Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11–17 years

• Published in: Vaccine 2018-08, Vol.36 (33), p.5084-5090
• Main Authors: Rodriguez, Serena A., Savas, Lara S., Baumler, Elizabeth, Nyitray, Alan G., Mullen, Patricia Dolan, Vernon, Sally W., Fernandez, Maria E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Cervical cancer; Cervix; Child; Correlation; Electronic health records; Electronic medical records; Female; Females; Health disparities; Hispanic Americans; HPV vaccine; Human papillomavirus; Humans; Immunization; Income; Morbidity; Motivation; Norms; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - therapeutic use; Parents; Patient Acceptance of Health Care - statistics & numerical data; Poverty; Predictors; Regression analysis; Side effects; Surveys and Questionnaires; Teenagers; Vaccination; Vaccination - statistics & numerical data; Vaccines
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2018.06.071

Hispanic women experience a disproportionate burden of cervical cancer morbidity and mortality compared to non-Hispanic women. Increasing HPV vaccination among Hispanic adolescents can help alleviate disparities. This study aimed to identify parental psychosocial predictors associated with HPV vaccine initiation and correlates of parental intentions to obtain the vaccine for their Hispanic adolescent daughters aged 11–17 years. This study is part of a larger three-arm randomized controlled trial testing the effectiveness of interventions to increase HPV vaccination. Parents of adolescent females were recruited in community clinics where we conducted baseline surveys. We obtained electronic medical records six months after baseline to assess vaccination status. Multilevel logistic regression was used to identify correlates of parental intentions to vaccinate and predictors of HPV vaccine initiation. Analyses with initiation as the outcome also controlled for intervention study arm. The Integrated Behavioral Model guided selection of psychosocial and outcome variables. Our sample (n = 765) consisted mostly of mothers with less than a high school education born outside of the U.S. Forty-one percent had a household income less than $15,000. Most daughters had public or private insurance. Twenty-one percent initiated the HPV vaccine series. Correlates of intention to vaccinate intention included subjective norms related to daughter’s doctor (AOR = 1.04; 95% CI 1.01–1.07), belief that the vaccine is safe (AOR = 1.38; 95% CI 1.06–1.78), self-efficacy to obtain the vaccine for their daughter (AOR = 2.39; 95% CI 1.52–3.77), and parental concern about vaccine side effects (AOR = 0.73; 95% CI 0.60–0.89). Intentions predicted initiation (AOR = 2.01; 95% CI 1.10–5.26); concern about sexual disinhibition decreased the odds of having a vaccinated daughter at follow-up (AOR = 0.66; 95% CI 0.47–0.92). Parental intention and concerns about sexual disinhibition predict vaccine initiation. Further research is needed to explore the role of intention as a potential mediator between psychosocial variables and vaccination status.