title: Awareness and acceptability of human papillomavirus vaccine: an application of the instrumental variables bivariate probit model.
abstract: BACKGROUND
  Although lower uptake rates of the human papillomavirus (HPV) vaccine among socioeconomically disadvantaged populations have been documented, less is known about the relationships between awareness and acceptability, and other factors affecting HPV vaccine uptake.The current study aimed to estimate the potential effectiveness of increased HPV vaccine awareness on the acceptability of HPV vaccination in a nationally representative sample of women, using a methodology that controlled for potential non-random selection.
  
  
  METHODS
  This study used a population-based sample from the 2007 Health Information National Trends Survey, a cross-sectional study of the US population aged 18 years or older, and focused on the subsample of 742 women who have any female children under the age of 18 years in the household. An instrumental variables bivariate probit model was used to jointly estimate HPV vaccine awareness and acceptability.
  
  
  RESULTS
  The proportion of HPV vaccine acceptability among the previously aware and non-aware groups was 58% and 47%, respectively. Results from the instrumental variables bivariate probit model showed that the estimated marginal effect of awareness on acceptability was 46 percentage points, an effect that was even greater than observed.
  
  
  CONCLUSIONS
  Among populations who are not currently aware of the HPV vaccine, the potential impact of raising awareness on acceptability of HPV vaccination is substantial. This finding provides additional support to strengthening public health programs that increase awareness and policy efforts that address barriers to HPV vaccination.
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Graduate Medical School Singapore, Singapore. young.do@duke-nus.edu.sg
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Do
authors.forename: Ker Yi
authors.initials: KY
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care; D014481:United States; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines