Parental intentions, beliefs, and concerns influence human papillomavirus (HPV) vaccination patterns, especially in Hispanic patients from lower-income communities, according to a study published in Vaccine.

A team of researchers from Houston, Texas, conducted a randomized controlled trial to identify parental predictors of HPV vaccination among Hispanic girls from low-income families. Data from the Por Nuestras Hijas trial, conducted at the Cancer Prevention & Research Institute of Texas, were collected from November 2012 to January 2015. Eligibility for participating clinics (n=29) included the treatment of predominantly Hispanic patients and participation in the Vaccines for Children (VFC) program, which provided free vaccines for those unable to pay.

Participants in the study (n=765) identified as Hispanic or Latina/o and had a daughter aged 11 to 17 years who was not previously vaccinated for HPV. Vaccination status was measured 6 months after baseline, and information on vaccination status was obtained either from clinic electronic medical records or from the parents themselves. Parental intention to not vaccinate was defined using a grouping of 3 statements: ‘‘no thought of getting her vaccinated”; ‘‘I think I need to consider getting her vaccinated”; and ‘‘I think I should get her vaccinated, but I am not quite ready.” Intention to vaccinate included the statements, “I will probably get her the vaccine” and “I am committed to vaccinating my child.”

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Mean parent age was 39 years, and 59% reported an annual household income of more than $15,000. The average age of each daughter was 13 years; 76% were insured through public health insurance. The majority of parents were women, did not graduate high school, were born outside of the United States, and had additional unvaccinated daughters. Unadjusted analyses showed that positive factors associated with child vaccination included subjective norms related to family (odds ratio [OR]=1.03) and daughter’s clinician (OR=1.06), perceived HPV vaccination safety (OR=1.56), and self-efficacy (OR=3.07). Negative factors included concerns about sexual disinhibition (OR= 0.88), potential side effects (OR=0.77), and vaccination cost (OR=0.86).

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Positive variables associated with intention to obtain the vaccine included subjective norms related to clinician (adjusted OR [aOR]=1.04), beliefs about vaccine safety (aOR=1.38), and self-efficacy (aOR=2.39); increased concern about side effects (aOR=0.73) was negatively associated with HPV vaccination intention. Parents with stronger beliefs pertaining to vaccine safety were 22% more likely to vaccinate their child 6 months later compared with those who did not believe in vaccine safety (OR=1.22). Parents with higher self-efficacy scores were approximately twice as likely to vaccinate their child compared with parents with lower self-efficacy scores (OR=1.91). However, parental concern about sexual disinhibition was associated with lower odds of having a vaccinated daughter at 6 months (OR = 0.66).

“Our study found parental intention to vaccinate predicts HPV vaccine series initiation, and greater concerns about sexual disinhibition were negatively associated with initiation,” the authors concluded. “Further, parental subjective norms related to daughter’s doctor, beliefs in vaccine safety, and self-efficacy to obtain the vaccine for daughters are correlates of parental intention.”


Rodriguez SA, Savas LS, Baumler E, et al. Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11-17 years [published online July 3, 2018]. Vaccine. doi: 10.1016/j.vaccine.2018.06.071