Human papillomavirus vaccine: how to potentiate vaccine acceptance and intent among parents of boys and young men
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Backgroud: Nearly 50% of sexually active men and women are infected with human papillomavirus (HPV) during their lifetime. The quadrivalent HPV vaccine (HPV4) can protect both males and females against HPV-related disease, yet vaccination rates are suboptimal, particularly in young males. Factors including parental attitudes, beliefs, and knowledge of HPV disease and HPV4 vaccine are of interest as they may influence parents' intent to vaccinate their adolescent sons. Objective: We sought to determine factors that would potentiate HPV4 vaccine acceptability and intent to vaccinate among parents of boys and young men. Factors tested included parents' knowledge of HPV infection and disease outcomes in males; and parents' perceived susceptibility, severity, and threat of HPV infection for their sons. In addition, we sought to determine parents' perceived benefits of and barriers to HPV vaccination for their sons. Methods: We surveyed parents in the setting of a university-based pediatrics clinic. All parents had at least one son aged 9-21 years. We examined data pertaining to parents' knowledge of HPV infection and disease, perceived susceptibility of sons to HPV-related disease, perceived threat of HPV disease to sons, perceived severity of HPV disease in sons, and intention to vaccinate sons against HPV. We dichotomized the responses related to each of these outcomes. We determined associations of perceived susceptibility of sons to both genital warts and anal cancer, as well as associations of parents' perceived severity of disease, using bivariate and multivariate logistic regression to determine factors that influence parental intent to vaccinate sons against HPV vaccine in the next year. Results: We report results for 290 parents who completed our survey. Most parents had relatively low knowledge of HPV infection and the HPV4 vaccine. Most parents answered 77% of the HPV and HPV4 vaccine knowledge questions incorrectly (17/22 questions). Approximately 44% of parents stated that their son would have a moderate or high chance of getting genital warts without the HPV vaccine. Parents who knew that HPV caused genital warts were more likely to perceive moderately high levels of susceptibility to genital warts (AOR 1.78, 95% CI 1.07, 2.96). Parents, who had the highest levels of education, including some graduate school or a graduate degree, were 0.23 times less likely to think their son had a moderate or high risk of getting anal cancer without the vaccine (95% CI 0.06, 0.89). Sixty-three percent of parents said that they were intending to vaccinate their son in the next year. Participants who believed that HPV4 was effective against preventing genital warts and cancer had higher intentions to vaccinate next year (AOR 1.91 and AOR 1.92 respectively). Higher knowledge about HPV infection and disease outcomes was not statistically associated with increased vaccine acceptability and intent to vaccinate among parents. Conclusions: Parents of adolescent boys and young men have low knowledge of HPV disease, its related disease outcomes, and its vaccine. However, there were no significant differences in parents' intent to vaccinate based on their knowledge of HPV disease related outcomes. Future research should be completed to gain a clearer understanding of why parents with knowledge of HPV disease and the availability of the vaccine for males have low acceptance of the vaccine and intent to vaccinate.
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