Review article
Improving adolescent health: Focus on HPV vaccine acceptance

https://doi.org/10.1016/j.jadohealth.2005.09.010Get rights and content

Abstract

The success of future human papillomavirus (HPV) vaccination programs will depend on individuals’ willingness to accept vaccination, parents’ willingness to have their preadolescent and early adolescent children vaccinated, and health care providers’ willingness to recommend HPV vaccination. The purpose of this article is to provide a qualitative review of the relevant literature, including research on knowledge and attitudes about HPV infection and its clinical sequelae, the acceptability of HPV vaccination to individuals and parents, and health care providers’ attitudes about recommending HPV vaccination. Additionally, strategies are suggested by which providers of adolescent health care can discuss and recommend HPV vaccines with parents and their children. The research published to date suggests that there is a good deal of misunderstanding about HPV infection, cervical cancer screening, and the sequelae of HPV infection. However, the majority of research studies to date indicate that young women, parents, and health care providers are interested in vaccines that prevent HPV and other sexually transmitted infections (STIs). Of particular note are the consistent findings that providers are less comfortable vaccinating younger versus older adolescents and that endorsement of vaccination by a professional organization is of great importance. Furthermore, research suggests that most parents are interested in having their preadolescent and adolescent children vaccinated against HPV. Parents value the information and recommendations provided by their children’s health care providers. To the extent that providers are concerned about potential negative reactions of parents to a recommendation of HPV vaccination, these findings should provide reassurance. At the same time, health care providers will need to be prepared to provide patients and parents with information about HPV and HPV immunization and to respond productively to the rare parent who expresses opposition to HPV vaccine or any other vaccine.

Section snippets

Knowledge and attitudes about HPV

It is well established that adult as well as adolescent women have limited understanding of HPV [8], [9], [10], [11], [12], [13]. In two United Kingdom studies, only 30% of women participants had ever heard of HPV [10], [12] and in a Canadian study only 13% of adolescents had heard of HPV [9]. Similarly, among a sample of university students in the United States, 37% had ever heard of HPV [13]. Although research with patients attending health clinics in the United States found more encouraging

HPV vaccination: personal acceptability

Clearly, adolescent and adult women are concerned about HPV and want to be better informed about infection, transmission, screening, and prevention. However, this desire for education about HPV does not imply that an HPV vaccine will be widely accepted by women. Given that HPV is an STI, potential barriers to vaccine acceptance may include the stigma associated with STIs and the possibility that acceptance of the vaccine may be seen as an admission of risky sexual behavior [7]. Although HPV

HPV vaccination: parental acceptability

The research summarized in the previous section suggests that most women are interested in HPV vaccines; however, given the fact that HPV vaccines are prophylactic, and will provide the greatest public health benefit prior to infection with the virus, the major targets of HPV vaccination campaigns should be pre- and early adolescents. Research on hepatitis B vaccination indicates that adolescents look to their parents for guidance around vaccination issues [22]. Moreover, parental consent most

Health care providers

Health care providers are important sources of information and parents value physician recommendations about health-related matters, including vaccines. The success of HPV vaccination programs, therefore, will depend on physicians’ willingness and ability to recommend HPV vaccines to their patients. This will undoubtedly involve developing skills to effectively communicate the advantages of vaccination to adolescents and their parents.

Three research studies have been published on health care

Other HPV issues

Genital HPV infection is the most common STI, with high incidence and prevalence rates [39], [40], [41], [42]. HPV infections that cause warts are, from a medical standpoint, relatively benign. Furthermore, infections with high-risk, oncogenic types are usually either spontaneously cleared or regress to an undetectable level [43], [44], [45]. HPV, therefore, is a common sexually transmitted infection, but a less common sexually transmitted disease. To encourage vaccination, it is important to

Provider recommendations

The body of research described in this article should reassure physicians and other clinicians who have concerns about offering or recommending HPV vaccination to their preadolescent and adolescent patients. Women want more information on HPV for themselves and their daughters and value information provided by health care providers, suggesting that physicians will have an important role in educating adolescent patients and their parents about HPV and HPV vaccination. The research also indicates

References (61)

  • E.L. Franco et al.

    Vaccination against human papillomavirus infectiona new paradigm in cervical cancer control

    Vaccine

    (2005)
  • J. Leask et al.

    ‘An attempt to swindle nature’press anti-immunisation reportage 1993–1997

    Aust N Z J Public Health

    (1998)
  • N. Lashuay et al.

    Exposure to immunization media messages among African American parents

    Prev Med

    (2000)
  • M.T. Keane et al.

    Confidence in vaccinationa parent model

    Vaccine

    (2005)
  • D.M. Harper

    Why am I scared of HPV?

    CA Cancer J Clin

    (2004)
  • S.J. Goldie et al.

    Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine

    J Natl Cancer Inst

    (2004)
  • A.V. Taira et al.

    Evaluating human papillomavirus vaccination programs

    Emerg Infect Dis

    (2004)
  • S.L. Kulasingam et al.

    Potential health and economic impact of adding a human papillomavirus vaccine to screening programs

    JAMA

    (2003)
  • J.C. Abma et al.

    Teenagers in the United Statessexual activity, contraceptive use, and childbearing, 2002

    Vital Health Stat 23

    (2004)
  • G.D. Zimet et al.

    Vaccines against sexually transmitted infectionspromise and problems of the magic bullets for prevention and control

    Sex Transm Dis

    (2000)
  • R.M. Mays et al.

    Human papillomavirus, genital warts, pap smears, and cervical cancerknowledge and beliefs of adolescent and adult women

    Health Care Women Int

    (2000)
  • M. Pitts et al.

    Human papillomavirus infections and risks of cervical cancerwhat do women know?

    Health Educ Res

    (2002)
  • B. Holcomb et al.

    Adults’ knowledge and behaviors related to human papillomavirus infection

    J Am Board Fam Pract

    (2004)
  • J. Waller et al.

    Awareness of human papillomavirus among women attending a well woman clinic

    Sex Transm Infect

    (2003)
  • C.R. Breitkopf et al.

    Poor knowledge regarding the pap test among low-income women undergoing routine screening

    Perspect Sex Reprod Health

    (2005)
  • D.R. Blake et al.

    Adolescent and young adult women’s misunderstanding of the term Pap Smear

    Arch Pediatr Adolesc Med

    (2004)
  • J.A. Kahn et al.

    Beliefs about papanicolaou smears and compliance with papanicolaou smear follow-up in adolescents

    Arch Pediatr Adolesc Med

    (1999)
  • R. Anhang et al.

    Women’s desired information about human papillomavirus

    Cancer

    (2004)
  • G.D. Zimet et al.

    Acceptability of HPV immunization

    J Womens Health

    (2000)
  • D.R. Hoover et al.

    Attitudes of adolescent/young adult women toward human papillomavirus vaccination and clinical trials

    Health Care Women Int

    (2000)

    • Cited by (173)

    • “I'm scared that if I have the vaccine, it's going to make my lung condition worse, not better.” COVID-19 vaccine acceptance in adults with underlying health conditions – A qualitative investigation

      2022, Vaccine: X

    • Human papillomavirus vaccine and risky sexual behavior: Regression discontinuity design evidence from Brazil

      2021, Economics and Human Biology
      Citation Excerpt :

      They may be concerned that their teenage children interpret parental approval of the vaccine as a tacit consent to early sexual behavior. Preadolescents and adolescents are more likely to have questions about sexual health care than children, and parents may be wary of describing the HPV vaccine to their daughters (Vamos et al., 2008; Zimet, 2005). Studies for the US and the UK show that part of the problem is the parental belief that vaccination would be a positive nod to risky sexual behaviors (Ferrer et al., 2016), such as early sex, not using condoms and having multiple sexual partners.

    • HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine

      2019, Papillomavirus Research

    • Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008–2016)

      2019, Vaccine

    • School children's perceptions about being offered the HPV vaccination – A focus group study

      2024, Acta Paediatrica, International Journal of Paediatrics

    • Assessing the Effectiveness of Web-Based Modules on Human Papillomavirus Among Dental and Dental Hygiene Students

      2023, Journal of Cancer Education
    View all citing articles on Scopus
    View full text
    Copyright © 2005 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.