title: Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013.
abstract: Since the introduction of HPV vaccination programs in Canada in 2007, coverage has been below public health goals in many provinces and territories. This analysis investigated the determinants of HPV non-vaccination and vaccine refusal. Data from the Childhood National Immunization Coverage Survey (CNICS) 2013 were used to estimate the prevalence of HPV non-vaccination and parental vaccine refusal in girls aged 12-14 years, for Canada and the provinces and territories. Multivariate logistic regression was used to examine factors associated with non-vaccination and vaccine refusal, after adjusting for potential confounders. An estimated 27.7% of 12-14 y old girls had not been vaccinated against HPV, and 14.4% of parents reported refusing the vaccine. The magnitude of non-vaccination and vaccine refusal varied by province or territory and also by responding parent's country of birth. In addition, higher education was associated with a higher risk of refusal of the HPV vaccine. Rates of HPV non-vaccination and of refusal of the HPV vaccine differ and are influenced by different variables. These findings warrant further investigation.
authors.affiliation: a Centre for Immunization and Respiratory Infectious Diseases ; Public Health Agency of Canada , Ottawa , Ontario , Canada.|b Département de médecine sociale et préventive ; Université de Montréal ; Montréal ; Québec ; Canada.
authors.forename: Nicolas L
authors.initials: NL
authors.lastname: Gilbert
authors.affiliation: c Health Analysis Division; Statistics Canada ; Ottawa ; Ontario ; Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Gilmour
authors.affiliation: d Institut national de santé publique du Québec ; Québec ; Québec ; Canada.
authors.forename: Ève
authors.initials: È
authors.lastname: Dubé
authors.affiliation: e Public Health Ontario ; Toronto ; Ontario ; Canada.|f Dalla Lana School of Public Health; University of Toronto ; Toronto ; Ontario ; Canada.|g Institute for Clinical Evaluative Sciences ; Toronto ; Ontario ; Canada.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Wilson
authors.affiliation: a Centre for Immunization and Respiratory Infectious Diseases ; Public Health Agency of Canada , Ottawa , Ontario , Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Laroche
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D000072758:Vaccination Refusal
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV; canada; coverage; determinants; vaccine