Ohio, a Midwestern US state, has three-shot HPV vaccination uptake rates of 35% for girls and 23% for boys, and has diverse populations based on race, ethnicity, income and geography, each potentially with different risks of acquiring high-risk HPV and cervical cancer. As part of Ohio efforts to increase HPV vaccine uptake, we conducted a survey of parents representing the major diverse Ohio populations to understand factors associated with HPV vaccination of their children.
A cross-sectional, anonymous survey was administered to 156 parents at Ohio events. Eligible respondents self-identified as English speaking/writing parents/legal guardians of one or more child aged 11-17. Analysis examined differences in survey responses to questions about HPV vaccine knowledge, attitudes, and uptake by parent race and household income, child gender, and geography (Appalachia, a rural lower socioeconomic area of 32 counties with less access to health care, vs non-Appalachia).
Overall, survey respondents were female (82%), white (61%), college graduates (46%), married (69%), working full time (80%), had incomes over $60,000 (57%), and had private health insurance (64%). While 83% of parents had heard of the HPV vaccine, white parents were more likely to have both heard of it (OR=4.6) and to report vaccinating their daughters (OR=3.9) and sons (OR=4.5) than African-American parents. Parents with household incomes less than $60,000 were 1.5 times as likely to report sons being vaccinated and twice as likely to report daughters being vaccinated. Also, 64% of married parents reported not vaccinating sons and 55% reported not vaccinating daughters. Parents who agreed the vaccine was safe and effective were 5 times as likely to report vaccinating. African-American parents cited lack of HPV vaccine awareness as the top reason for not vaccinating sons and daughters (62.5%, 57.2%, respectively), white, non-Appalachian parents cited the vaccine as too new and not knowing enough about it (41.6%, 54.6%, respectively), while white, Appalachian parents cited no doctor recommendation (46%) for sons and that daughters were too young (29.4%).
This study highlighted disparities in vaccination rates. Reasons for not vaccinating varied by race and geographic location, with white parents concerned about vaccine newness, African-American parents not knowing about the vaccine, and Appalachian parents not getting a doctor recommendation. These results suggest the need for different messages for each population and that multi-level strategies (including parents and health care providers) need to be implemented to increase HPV vaccination rates among Ohio children.