Sexually Transmitted Disease Prevention Framing for Human Papillomavirus Vaccination: A Missed Opportunity?

Background: Vaccines that prevent human papillomavirus (HPV) infections are recommended for routine use in adolescents but coverage remains suboptimal.  Because they are often promoted as cancer prevention vaccines, little is known about the role of sexually transmitted disease (STD) prevention framing for increasing uptake.

Methods:  A qualitative study of parents/caregivers (n=22, 86% black or Hispanic) of adolescents ages 11–18 years at an urban primary care clinic serving low-income families was conducted May–September 2013.  Interviews were transcribed and coded using a thematic approach.

Results: Nineteen parents discussed attitudes about prevention framing with a substantial majority (n=15, 79%) expressing STD prevention framing as acceptable and important.  Many of those parents (n=8, 53%) reported having children that had not received HPV vaccinations, and several had increased enthusiasm for the vaccine after realizing the sexually transmitted nature of HPV.  Parents often invoked notions of wanting to “protect” their children because “you never know” when they might become sexually active and “a lot of diseases that are out there”.  STD prevention framing was viewed as important even at ages 11 and 12 years because “they are starting earlier and earlier”, and was viewed by some as especially important for daughters because “little trickier with girls”.  A smaller minority of parents (n=4, 21%) preferred cancer framing, noting that cancer is “frightening” and “could kill her”.  Framing preferences were often influenced by personal experiences with both HPV infections and cancer; as parents described their own diagnosis of cervical dysplasia (“it wasn’t nice”) and/or family history of cancer (“don’t ever want to see anybody go through”) as motivating reasons to vaccinate children.

Conclusions: Promotion of HPV vaccination through STD prevention framing messages to parents is widely acceptable in this population and may be an under-utilized approach to increase uptake of this safe and effective vaccine.