PHILADELPHIA – A study that tracked parental opinion about the human papillomavirus (HPV) vaccine showed that after hesitancy decreased for several years, hesitancy has now either stabilized or increased in some ethnic and age groups, according to results presented at the virtual 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held October 6-8, 2021.
The HPV vaccine is considered a powerful tool to prevent cervical cancer and several other cancer types, including anal, penile, vulvar, vaginal, and oropharyngeal cancers. In the United States, two doses of the vaccine are recommended for most adolescents, with the first dose to begin before the child’s 15th birthday.
After the HPV vaccine was approved by the U.S. Food and Drug Administration in 2006, the government set a goal of 80 percent of the eligible population receiving the vaccine by 2020. However, just over half of adolescents in the United States have received two or more doses of the vaccine. “More work needs to be done so that we can achieve the 80 percent completion goal now set by Healthy People 2030,” said the study’s lead author, Eric Adjei Boakye, PhD, assistant professor in the Department of Population Science and Policy at Southern Illinois University School of Medicine.
“Parental skepticism regarding the HPV vaccine has been a known driver of suboptimal vaccine uptake in the United States,” Adjei Boakye continued. In this study, Adjei Boakye and colleagues aimed to assess whether parental hesitancy has changed over time, and whether parental opinion varied by ethnic or age group.
Using data from the 2010–2019 National Immunization Survey (NIS)–Teen, the researchers identified 16,383 adolescents who had not received any dose of the HPV vaccine. They assessed vaccine hesitancy among the parents by asking, “How likely is it that your teen will receive HPV shots in the next 12 months?” Parents who responded with “not too likely,” “not likely at all,” or “not sure/don’t know” were deemed vaccine hesitant.
The results showed that overall, HPV vaccine hesitancy decreased from approximately 69 percent in 2010 to 63 percent in 2019.
However, many subgroups demonstrated increased hesitancy, or hesitancy that improved for a while then stalled. The study showed:
- Average vaccine hesitancy for mothers with male adolescents decreased 6.17 percent annually from 2010 to 2012 but remained stable from 2012 to 2019.
- Mothers with children of Hispanic race had an average hesitancy decrease of 6.24 percent per year from 2010 to 2013 but an average increase of 1.19 percent per year from 2013 to 2019. No significant changes were observed for other races.
- For mothers aged 35-44, average vaccine hesitancy decreased 5.88 percent from 2010 to 2012 and remained stable from 2012 to 2019.
- For mothers aged 45 or older, average vaccine hesitancy decreased 3.92 percent from 2010 to 2013 and remained stable from 2013 to 2019.
- Mothers who had a college degree or higher had a 6.03 percent average decrease in vaccine hesitancy from 2010 to 2012, compared with a 6.24 percent average decrease for those with a high school diploma. Both groups saw hesitancy stabilize after 2012.
“Overall, vaccine hesitancy remains very high in the United States, with almost two-thirds of the parents in our study remaining hesitant about the vaccine as of 2019,” Adjei Boakye said, noting that hesitancy may have been exacerbated by anti-vaccine sentiment in American society and social media disinformation.
Adjei Boakye said parents who do not want their child to receive the HPV vaccination cite several reasons: some feel the vaccine is not necessary; some have concerns about safety; some feel it is not necessary because their children were not sexually active; and some did not have enough knowledge about it.
He said the study results suggest that public information campaigns should focus on parents who are hesitant about the HPV vaccine. Culturally tailored messages could be effective in the Hispanic population, which has higher incidence of cervical cancer. Also, direct conversation about the vaccine’s safety and efficacy could help assuage fears.
“The HPV vaccine is very safe, and it is effective at preventing HPV-associated cancers. Over 135 million doses have been administered in the United States alone with very few reported adverse effects,” he said. He also urged parents to be wary of disinformation on social media.
“Do not trust everything you read on the internet or social media platforms. If you are in doubt or have a question, please talk to your doctor,” he said.
Adjei Boakye noted that a limitation of the study is that it did not follow the same parents over the 10-year time period to evaluate whether their opinions had changed. The researchers declare no conflicts of interest.
Title: Tracking a decade of trends in human papillomavirus (HPV) vaccine hesitancy in the United States
Background: The human papillomavirus was first approved for use in adolescents in the United States in 2006, and teen vaccine uptake is primarily a decision of parents. Parental skepticism regarding HPV vaccine has been a known driver of suboptimal vaccine uptake in the United States, and may have been exacerbated by societal anti-vaccine sentiments, medical mistrust and social media disinformation. However, no study has tracked whether HPV vaccine hesitancy trends in the last decade has changed based on drivers of vaccine hesitancy. Thus, we assessed trends in the characteristics of parents without an intent to initiate HPV vaccination for their unvaccinated adolescents in the last decade.
Methods: We analyzed the 2010–2019 National Immunization Survey (NIS)–Teen data, a national survey representative of the United States’ adolescent population. Adolescents who had received zero dose of the HPV vaccine (unvaccinated adolescents) were included in this study. Vaccine hesitancy of parents was assessed with the question “How likely is it that your teen will receive HPV shots in the next 12 months?” Parents who responded with “not too likely”, “not likely at all” or “not sure/don’t know” were deemed vaccine hesitant. Joinpoint regression estimated yearly increases/decreases in vaccine hesitancy by mother’s age, marital status, and education as well as the adolescent’s gender and race through annual percent changes (APC).
Results: A total of 16,383 adolescents were included in the study. HPV vaccine hesitancy decreased from approximately 69% in 2010 to 63% in 2019. Average vaccine hesitancy for mothers with male adolescents decreased 6.17% annually from 2010 to 2012 but remained stable from 2012 to 2019. Mothers with children of Hispanic race had an average hesitancy decrease of 6.24% per year from 2010 to 2013 but an average increase of 1.19% per year from 2013 to 2019. No significant changes were observed for children of other races. For mothers aged 35-44, average vaccine hesitancy decreased 5.88% from 2010 to 2012 and remained stable from 2012 to 2019; and for mothers aged >45, average vaccine hesitancy decreased 3.92% from 2010 to 2013 and remained stable afterwards. Mothers who had college degree/higher or high school diploma had 6.03% and 6.24% average decrease in vaccine hesitancy from 2010 to 2012, respectively and the trend remained stable. Average vaccine hesitancy among married mothers decreased at 5.07% annually from 2010 to 2012 and then remained stable the remaining 8 years.
Conclusions: While parental vaccine hesitancy declined from 2010 to 2012, it has remained stable until 2019. Overall, vaccine hesitancy remains very high in the United States, with almost two-thirds of the parents in our study remaining hesitant about the vaccine as of 2019. Hispanic mothers may have higher rates of vaccine hesitancy than other races, which is important given the burden of HPV-associated cancer among Hispanics.