140. Exploring the Reasons for Non-Initiation and Non-Completion of the HPV Vaccine Series Among Parents of Adolescent Girls in a Low SES Population
Session: Poster Abstract Session: Adult and Pediatric Vaccines
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: ACIP recommended routine HPV vaccination for girls ages 11-12 years in 2006, yet vaccination rates remain low.  Significant disparities in series completion exist among minority and  poor populations, who are at highest risk of cervical cancer. To inform future interventions to improve vaccine uptake, we performed a qualitative study to understand factors influencing parents’ decisions regarding initiation and completion of the HPV vaccine series for their daughters.

Methods: Parents of girls ages 12-15 years who had either not initiated (NI) or not completed (NC) the HPV vaccine series were identified through administrative data in 2 large urban safety net systems in Colorado. NI was defined as having been seen for well child care in the prior 2 years with no record of an HPV vaccine. NC was defined as having initiated the series without receiving subsequent doses after 6-12 months (2nd and 3rd dose, respectively). Parents were recruited to participate in either focus groups or phone interviews within 4 stratifications: English-speaking NI and NC and Spanish-speaking NI and NC.

Results: Thirty parents were interviewed by telephone for 25-40 minutes (10 in each of 3 groups: English-speaking NC, Spanish-speaking NI and Spanish-speaking NC) and 11 parents of English-speaking NI participated in a 2-hour focus group. Among English-speakers (both NI and NC), vaccine safety concerns, a low perceived risk of HPV infection, and distrust of government and/or medicine were the primary barriers to vaccination. Surprisingly, some parents of NC also reported that safety concerns emerged only after their daughter had received the first dose. Only Spanish speaking NI cited spiritual influences as common barriers to vaccination, especially concerns that vaccination would encourage sexual activity and undermine their expectations of abstinence until marriage. Both Spanish-speaking groups also frequently reported that providers had either not encouraged initiating the HPV vaccine series (NI) or had not explained the necessity of completing the series (NC).

Conclusion: Reasons cited for NI and NC of the HPV vaccine series were markedly different between English- and Spanish-speaking parents. To maximize uptake of HPV vaccine, varying approaches may be needed to target specific populations.

Sean O'leary, MD, MPH1, Juliana Barnard, MA2, Steven Lockhart, BA3, Karen Albright, PhD2, Andrea Clinger, BS4, Michelle Lee, MPH2, Shannon Stokley, MPH5, Amanda Dempsey, MD, PhD, MPH1 and Allison Kempe, MD, MPH1, (1)Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, (2)The Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, CO, (3)University of Colorado, Aurora, CO, (4)Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, CO, (5)National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA


S. O'leary, None

J. Barnard, None

S. Lockhart, None

K. Albright, None

A. Clinger, None

M. Lee, None

S. Stokley, None

A. Dempsey, Merck: Scientific Advisor, Consulting fee
Pfizer: Scientific Advisor, Consulting fee

A. Kempe, None

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