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Background: Human papillomavirus (HPV) immunization requirements for school-entry could increase HPV vaccine uptake and maximize cervical cancer protection but have been controversial.
Objectives: To determine parents’ attitudes about HPV vaccine school requirements in communities at elevated risk for cervical cancer.
Methods: We surveyed 512 parents/guardians of girls attending public middle/high schools serving economically disadvantaged populations in
Results: Respondents were mostly Hispanic (82%) or African-American (15%); 71% responded in Spanish and 49% had ≤8th grade education; 23% of respondents’ daughters had initiated HPV vaccine. Overall, 59% of parents agreed that HPV vaccine school requirement laws “are a good idea” when opt-out options were not mentioned. Another 33% agreed with a follow-up statement that laws “are okay only if parents can opt-out.” Only 8% disagreed with such laws regardless of opt-out options. Hispanic parents were more likely than African-American parents to agree these laws “are a good idea” (66% vs. 25%, P<0.001) or to agree when an opt-out option was added (96% vs. 75%, P<0.001). Parents were more likely to agree these laws ”are a good idea” if their daughter had received HPV vaccine, if they believed the vaccine works well, or believed their daughter is at risk of acquiring HPV (P<0.05 for each). Parents were less likely to agree if they had concerns about HPV vaccine safety or believed the vaccine is too new (P<0.05 for each). Concerns about sexual disinhibition and cost were not associated with attitudes about HPV immunization requirements.
Conclusions: In this at-risk community, agreement with school immunization requirements for HPV vaccine was high overall, especially when an opt-out option was provided, but varied substantially by race/ethnicity. Parental support of HPV immunization requirements appears to depend on perceptions of HPV vaccine effectiveness and safety and inclusion of opt-out provisions.