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May 11.2006

Will parents accept new HPV vaccines for their preadolescent children?

U-M study finds simple educational materials not enough to sway parents' decisions to vaccinate; parents need to believe there will be a benefit to society, child

ANN ARBOR, MI – This summer, new vaccines are expected to be licensed to provide protection again human papillomavirus, or HPV, a sexually transmitted disease that is very common in the United States and across the world, and can cause cervical cancer and genital warts.

While the new vaccines have been found to be highly effective in preventing HPV infections in clinical trails, parents may actually hold the key to their success, especially since the intended target group for the vaccines – children ages 11 to 12 – most likely will need parental consent to be immunized.

Parents’ resistance to the use of the vaccines could, in fact, become a major barrier to the use of this preventive treatment, if their concerns and questions about the HPV vaccines are not adequately addressed.

Simply providing parents with general information about HPV and HPV vaccines won’t be enough to gain their acceptance or influence their decision to vaccinate their young, non-sexually active children against an STD, say researchers at the University of Michigan Health System's Child Health Evaluation and Research (CHEAR) Unit.

They found that parental beliefs about the benefits of HPV vaccinations, the opinions of peers and doctors, and their personal experiences with STDs or HPV-related illnesses were actually more influential on their decision-making process than general education materials alone.

Results from this study – appearing in the May issue of the journal Pediatrics – also reveal parents to be more reluctant to vaccinate male children than female children.

“Many people feel that ‘education’ is the key to improving acceptance of HPV vaccines,” says study lead author Amanda F. Dempsey, M.D., Ph.D., MPH, a member of the CHEAR team in the Division of General Pediatrics at U-M C.S. Mott Children’s Hospital.

“However, we found that educating parents by providing them with written information about HPV did little to influence their attitudes about HPV. Instead, these attitudes seemed to be related to a person’s beliefs and life experiences, which have important implications for medical providers and public health practitioners who will be communicating with parents about HPV vaccines in the future.”

Many medical experts already have expressed concern that parents might avoid vaccinating their children against HPV because of the fear that it might condone risky sexual behavior, or harm their child’s health.

Since parental consent is critical to the vaccines’ success in preventing HPV-associated illnesses, Dempsey and her colleagues set out to learn more about parents’ overall acceptance of HPV vaccines, and identify barriers to vaccination.

A written, self-administered survey was sent by mail to a random sample of 1,600 parents and primary caregivers with children ages 8 to 12 to assess their attitudes and knowledge about HPV vaccines. Of the group, only half randomly received a detailed HPV information sheet explaining HPV and outlining the vaccine along with their written survey

While parents who received the HPV information sheet scored higher on the HPV knowledge assessment portion of the survey, the extra information did little to influence their overall acceptance of the vaccines for their children.

Instead, those who were the most accepting were the parents who believed in the benefits of HPV vaccines to society and their children, suggesting that simply providing general information about HPV and HPV vaccines is not enough to sway parental opinion. For both groups, too, the opinions of their peers and physician recommendations were found to impact parents’ decision-making processes.

Additionally, personal experience with HPV-related illness affected parents’ attitudes about vaccination. Those who had a past experience – either personally or through someone close to them – with genital warts were more inclined to want to vaccinate their child against HPV.

But parents did express reservations about the HPV vaccines. Parents were less accepting of the vaccines if they believed their child would experience significant discomfort or danger when receiving immunizations.

Further, the study revealed that vaccine acceptance among parents was somewhat lower for those considering vaccination for a male child. This finding, Dempsey says, may be attributable to the fact that HPV vaccines will likely have a more measurable impact on the health of females by providing them with protection against cervical cancer, though this hypothesis was not tested in this study.

“Medical providers and policy makers need to be thoughtful about how best to educate the public about these vaccines and address the most prominent concerns that parents have about them,” says Dempsey. “Focusing on the benefits to HPV vaccination, and addressing general concerns parents have about vaccine safety appears to be the most influential factors related to HPV vaccine acceptance.”

Dempsey also notes that additional studies should be conducted to test specific public health messages about HPV vaccines to determine the most effective ways to communicate with parents.

Dempsey conducted this study while part of the Robert Wood Johnson Clinical Scholars Program at the University of Washington in Seattle. Co-authors for the study are Gregory D. Zimet, Ph.D., Department of Pediatrics, Indiana University; Robert L. Davis, M.D., MPH, Immunization Safety Office and Office of Genomics and Disease Prevention, Centers for Disease Control and Prevention; and Laura Koutsky, Department of Epidemiology, University of Washington.

The study was funded by the Robert Wood Johnson Foundation.    
Reference: Pediatrics, May 2006, Vol.117, Issue 5.

Written by Krista Hopson

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