Poster Abstracts / 50 (2012) S16 –S95
Purpose: To describe differences between African-American and Haitian parents’ attitudes towards HPV vaccination for their sons. Methods: We performed semi-structured interviews with AA and Haitian parents of boys aged 9-17 from an urban primary care clinic in an academic center. Eligible parents were those who self-identiﬁed as AA or Haitian, spoke English or Haitian Creole, and whose sons had never received HPV vaccination. We collected demographic information, knowledge about HPV, parental attitudes toward HPV vaccination, parents’ intent to vaccinate their children, and actual HPV vaccination rates. Results: 37 African-American and 21 Haitian parents participated in the study. African-American and Haitian parents were similar in parents’ age (African-American 44.5 [SD 9], Haitian 46.9 [SD 7]), son’s age (African-American 13.4 [SD 2], Haitian 14.5 [SD2]), and parents’ years of education (African-American 13.2 [SD3], Haitian 13.5 [SD 3]). Haitian parents were more likely to practice a religion (AfricanAmerican 75.7%, Haitian 100%, p⫽0.013). Both groups of parents preferred to receive vaccine-related information from their physicians (African-American 91.9%, Haitian 100%) and expressed high levels of trust in their physicians (African-American 94.6%, Haitian 90.5%). Consistent with this, most parents indicated that they would accept HPV vaccination if recommended by their physician (70.3% of African Americans, 61.9% of Haitians). However, only 19.4% of parents stated that their doctors offered vaccination and medical record review indicated that 10.8% of African-American and 23.8% of Haitian sons received vaccination. Parental knowledge of HPV was poor: 40.5% of African-American and 52.4% of Haitian parents were unable to correctly answer any of the number about HPV. When asked to explain their attitudes toward HPV vaccination, interesting differences emerged. Because HPV is a sexually transmitted infection, and sex is considered an adult activity in Haitian culture, Haitian parents stated HPV vaccination should be the adolescent’s choice. In contrast, African-American parents felt that HPV vaccination was within the purview of parental responsibility. African-American parents, however, were more likely to decline vaccination based on lack of information, and speciﬁcally asked for research data on vaccine safety and efﬁcacy. Haitian parents more often declined vaccination based on their religious beliefs. Conclusions: HPV knowledge is very low in both African-American and Haitian parents, and vaccination rates are very low in their adolescent sons. Improving knowledge and vaccination rates will require culturally competent educational interventions addressing the distinct informational needs of each community. Physicians are uniquely situated to provide culturally competent education and should address patients’ vaccination preferences by routinely offering HPV vaccination to male patients. Sources of Support: American Cancer Society (CDDA-10-086-01, MRSG-09-151-01); Merck ISSP: 38232; American College of Obstetricians and Gynecologists/Merck Adolescent Health Research Award. 115. PARENT-SON DECISION-MAKING ABOUT HPV VACCINATION Andreia B. Alexander, MPH, Nathan Stupiansky, PhD, Mary A. Ott, MD, Ashley Suah, BS, Marcia Shew, MD, MPH, Gregory D. Zimet, PhD.
olescent males and their parents about HPV vaccination and (2) elicit components of health messages to increase HPV vaccine uptake. Methods: 14 parent-son dyads have been recruited (with 30 planned to ensure theoretical saturation) from adolescent primary care clinics serving Medicaid eligible families in a large Midwestern city. Using purposive sampling the goal is to recruit equal numbers of Black, White, and Hispanic dyads. Adolescent boys (aged 13-17) are being recruited after the completion of their physician visit. Parents and sons participate in separate in-person semi-structured interviews assessing the relative role of the parent, son, and HCP in the decision regarding HPV vaccination, the factors considered in the decision to be vaccinated, and the suggested content for messages to increase vaccine uptake. Interviews were recorded, transcribed, and coded using thematic analysis. Thematic coding was conﬁrmed by having two individuals separately code the data, with disagreements resolved through discussion. Results: To date, 9 Black, 2 White, and 3 Hispanic dyads have been interviewed. All received the ﬁrst dose of vaccine. Most participants (parents and sons) felt the HCP recommendation was crucial to the decision to get vaccinated for two reasons: (1) most dyads did not know the vaccine was available for males, and (2) participants would not have agreed to vaccination if the HCP did not positively recommend the vaccine. Most parents felt the son had an increased role in this decision compared to other health decisions because of the sexual transmissibility of the virus, but sons typically deferred to the recommendations of the HCP and parents. If the parent and son did not agree on vaccination, typically a discussion would take place between the dyad. Although some parents said that they would have respected their son’s decision to refuse vaccination, no refusals took place. The most common factors considered by both parents and sons were side effects, prevention of genital warts, and prevention of anal/penile cancer. Sons expressed concern about pain associated with the injection. Most parents did not feel the three shot series was a factor in their decision. The most frequently stated message components included HPV as an STD without a cure and often no symptoms, the prevention of genital warts, and the prevention of anal/penile cancer. Conclusions: HPV vaccine for males has received relatively little media attention, leading many of these parents to be unaware of its availability for their sons and of its beneﬁts to their son’s health. Taken together with the ACIP’s weaker, permissive, recommendation for male vaccination, HCP recommendation of vaccination and education of parents and sons about the personal health beneﬁts of HPV vaccine appear to be particularly important in ensuring adequate rates of vaccination of young males. Sources of Support: Merck-IISP#38094. 116. SOURCES OF INFORMATION ABOUT HPV VACCINES AND THEIR ASSOCIATION WITH KNOWLEDGE AND ATTITUDES ABOUT HPV VACCINES AMONG ADOLESCENT FEMALES Marcia L. Shew, MD, MPH1, Gregory D. Zimet, PhD, FSAHM2, Lili Ding, PhD3, Tanya K. Mullins, MD3, Jessica A. Kahn, MD, MPH3.
Indiana University School of Medicine
1 Indiana University 2Indiana University School of Medicine 3Cincinnati Children’s Hospital Medical Center
Purpose: HPV vaccination has been approved for males since 2009. However, the weaker “permissive” recommendation for males means that many parents may not know about availability of HPV vaccine for their sons. The purpose of this study is to: (1) identify components of the decision making process between ad-
Purpose: To understand how the media and key individuals inform female adolescents’ knowledge and attitudes about HPV vaccines, we examined sources of information (SOI) about HPV vaccines and their associations with knowledge about HPV/HPV vaccines and attitudes about HPV vaccination.
Poster Abstracts / 50 (2012) S16 –S95
Methods: This analysis includes baseline data for young women ages 13-21 years who were enrolled into a longitudinal study of attitudes and risk perceptions following HPV vaccination. Participants were recruited from an urban primary care clinic at the time of their ﬁrst vaccine dose and each completed a survey assessing whether or not they had received information about HPV vaccines from 11 different sources (including the media, individuals and institutions) and the helpfulness of this information (not, somewhat or extremely helpful); knowledge about HPV/HPV vaccines; and attitudes about HPV vaccination. Using independent T-tests, we compared HPV/HPV vaccine knowledge and attitudes for individuals who reported that they had received information about the vaccines from a given source to those who did not. Results: Of the 339 adolescents enrolled, mean age was 16.8 years and 76.4% were Black. TV ads (65.7%), the Internet (34.8%), doctors/ nurses (88.5%) and mothers (38.1%) were the most frequently reported sources of vaccine information; over 90% who received information from each of these four sources reported them to be somewhat or extremely helpful. Those who reported that TV ads were a SOI, compared to those who did not, had higher HPV and vaccine knowledge (p⬍.0001); were more likely to believe that important individuals would want them to be vaccinated (p⬍.005); the vaccine is beneﬁcial to their health (p⬍.003); and the vaccine would protect them (p⬍.005). Those who reported that the Internet was a SOI had greater HPV knowledge (p⫽.001) and were more likely to believe that important individuals would want them to be vaccinated (p⫽.04). Those who reported a clinician as a SOI had higher knowledge (p⫽.05); more likely to report that important individuals would want them to get the vaccinated (p⫽.03) and were more likely to believe that HPV vaccines were safe (p⫽.001) and effective (p⬍.02). Those who reported mothers as a SOI were more likely to believe HPV vaccines were safe (p ⬍.05) and that important others would want them to be vaccinated (p⬍02). Conclusions: Adolescents who received information about HPV vaccines from TV ads, the Internet, clinicians and mothers, compared to those who did not, had higher knowledge about HPV vaccines and more positive attitudes about HPV vaccines. Assuring the accuracy of messages from these sources will be essential, given their importance in inﬂuencing adolescents’ knowledge and attitudes about HPV vaccines. Sources of Support: NIH, R01 AI073713 (J. Kahn, PI). 117. HPV VACCINE FOR SONS: DO PARENTS WHO ALSO HAVE DAUGHTERS THINK DIFFERENTLY? Christine L. Schuler, MD, MPH, Abigail C. Lees, BS, Sara E. Massie, MPH, Tamera Coyne-Beasley, MD, MPH, FSAHM. University of North Carolina Purpose: Quadrivalent HPV vaccine is now licensed for males aged 9-26 years old to prevent genital warts and anal cancer. Factors associated with parents’ beliefs about HPV vaccine for sons are of interest and not completely understood. One potentially important factor that has not been thoroughly explored is the inﬂuence of a daughter or daughters within a family. We sought to determine if a female child or children is associated with parents’ awareness of and beliefs about HPV infection and HPV vaccine. Methods: We analyzed data from parents recruited from hospitalbased pediatric clinics with at least one son 9-21 years old. We examined awareness of HPV vaccine, knowledge of HPV-related disease, intention to vaccinate, vaccination status of sons, factors that may inﬂuence decisions to vaccinate, and attitudes regarding vaccine mandates and provision of HPV vaccine in schools. We performed
bivariate and multivariate logistic regression to compare responses of parents with only sons, to those with at least one daughter, multiple daughters, or daughters of various ages. Multivariate models adjusted for parent age, gender, race, ethnicity, education, and marital status. Results: Analyses included data from 290 parents. Seventy-two percent of parents had at least one daughter as well as a son (n⫽ 209). Parents with 1 or more daughters were more likely to have heard of the quadrivalent HPV vaccine (AOR 1.83) compared to parents without daughters. Analyses accounting for age of daughters showed parents of daughters aged 12-17 years had greater odds of having heard of HPV infection (bivariate OR 2.88), having heard of quadrivalent HPV vaccine (AOR 3.96), believing HPV is a sexually transmitted infection (AOR 2.39), believing HPV causes cervical cancer (AOR 2.72), and believing women are at higher risk for HPV than men (AOR 2.24), when compared to parents without daughters. Parents with 1 or more daughters 18 years or older were more likely to agree giving HPV vaccine between ages 9-12 is best (AOR 3.76). Parents with 1 or more daughters 18 or older, as well as those with 1 or more daughters 9-11 years, were more likely to think HPV only affects those with many sexual partners (AOR ⫽ 18 years 6.57, AOR 9-11 years 10.82). Parents with more than one daughter had greater odds of supporting HPV vaccine administration to all middle-school-aged boys and girls at school (AOR boys 3.37, AOR girls 2.58), and agreeing that all adolescent boys and girls should receive HPV vaccine (AOR boys 2.93, 95% CI 1.14, 7.50, AOR girls 3.54, 95% CI 1.34, 9.31). Conclusions: Parents with both daughters and sons have beliefs regarding HPV-related disease and HPV vaccination that differ in some cases compared to parents with sons and no daughters. Daughters’ age and the number of daughters were associated with differences in parents’ responses. One or more daughters and daughters’ ages may be important factors in parents’ knowledge and attitudes about HPV infection and HPV vaccine. HPV awareness and vaccination campaigns should consider these factors. Sources of Support: Merck. 118. ROLE OF CHILD’S GENDER ON ACCEPTANCE OF THE HUMAN PAPILLOMAVIRUS (HPV) VACCINE AMONG A HIGH-RISK SAMPLE OF HAITIAN AND AFRICAN-AMERICAN PARENTS OF ADOLESCENT SONS AND DAUGHTERS Natalie Pierre-Joseph, MD, MPH, Jared Walsh, BA, Courtney Porte, MPH, Myrdell Belizaire, BA, Rebecca Perkins, MD. Boston University School of Medicine Purpose: To describe differences in parental attitudes/willingness to vaccinate adolescent sons and daughters among African-American and Haitian parents. Methods: We compared data collected in two distinct studies: parents of adolescent girls in 2008-2009 and parents of adolescent boys in 2011. Both studies involved interviewing African-American and Haitian parents of vaccine-eligible adolescent boys and girls aged 11-17 from urban primary care clinics serving low-income populations. Eligible parents were those who self-identiﬁed as AfricanAmerican or Haitian, spoke English or Haitian Creole, and whose children had never received HPV vaccination. Questionnaires were identical except for references to their child’s gender. We compared demographic characteristics, knowledge about HPV, parental attitudes toward HPV vaccination, parents’ intent to vaccinate their children, and actual HPV vaccination rates between parents of sons vs. daughters.