title: Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: a survey of mothers and adolescents.
abstract: BACKGROUND
  Organized population-based HPV vaccination programs can be effective in reducing the burden of cervical cancer, especially in the absence of a comprehensive cervical screening program (e.g. Hong Kong). Assessment of vaccine acceptability is important when evaluating the feasibility and cost-effectiveness of such vaccination programs.
  
  
  METHODS
  To provide a more representative and updated assessment on the acceptability of female adolescent HPV vaccination in Hong Kong, we conducted surveys in 2008 among 1022 mothers with daughters aged ≤ 18 years through random digit-dialing telephone interviewing and 2167 schoolgirls aged 11-18 years using two-stage stratified cluster sampling. We conducted the maternal survey again in 2012 with an independent group of 1005 mothers.
  
  
  RESULTS
  In 2008, 2.4% (95% confidence interval [CI]=1.8-3.2%) of the recruited schoolgirls reported having received HPV vaccination. In 2012, the mothers reported that 9.1% (7.0-11.6%) of their daughters who were in the same age range (11-18 years) as the schoolgirls had been vaccinated (p<0.01). Regarding acceptability, 27.5% (24.8-30.4%) and 37.6% (34.5-40.8%) of the mothers were willing to have their daughters vaccinated at market price in 2008 and 2012 (p<0.01), respectively. 27.1% (25.2-29.1%) of the schoolgirls were willing to receive HPV vaccination at market price in 2008. The willingness to pay for full-course vaccination among mothers had a median of US$128/HK$1000 (50% central range=US$64-192/HK$500-1500), i.e. substantially lower than the current market price.
  
  
  CONCLUSIONS
  The gap between acceptability and actual uptake of HPV vaccination among adolescent girls suggested that coverage is likely to be low without an organized HPV vaccination program, although the difference might be partially attributed to the possibility that at the time of the interview female adolescents who were willing to be vaccinated had not yet taken action. Policymakers should devise tailored, targeted and efficient vaccination strategies to achieve universal coverage for an effectively organized HPV vaccination program.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Horace C W
authors.initials: HC
authors.lastname: Choi
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.affiliation: Hospital Authority, Hong Kong.
authors.forename: Pauline P S
authors.initials: PP
authors.lastname: Woo
authors.affiliation: Modelling and Economics Unit, Public Health England, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Electronic address: joewu@hku.hk.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000276:immunology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Attitudes; Cervical cancer; HPV vaccines; Health expenditures; Hong Kong