their communication about sex, even controlling for these other factors.
To our knowledge, this study is among the first to compare multiple potential cues to talking about sex. We found that HPV vaccine discussions provide a cue to talking about sex that is as important as some more widely recognized cues (such as menarche),2, 24, 25
even though HPV vaccine discussions have not yet been promoted as a possible cue to parent-child communication. Many mothers who included sex topics in their HPV vaccine discussions reported that talking about the vaccine facilitated discussing sex by providing a good reason or by making it easier to start the conversation.
Taken together, these findings suggest that it may be possible to capitalize on HPV vaccine discussions to facilitate parent-child communication about sex. Some mothers may not talk with their daughters about sex because they have difficulty beginning conversations or finding the “right” time to talk.22, 26, 27
For mothers who have not yet talked with their daughters about sex, initiating HPV vaccine discussions may provide an avenue to begin talking with their daughters about sex topics. As a substantial proportion of mothers in our sample had low knowledge of HPV and HPV vaccine, previous research suggests that education about the vaccine and health care provider recommendation might promote HPV vaccine communication among more mothers and their daughters,15
as well as potentially increase vaccine acceptability and uptake. For mothers who are already talking with their daughters about HPV vaccine, more could be encouraged to take advantage of this opportunity to promote sexual health.
Health care providers may be able to use HPV vaccination visits to provide information and guidance to parents about discussing sex topics with their children. Research shows that parents want providers to broach sensitive topics like sex,28, 29
and such an approach is aligned with current guidelines for adolescent preventive services suggesting that providers offer guidance to adolescents and their parents about sexual health.30
However, provision of such guidance is low.31–33
Because HPV vaccine protects against an STI, it may provide a natural segue to talking about sex. As it is recommended for all 11–12 year-old girls and administered over 3 visits,10
it could be a cue for early and frequent communication about sexual health and an opportunity to integrate preventive counseling and guidance into clinical practice. However, providers may be less likely to recommend HPV vaccine when considering it necessary to discuss sexuality beforehand.34
Research suggests that training and access to materials for parent education may address some of the barriers clinicians have to broaching sensitive topics.35
Further, while parents are largely supportive of HPV vaccine, they are more supportive when it is framed as preventing cancer, as opposed to an STI or genital warts only.36
Thus, it is possible that using HPV vaccine to promote sexuality discussions could negatively affect vaccination rates. The effect of including sexual health promotion messages alongside cancer prevention information on HPV vaccine acceptability should be explored further.
Our study’s strengths include a large nationally-representative sample and extensive controls for variables associated with parent-child communication about sex. The main limitation is reliance on mothers’ reports, which may not fully reflect actual conversations, as parent and adolescent reports of communication about sex can be discrepant.4
However, data on parent (as opposed to child) perceptions may be more appropriate for the present study, as it can inform interventions targeting parents. Our study used a single, dichotomous measure of mother-daughter communication; future research should assess the content, timing, and frequency of mothers’ conversations with their daughters about HPV vaccine and sex. The study’s cross-sectional design precludes causal inferences about associations between HPV vaccine-related variables and parent-child communication about sex topics. The generalizability of study findings to other populations is unknown.
Our findings highlight the potential of HPV vaccine discussions to promote sexual health. Clearly HPV vaccine discussions are not the only opportunity for mothers to talk with their daughters about sex, but they provide an acceptable opportunity at an age when such communication can be most influential. Given the importance of communication about sex that is early and frequent, conversations about HPV vaccine could facilitate mothers’ conversations with their preadolescent and young adolescent daughters. Now that HPV vaccine is also recommended for routine administration to adolescent males,37
research on parents’ communication with their sons about the vaccine and sexual health is warranted. Future research should also examine health care provider communication about HPV vaccine and explore ways to use HPV vaccine and other cues to maximize important discussions about sexual health at different stages of an adolescent’s development.