The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

Figures & data

Table 1. Child and caregiver sociodemographic characteristics of respondents, stratified by initiation of HPV vaccine.

	Overall (N = 926)		No HPV Initiation (N = 534)		HPV series initiated (N = 392)
	N	%	N	%	N	%
Child’s age
9–12	274	29.59	223	41.76	51	13.01
13+	652	70.41	311	58.24	341	86.99
Child’s gender
Male	471	51.82	288	54.75	183	47.78
Female	438	48.18	238	45.25	200	52.22
Meningococcal conjugate vaccine
Vaccinated	718	77.54	379	70.97	399	86.48
Not vaccinated	90	9.72	66	12.36	24	6.12
Missing	118	12.74	89	16.67	29	7.40
Seasonal flu vaccine for the 2020–2021 season
Vaccinated	450	49.34	207	39.66	243	62.31
Not vaccinated	462	50.66	315	60.34	147	37.69
Caregiver age
25–34	209	22.69	151	28.44	58	14.87
35–44	489	53.09	269	50.66	220	56.41
45+	223	24.21	111	20.90	112	28.72
Caregiver gender
Male	198	21.55	114	21.63	84	21.43
Female	721	78.45	413	78.37	308	78.57
State
Arkansas	175	18.90	100	18.73	75	19.13
Illinois	68	7.34	35	6.55	33	8.42
Missouri	294	31.75	173	32.40	121	30.87
Mississippi	57	6.16	29	5.43	28	7.14
Tennessee	332	35.85	197	36.89	135	34.44
Caregiver race
Non-Hispanic White	697	76.09	410	77.65	287	73.97
Non-Hispanic Black	126	13.76	71	13.45	55	14.18
Some other race	93	10.15	47	8.90	46	11.86
Rurality (RUCA categorization)
Metropolitan	631	68.14	367	68.73	264	67.35
Micropolitan	158	17.06	88	16.48	70	17.86
Rural	137	14.79	79	14.79	58	14.80

Table abbreviations: RUCA = rural-urban commuting area.

Table 2. Information needed to make a decision whether to receive the HPV vaccine among undecided caregivers (N = 102).

	N	%
What information do you need to make this decision?^a
Information on safety of the vaccine	55	53.9
Information on how well the vaccine works	48	47.1
A physician’s recommendation	46	45.1
If it is safe right now during the COVID-19 pandemic	18	17.7
I want to know what other parents are doing	10	9.8
My child’s school to require it	6	5.9
Some other reason^b	14	13.7

^aAsked to caregivers who responded “Not yet, I haven’t decided” to the question “Has your oldest child been vaccinated against HPV?”

^bWrite in responses were provided such as child’s input and financial.

Table 3. Caregiver HPV vaccine attitudes, information sources, and adolescent HPV vaccine initiation.

	Overall (N = 926)		No HPV Initiation (N = 534)		HPV series initiated (N = 392)
	N	%	N	%	N	%	p-value^a
HPV VACCINE ATTITUDES
HPV vaccine
… is effective							<.0001
Strongly disagree/disagree	161	17.42	129	24.20	32	8.18
Agree/Strongly agree	763	82.58	404	75.80	359	91.82
… is beneficial for my child(ren)							<.0001
Strongly disagree/disagree	182	19.70	157	29.46	25	6.39
Agree/Strongly agree	742	80.30	376	70.54	366	93.61
… follow HCP’s recommendations							<.0001
Strongly disagree/disagree	166	17.97	131	24.58	35	8.95
Agree/Strongly agree	758	82.03	402	75.42	356	93.61
… has not been around long enough to be sure it’s safe							<.0001
Strongly disagree/disagree	519	56.17	250	46.90	269	68.80
Agree/Strongly agree	405	43.83	283	53.10	122	31.20
… I am concerned about the side effects							<.0001
Strongly disagree/disagree	429	46.48	189	35.46	240	61.54
Agree/Strongly agree	494	53.52	344	64.54	150	38.46
Do you think the HPV vaccine can prevent some cancers?							<.0001
Yes	557	60.15	256	47.94	301	76.79
No	77	8.32	58	10.86	19	4.85
I don’t know/I’m not sure	292	31.53	220	41.2	72	18.37
HPV VACCINE INFORMATION
Sources of HPV vaccine information
Doctor or health care provider	809	87.37	443	82.96	366	93.37	<.0001
Family or friends	151	16.31	109	20.41	42	10.71	<.0001
Social media (e.g. Twitter, Facebook, Instagram, etc.)	98	10.58	63	11.8	35	8.93	.1608
Other internet sources	287	30.99	186	34.83	101	25.77	.0032
Books, newspapers, or magazines	112	12.1	68	12.73	44	11.22	.4864
Television or radio	137	14.79	92	17.23	45	11.48	.0149
Government agencies	75	8.1	38	7.12	37	9.44	.2005
Religious organizations or leaders	16	1.73	10	1.87	6	1.53	.6931
Trust in HPV vaccine information sources
Doctor or health care provider							<.0001
A great deal, a lot, or a moderate amount	856	92.44	474	88.76	382	97.45
A little or none at all	70	7.56	60	11.24	10	2.55
Family or friends							.0050
A great deal, a lot, or a moderate amount	634	68.47	346	64.79	288	73.47
A little or none at all	292	31.53	188	35.21	104	26.53
Social media (e.g. Twitter, Facebook, Instagram, etc.)							.0048
A great deal, a lot, or a moderate amount	271	29.27	137	25.66	134	34.18
A little or none at all	655	70.73	397	74.34	258	65.82
Other internet sources							.0349
A great deal, a lot, or a moderate amount	487	52.59	265	49.63	222	56.63
A little or none at all	439	47.41	269	50.37	170	43.37
Books, newspapers, or magazines							.0394
A great deal, a lot, or a moderate amount	586	63.28	323	60.49	263	67.09
A little or none at all	340	36.72	211	39.51	129	32.91
Television or radio							<.0001
A great deal, a lot, or a moderate amount	446	48.16	225	42.13	221	56.38
A little or none at all	480	51.84	309	57.87	171	43.62
Government agencies							<.0001
A great deal, a lot, or a moderate amount	505	54.54	252	47.19	253	64.54
A little or none at all	421	45.46	282	52.81	139	35.46
Religious organizations or leaders							<.0001
A great deal, a lot, or a moderate amount	356	38.44	176	32.96	180	45.92
A little or none at all	570	61.56	358	67.04	212	54.08

^aChi-Square test.

Table 4. Unadjusted and adjusted logistic regression for association between HPV vaccine attitudes and information sources and HPV vaccination initiation.

	Unadjusted OR (LCL, UCL)	Adjusted^a OR (LCL, UCL)
HPV VACCINE ATTITUDES
HPV vaccine
… is effective
Strongly agree or agree	3.58 (2.37, 5.41)	0.70 (0.35, 1.41)
Disagree or strongly disagree	Ref	Ref
… is beneficial for my child(ren)
Strongly agree or agree	6.11 (3.91, 9.55)	4.39 (2.05, 9.39)
Disagree or strongly disagree	Ref	Ref
… follow HCP’s recommendations
Strongly agree or agree	3.32 (2.22, 4.94)	1.14 (0.63, 2.06)
Disagree or strongly disagree	Ref	Ref
… has not been around long enough to be sure it’s safe
Strongly agree or agree	0.40 (0.31, 0.54)	0.74 (0.50, 1.09)
Disagree or strongly disagree	Ref	Ref
… I am concerned about the side effects
Strongly agree or agree	0.34 (0.26, 0.45)	0.61 (0.42, 0.88)
Disagree or strongly disagree	Ref	Ref
Do you think the HPV vaccine can prevent some cancers?
I don’t know/I’m not sure	1.00 (0.56, 1.79)	0.51 (0.23, 1.11)
Yes	3.59 (2.08, 6.19)	1.06 (0.49, 2.27)
No	Ref	Ref
HPV VACCINE INFORMATION
Sources of HPV vaccine information
Doctor or health care provider
Yes	2.89 (1.83, 4.57)	1.66 (0.93, 3.00)
No	Ref	Ref
Family or friends
Yes	0.47 (0.32, 0.67)	0.57 (0.35, 0.93)
No	Ref	Ref
Other internet sources
Yes	0.65 (0.49, 0.87)	0.64 (0.43, 0.94)
No	Ref	Ref
Television or radio
Yes	0.62 (0.43, 0.91)	0.70 (0.43, 1.16)
No	Ref	Ref
Trust in HPV vaccine information sources
Doctor or health care provider
A great deal, a lot, or a moderate amount	4.83 (2.44, 9.57)	1.35 (0.55, 3.34)
A little or none at all	Ref	Ref
Family or friends
A great deal, a lot, or a moderate amount	1.51 (1.13, 2.00)	0.98 (0.66, 1.44)
A little or none at all	Ref	Ref
Other internet sources
A great deal, a lot, or a moderate amount	1.33 (1.02, 1.72)	1.27 (0.85, 1.90)
A little or none at all	Ref	Ref
Television or radio
A great deal, a lot, or a moderate amount	1.78 (1.36, 2.31)	1.48 (0.99, 2.21)
A little or none at all	Ref	Ref

Table abbreviations: LCL = lower confidence limit, OR = odds ratio, Ref = reference, UCL = upper confidence limit.

^aAdjusted for all other variables in the table in addition to child gender, meningococcal conjugate vaccine uptake, seasonal flu vaccine uptake for the 2020–2021 season, child age, caregiver age, and caregiver gender.

Data availability statement

Please contact the corresponding author at [email protected] for access to any of the data associated with this study.