title: CHIAS: a standardized measure of parental HPV immunization attitudes and beliefs and its associations with vaccine uptake.
abstract: BACKGROUND
  Despite the burden of human papillomavirus (HPV)-associated morbidity, less than half of US adolescent females had begun the 3-dose HPV vaccination series as of 2010. Given that parental attitudes significantly influence vaccine uptake, having a standardized measure of parental beliefs that predict HPV vaccine uptake would contribute substantially to the development of effective immunization strategies. We explored whether a modified version of the previously published Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) could be applied nationally to identify attitudinal constructs that were associated with HPV vaccine uptake and maternal HPV vaccination intention.
  
  
  METHODS
  We administered the modified CHIAS as part of a cross-sectional, web-based survey to a nationally representative sample of mothers of adolescent females. Exploratory factor analysis was used to identify underlying attitudinal constructs, which were compared with those identified in the original CHIAS. Bivariate and multivariate analyses determined associations between these attitudinal constructs and HPV vaccine uptake as well as vaccination intention.
  
  
  RESULTS
  Overall survey response rate was 57%. The modified CHIAS yielded a factor structure that was similar to the original CHIAS, identifying 3 attitudinal constructs: harms/ineffectiveness, barriers, and social norms. In multivariate models, harms/ineffectiveness and social norms were independently associated with HPV vaccine uptake.
  
  
  CONCLUSIONS
  The CHIAS seems to be a valid instrument for identifying important factors associated with HPV-vaccine uptake and parental vaccination intention nationally. Longitudinal studies are merited to explore whether these attitudinal constructs also reliably predict HPV-vaccine uptake.
authors.affiliation: Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Charitha
authors.initials: C
authors.lastname: Gowda
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Carlos
authors.forename: Amy T
authors.initials: AT
authors.lastname: Butchart
authors.forename: Dianne C
authors.initials: DC
authors.lastname: Singer
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Dempsey
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D033282:Parental Consent / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines