Insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial

Figures & data

Table 1. Profile of the sample of mothers (n = 881).

Age (mean [standard deviation])	43.13 (6.63)
Race
White	86.6%
Non-White	12.9%
Prefer not to answer	0.5%
Ethnicity
Not Hispanic/Latino	92.8%
Hispanic/Latino	6.5%
Prefer not to answer	0.7%
Political Leaning
Conservative	24.0%
Middle of the road	49.8%
Liberal	23.4%
Prefer not to answer	2.8%
General health status: good, very good, excellent	88.3%
Daily servings of fruit (mean [standard deviation])	2.27 (1.54)
Daily servings of vegetables (mean [standard deviation])	2.60 (1.55)
Sugar-sweetened soda/pop intake (drinks) during past 30 days (mean [standard deviation])	8.48 (17.06)
Light or moderate physical activity during past week (mean [standard deviation])	4.18 (3.54)
Vigorous physical activity during past week (mean [standard deviation])	2.73 (2.55)
Body Mass Index (BMI)
Underweight (<18.5)	2.0%
Normal weight (18.5–25)	30.1%
Overweight (25.1–29.9)	28.0%
Obese (≥30)	39.9%
Binge drank at least once during past two weeks	33.0%
Currently smoke (some days or every day)	19.1%

Table 2. HPV vaccination posts in social media campaign.

Post	Type	Total Reactions* (n = 28)	Total Comments (n = 80)
Did you know there are certain diseases (for example, HPV, meningococcal, and whooping cough) that teenagers are more likely to contract? Experts explain why vaccines are the best defense. #link to video	Didactic	1	5
While 6 out of 10 parents are now choosing to vaccinate their children against HPV, many aren’t completing the 3-shot series. Do you know if your daughter is up to date on her vaccines?	Didactic	6	20
About 14 million people, including teens, become infected with HPV each year! You can help protect your daughter from the most serious, cancer-causing strains by getting her vaccinated.	Didactic	1	2
HPV vaccines are working! A 2016 study found that the number of girls ages 14–19 with the virus has decreased by 64%. Has your daughter been immunized? If not, talk to her doctor. #link to article	Didactic	13	46
Today would have been Kelly Pozzoli’s 36th birthday. She died from cervical cancer at age 33. While fighting for her own life, she shared her story in a documentary about HPV, in the hopes that she would save other lives, too. Watch this documentary with your daughter: #link to video	Narrative	2	0
Amazing! Australian schools started offering free HPV vaccines in 2007 and their rates of infection have dropped dramatically (only 1.1% of women ages 18–24 had HPV in 2015!). How would you feel if your daughter’s school started doing the same? #link to article	Didactic	4	5
As of September 2015, less than 20% of Tennessee teens had been fully vaccinated for HPV. Have you talked about the HPV vaccine with your daughter’s doctor?	Didactic	1	0
January is National Cervical Health Awareness Month. What do you know about HPV and cervical cancer? Get the facts from the National Cancer Institute: #link to infographic	Didactic	0	2
There wasn’t anything Kirk could do after his 22-year-old daughter was diagnosed with cervical cancer. But he’d do a lot differently if he’d known there was a way to prevent it. Since Kristen’s death, Kirk has made it his mission to educate other parents and encourage them to talk with their teens about the HPV vaccine. What have you said to your daughter about the vaccine? #link to photo	Narrative	0	0
Who knows better than a doctor? A doctor who’s also a mom. Check out this mommy doc explaining why HPV vaccine is so important. #link to video	Narrative	0	0

* Reactions are defined as a sum of the interaction of the like, love, and sad buttons on Facebook.

Table 3. Themes expressed in mother comments on HPV vaccination posts from content analysis.

Themes*	N (%)	Example Statement
Favorable toward vaccination (n = 43 comments)
Disclosed daughter being vaccinated	31 (38.8%)	“Absolutely! My daughter was immunized at age 10 and my 12 year old twin boys have one shot left to go before their series of 3 is complete.”
Stated need for boys to be vaccinated	12 (15.0%)	“Don’t forget your sons either. My 14 year old son’s pediatrician looked startled when I asked him to vaccinate C. He said I was one of only a handful of parents who had asked for it for their son. So many girls have parents who refuse this vac thinking it’s permission to have sex. I don’t want my son to give HPV to one of those girls.”
Vaccine reduced mother’s anxiety	2 (2.5%)	“All of my children completed their HPV vaccines without any side effects and this study increases my peace of mind. I’m glad we decided to immunize.”
Reduced risk of related disease cited	2 (2.5%)	“Yes, she got the series of shots. Our pediatrician recommended it. I also wrote a paper about the pros and cons when Gardisil first came out so I knew the benefits outweighed the risks. I work for a hospital system that specializes in cancer treatment so I’ve seen how horrible the disease and treatment side effects can be. Anything I can do to minimize my kids’ chances of getting cancer is better than nothing.”
Mentioned physician support	2 (2.5%)	“My daughter got this when her doctor recommended it. They gave us a magnet that lit up when she was due for the subsequent injections. Very convenient”
Reduced HPV infection rates cited	1 (1.3%)	“Significant reduction in infection with HPV. The most sig for me is the connection between HPV infection and head and neck cancer in young people which is devastating.”
Mentioned family history of cancer increasing desire for vaccination	3 (3.7%)	“My daughter has been vaccinated and I plan on doing it for my son’s. I had hpv, and had precancerous cells on my cervix and had to have part of my cervix frozen and removed. If I hadn’t been going for my annual gynecologist appointments, I would have gotten cancer. This is something I never want my children to go through. My mother had a very rare form of ovarian cancer and had a reoccurrence a couple years ago. I believe strongly in vaccines.”
Unfavorable toward vaccination (n = 34 comments)
Cited safety concerns	16 (20.0%)	“I leave this one for my kids to decide for themselves. My son didn’t get it that I know of and so far my daughter hasn’t either. My 1 step daughter has and didn’t have any problems but her mom found stuff out about it after her first shot and left it up to her also, and she’s usually one to give any and every type of medicine she can. Our doctor mentioned fertility concerns about this and I heard about kids not being themselves and unable to do things they previously could. I don’t trust it but at the same time cancer runs in our family so we talk about benefits and possible risks and then I leave it up to them since so far they have all been mature enough to make that type of decision. One thing with that article that bothers me is that they state the amount of aluminum in the vaccine is a safe amount because everyone comes in contact with more than that amount every day. Wouldn’t that mean that you should limit the amount you intentionally come in contact with? Just like bleach, a small amount might not hurt you but if you get too much of it then it can kill you. Or you might have been exposed to second hand smoke for 1 day and it probably wouldn’t hurt you but if you are exposed to it every day, there is definitely more of a chance you will get lung cancer than if you weren’t.”
Mentioned lack of physician support	5 (6.3%)	“When I asked my OBGYN what she thought about it, she admitted she wouldn’t be getting it for her kids”
Stated lack of trust in vaccination sources/organizations	5 (6.3%)	“I respect the CDC but the chance of getting cervical cancer from HPV given the number of strains of HPV is very low and most cases of HPV are undetected and cure themselves. This vaccine works like the flu vaccine which this year was only 33% effective It’s based on predictive stats and some years they get it right and others they don’t. All other vaccines prevent communicable childhood diseases like polio, measles, chicken pox, etc HPV pathology is not similar to these communicable diseases. While the Europeans have embraced this vaccine, the research in the US isn’t convincing and unlike other vaccines, the side effect chances appear to be more than “a sore arm” or a “fever” If my children disagree, they can decide to get this vaccine after they turn 18 and make their own decisions. And like all prevention of STDs they should be using condoms as well.”
Stated daughter has been vaccinated, but not the complete series	5 (6.3%)	“My daughter got two shots close together – didn’t know there was a third? Can someone explain?”
Cited concerns about unknown long-term effects of vaccination	4 (5.0%)	“I am pro-vaccine also, but like several have stated, there simply isn’t enough data (to include long-term) to make me comfortable with it. I pray that my children remain healthy in the absence of receiving the HPV vaccine. But I don’t have a good feeling about this one, so I’m not going to do it.”
Shared concerns that vaccination will increase sexual activity	4 (5.0%)	“Yes they both have opinions about it! Lol. I personally wish we had not given my oldest the vaccine and let her have the opportunity to decide for herself. She tends to stay sick a lot and I truly believe that any immunization taxes the immune system. Yes, I have debates with many doctors about this. Lol. But we waited with our youngest . She knows that before she can become sexually active that she must allow for 6 months for this vaccine. She is 15 and said she will probably get it before she starts college. Here is the bigger issue…I old my girls to INSIST that their boyfriends have the same vaccine. And if he is not willing, then he is not the one. We may communicate too much in our family, but I feel that knowledge is so important in making informed decisions.”
Cited concerns about lack of efficacy	3 (3.7%)	“I had one daughter vaccinated and the other I did not. If a booster is required and they didn’t cover all strains, what was the point. They recommend this at 12…a bit young in our household.”
Shared apprehension from other mothers	1 (1.3%)	“My two oldest have had it, but there’s growing concern among some mom’s of my youngest daughter that they shouldn’t get the vaccine.”

*Each comment could have statements that expressed more than one theme. In those cases, the comment was counted twice.