University of British Columbia, Vancouver, Canada.
PLoS Med. 2010 May 4;7(5):e1000270. doi: 10.1371/journal.pmed.1000270.
Information on factors that influence parental decisions for actual human papillomavirus (HPV) vaccine receipt in publicly funded, school-based HPV vaccine programs for girls is limited. We report on the level of uptake of the first dose of the HPV vaccine, and determine parental factors associated with receipt of the HPV vaccine, in a publicly funded school-based HPV vaccine program in British Columbia, Canada.
All parents of girls enrolled in grade 6 during the academic year of September 2008-June 2009 in the province of British Columbia were eligible to participate. Eligible households identified through the provincial public health information system were randomly selected and those who consented completed a validated survey exploring factors associated with HPV vaccine uptake. Bivariate and multivariate analyses were conducted to calculate adjusted odds ratios to identify the factors that were associated with parents' decision to vaccinate their daughter(s) against HPV. 2,025 parents agreed to complete the survey, and 65.1% (95% confidence interval [CI] 63.1-67.1) of parents in the survey reported that their daughters received the first dose of the HPV vaccine. In the same school-based vaccine program, 88.4% (95% CI 87.1-89.7) consented to the hepatitis B vaccine, and 86.5% (95% CI 85.1-87.9) consented to the meningococcal C vaccine. The main reasons for having a daughter receive the HPV vaccine were the effectiveness of the vaccine (47.9%), advice from a physician (8.7%), and concerns about daughter's health (8.4%). The main reasons for not having a daughter receive the HPV vaccine were concerns about HPV vaccine safety (29.2%), preference to wait until the daughter is older (15.6%), and not enough information to make an informed decision (12.6%). In multivariate analysis, overall attitudes to vaccines, the impact of the HPV vaccine on sexual practices, and childhood vaccine history were predictive of parents having a daughter receive the HPV vaccine in a publicly funded school-based HPV vaccine program. By contrast, having a family with two parents, having three or more children, and having more education was associated with a decreased likelihood of having a daughter receive the HPV vaccine.
This study is, to our knowledge, one of the first population-based assessments of factors associated with HPV vaccine uptake in a publicly funded school-based program worldwide. Policy makers need to consider that even with the removal of financial and health care barriers, parents, who are key decision makers in the uptake of this vaccine, are still hesitant to have their daughters receive the HPV vaccine, and strategies to ensure optimal HPV vaccine uptake need to be employed.
在公共资助的基于学校的 HPV 疫苗接种计划中，关于影响父母对实际人乳头瘤病毒（HPV）疫苗接种决定的因素的信息有限。我们报告了在加拿大不列颠哥伦比亚省的一个公共资助的基于学校的 HPV 疫苗接种计划中，HPV 疫苗接种的第一针接种率，并确定了与 HPV 疫苗接种相关的父母因素。
在 2008 年 9 月至 2009 年 6 月学年期间，有资格参加该省六年级的所有女孩的父母都有资格参加。通过省级公共卫生信息系统确定符合条件的家庭，并随机选择那些同意完成调查的家庭，该调查旨在探索与 HPV 疫苗接种率相关的因素。进行了双变量和多变量分析，以计算调整后的优势比，以确定与父母决定为女儿接种 HPV 疫苗相关的因素。共有 2025 名父母同意完成调查，65.1%（95%置信区间 [CI] 63.1-67.1）的父母报告说他们的女儿接种了 HPV 疫苗的第一针。在同一基于学校的疫苗接种计划中，88.4%（95%CI 87.1-89.7）同意接种乙型肝炎疫苗，86.5%（95%CI 85.1-87.9）同意接种脑膜炎球菌 C 疫苗。让女儿接种 HPV 疫苗的主要原因是疫苗的有效性（47.9%）、医生的建议（8.7%）和对女儿健康的担忧（8.4%）。不让女儿接种 HPV 疫苗的主要原因是对 HPV 疫苗安全性的担忧（29.2%）、更喜欢等到女儿长大（15.6%）以及没有足够的信息来做出明智的决定（12.6%）。在多变量分析中，对疫苗的总体态度、HPV 疫苗对性行为的影响以及儿童疫苗接种史是父母决定在公共资助的基于学校的 HPV 疫苗接种计划中为女儿接种 HPV 疫苗的预测因素。相比之下，有两个父母的家庭、有三个或更多孩子的家庭和受过更多教育的家庭与女儿不太可能接种 HPV 疫苗有关。
据我们所知，这项研究是全球范围内首次对公共资助的基于学校的 HPV 疫苗接种计划中与 HPV 疫苗接种率相关的因素进行的基于人群的评估之一。政策制定者需要考虑到，即使消除了财务和医疗保健方面的障碍，作为该疫苗接种的关键决策者的父母仍然对让女儿接种 HPV 疫苗犹豫不决，需要采取确保 HPV 疫苗最佳接种率的策略。
