Attitudes and knowledge among parents or guardians of 12-year-old girls about HPV vaccination – A population-based survey in Iceland

Purpose: To assess attitude and knowledge among parents or guardians of 12-year-old girls about human papillomavirus (HPV), cervical cancer, and HPV vaccination. Material and Methods: A mail survey was sent to a randomized sample of 1,000 parents or guardians of 12-year-old girls from a cohort of total 2,092 girls born in 1995 and registered in the Icelandic National Register by the end of December 2007. Results: Of the 994 eligible parents, 583 (59%) returned the questionnaire. Majority of the respondents were mothers who had two or three children. More than one-third of respondents had university education and 84% were married or living with a partner. Over two-thirds did not know that HPV causes cervical cancer and genital warts. Almost all (> 90%) would vaccinate theirs daughters with a HPV vaccine, 73% said they would vaccinate their sons, or themselves if the vaccine was effective for them. Only 11% believed HPV vaccination would increase promiscuity or decrease cervical screening attendance. Conclusion: In Iceland, willingness to vaccinate young girls with HPV vaccine is high, however, knowledge about HPV infections is limited.

HPV; Attitudes; Knowledge; Acceptability; Cervical cancer.

[1] Bosch F.X., Lorincz A., Munoz N., Meijer C.J., Shah K.V.: “The causal relation between human papillomavirus and cervical cancer”. J. Clin. Pathol., 2002, 55, 244.

[2] Munoz N., Bosch F.X., de Sanjose S., Herrero R., Castellsague X., Shah K.V., et al.: “Epidemiologic classification of human papillomavirus types associated with cervical cancer”. N. Engl. J. Med., 2003, 348, 518.

[3] Parkin D.M., Bray F.: “Chapter 2: The burden of HPV-related cancers”. Vaccine, 2006, 24, S11.

[4] Clifford G.M., Smith J.S., Plummer M., Munoz N., Franceschi S.: “Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis”. Br. J. Cancer, 2003, 88, 63.

[5] Smith J.S., Lindsay L., Hoots B., Keys J., Franceschi S., Winer R., et al.: “Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update”. Int.J. Cancer, 2007, 121, 621.

[6] Markowitz L.E., Dunne E.F., Saraiya M., Lawson H.W., Chesson H., Unger E.R., et al.: “Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)”. MMWR Recomm. Rep., 2007, 56, 1.

[7] Brown D.R., Shew M.L., Qadadri B., Neptune N., Vargas M., Tu W., et al.: “A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women”. J. Infect. Dis., 2005, 191, 182.

[8] Zimet G.D., Perkins S.M., Sturm L.A., Bair R.M., Juliar B.E., Mays R.M.: “Predictors of STI vaccine acceptability among parents and their adolescent children”. J. Adolesc. Health, 2005, 37, 179.

[9] Brabin L., Roberts S.A., Farzaneh F., Kitchener H.C.: “Future acceptance of adolescent human papillomavirus vaccination: a survey of parental attitudes”. Vaccine, 2006, 24, 3087.

[10] Lenselink C.H., Gerrits M.M., Melchers W.J., Massuger L.F., van Hamont D., Bekkers R.L.: “Parental acceptance of Human Papillomavirus vaccines”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2008, 137, 103.

[11] Marlow L.A., Waller J., Wardle J.: “Public awareness that HPV is a risk factor for cervical cancer”. Br. J. Cancer, 2007, 97, 691.

[12] Marshall H., Ryan P., Roberton D., Baghurst P.: “A cross-sectional survey to assess community attitudes to introduction of Human papillomavirus vaccine”. Aust. N. Z. J. Public Health, 2007, 31, 235.

[13] Marlow L.A., Waller J., Wardle J.: “Parental attitudes to pre-pubertal HPV vaccination”. Vaccine, 2007, 25, 1945.

[14] Walsh C.D., Gera A., Shah M., Sharma A., Powell J.E., Wilson S.: “Public knowledge and attitudes towards Human Papilloma Virus (HPV) vaccination”. BMC Public Health, 2008, 8, 368.

[15] Slomovitz B.M., Sun C.C., Frumovitz M., Soliman P.T., Schmeler K.M., Pearson H.C., et al.: “Are women ready for the HPV vaccine?” Gynecol. Oncol., 2006, 103, 151.

[16] Jaspers L., Budiningsih S., Wolterbeek R., Henderson F.C., Peters A.A.: “Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: a cross-sectional study”. Vaccine, 2011, 29, 7785.

[17] Kahn J.A., Rosenthal S.L., Hamann T., Bernstein D.I.: “Attitudes about human papillomavirus vaccine in young women”. Int. J. STD AIDS, 2003, 14, 300.

[18] Dempsey A.F., Zimet G.D., Davis R.L., Koutsky L.: “Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV”. Pediatrics, 2006, 117, 1486.

[19] Gudnason T.: “Þátttaka í almennum bólusetningum barna á Íslandi 2013. Uppgjor̈ 2014”. Available at: http://www.landlaeknir.is/servlet/file/store93/item24619/Þátttaka%20%C3%AD%20almennum%20bólusetningum%20barna%20árið%20%202013.%20Uppgjör%202014.pdf

[20] Dahlström L.A., Tran T.N., Lundholm C., Young C., Sundström K., Sparén P.: “Attitudes to HPV vaccination among parents of children aged 12-15 years-a population-based survey in Sweden”. Int. J. Cancer, 2010, 126, 500.

[21] Riedesel J.M., Rosenthal S.L., Zimet G.D., Bernstein D.I., Huang B., Lan D., et al.: “Attitudes about human papillomavirus vaccine among family physicians”. J. Pediatr. Adolesc. Gynecol., 2005, 18, 391.

[22] Kessels S.J., Marshall H.S., Watson M., Braunack-Mayer A.J., Reuzel R., Tooher R.L.: “Factors associated with HPV vaccine uptake in teenage girls: a systematic review”. Vaccine, 2012, 30, 3546.

[23] Marlow L.A., Waller J., Wardle J.: “Trust and experience as predictors of HPV vaccine acceptance”. Hum. Vaccin., 2007, 3, 171.

[24] Davis K., Dickman E.D., Ferris D., Dias J.K.: “Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents”. J. Low. Genit. Tract Dis., 2004, 8, 188.

[25] Brewer N.T., Fazekas K.I.: “Predictors of HPV vaccine acceptability: a theory-informed, systematic review”. Prev. Med., 2007, 45, 107.

[26] Adams M., Jasani B., Fiander A.: “Human papilloma virus (HPV) prophylactic vaccination: challenges for public health and implications for screening”. Vaccine, 2007, 25, 3007.

[27] Liddon N.C., Leichliter J.S., Markowitz L.E.: “Human papillomavirus vaccine and sexual behavior among adolescent and young women”. Am. J. Prev. Med., 2012, 42, 44.

[28] Marchand E., Glenn B.A., Bastani R.: “HPV vaccination and sexual behavior in a community college sample”. J. Community Health, 2013, 38, 1010.

[29] Hansen B.T., Kjær S.K., Arnheim-Dahlström L., Liaw K.L., Jensen K.E., Thomsen L.T., et al.: “Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: Evidence from a large survey of Nordic women”. Vaccine, 2014, 32, 4945.

[30] Dahlström L.A., Sundström K., Young C., Lundholm C., Sparén P., Tran T.N.: “Awareness and knowledge of human papillomavirus in the Swedish adult population”. J. Adolesc. Health, 2012, 50, 204.

[31] Waller J., McCaffery K., Forrest S., Szarewski A., Cadman L., Wardle J.: “Awareness of human papillomavirus among women attending a well woman clinic”. Sex Transm. Infect., 2003, 79, 320.

[32] Smith P.J., Chu S.Y., Barker L.E.: “Children who have received no vaccines: who are they and where do they live?” Pediatrics, 2004, 114, 187.