HPV Vaccination in Communities with High Rates of Cervical Cancer: A Survey of Caregivers of Adolescent Girls in North Carolina

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

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

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

Result:
We interviewed 887 caregivers (response rate 55%); 23% were black; 82% had heard of HPV vaccine before the interview. Overall, 106 (12%) daughters had received ≥1 dose of HPV vaccine. Most had received vaccine from pediatrics (40%), family practice (27%), or obstetrics/gynecology (18%) practices. The main reasons reported for daughters not having received vaccine were: caregiver needing more information about the vaccine (23%), not having gone to the doctor or getting around to it yet (15%), feeling daughter is too young (14%) or is not yet sexually active (11%), or never having heard of the vaccine (11%). Although 20% of caregivers agreed the vaccine may make a teenage girl more likely to have sex, <1% cited this as a main reason for not vaccinating. Of 781 caregivers with unvaccinated daughters, 61% reported that their daughters “probably” or “definitely” will get the vaccine in the next year. Only 11% reported that their daughters “definitely won't” get the vaccine in the next year.

Conclusion:
Although low, the 12% vaccine uptake we observed was promising, as HPV vaccine had only recently become available. The majority of caregivers whose daughters had not received vaccine reported intentions for them to receive it. However, several barriers remain.

Implications:
Additional efforts are needed in communities with high cervical cancer rates to ensure that caregivers' intentions to vaccinate translate into HPV vaccination.