title: Associations of trust and healthcare provider advice with HPV vaccine acceptance among African American parents.
abstract: Healthcare providers (HCPs) are advised to give all parents a strong recommendation for HPV vaccination. However, it is possible that strong recommendations could be less effective at promoting vaccination among African Americans who on average have greater mistrust in the healthcare system. This study examines the associations of parental trust in HCPs and strength of HCP vaccination recommendation on HPV vaccine acceptance among African American parents.
  
  
  
  Participants were recruited from an urban, academic medical center between July 2012 and July 2014. We surveyed 400 African American parents of children ages 10-12years who were offered HPV vaccine by their HCPs to assess sociodemographic factors, vaccine beliefs, trust in HCPs, and the HPV vaccine recommendation received. Medical records were reviewed to determine vaccination receipt.
  
  
  
  In multivariable analysis, children whose parents were "very strongly" recommended the HPV vaccine had over four times higher odds of vaccine receipt compared with those whose parents were "not very strongly" recommended the vaccine. Having a parent with "a lot of" versus "none" or only "some" trust in HCPs was associated with over twice the odds of receiving HPV vaccine. Very strong HCP recommendations were associated with higher odds of vaccination among all subgroups, including those with more negative baseline attitudes toward HPV vaccine and those with lower levels of trust. Adding the variables strength of HCP recommendation and parental trust in HCPs to a multivariable model already adjusted for sociodemographic factors and parental vaccine beliefs improved the pseudo R2from 0.52 to 0.55.
  
  
  
  Among participants, receiving a strong vaccine recommendation and having a higher level of trust in HCPs were associated with higher odds of HPV vaccination, but did not add much to the predictive value of a model that already adjusted for baseline personal beliefs and sociodemographic factors.
authors.affiliation: General and Community Pediatrics, Children's National Health System, 111 Michigan Ave, NW, Washington, DC 20010, United States. Electronic address: lfu@childrensnational.org.
authors.forename: Linda Y
authors.initials: LY
authors.lastname: Fu
authors.affiliation: Department of Pediatrics, Indiana University, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States. Electronic address: gzimet@iu.edu.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Zimet
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 7th Floor, Baltimore, MD 21205, United States. Electronic address: Carl.Latkin@jhu.edu.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
authors.affiliation: Betty Irene Moore School of Nursing, University of California, Davis, CA, 4610 "X" Street, Sacramento, CA 95817, United States. Electronic address: jgjoseph@ucdavis.edu.
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
mesh_terms: D000328:Adult; D001741:Black or African American; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000941:ethics*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000208:ethnology* / Q000517:prevention & control / Q000523:psychology / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: African Americans; Directive counseling; Health knowledge, attitudes, practice; Human papillomavirus vaccines