title: Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences.
abstract: We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences.
  
  
  
  In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay.
  
  
  
  Overall, 28% of parents reported that they had ever "refused or decided not to get" HPV vaccine for their child, and an additional 8% of parents reported that they had "delayed or put off getting" HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48-0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50-0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65-4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08-2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often.
  
  
  
  Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy.
authors.affiliation: a Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: b Department of Health Policy and Management , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.affiliation: c Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Macary W
authors.initials: MW
authors.lastname: Marciniak
authors.affiliation: d Department of Health Behavior & Lineberger Comprehensive Cancer Center , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D014481:United States; D000072758:Vaccination Refusal / Q000523:psychology*
chemical_list: D053918:Papillomavirus Vaccines
keywords: adolescent health; human papillomavirus infections/prevention and control; human papillomavirus vaccine; vaccine hesitancy; vaccine refusal