A health care provider's recommendation that parents have their teenage daughter vaccinated against human papillomavirus (HPV) is strongly associated with the likelihood that the adolescent begins the three‐part vaccine series, but not all parents receive such a recommendation.1 For example, according to analyses of data from the 2007 National Survey of Children's Health, the odds that parents reported having been advised to have a teenage daughter vaccinated were reduced among blacks and among those whose daughter lacked health insurance. Parents whose daughter had a regular health care provider or had had other vaccinations had elevated odds of reporting that they had gotten a recommendation.
The survey, which was conducted among parents of children up to 17 years old, produced nationally representative data about a variety of physical, emotional and behavioral health indicators. Because the Centers for Disease Control and Prevention recommends initiation of the HPV vaccine series for females aged 11–12, analysts explored the correlates of vaccine initiation and health care providers’ recommendation for vaccination among 12–17‐year‐olds.
In all, more than 16,000 parents provided information about a daughter aged 12–17; of these, 20% said that their daughter had had at least one HPV shot. Teenagers who had initiated the vaccine series and those who had not were generally similar with respect to socioeconomic and demographic characteristics: Three in five were white, and most of the rest were black or Latino; the majority had parents who were married or living together, and at least one parent with some postsecondary education. However, those who had begun the vaccine series were more likely than others to be poor and to live in the Northeast.
The groups differed significantly on every health care–related characteristic examined. Most notably, 83% of parents whose daughter had had a shot, but only 20% of others, said that a health care provider had recommended vaccination. Additionally, greater proportions of adolescents who had begun the vaccine series than of others had a personal doctor or nurse (95% vs. 92%), had a usual source of health care (96% vs. 93%), had received a tetanus booster (94% vs. 82%) and had been vaccinated against meningitis (65% vs. 31%); lower proportions lacked health insurance (6% vs. 9%) and had not had preventive medical care in the past year (6% vs. 19%).
In a multivariate logistic model, the odds that an adolescent had received at least one shot were dramatically elevated if a health care provider had advised the parent to have her vaccinated (odds ratio, 17.8). They also were elevated if the teenager was poor (1.5) or had had a tetanus booster (1.5) or meningitis vaccination (2.8); American Indians, Alaska Natives and multiracial teenagers were more likely than whites to have begun the vaccine series (2.4–2.5). Adolescents who had received no preventive medical care in the past year had significantly lower odds of having had an HPV shot than those who had had such care (0.6).
Parents’ likelihood of reporting that they had been advised to have their daughter vaccinated was positively associated with the adolescent's receipt of tetanus booster and meningitis vaccination (odds ratios, 2.2–2.5), and with her having a personal doctor or nurse (1.8). It was reduced if the adolescent was black (0.7), her better educated parent had not gone beyond high school (0.7), she resided in a region other than the Northeast (0.6), she lacked health insurance (0.6) or she had not received preventive care in the past year (0.4).
The analysts note that the prevalence of HPV vaccine series initiation and of health care providers’ recommendation of vaccination may have been influenced by recall bias and that the survey lacked information on some potentially relevant characteristics—for instance, religious affiliation and medical providers’ areas of specialization. However, they feel that given the study's strengths, particularly its use of "one of the largest and most diverse national datasets" for studying child and adolescent health, their findings have important implications for improving initiation of HPV vaccination: Providers, the analysts write, "may need to initiate the HPV vaccine series with administration of other adolescent vaccines" and "might consider any healthcare visit as an opportunity to recommend the HPV vaccine series for unimmunized, vaccine‐eligible adolescent females.—D. Hollander