On Monday I discussed a study examining the link between parental vaccination refusal and childhood pertussis. I was most interested in discussing the process by which parents reach the decision to reject vaccine recommendations. In theory, I assume most parents reach such a decision after weighting the risk of vaccines against the risk of refusing the vaccines, and I questioned whether parents have the necessary information to properly weight these risks.

While reading the same issue of the journal Pediatrics, I came across a related study that examined the factors that predict whether a mother intended to vaccinate her daughter against HPV. I was very interested in this study because it could shed light into the decision processes behind parental refusal to vaccinate. That is, is the decision to refuse vaccination only a function of weighting risks vs. benefits? Or is such a decision also associated with other factors that may not be related to the issue of vaccine safety at all?

As background, HVP is a sexually transmitted infection that is associated with a number of serious conditions including cervical cancer. A vaccine for HPV was approved by the FDA in 2006, which has the potential to significantly decrease the prevalence of HPV-related conditions. In this new study, the authors examined 7,207 nurses who had at least 1 daughter participating in a large longitudinal study of adolescence. The authors were interested in examining what demographic and attitudinal variables were associated with intention to vaccinate their daughters against HVP.

The results:

  1. Intention to vaccinate was associated with the age of the daughter. 48% of mothers of girls between 9 to 12 intended to vaccinate, compared to 86% of mothers of teens between 16 to 18 years of age.
  2. Income was highly associated with intention to vaccinate with those making over $40,000 being 2 times more likely to report an intention to vaccinate their daughters than those making less than 40K
  3. Having a history of HPV or HPV related disease doubled the changes of intention to vaccinate.
  4. A number of beliefs about vaccines also predicted whether the mothers intended to vaccinate the daughters. A few interesting findings:

  5. Mothers who believed that vaccinated girls would practice riskier sex were 38 times less likely to report an intention to vaccinate their daughters than mothers who did not have this belief.
  6. Mothers who believed their daughters were at risk of HPV were 77 times more likely to intend to vaccinate than other mothers
  7. Mothers who believed that the vaccine was the best protection against cervical cancer were 234 times more likely to intend to vaccinate their daughters than mothers who did not have this belief.

Initially these results were not that surprising. It seems clear that intention to vaccinate was highly associated with specific beliefs mothers have about the effects, nature, and potential consequences of the vaccine. What I found most interesting is that these results were based on a very unique and not highly representative sample. That is, these mothers were all nurses, and theoretically, they would be better educated than the general population about vaccines. Thus, it was very surprising that even among these highly educated mothers, the decision to vaccinate their daughters was affected by factors not necessarily directly associated with “vaccine safety” but with other ‘values’ or “beliefs” factors, such as the belief that if they vaccinated their daughters, the teens would be more likely to have risky sexual relations.

Kahn, J., Ding, L., Huang, B., Zimet, G., Rosenthal, S., & Frazier, A. (2009). Mothers’ Intention for Their Daughters and Themselves to Receive the Human Papillomavirus Vaccine: A National Study of Nurses PEDIATRICS, 123 (6), 1439-1445 DOI: 10.1542/peds.2008-1536

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5 Responses to “If I vaccinate her, my teen will have sex”: Factors affecting mothers’ rejection of HPV vaccines.

  1. Ricahrd Eis says:

    I’m pretty sure the girls would have forgotten all about the vaccine after a few days of having it done. The idea that they would run off to have risky sex because of this would be amusing if the affect on mothers wasn’t so noticeable.

  2. wenchacha says:

    I’m curious: were all the respondents RNs or does the term “nurse” mean anything from CNA and up?

    I would hope that more education would mean a more scientific approach about whether or not to vaccinate. That said, many in nursing are there as a kind of “calling.” Their religious values and beliefs may be one reason they entered the profession of nursing instead of other career pursuits.

    We need more studies about actual abstinence until marriage. Young women may plan to remain abstinent in their high school years, and even their college years. Some will succeed, by faith or sheer will. That has to be a small number, though.

    I’d also like to ask the survey respondents how they can be sure their daughters’ future partners or husbands will not have HPV themselves? Your daughter may decide to remain abstinent, but if her husband wasn’t as committed as she was to the plan, then anything can happen. And I’m certain that we still have no guarantee that young women can absolutely avoid rape.

  3. Neuroskeptic says:

    Of course if you were worried about that you could just not tell your daughter what the vaccine was for. Just say it’s yet another vaccine against a nasty disease, don’t mention sex at all.

  4. DSC says:

    I have students getting the vaccine. None of them are in risk groups for getting HPV, given where we live, the low rate of HPV infection, and parental belief (“my daughter won’t do that”). When polled, the parents did not understand that the HPV is contractible through sex alone, really. It was a school policy, so they did it, one girl missed a week of school due to illness. Second time around, only that one girl did not get the booster.

    When asked if the vaccine made sex safer, all girls responded yes, two months later. They understood that was the point of them getting the vaccine.

    Will getting the vaccine make them more likely to have sex? Not likely, this group. I reminded them sex leads to pregnancy, Chlamydia, herpes, AIDs, and more, which the vaccine won’t affect, and that the vaccine only is to prevent 4 of 12 strains of HPV in their case, bad odds. Cross your fingers.

  5. Nicole says:

    Yes, I believe that these are some of the major factors why most parents, especially moms, reject HPV vaccines for their teens. I think the best solution for this is to educate both parents and their children regarding vaccination. Maybe the 4th International Public Conference on Vaccination can provide huge help for everybody. Here’s the link with complete info regarding this convention – http://www.nvic.org/events.aspx.

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