HPV vaccine's safety trumps concern about sex

Safety, not sexuality was a key factor in the reluctance of mothers to have their teenage daughters vaccinated against human papilloma virus, according to results of a survey.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices currently recommends a three-dose vaccine against the human papilloma virus (HPV) for all girls aged 11-12 years and young women aged 13-26 years. HPV has been identified as a leading cause of cervical cancer.

Previous studies have shown that parents were in favor of vaccination for adolescents but hesitant to vaccinate younger girls. But data from these studies have shown that in most cases, this resistance was not brought on by concerns that the vaccination might make teenage girls more likely to engage in risky sexual activities.

To examine the factors that influence parents’ acceptance of the HPV vaccine, the University of Texas Medical Branch in Galveston, Tex., interviewed mothers with daughters aged 11-17 years who were visitors to a university-based primary care clinic.

The study included complete results from 153 mothers of various ethnicities (average 41 years) who completed a questionnaire. The questionnaire included ratings of seven health beliefs including perceptions of HPV disease severity and barriers to vaccination, such as cost. The questionnaire also addressed aspects of the parent/child relationship, including how closely the girls’ activities were monitored by parents and whether the parents had discussed topics such as birth control, dating, and making decisions about sex.

Overall, 18% (27) of the mothers had been offered the HPV vaccination for their daughters but had not chosen it, and did not plan to vaccinate their daughters within the next year, while 34% (52) had not been offered the vaccination and did not plan to vaccinate their daughters within the next year. Another 22% (34) had not been offered the vaccine but were aware of it and planned to vaccinate their daughters within the next year, and 26% (40) of the mothers reported that their daughters had started or completed the vaccination series.

None of the mothers whose daughters had been vaccinated said they viewed the vaccine as unsafe, but objections to the vaccine were focused mostly on the lack of safety data because of the newness of the vaccine. Mothers who were offered the vaccine but did not plan to vaccinate their daughters within the year often cited a lack of information about the vaccine, and some cited a lack of urgency based on their perceptions of their daughters’ likely exposure to HPV.

Significant predictors of HPV vaccination after a multivariate analysis were mothers who had less than a high school education, had a history of sexually transmitted infections, had monitored their daughters activities with peers, and had thought their daughters would not mind getting the shots.

There was no significant association between HPV vaccine and the ages and ethnicities of the mothers and daughters, the daughters’ dating status, mothers history of HPV, mother/daughter discussion of sex topics, or the general family environment.

“Although the study was not designed to examine the process of and impact of physician counseling, it appeared that those who had been counseled had more positive attitudes toward the vaccine and understood better the reasons for vaccinating their daughters prior to initiation of sexual activity,” the researchers noted.

The study was limited by the relatively small sample and by the university setting, which might have provided more education to parents and daughters than would be provided in other settings.

But the results suggest that even those parents and daughters who were counseled about the HPV vaccine wanted more information, and further studies are needed to determine the most effective ways to provide more education, the authors wrote.

Many mothers who were not planning to have their daughters vaccinated within the next year planned to have them vaccinated eventually, they added.