title: A sequential logit model of caretakers' decision to vaccinate children for the human papillomavirus virus in the general population.
abstract: OBJECTIVE
  This study explores the predisposing, enabling, and need-based factors associated with parents' or guardians' decision to have their child initiate, continue, and complete the human papillomavirus (HPV) vaccine.
  
  
  METHODS
  Parents and guardians of children between the ages of 9 and 17years who completed the 2010 Behavioral Risk Factor Surveillance System survey collected by the Center for Disease Control (CDC, 2010) were analyzed. Utilizing Andersen's health care beliefs model, we explored the sequential nature of the decision to vaccinate (i.e., the decision to receive the first, second, and third dose), thereby allowing the independent variables to vary across each transition.
  
  
  RESULTS
  Among all children, 3.7% received exactly 1 shot, 16.3% received at least one shot, and 8.9% received all three shots. Among those who received at least one shot, 22.4% received exactly one shot, 23.7% received exactly 2 shots, and 54.9% completed all 3 shots. A differential impact was observed across transitions. Predisposing factors, such as being Hispanic (OR=1.9) and child age (OR=1.4), significantly predicted the decision to receive the first dose but enabling factors, such as having a regular physician (OR=4.5) and income (OR=.74) were more important for predicting completion.
  
  
  CONCLUSIONS
  The decision to initiate and complete HPV vaccination depends on a specific mix of enabling, predisposing, and need-based factors. Our analysis underscores the importance of modeling the vaccination decision in a manner that is consistent with how primary caregivers navigate real-life health care decisions for their children.
authors.affiliation: College of Social Science and Humanities, Northeastern University, 201 Renaissance Park, Boston, MA 02115, USA.. Electronic address: g.barboza@neu.edu.
authors.forename: Gia Elise
authors.initials: GE
authors.lastname: Barboza
authors.affiliation: College of Social Science and Humanities, Northeastern University, 201 Renaissance Park, Boston, MA 02115, USA.. Electronic address: s.dominguez@neu.edu.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dominguez
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D017028:Caregivers / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D002648:Child; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010290:Parents / Q000523:psychology*; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Andersen's Socio-Behavioral Health Model; Cervical cancer; Human papillomavirus; Racial disparities in health; Vaccination