The factors associated with maternal consent to human papillomavirus vaccination among adolescents in Israel

Figures & data

Table 1. Study population characteristics

Categorical characteristics	n (%)
Nationality
Jewish	232 (74.1)
Arab	81 (25.9)
Religious observance
Secular	130 (41.5)
Observant	103 (32.9)
Religious	80 (25.6)
Education level
≤ 10 years	22 (7.0)
10–11 years	103 (32.9)
>12 years without academic degree	71 (22.7)
Academic degree	117 (37.4)
Place of residence
Urban	202 (64.5)
Rural	111 (35.5)
Gender (of the adolescent)
Male	153 (48.9)
Female	160 (51.1)
Continuous characteristics	Mean (± SD)
Age (years)	42.9 (±4.8)

Table 2. Knowledge and attitudes toward HPV vaccine

Questions exploring knowledge			Correct answer, n (%)
Is HPV transmitted by sexual contact?			194 (62.0)
Can HPV cause cervical cancer?			231 (73.8)
Can HPV cause genital warts?			111 (35.5)
Can HPV cause oropharyngeal cancer?			60 (19.2)
Can HPV cause anal cancer?			56 (17.9)
Can HPV cause bladder cancer?			25 (8.0)
Is the HPV vaccine recommended to prevent cervical cancer in the future?			236 (75.4)
Is the HPV vaccine recommended to prevent several types of cancer in the future?			51 (16.3)
Is the HPV vaccine recommended to prevent genital warts?			88 (28.1)
Who is given the HPV vaccine in 8th grade: boys/girls/both?			186 (59.4)
Attitude statements	Agree n (%)	Disagree n (%)	Neutral n (%)
The HPV vaccine is an effective vaccine	194 (62.0)	96 (30.7)	23 (7.3)
The HPV vaccine is a safe vaccine	149 (47.6)	98 (31.3)	66 (21.1)
You are concerned about the side effects of the HPV vaccine	178 (56.9)	20 (6.4)	115 (36.7)
Your son/daughter is too young to get the vaccine	118 (37.7)	59 (18.8)	136 (43.5)
It is important that your son/daughter receive the HPV vaccine	196 (62.6)	47 (15.0)	70 (22.4)
You rely on the Ministry of Health statements regarding the vaccine’s effectiveness	213 (68.1)	44 (14.1)	56 (17.9)
You rely on the Ministry of Health statements regarding the safety of the vaccine	175 (55.9)	57 (18.2)	81 (25.9)
Your son/daughter may be infected with HPV at some point	149 (47.6)	79 (25.2)	85 (27.2)
Your child may suffer from HPV-related diseases at some point	137 (43.8)	85 (27.2)	91 (29.1)

Table 3. Factors associated with the knowledge level regarding HPV vaccine

a. Bi-variate analysis
Categorical independent variables	Knowledge score mean (± SD)	95% CI for mean	F	df	P
Nationality			72.52	311	0.000
Jewish	4.64(±2.22)	4.36–4.93
Arab	1.99(±2.92)	1.34–2.63
Religious observance			13.19	310	0.000
Secular	4.81(±2.53)	4.37–5.25
Observant	3.59(±2.68)	3.07–4.12
Religious	3.04(±2.53)	2.47–3.60
Education level			12.78	309	0.000
≤ 10 years	1.82(±2.36)	0.77–2.87
10–11 years	3.76(±2.38)	3.29–4.22
>12 years without academic degree	3.30(±2.57)	2.69–3.90
Academic degree	4.93(±2.68)	4.44–5.42
Place of residence			1.31	311	0.253
Urban	3.83(±2.61)	3.46–4.19
Rural	4.19(±2.78)	3.66–4.71
Gender (of the adolescent)			0.006	311	0.938
Male	3.97(±2.89)	3.50–4.43
Female	3.94(±2.46)	3.66–4.71
Continuous independent variables	Pearson’s r				P
Age	0.188				0.001
Attitudes	0.063				0.263
b. Results of the linear regression model
Independent Variables	B	95% CI for B	β	t	P
(constant)	5.41	2.57–8.26	0.09	3.75	0.000
Age	0.05	−0.01–0.12	0.09	1.73	0.086
Nationality*	−2.03	−2.70- −1.35	−0.34	−5.90	0.000
Religious observance **
Observant	−0.39	−1.05- −0.26	−0.07	−1.18	0.240
Religious	−1.07	−1.76- −0.37	−0.18	−3.02	0.003
Education***
≤ 10 years	−1.84	−2.97- −0.72	−0.18	−3.23	0.001
10–11 years	−0.77	−1.42- −0.11	−0.13	−2.30	0.022
>12 years without academic degree	−1.26	−1.96- −0.57	−0.20	−3.57	0.000

*Arab vs. Jewish

**Dummy variable. Reference category – secular

*** Dummy variable. Reference category – academic degree

Table 4. Bi-variate analysis to identify factors associated with the attitudes towards HPV vaccine

Categorical Independent variables	Attitude score mean(±SD)	95%CI for mean	F	df	P
Nationality			10.35	311	0.000
Jewish	10.52(±5.04)	9.87–11.17
Arab	13.17(±3.22)	12.46–13.88
Religious observance			2.10	310	0.125
Secular	10.83(±5.18)	9.83–11.73
Observant	12.01(±4.42)	11.15–12.87
Religious	10.85(±4.45)	9.86–11.84
Education level
≤ 10 years	12.68(±3.93)	10.94–14.43	1.57	309	0.197
10–11 years	11.67(±4.42)	10.81–12.53
>12 years without academic degree	11.06(±4.97)	9.88–12.53
Academic degree	10.66(±5.05)	9.73–11.58
Place of residence			3.27	311	0.071
Urban	11.58(±4.84)	10.91–12.25
Rural	10.57(±4.61)	9.70–11.43
Gender (of the adolescent)			2.22	311	0.137
Male	11.63(±4.69)	10.88–12.38
Female	10.83(±4.83)	10.08–11.59
Continuous independent variables	Pearson’s r				P
Age	−0.071 0.063				0.223
Knowledge					0.263

Table 5. Factors associated with the mothers’ consent to the HPV vaccine

a. Bi-variate analysis
Continuous independent variables	Consent to HPV vaccine Mean (±SD)	Refusal to HPV vaccine Mean(± SD)	df	F	P
Knowledge level	3.70(±2.91)	4.44(±2.10)	311	5.39	0.021
Attitudes	13.67(±3.25)	6.51(±3.56)	311	319	0.000
Age, years	42.72(±4.95)	43.40(±4.33)	296	1.39	0.240
Categorical independent variables			OR	95% CI	P
Place of residence			0.83	0.51–1.35	0.457
Gender			1.21	0.77–1.93	0.475
Nationality*			67.30	9.21–491.87	0.000
Religious observance			-	-	0.008
Education level			-	-	0.104
The receipt of other routine childhood vaccinations			10.52	2.26–48.92	0.001
The adolescent’s willingness to receive the HPV vaccine			-	-	0.000
b. Results of the multivariate logistic regression model
Independent variables			OR	95% CI	P
Knowledge level			0.82	0.68–0.98	0.036
Attitudes			1.76	1.53–2.02	0.000
The receipt of other routine childhood vaccinations			12.61	0.58–272.57	0.106
The adolescent’s willingness to receive the HPV vaccine			1.09	0.84–1.42	0.506
Nationality*			27.86	3.41–227.56	0.002
Religious observance			1.18	0.74–1.96	0.460

*Arab vs. Jew