Why do so many U.S. teens skip the HPV vaccine?

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The human papillomavirus (HPV) is responsible for 70 percent of all cervical cancers in the United States and 90 percent of genital warts. A three-dose vaccine sequence is recommended for teenagers, but a new study shows that in 2013, the vaccination completion rate for 13- to 17-year-olds was just 26 percent.

Another 19 percent of teens initiated the sequence but didn’t complete it. Completion rates were higher for girls than boys—38 percent, versus 14 percent.

Vaccination rates were measurably higher among teenagers who received a recommendation by a medical provider. Rates for girls living in the Midwest and boys from low-income families eligible for the “Vaccines for Children” program were also higher.

But while provider recommendation was “the strongest predictor” of vaccine completion, it was “insufficient to achieve high coverage rates, especially among boys,” according to the study published in the Journal of Community Health.

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In addition, provider recommendation did not lead to a higher rate of vaccine acceptance among girls with “highly educated” mothers.

“Highly educated mothers were immune to provider recommendations, suggesting that they may arrive at clinic visits with preconceived notions of what is appropriate for their child,” the study says. “This paradox suggests some caregivers may perceive messages conveyed by clinicians as an option, rather than a direct recommendation.

“Failure to address the skepticism of caregivers about HPV vaccines may significantly weaken the effectiveness of provider recommendations,” the authors say.

Reasons for refusal

The most common reasons for refusal were that the vaccine was not recommended (21.3 percent); belief that the vaccine was unnecessary (16.8 percent); lack of knowledge (16.3 percent); safety concerns (9.7 percent); and that the teen was not sexually active (8.7 percent).

Caregivers of boys were more likely to report that the vaccine was not recommended by a provider or that the vaccine was not needed, while parents and guardians of girls were more likely to decline vaccination because of safety concerns.

The findings “suggest that health care providers need to be attentive to potential gender bias with regard to HPV vaccination,” the authors say. In addition, the findings emphasize “a need for enhanced efforts to educate caregivers about the safety and efficacy” of the vaccine.

“Tailoring and targeting the recommendations to address the unique concerns of caregivers of male and female teens may improve acceptability and uptake of the HPV vaccine,” they conclude.

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The World Health Organization recommends HPV vaccines as part of routine vaccinations in countries that can afford them, along with other prevention measures.

The first HPV vaccine became available in 2006. As of 2014, 58 countries had included it in their routine vaccinations, at least for girls.

In the US, the Centers for Disease Control and Prevention recommends the vaccine for preteen boys and girls at ages 11 or 12, so they are protected before ever being exposed to the virus. Young women can get the vaccine through age 26, and young men can get vaccinated through age 21.

Other researchers from Boston University and from Harvard Medical School are coauthors of the work.

Source: Boston University