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.
- 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.
- 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
- Having a history of HPV or HPV related disease doubled the changes of intention to vaccinate.
- 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.
- Mothers who believed their daughters were at risk of HPV were 77 times more likely to intend to vaccinate than other mothers
- 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.
A number of beliefs about vaccines also predicted whether the mothers intended to vaccinate the daughters. A few interesting findings:
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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