Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013

Figures & data

Table 1. Association between sociodemographic variables and not being vaccinated against HPV in 12–14-year girls, Canada, 2013.

	n	Rate (95% CI)		Unadjusted OR (95% CI)	p	Adjusted OR (95% CI)	p
Overall	5720	27.7 (25.8–29.6)
Age (years)
12	1723	28.9 (26.0–31.8)		1.22 (0.98–1.52)	0.074	1.46 (1.16–1.83)	0.001
13	2007	29.7 (26.4–33.1)		1.27 (1.01–1.60)	0.040	1.31 (1.03–1.67)	0.026
14	1990	25.0 (21.9–28.0)		Reference
Province or territory
Newfoundland and Labrador	527	10.7 (8.1–13.3)		0.63 (0.43–0.93)	0.019	0.64 (0.43–0.94)	0.022
Prince Edward Island	335	15.9 (12.5–19.2)		Reference		Reference
Nova Scotia	563	21.1 (17.7–24.5)		1.42 (1.02–1.97)	0.038	1.35 (0.97–1.89)	0.075
New Brunswick	486	18.5 (15.0–22.0)		1.20 (0.86–1.69)	0.281	1.15 (0.82–1.62)	0.429
Quebec	652	20.3 (17.2–23.4)		1.35 (0.99–1.85)	0.055	1.25 (0.91–1.71)	0.174
Ontario	405	32.4 (27.6–37.1)		2.54 (1.84–3.51)	<0.001	2.42 (1.72–3.40)	<0.001
Manitoba	500	34.8 (30.6–39.0)		2.83 (2.08–3.86)	<0.001	2.59 (1.89–3.57)	<0.001
Saskatchewan	504	23.9 (20.0–27.8)		1.66 (1.20–2.30)	0.002	1.60 (1.14–2.23)	0.006
Alberta	571	29.2 (25.5–32.9)		2.19 (1.61–2.96)	<0.001	2.03 (1.49–2.76)	<0.001
British Columbia	490	32.4 (28.2–36.7)		2.55 (1.86–3.48)	<0.001	2.20 (1.58–3.05)	<0.001
Yukon	264	35.7 (32.7–38.7)		2.94 (2.22–3.91)	<0.001	2.65 (1.98–3.54)	<0.001
Northwest Territories	257	47.6 (43.6–51.6)		4.82 (3.61–6.46)	<0.001	4.62 (3.43–6.23)	<0.001
Nunavut	166	47.4 (42.0–52.9)		4.79 (3.44–6.66)	<0.001	4.68 (3.36–6.53)	<0.001
Place of Birth
Canada	5161	26.5 (24.5–28.5)		Reference		Reference
Americas (outside Canada)	91	35.2 (22.8–47.6)	A	1.51 (0.86–2.64)	0.154	1.14 (0.58–2.23)	0.709
Europe	63	45.4 (28.0–62.9)	A	2.31 (1.10–4.82)	0.026	1.33 (0.55–3.22)	0.531
Africa	62	21.1 (9.6–32.6)	A	0.74 (0.36–1.54)	0.422	0.73 (0.24–2.19)	0.569
Asia	259	36.6 (27.7–45.4)		1.60 (1.07–2.39)	0.022	1.45 (0.88–2.38)	0.142
Oceania/other/not stated	84	38.4 (23.0–53.7)	A	1.73 (0.88–3.40)	0.113	1.57 (0.55–4.55)	0.402
Education of respondingparent
Secondary or less	1927	28.3 (25.1–31.5)		1.00 (0.79–1.27)	0.985
Post-secondary	2003	26.2 (23.0–29.3)		0.90 (0.70–1.14)	0.375
University graduate	1598	28.3 (24.7–32.0)		Reference
Total household income
0 - $19,999	358	26.2 (19.2–33.2)		1.01 (0.69–1.50)	0.947
$20,000 - $39,999	770	29.7 (24.7–34.8)		1.21 (0.92–1.59)	0.181
$40,000 - $59,000	786	31.3 (26.1–36.5)		1.30 (0.99–1.71)	0.061
$60,000 - $79,999	849	28.4 (23.6–33.1)		1.13 (0.86–1.48)	0.370
$80,000 or more	2957	26.0 (23.4–28.5)		Reference
Country of birth of responding parent
Canada	4623	24.7 (22.6–26.8)		Reference		Reference
Americas (outside Canada)	185	37.3 (27.7–46.9)		1.81 (1.17–2.79)	0.007	1.69 (1.03–2.77)	0.037
Europe	172	50.7 (39.5–61.9)		3.13 (1.96–5.01)	<0.001	2.66 (1.58–4.49)	<0.001
Africa	107	26.0 (15.6–36.4)	A	1.07 (0.61–1.88)	0.819	1.23 (0.55–2.75)	0.620
Asia	470	32.2 (26.2–38.1)		1.45 (1.07–1.95)	0.016	1.06 (0.73–1.54)	0.754
Oceania/other/not stated/ respondent not a parent	163	34.5 (23.6–45.5)	A	1.61 (0.97–2.67)	0.067	1.34 (0.60–3.02)	0.475

Rates and odds ratios are weighted (see methods)

Adjusted OR: adjusted for all variables shown in the column

A: coefficient of variation between 16.5% and 33%; interpret with caution

Table 2. Association between sociodemographic variables and parental refusal of HPV vaccination in 12–14-year girls, Canada, 2013.

	n	Rate (95% CI)		Unadjusted OR (95% CI)	p	Adjusted OR (95% CI)	p
Overall	5595	14.4 (13.0–15.9)
Age (years)
12	1683	13.6 (11.3–15.9)		0.93 (0.70–1.24)
13	1972	14.9 (12.4–17.4)		1.04 (0.78–1.37)
14	1940	14.4 (12.0–16.9)		Reference
Province or territory
Newfoundland and Labrador	525	2.9 (1.5–4.3)	A	0.28 (0.16–0.51)	<0.001	0.31 (0.17–0.56)	<0.001
Prince Edward Island	331	12.3 (9.2–15.4)		1.34 (0.89–2.02)	0.163	1.37 (0.90–2.07)	0.144
Nova Scotia	558	9.5 (7.0–12.0)		Reference		Reference
New Brunswick	484	11.8 (8.9–14.7)		1.28 (0.85–1.92)	0.235	1.32 (0.88–2.00)	0.183
Quebec	634	10.5 (8.1–12.9)		1.12 (0.76–1.65)	0.553	1.17 (0.79–1.74)	0.440
Ontario	401	16.7 (13.1–20.2)		1.91 (1.28–2.84)	0.001	2.13 (1.42–3.21)	<0.001
Manitoba	486	17.9 (14.4–21.3)		2.08 (1.41–3.06)	<0.001	2.31 (1.55–3.45)	<0.001
Saskatchewan	491	11.0 (8.2–13.8)		1.18 (0.78–1.79)	0.439	1.29 (0.84–1.96)	0.241
Alberta	556	15.9 (12.9–19.0)		1.81 (1.25–2.63)	0.002	2.01 (1.36–2.97)	<0.001
British Columbia	473	17.6 (14.1–21.0)		2.03 (1.38–2.99)	<0.001	2.33 (1.56–3.49)	<0.001
Territories	656	12.7 (11.2–14.2)		1.39 (0.99–1.94)	0.055	1.59 (1.12–2.25)	0.010
Born outside Canada
No	5076	14.7 (13.2–16.2)		Reference
Yes	464	12.3 (8.4–16.2)		0.93 (0.62–1.38)	0.704
Education of responding parent		0.0 (0.0–0.0)
Secondary or less	1878	11.9 (9.7–14.2)		0.60 (0.44–0.81)	0.001	0.61 (0.43–0.87)	0.006
Post-secondary	1970	14.4 (11.9–16.9)		0.74 (0.56–0.99)	0.041	0.69 (0.51–0.92)	0.013
University graduate	1578	18.5 (15.5–21.5)				Reference
Total household income
0 - $19,999	350	9.8 (5.3–14.4)	A	0.57 (0.33–0.98)	0.043	0.73 (0.39–1.36)	0.326
$20,000 - $39,999	744	11.9 (8.4–15.4)		0.70 (0.48–1.04)	0.077	0.89 (0.58–1.35)	0.577
$40,000 - $59,000	773	13.2 (9.3–17.2)		0.79 (0.54–1.16)	0.238	0.98 (0.64–1.50)	0.920
$60,000 - $79,999	824	15.4 (11.5–19.3)		0.95 (0.67–1.33)	0.747	1.07 (0.74–1.53)	0.720
$80,000 or more	2904	16.1 (13.9–18.3)		Reference		Reference
Country of birth of responding parent
Canada	4547	14.9 (13.1–16.6)		Reference		Reference
Americas (outside Canada)	181	16.8 (8.6–25.0)	A	1.16 (0.62–2.17)	0.650	1.13 (0.59–2.17)	0.719
Europe	168	25.4 (15.7–35.0)	A	1.95 (1.13–3.36)	0.016	1.67 (0.94–2.95)	0.079
Africa	104	16.7 (7.6–25.8)	A	1.15 (0.56–2.36)	0.700	1.11 (0.52–2.36)	0.787
Asia	456	9.4 (5.9–12.8)	A	0.59 (0.38–0.92)	0.020	0.47 (0.29–0.77)	0.003
Oceania/other/not stated/ respondent not a parent	139	–		0.27 (0.07–0.97)	0.045	0.49 (0.12–1.93)	0.308

Rates and odds ratios are weighted (see methods)

Adjusted OR: adjusted for all variables shown in the column

A: coefficient of variation between 16.5% and 33%; interpret with caution – Unreliable estimate because coefficient of variation >33%

Table 3. Association between knowledge, attitudes and beliefs, and parental refusal of HPV vaccination in 12–14-year girls, Canada, 2013.

	n	Rate (95% CI)	Unadjusted OR (95% CI)	p
TOTAL
Childhood vaccines are safe
Strongly agree	3453	11.2 (9.4–12.9)	0.26 (0.17–0.40)	<0.001
Somewhat agree	1792	17.5 (14.9–20.2)	0.44 (0.28–0.68)	<0.001
Somewhat/strongly disagree	238	32.6 (23.8–41.3)	Reference
Childhood vaccines are effective
Strongly agree	3798	12.6 (10.9–14.3)	0.31 (0.18–0.52)	<0.001
Somewhat agree	1512	17.7 (14.7–20.7)	0.46 (0.27–0.78)	0.005
Somewhat/strongly disagree	144	32.0 (21.3–42.7)	Reference
Childhood vaccines are important for child's health
Strongly agree	4201	11.4 (9.9–13.0)	0.24 (0.14–0.40)	<0.001
Somewhat agree	1144	21.7 (18.2–25.3)	0.51 (0.31–0.86)	0.011
Somewhat/strongly disagree	149	35.2 (24.5–45.8)	Reference
In general, (I) understand how vaccines work
Strongly agree	3599	15.0 (13.2–16.8)	1.92 (0.65–5.64)	0.237
Somewhat agree	1742	14.7 (12.0–17.4)	1.87 (0.64–5.50)	0.255
Somewhat/strongly disagree	153	–	Reference
In general, (I am) concerned about the potential side effects of vaccnes
Strongly agree	1718	19.9 (16.8–22.9)	2.47 (1.53–3.99)	<0.001
Somewhat agree	2095	15.7 (13.3–18.2)	1.87 (1.17–2.96)	0.008
Somewhat disagree	893	6.7 (4.1–9.3)	0.72 (0.39–1.31)	0.281
Strongly disagree	765	9.1 (5.6–12.6)	Reference
In general, a vaccine can give a serious case of the very same disease it is meant to prevent
Strongly agree	583	16.8 (12.0–21.7)	1.34 (0.87–2.06)	0.185
Somewhat agree	1351	14.5 (11.7–17.4)	1.13 (0.80–1.58)	0.494
Somewhat disagree	1616	16.2 (13.4–19.0)	1.28 (0.93–1.75)	0.129
Strongly disagree	1528	13.1 (10.4–15.9)	Reference
In general, the use of alternative practices, such as homeopathy or chiropractics, can eliminate the need for vaccination,
Strongly agree	232	16.3 (9.1–23.5)	1.30 (0.74–2.29)	0.365
Somewhat agree	645	20.6 (15.6–25.5)	1.73 (1.23–2.45)	0.002
Somewhat disagree	1339	16.0 (13.0–19.0)	1.28 (0.96–1.70)	0.094
Strongly disagree	2742	13.0 (11.1–15.0)	Reference
(I) feel (I) have enough information about immunization
No	946	14.8 (11.3–18.3)	1.00 (0.73–1.37)	0.991
Yes	4503	14.8 (13.1–16.4)	Reference

Rates and odds ratios are weighted

A: Coefficient of variation between 16.5 and 33.3%; interpret with caution –: Unreliable estimate because coefficient of variation equal to or greater than 33.3%