HPV Vaccine Initiation in North Carolina Communities with High Rates of Cervical Cancer

Background:
Adolescent girls living in communities with high rates of cervical cancer might benefit most from human papillomavirus (HPV) vaccine.

Objectives:
To assess HPV vaccination of adolescent girls and barriers to vaccination in an area with high cervical cancer rates.

Methods:
During July-October 2007, we conducted telephone interviews with a probability sample of caregivers (parents/guardians) of 10-18 year-old girls in 5 North Carolina counties with high cervical cancer rates (mean 12.0 cases/100,000 women annually). Estimates are weighted.

Results:
We interviewed 889 (73%) of 1,220 eligible caregivers; 38% were black. Overall, 10.3% (95% CI 7.7%-13.5%) of daughters had received ≥1 dose of HPV vaccine. Only 6.4% of 10-12 year-olds had initiated HPV vaccine, whereas 17.5% of 16-18 year-olds had (OR 3.1, 95% CI 1.7-5.9). Older age of daughters and doctor's recommendation were the only factors independently associated with vaccine initiation. Main reasons reported for daughters not having initiated HPV vaccine were: caregiver needing more information about vaccine (22%) or never having heard of it (14%), believing daughter is too young (16%) or is not yet sexually active (13%), and not having gone to the doctor yet (13%). Only 0.5% of caregivers cited concern about HPV vaccine making a teenage girl more likely to have sex as a main reason for not vaccinating. Of 780 caregivers with unvaccinated daughters, 62% reported their daughters "probably" or "definitely" will get HPV vaccine, and only 10% reported their daughters "definitely won't" get it, in the next year.

Conclusions:
Approximately 1 year after its introduction, HPV vaccine had been initiated by only 10% of adolescent girls in an area with high cervical cancer rates; however, most caregivers intended for their daughters to be vaccinated. Additional efforts are needed in communities with high cervical cancer rates to ensure that caregivers' intentions to vaccinate translate into HPV vaccination.