Vaccination perspectives among adolescents and their desired role in the decision-making process

Figures & data

Table 1. Demographic characteristics of 336 participating 7^th and 8^th grade students.

Factors	N	Percent
Gender
Female	180	53.6
Male	156	46.4
Grade
7^th	228	67.9
8^th	108	32.1
Age
11	1	0.3
12	118	35.2
13	143	42.7
14	68	20.3
15	5	1.5
Missing	1	–
Race/Ethnicity
White, non-Latin	238	71.3
Black, Non-Latin	24	7.2
Latin	22	6.6
Asian	13	3.9
American Indian	3	0.8
Mixed race (including White)	28	8.4
Mixed race (not White)	6	1.8
Missing	2	–

Table 2. Participants’ perspective on vaccines and experience with medical encounter, stratified by gender.

	Female (N = 180)		Male (N = 156)		Total
Survey questions	N	%	N	%	N	P*
Do you always get the vaccines your doctor recommends?						0.03
Yes	73	40.8	82	52.6	155
I think so	80	44.7	63	40.4	143
No	24	13.4	8	5.1	32
Other	2	1.1	3	1.9	5
Missing	1	–	0	–	1
Who makes decisions about you being vaccinated?**						0.60
Doctor	17	9.5	19	12.3	36
Parents & Doctor	103	57.5	78	50.3	181
Parents & me	54	30.2	53	34.2	107
Parents, doctor & me	5	2.8	5	3.2	10
Missing	1	–	1	–	2
Who do you think has the biggest influence on if and when you are vaccinated?						0.01
Doctor	60	35.5	60	41.4	120
Father	4	2.4	10	6.9	14
Me	16	9.5	24	16.6	40
Mother	82	48.5	46	31.7	128
Someone else	7	4.1	5	3.4	12
Missing	11	–	11	–	22
Have you ever discussed vaccines with your doctor?						0.86
Yes	70	39.3	62	40.3	132
No	108	60.7	92	59.7	200
Missing	2	–	2	–	4
Have you ever discussed vaccines with your parents?						0.26
Only in presence of doctor	61	34.1	40	25.8	101
Yes, outside of doctors’ office	63	35.2	61	39.4	124
No	55	30.7	54	34.8	109
Missing	1	–	1	–	2
Do you want to decide when you get vaccines?						0.36
Yes. By myself	53	29.9	52	34.7	105
No, want doctor to decide	53	29.9	35	23.3	88
No, want parents to decide	53	29.9	52	34.7	105
Other	18	10.2	11	7.3	29
Missing	3	–	6	–	9
To the best of your knowledge, do you think you received all recommended vaccines?						0.22
Yes	104	57.8	98	62.8	202
No	14	7.8	17	10.9	31
Not sure	62	34.4	41	26.3	103
Missing	0	–	0	–	0
The last time you got a vaccine (shot), where did you get it?						0.33
Doctor’s	119	66.5	109	70.8	228
Children’s clinic	38	21.2	31	20.1	69
School	21	11.7	11	7.1	32
Don’t know	1	0.6	3	2.0	4
Missing	1	–	2	–	3
How safe do you think vaccines are?						<0.01
Very	54	30.2	75	48.4	129
Somewhat	93	52.0	58	37.4	152
Not	7	3.9	5	3.2	12
Don’t know	25	14.0	17	11.0	42
Missing	1	–	1	–	2
How well do you think vaccines work?						<0.01
Very well	52	29.0	77	49.7	129
Works well for some, not Others	100	55.9	54	34.8	154
Not well	7	3.9	5	3.2	12
Don’t know	20	11.2	19	12.3	39
Missing	1	–	1	–	2
Do you have any concerns about vaccines?						0.14
Yes	29	16.5	17	10.9	46
No	147	83.5	139	89.1	286
Missing	4	–	0	–	4
Would you like more information about vaccines when you see your doctor?						0.08
Yes	56	31.6	36	23.1	92
No	121	68.4	120	76.9	241
Missing	3	–	0	–	3
There was equal exchange of information between you and the doctor.						0.85
Strongly agree	53	30.3	49	32.7	102
Agree	101	57.7	82	54.7	183
Disagree	21	12.0	19	12.6	40
Missing	5	–	6	–	11
Who was in control of the visit?						0.81
You and doctor were equal	81	46.8	77	52.4	158
Doctor	34	19.7	24	16.3	58
You	3	1.7	2	1.4	5
Parent	39	22.5	34	23.1	73
Other	16	9.3	10	6.8	26
Missing	7	–	9	–	16
Who was the doctor you saw for your last routine checkup (physical exam)?						0.09
Regular doctor	119	68.4	93	60.3	212
Doctor I know but not regular doctor	22	12.6	29	18.8	51
Doctor I never saw before	15	8.6	22	14.3	37
[School-Based Health Clinic] is my only health care provider	18	10.3	10	6.5	28
Missing	6	–	2	–	8

*p-values are for exact tests of general association between gender and the categories listed for each survey question.

**Having “No say in the decision about being vaccinated” was created by combining two response categories: (1) “Doctor” or (2) “Parent and doctor” made the decision(s).

Table 3. 8^th graders’ attitudes and knowledge about HPV vaccine, stratified by gender.

	Female (n = 64)		Male (n = 44)		Total
	N	%	N	%	N	P*
How safe do you think the Gardasil vaccine is?						0.23
Very	14	23.3	16	38.1	30
Somewhat	22	36.7	14	33.3	36
Not safe	3	5.0	0	0.0	3
Don’t know	21	34.0	12	28.6	33
Missing	4	–	2	–	6
How well do you think Gardasil works?						0.42
Very well	16	26.7	16	38.1	32
Works well for some not Others	19	31.6	12	28.6	31
Not well	1	1.7	2	4.8	3
Don’t know	24	40.0	12	28.6	36
Missing	4	–	0	–	4
Did your doctor talk to you about the Gardasil (HPV) vaccine?						0.99
Yes	25	40.0	17	40.5	42
No	37	60.0	25	59.5	62
Missing	2	–	2	–	4
Did your doctor recommend you wait to get Gardasil until you are older?						0.05
Yes	16	29.1	5	12.5	21
No	39	70.9	35	87.5	74
Missing	9	–	4	–	13
To the best of your knowledge, how many Gardasil (HPV) shots have you received?						0.62
None	15	28.3	13	31.0	28
Some	14	26.4	14	33.3	28
All	24	45.3	15	35.7	39
Missing	11	–	2	–	13
If you received a Gardasil (HPV) shot, what is the single most important reason for you to receive all 3 doses?**						0.70
Want best protection against Infection	10	43.5	9	60.0	19
Doctor recommended	8	34.8	3	20.0	11
Parents wanted	4	17.4	2	13.3	6
Friends also did it/other	1	4.3	1	6.7	2
Missing	1	–	0	–	1
If you received a Gardasil shot what is the single most important reason for you not to get all recommended doses?***						0.72
Will get all doses	7	53.8	5	35.7	12
Shot was painful	3	23.1	2	14.3	5
No time	1	7.7	2	14.3	3
Parents didn’t want	1	7.7	4	28.6	5
Friends didn’t do it	1	7.7	1	7.1	2
Missing	1	–	0	–	1
Where did you get the Gardasil shots?****						0.93
Doctor’s	25	69.4	18	64.3	43
Children’s Clinic	7	19.4	6	21.4	13
School	4	11.2	4	14.3	8
Missing	2	–	1	–	3

*p-values are for exact tests of general association between gender and the categories listed for each survey question.

**includes students who completed the HPV vaccine series.

***includes students who initiated HPV vaccination but have not completed.

**** includes students who received at least one HPV vaccination.

Table 4. Summary of 7^th and 8^th grade students’ qualitative responses categorized by themes elicited.

Themes	Descriptions	Examples
Perceived vaccine harm	Students were concerned that vaccines could have harmful immediate or long-term side effects. Some of these perspectives were grounded in experiences they had themselves while others expressed a lack of knowledge about the potential harm and wanted to learn more. Predominant concerns included:
	Vaccines cause unspecified illness	“They make me sick!” “Last time I got a vaccine they injected the shot in the wrong place and I got really sick.”
	Association between vaccines and future illness	“The vaccine might not work and the person could get hurt.”
	Illustration of a lack of knowledge about vaccines	“The side effects to them are they cancerous?” “What if they affect someone differently and kill them? Like the Gardasil shot.”
Fear of needles	Students expressed concerns and experiences related to pain with some belief that vaccines do not need to hurt.	“… they hurt.” “They should give tips so shots will not hurt as much.” “I hate the pain of shots! Work on it.”
	Fear of needles causing emotional distress.	“Needles. Some kids are TERRIFIED.” “Some people have “needle phobia”, like I do, and have anxiety, breakdowns.”
	Fear needles may be a potential source of infection	“I’m not sure if the needles are clean.”
Need for more education about vaccines	Unclear if vaccines work and how they work	“Some people have different bodies so vaccine might not work for them.” “What are the vaccines for, how do they help me? Etc.”
	What is in the vaccine?	“What are they putting in my body?” “How much of the virus is in the shot?” “What chemicals are in it?”
	What do vaccine do?	“What illness does the vaccine protect from? What does the illness do?” “What exactly it may be doing” “How well the vaccine works on a scale of 1 to 10.” “What are the vaccines for, how do they help me? Etc” “More about what they are for, the dangers if you don’t get one, and the dangers if you do”
	What kind of harm do vaccines cause?	“I want to know if it’s safe” “The side effects.”