Exploring variation in parental worries about HPV vaccination: a latent-class analysis

Figures & data

Table 1. Sample characteristics (n = 431).

	n	(%)
Child characteristics
Sex
Male	235	(55)
Age (years)
11–12	146	(34)
13–15	148	(34)
16–17	137	(32)
Race
Non-Hispanic white	271	(63)
Non-Hispanic black	41	(10)
Hispanic	85	(20)
Other	34	(8)
HPV vaccination status
1 or more doses	146	(34)
Parent characteristics
Sex
Male	240	(56)
Educational attainment
High school degree or less	181	(42)
Some college, no degree	126	(29)
College degree or more	124	(29)
Household characteristics
Annual income
<$35,000	98	(23)
$35,000-$74,999	128	(30)
≥$75,000	205	(48)
Region
Northeast	68	(16)
Midwest	105	(24)
South	157	(36)
West	101	(23)

Table 2. Best-worst scaling prioritization of worries about HPV vaccination.

	Frequency of choice		Conditional logit model
	Most worrisome	Least worrisome	β	SE	Conditional Probability
Long-term side effects	1182	76	2.86	0.04	36%
How new the vaccine is	603	175	1.50	0.04	12%
Motives of drug companies	547	249	1.40	0.04	11%
Short-term side effects	473	162	1.22	0.04	10%
It may be unnecessary	503	261	1.22	0.04	10%
Getting too many vaccines	416	255	0.70	0.04	7%
Encouraging sexual activity	414	459	−0.20	0.04	4%
Opinion of the child	119	552	−1.55	0.04	3%
Having to talk about sex	151	606	−1.62	0.04	3%
Making the child upset	138	721	−2.15	0.04	3%
Opinions of family members	75	1105	−3.39	0.04	2%

Table 3. Conditional probability of endorsing worries by latent class membership (5-class model).

	Classes of Parental Worry
	1. Vaccine harms	2. Industry	3. General risk	4. Novelty	5. Sex
Class Size	28%	29%	15%	23%	5%
Long-term side effects	60%	22%	19%	42%	–
How new the vaccine is	–	–	–	15%	–
Motives of drug companies	–	33%	–	–	–
Short-term side effects	–	–	–	–	–
It may be unnecessary	–	–	–	–	–
Getting too many vaccines	–	–	–	–	–
Encouraging sexual activity	–	–	44%	–	30%
Opinion of the child	–	–	–	–	–
Having to talk about sex	–	–	–	–	29%
Making the child upset	–	–	–	–	–
Opinions of family members	–	–	–	–	–

Note. Data are shown for worries that in combination make up >50% of parents within the class.

Table 4. Worries that parents might have about HPV vaccine.

I would worry about…	This means….	Source
Short-term side effects	I would worry that the HPV vaccine would cause problems that last for a few days, like pain or swelling.	^Citation3,Citation39,Citation44,Citation45
Long-term side effects	I would worry that the HPV vaccine would cause lasting health problems.	^Citation3,Citation39,Citation44
Making the child upset	My child does not like getting shots. I would worry that my child would complain or get upset about having to get the HPV vaccine.	^Citation46
Motives of drug companies	I would worry that drug companies are pushing the HPV vaccine to make a profit.	^Citation39,Citation47,Citation48
Having to talk about sex	I would worry that getting the HPV vaccine for my child would lead to uncomfortable conversations about sex.	^Citation10
Opinions of family members	I would not want to make a decision about the HPV vaccine that other members of my family disagree with.	^Citation49
Encouraging sexual activity	I would worry that my child would think that getting the HPV vaccine means it is okay to have sex.	^Citation5,Citation10,Citation38
Opinion of the child	Children should make their own decisions about the HPV vaccine. I would worry that my child is not old enough to fully participate in the decision at age 12.	^Citation45,Citation49
It may be unnecessary	I would worry that the HPV vaccine might not have any real benefit for my child.	^Citation12,Citation38,Citation50
How new the vaccine is	I would worry that the HPV vaccine is too new.	^Citation39,Citation45,Citation50
Getting too many vaccines	Children can get the HPV vaccine at the same time as other vaccines. I would worry about getting too many vaccines at one visit.	^Citation51,Citation52

Figure 1. Sample choice task.

Gilkey MB, Calo WA, Marciniak MW, Brewer NT. Parents who refuse or delay HPV vaccine: differences in vaccination behavior, beliefs, and clinical communication preferences. Hum Vaccin Immunother. 2017;13(3):680–86. doi:10.1080/21645515.2016.1247134.

 PubMed Web of Science ®Google Scholar

McRee AL, Brewer NT, Reiter PL, Gottlieb SL, Smith JS. The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): scale development and associations with intentions to vaccinate. Sex Transm Dis. 2010;37(4):234–39. doi:10.1097/OLQ.0b013e3181c37e15.

 PubMed Web of Science ®Google Scholar

Katz ML, Reiter PL, Heaner S, Ruffin MT, Post DM, Paskett ED. Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia. Vaccine. 2009;27(30):3945–52. doi:10.1016/j.vaccine.2009.04.040.

 PubMed Web of Science ®Google Scholar

Dempsey AF, Abraham LM, Dalton V, Ruffin M. Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus. Ann Epidemiol. 2009;19(8):531–38. doi:10.1016/j.annepidem.2009.03.011.

 PubMed Web of Science ®Google Scholar

Rosenthal SL, Rupp R, Zimet GD, Meza HM, Loza ML, Short MB, Succop PA. Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes. J Adolesc Health. 2008;43(3):239–45. doi:10.1016/j.jadohealth.2008.06.009.

 PubMed Web of Science ®Google Scholar

Cunningham-Erves J, Forbes L, Ivankova N, Mayo-Gamble T, Kelly-Taylor K, Deakings J. Black mother’s intention to vaccinate daughters against HPV: a mixed methods approach to identify opportunities for targeted communication. Gynecol Oncol. 2018;149(3):506–12. doi:10.1016/j.ygyno.2018.03.047.

 PubMed Web of Science ®Google Scholar

Opel DJ, Mangione-Smith R, Taylor JA, Korfiatis C, Wiese C, Catz S, Martin DP. Development of a survey to identify vaccine-hesitant parents: the Parent Attitudes about Childhood Vaccines Survey. Hum Vaccin. 2011;7:419–25.

 PubMed Web of Science ®Google Scholar

Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to Human Papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr. 2014;168(1):76–82. doi:10.1001/jamapediatrics.2013.2752.

 PubMed Web of Science ®Google Scholar

Perez S, Restle H, Naz A, Tatar O, Shapiro GK, Rosberger Z. Parents’ involvement in the human papillomavirus vaccination decision for their sons. Sexual Reprod Healthcare. 2017;14:33–39. doi:10.1016/j.srhc.2017.08.005.

 PubMed Web of Science ®Google Scholar

Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Prev Med. 2007;45(2–3):107–14. doi:10.1016/j.ypmed.2007.05.013.

 PubMed Web of Science ®Google Scholar

Perkins RB, Clark JA, Apte G, Vercruysse JL, Sumner JJ, Wall-Haas CL, Rosenquist AW, Pierre-Joseph N. Missed opportunities for HPV vaccination in adolescent girls: a qualitative study. Pediatrics. 2014;134(3):e666–674. doi:10.1542/peds.2014-0442.

 PubMed Web of Science ®Google Scholar

Darden PM, Thompson DM, Roberts JR, Hale JJ, Pope C, Naifeh M, Jacobson RM. Reasons for not vaccinating adolescents: national immunization survey of teens, 2008-2010. Pediatrics. 2013;131(4):645–51. doi:10.1542/peds.2012-2384.

 PubMed Web of Science ®Google Scholar

Rambout L, Tashkandi M, Hopkins L, Tricco AC. Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review. Prev Med. 2014;58:22–32. doi:10.1016/j.ypmed.2013.10.009.

 PubMed Web of Science ®Google Scholar

Kennedy A, Basket M, Sheedy K. Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey. Pediatrics. 2011;127(Suppl 1):S92–99. doi:10.1542/peds.2010-1722N.

 PubMed Web of Science ®Google Scholar

Gilkey MB, Reiter PL, Magnus BE, McRee AL, Dempsey AF, Brewer NT. Validation of the Vaccination Confidence Scale: a brief measure to identify parents at risk for refusing adolescent vaccines. Acad Pediatr. 2016;16(1):42–49. doi:10.1016/j.acap.2015.06.007.

 PubMed Web of Science ®Google Scholar