title: Parent perceptions important for HPV vaccine initiation among low income adolescent girls.
abstract: OBJECTIVE
  The study aims were to assess the influence of provider recommendations on parental vaccine perceptions and identify the most potent parent vaccine perceptions for HPV vaccine series initiation considering provider recommendation strength.
  
  
  METHODS
  We administered a questionnaire and assessed HPV vaccine claims among a stratified-random sample of parents of 9-17 year old girls enrolled in Florida's Medicaid and the Children's Health Insurance Program. Using multivariate analyses, we evaluated the associations between: (1) parent vaccine perceptions and provider recommendation strength, and (2) parent vaccine perceptions and HPV vaccine series initiation (≥1 vaccine claim or positive parental report) controlling for provider recommendation strength.
  
  
  RESULTS
  The majority of the 2422 participating parents agreed that the HPV vaccine was safe (61%), would not make girls more likely to have sex (69%), and prevented cervical cancer (71%). About half (44%) reported receiving a strong provider recommendation. Compared to parents without recommendations, parents with strong recommendations had 2 to 7 times higher odds of agreeing that: vaccines are safe, the HPV vaccine is safe, not concerned about side effects, and the vaccine prevents cervical cancer. Even when considering provider recommendation strength, HPV vaccine series initiation was more likely among girls of parents who agreed rather than disagreed that the HPV vaccine was safe [odds ratio (OR)=5.8, 95% confidence interval (CI)=3.1, 11.1], does not cause sex (OR=2.0, 95% CI=1.2, 3.4), prevents cervical cancer (OR=2.0, 95% CI=1.0, 3.4), and prevents HPV infections (OR=1.8, 95% CI=1.0, 3.0).
  
  
  CONCLUSIONS
  Parent concerns about HPV vaccine are similar to their concerns about other vaccines. Providers should focus HPV vaccine discussions with parents on vaccine safety and illness prevention.
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States. Electronic address: sstaras@ufl.edu.
authors.forename: Stephanie A S
authors.initials: SA
authors.lastname: Staras
authors.affiliation: Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, United States; Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States; Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, FL, United States.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States.
authors.forename: Roshni P
authors.initials: RP
authors.lastname: Patel
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shenkman
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010290:Parents / Q000523:psychology*; D011203:Poverty; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; HPV; Parent attitudes; Provider recommendations; Vaccine