Abstract and Introduction
Abstract
Objectives. We investigated whether maternal attitude toward prevention, as indicated by history of seeking Papanicolaou (Pap) tests and contracting sexually transmitted infections, influenced human papillomavirus (HPV) vaccine uptake among their adolescent daughters.
Methods. We linked the electronic health records of girls aged 9 to 17 years with their mothers at Kaiser Permanente Southern California (n=148 350 mother–daughter pairs). Personal identifying information was removed from the data set after the matching of daughters and mothers was completed. We used logistic regression models to detect associations between mothers' history of Pap tests and abnormal results, genital or anal warts, and other sexually transmitted infections and daughters' HPV vaccine initiation and 3-dose regimen completion.
Results. Mothers' testing history was associated with daughters' likelihood for vaccination across ethnic and neighborhood socioeconomic strata (overall odds ratio [OR]=1.47; 95% confidence interval [CI]=1.43, 1.52). Mothers' history of sexually transmitted infections was only modestly associated with daughters' vaccination. Mothers' testing history was positively associated with daughters' regimen completion (overall OR=1.42; 95% CI=1.31, 1.54).
Conclusions. Mothers' attitude toward prevention may influence HPV vaccine uptake among adolescent girls. The impacts of targeting mothers should be considered by HPV vaccination programs and investigated by further research. (Am J Public Health. 2009;99:1137–1142. doi:10.2105/AJPH.2008.147876)
Introduction
The quadrivalent human papillomavirus vaccine (HPV4), Gardasil (Merck & Co, Whitehouse Station, NJ), has been shown to be efficacious in preventing cervical cancer and other conditions caused by HPV types 6, 11, 16, and 18. The vaccine is indicated for girls and women aged 9 to 26 years and is given in 3 injections over 6 months. The Advisory Committee on Immunization Practice (ACIP) recommends vaccinating adolescent girls before they become sexually active. Because of concern that vaccinating against HPV may condone or promote sexual activity in adolescent girls, integration of this procedure into clinical care has been somewhat controversial. Furthermore, the safety and long-term efficacy of the vaccine remain to be elucidated. This controversy and the fact that state law does not require the vaccine may impede its implementation in public health and clinical settings.
Parental consent is generally required for medical intervention given to adolescents younger than 18 years old, so parents' perceptions about sexuality, vaccination, and sexually transmitted infections (STIs) may play an important role in determining the uptake of the HPV vaccine among adolescent girls. Several studies on HPV and STI vaccine acceptability have reported that parental health beliefs about STIs, personal history of STIs, and knowledge about HPV are significant predictors of parental intent for vaccination.
Because the HPV4 vaccine has potential public health importance, we investigated the hypothesis that uptake of HPV4 among girls aged 9 to 17 years is associated with their mothers' personal attitude about preventive measures related to cervical cancer as assessed by history of seeking Papanicolaou (Pap) tests and personal experience of STIs. We measured HPV4 uptake by initiation of the vaccination and completion of the 3-dose regimen within 1 year. We took advantage of the electronic health records available at Kaiser Permanente Southern California (KPSC), which allowed linkage of the medical records of mothers and daughters.