HPV vaccine: opportunities for mother-daughter communication about sex

Background. Mother-daughter communication about sex is associated with healthier behavior during adolescence. This dissertation explores human papillomavirus (HPV) vaccine as a potential opportunity for communication about sexual health. Methods. Data are from a national sample of mothers of adolescent girls aged 11-14 in the United States who completed an online survey in December 2009. Analyses incorporated sample weights to yield nationally-representative estimates. The first set of analyses examined HPV vaccine discussions as an opportunity for mothers (n=900) to deliver messages about sexual health to their early adolescent children. The second set of analyses described mothers' (n=902) communication with health care providers about HPV vaccine and assessed these conversations as an opportunity to offer mothers information about sexual health. Results. Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that talking about the vaccine led to a conversation about sex. Mothers who talked with their daughters about HPV vaccine were more likely to also have talked with them about sex topics (92% vs. 74%, OR=3.07, CI=1.44-6.54.), in multivariate analyses. Just half (55%) of all mothers reported ever talking with their daughters' providers about HPV vaccine, and only a quarter (25%) of those said the conversations included sex topics. Provider discussions about HPV vaccine that included messages about sex were associated with mothers talking with their daughters about sex topics both in the context of HPV vaccine discussions (OR= 3.34 95% CI: 1.59-7.00) and overall (OR= 6.21, 95% CI: 1.76-21.94). Discussion. HPV vaccine discussions provide an acceptable opportunity for mothers to talk with their daughters about sex at an age when such communication is most influential. Health care provider discussions with mothers about HPV vaccine could help promote parent-child communication about sexual health

Validation of the Vaccination Confidence Scale: A Brief Measure to Identify Parents at Risk for Refusing Adolescent Vaccines

Objective To validate a brief measure of vaccination confidence using a large, nationally representative sample of parents. Methods We analyzed weighted data from 9018 parents who completed the 2010 National Immunization Survey–Teen, an annual, population-based telephone survey. Parents reported on the immunization history of a 13- to 17-year-old child in their households for vaccines including tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, and human papillomavirus vaccines. For each vaccine, separate logistic regression models assessed associations between parents\u27 mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. We repeated analyses for the scale\u27s 4-item short form. Results One quarter of parents (24%) reported refusal of any vaccine, with refusal of specific vaccines ranging from 21% for human papillomavirus to 2% for Tdap. Using the full 8-item scale, vaccination confidence was negatively associated with measures of vaccine refusal and positively associated with measures of vaccination status. For example, refusal of any vaccine was more common among parents whose scale scores were medium (odds ratio, 2.08; 95% confidence interval, 1.75–2.47) or low (odds ratio, 4.61; 95% confidence interval, 3.51–6.05) versus high. For the 4-item short form, scores were also consistently associated with vaccine refusal and vaccination status. Vaccination confidence was inconsistently associated with vaccine delay. Conclusions The Vaccination Confidence Scale shows promise as a tool for identifying parents at risk for refusing adolescent vaccines. The scale\u27s short form appears to offer comparable performance

Unwanted Sex Among Young Adults in the United States: The Role of Physical Disability and Cognitive Performance

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26–32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and non-physically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR=1.49; 95% CI: 1.06, 2.08), while males with a physical disability had greater odds of coerced sex (OR: 1.90; 95% CI: 1.02, 3.52). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR=1.20; 95% CI: 1.03–1.41). Further research on pathways underlying these associations is needed to inform prevention efforts

Parents’ Internet use for information about HPV vaccine

The Internet is an increasingly common source of health-related information. We sought to examine associations between parents’ Internet information-seeking and their knowledge, attitudes and beliefs about human papillomavirus (HPV) vaccine

Reproductive health of young adults with physical disabilities in the U.S.

Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample

Forgone vaccination during childhood and adolescence: Findings of a statewide survey of parents

Widespread immunization confers both individual- and community-level protection against vaccine-preventable diseases. To better understand vaccine hesitancy, we assessed correlates of forgone vaccination for children and adolescents

Healthcare Providers' Beliefs and Attitudes About Electronic Cigarettes and Preventive Counseling for Adolescent Patients

Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery systems that may serve as a “gateway” to tobacco use by adolescents. Use of e-cigarettes by U.S. adolescents rose from 3% in 2011 to 7% in 2012. We sought to describe healthcare providers’ awareness of e-cigarettes and to assess their comfort with and attitudes toward discussing e-cigarettes with adolescent patients and their parents

HPV Vaccine Hesitancy: Findings From a Statewide Survey of Health Care Providers

Healthcare provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy

Does Framing Human Papillomavirus Vaccine as Preventing Cancer in Men Increase Vaccine Acceptability?

Human papillomavirus (HPV) vaccine is now approved for use in males in the United States to prevent genital warts. We conducted an experiment to see whether framing HPV vaccination as also preventing cancer in men would increase men’s vaccination willingness

Men’s beliefs about HPV-related disease

While human papillomavirus (HPV) infection is associated with genital warts, anal cancer, and oral cancer, limited research has examined what men think causes these diseases. We sought to examine knowledge and beliefs about HPV-related disease among gay and bisexual men, who are at high risk for HPV infection and HPV-related cancers, and compare them to heterosexual men. We conducted an online survey in January 2009 with a national sample of men aged 18–59 who self-identified as either gay or bisexual (n = 312) or heterosexual (n = 296). The response rate was 70%. Fewer than half of men knew that HPV can cause genital warts (41%), anal cancer (24%), and oral cancers (23%). However, gay and bisexual men typically knew more than heterosexual men about these topics. Overall, most men believed that sexual behavior causes genital warts (70%) and anal cancer (54%), and tobacco use causes oral cancer (89%). Perceived causal factors differed substantially among the three diseases, while differences by sexual orientation were fewer and smaller in magnitude. Many men were unaware that HPV infection can cause genital warts, oral cancer, and anal cancer