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CHIAS: A Standardized Measure of Parental HPV Immunization Attitudes and Beliefs and Its Associations With Vaccine Uptake

Gowda, Charitha MD, MPH*; Carlos, Ruth C. MD, MS; Butchart, Amy T. MPH*; Singer, Dianne C. MPH*; Davis, Matthew M. MD, MAPP*; Clark, Sarah J. MPH*; Dempsey, Amanda F. MD, PhD, MPH*

Sexually Transmitted Diseases: June 2012 - Volume 39 - Issue 6 - p 475–481
doi: 10.1097/OLQ.0b013e318248a6d5
Original Study

Background: Despite the burden of human papillomavirus (HPV)-associated morbidity, less than half of US adolescent females had begun the 3-dose HPV vaccination series as of 2010. Given that parental attitudes significantly influence vaccine uptake, having a standardized measure of parental beliefs that predict HPV vaccine uptake would contribute substantially to the development of effective immunization strategies. We explored whether a modified version of the previously published Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) could be applied nationally to identify attitudinal constructs that were associated with HPV vaccine uptake and maternal HPV vaccination intention.

Methods: We administered the modified CHIAS as part of a cross-sectional, web-based survey to a nationally representative sample of mothers of adolescent females. Exploratory factor analysis was used to identify underlying attitudinal constructs, which were compared with those identified in the original CHIAS. Bivariate and multivariate analyses determined associations between these attitudinal constructs and HPV vaccine uptake as well as vaccination intention.

Results: Overall survey response rate was 57%. The modified CHIAS yielded a factor structure that was similar to the original CHIAS, identifying 3 attitudinal constructs: harms/ineffectiveness, barriers, and social norms. In multivariate models, harms/ineffectiveness and social norms were independently associated with HPV vaccine uptake.

Conclusions: The CHIAS seems to be a valid instrument for identifying important factors associated with HPV-vaccine uptake and parental vaccination intention nationally. Longitudinal studies are merited to explore whether these attitudinal constructs also reliably predict HPV-vaccine uptake.


From the *Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI; and Department of Radiology, University of Michigan Health Center, Ann Arbor, MI

This work is funded by the Clinical Sciences Scholars Program at the University of Michigan.

Since June 2009, Amanda Dempsey has served as an advisory board member for Merck, providing advice on male HPV vaccination. This company had no role in the design or analysis of this study and is unaware of the study's results. Dr. Dempsey does not receive research support from this company.

Supplemental Digital Content is available for this article. A direct URL citation appears in the printed text, and a link to the digital file is provided in the HTML text of this article on the journal's Web site (

Correspondence: Amanda F. Dempsey, MD, PhD, MPH, Associate Professor of Pediatrics, Children's Outcomes Research Program, University of Colorado, Denver, 13199 E. Montview Blvd, Suite 300, Aurora, CO 80045. E-mail:

Received for publication October 6, 2011, and accepted December 28, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association