Assessing Parental Attitudes and Sources of Information that Influence Adolescent Uptake of Human Papillomavirus (HPV) Vaccine in Richmond County, Georgia Public

Abstract

The Advisory Committee on Immunization Practices recommends human papillomavirus (HPV) vaccination for adolescents. Since its introduction into the routine immunization schedule, HPV vaccine uptake has been extremely low nationwide. This study aimed to assess how sources of information and parental attitudes were associated with adolescent HPV vaccine uptake in Richmond County, GA. From March-July of 2013, a cross-sectional survey was administered to parents of middle- and high-school students who participated in a study designed to enhance adolescent immunization uptake (N=129). Guided by the Health Belief Model and the Integrated Behavioral Model, survey items measured perceived susceptibility, perceived severity, perceived benefits, and social norms. Attitude items were combined to form a total HPV vaccine attitude score. The survey asked about sources of HPV vaccine information; each source contributed 1 point towards a total HPV vaccine information source score (range: 0-8). A majority of students inquired about in the survey were African-American and insured by Medicaid. Vaccine receipt was higher in this sample than national estimates, along with a high reported frequency of physician recommendation. Main findings from this study demonstrated that receipt of at least 1 dose of HPV vaccine was significantly associated with a greater number of sources where one heard about HPV vaccine, higher HPV vaccine attitude score, and recommendation from a health care provider. Parents heard about HPV vaccine from an average of 4.2 sources; doctor/medical professional was the most frequently reported source, followed by TV and drug advertisements. In bivariate analyses, hearing about HPV vaccine from a doctor/medical professional, TV, and radio were significantly associated with vaccine uptake. Mediation analyses suggested that parental attitudes explain, in part, the association between a greater number of HPV vaccine information source exposures and HPV vaccine uptake. In this sample, exposure to HPV vaccine information was high and attitudes were largely positive. This study demonstrates that broadcast media may be an appropriate communication channel for this population, whereas Internet is less supported. Communication mechanisms should be selected carefully and include messages that enhance positive attitudes towards HPV immunization.

Table of Contents

Table of Contents

CHAPTER I. INTRODUCTION... 1

HPV Vaccine as Primary Prevention... 2

HPV Vaccine Coverage Rates... 5

Racial, Ethnic, and Income Disparities in HPV Vaccine Uptake... 6

Factors Contributing to Low HPV Vaccine Uptake... 7

Significance... 9

Theoretical Frameworks... 10

Research Questions... 11

CHAPTER II. LITERATURE REVIEW... 12

Purpose... 12

HBM and IBM Construct Validity Applied to HPV Immunization Research... 12

HBM/IBM Related Barriers and Facilitators Towards HPV Vaccination... 13

Health Communication Surrounding HPV Vaccination... 16

Objective of the Current Study... 24

CHAPTER III. METHODS... 25

Overview...25

Participants... 25

Eligibility Criteria... 28

Sample Size... 28

Procedures for the Parent Study... 28

Measures... 29

Data Analysis... 34

CHAPTER IV. RESULTS... 38

Descriptive Statistics... 38

Bivariate Analyses... 43

CHAPTER V. DISCUSSION... 50

Limitations... 52

Strengths...54

Implications... 55

References... 60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	HPV Adolescent Health Immunization HPV vaccine Human papillomavirus Health Communication Health Belief Model Vaccination
Committee Chair / Thesis Advisor	Sales, Jessica, Emory University
Committee Members	Hughes, James M, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local health department

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