Skip Navigation LinksHome > July 2007 - Volume 34 - Issue 7 > Predictors of Human Papillomavirus Vaccination Acceptability...
Sexually Transmitted Diseases:
doi: 10.1097/01.olq.0000245915.38315.bd
Article

Predictors of Human Papillomavirus Vaccination Acceptability Among Underserved Women

Gerend, Mary A. PhD; Lee, Stephanie Cruz MD; Shepherd, Janet E. MD

Free Access
Article Outline
Collapse Box

Author Information

From Florida State University College of Medicine, Tallahassee, Florida

The authors thank the participating health clinics and the following individuals for their assistance with the project: Kim Barnhill, Donna Moore, Jerry Boland, MD, Suzanne Harrison, MD, and Donald Zorn, MD.

Stephanie Cruz Lee was supported by a summer research fellowship from the Florida State University College of Medicine.

Correspondence: Mary A. Gerend, PhD, Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300. E-mail: mary.gerend@med.fsu.edu.

Received for publication May 1, 2006, and accepted August 27, 2006.

Collapse Box

Abstract

Objectives: The objectives of this study were to examine underserved women's acceptability of the forthcoming human papillomavirus (HPV) vaccines and to identify correlates of HPV vaccine acceptability.

Study Design: A sample of primarily low-income minority women (n = 58) recruited from community health clinics completed a semistructured interview assessing health beliefs, vaccination attitudes, health behavior, and HPV vaccination intentions.

Results: Personal acceptability of the HPV vaccines was generally high. Moreover, 100% of parents were interested in having their children vaccinated. Correlates of vaccination intentions included health beliefs and attitudes (perceived risk of HPV infection, perceived safety and effectiveness of HPV vaccines, perceived physician encouragement for vaccination) and previous health behavior (HIV testing). Independent predictors of vaccine acceptability were also identified.

Conclusions: The current study highlights key correlates of vaccine acceptability that may inform HPV vaccination campaigns for underserved populations.

PERSISTENT INFECTION WITH HUMAN PAPILLOMAVIRUS (HPV) is a necessary cause of cervical cancer.1 Genital infection with low-risk HPV subtypes (HPV 6, 11) can cause genital warts, whereas infection with high-risk subtypes (most often HPV 16 and 18) can result in cervical intraepithelial neoplasia (CIN) and may eventually progress to cervical cancer.1,2 Although Pap testing has significantly reduced the incidence of cervical cancer in the United States,2 an estimated 4,000 U.S. women died of cervical cancer in 2005.3

Prophylactic HPV vaccines have been developed and will be available in the near future. Clinical trials suggest that they are safe and highly effective in preventing HPV infection and CIN.4–6 A quadrivalent vaccine (Gardasil manufactured by Merck) that protects against infection by HPV 6, 11, 16, and 18 was approved by the U.S. Food and Drug Administration in June 2006 for females ages 9 to 26. The Advisory Committee on Immunization Practices (ACIP) has since recommended routine HPV vaccination in 11- and 12-year-old girls, but noted that the HPV vaccine can be given to girls as young as age 9.7 Furthermore, the ACIP recommends that girls/women ages 13 to 26 receive HPV vaccination if they have not been previously vaccinated for HPV or have not completed the 3-dose HPV series.

The purpose of the current study was to examine underserved women's acceptability of the forthcoming HPV vaccines, both for themselves and their children, and to identify health beliefs and behaviors associated with vaccine acceptance. Although some have speculated that sexually transmitted infection (STI) vaccines will be met with reluctance because of the social stigma that often accompanies such infections,8 research is inconsistent with this view.9 In fact, data suggest that people are generally interested in STI vaccination for themselves10–14 and their children.15–19 Greater willingness to get vaccinated for HPV is typically seen among individuals who feel more vulnerable to HPV infection, associate vaccination with greater benefits and fewer barriers, hold positive attitudes toward vaccination, perceive the HPV vaccines to be safe and effective, and believe that other people—parents, healthcare providers—would encourage them to get vaccinated.8–11,19

Theory and previous research guided the selection of predictor variables. We drew on the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA)—theories that have successfully predicted a wide range of health behaviors,20 including STI vaccination.10,12 Consistent with the HBM, we predicted that greater perceived benefits of HPV vaccination and greater perceptions of susceptibility to and severity of HPV infection would be associated with higher vaccine acceptability, whereas greater perceived barriers to HPV vaccination would be associated with lower acceptability. Consistent with the TRA, we predicted that positive attitudes and normative beliefs favoring HPV vaccination would be related to higher acceptance rates. Based on previous research,10,11,13,18 greater vaccination intentions were expected to be associated with more lifetime sexual partners and previous engagement in health protective behaviors (e.g., Pap testing, HIV testing).

Research suggests that knowledge of HPV and its relationship to cervical cancer is relatively low in the general population.21,22 Thus, before assessing participants' interest in obtaining the HPV vaccine, we provided each participant with detailed information about HPV, the relationship between HPV and cervical cancer, and the potential role of the new vaccines in preventing infection by HPV and, ultimately, cervical cancer.

Back to Top | Article Outline

Methods

Participants (n = 58) were recruited from 3 community clinics providing health care to underserved populations in North Florida: Tallahassee Memorial Family Practice Residency Program (n = 36), Jefferson County Health Department (n = 11), and Leon County Health Department (n = 11). Approximately two thirds of the sample was age 26 or younger. See Table 1 for sociodemographic characteristics. Recruitment signs instructed women ages 18 to 50 years to approach the interviewer in the waiting room if they were interested in participating in a women's health study. Data were collected during July, October, and November 2005. Participants were paid $10 for completing the 20- to 25-minute interview.

Table 1
Table 1
Image Tools

The semistructured interview was divided into 3 phases: 1) preeducation interview, 2) patient education session, and 3) posteducation interview. The preeducation interview assessed sociodemographic information, sexual history, and other health-related behaviors (see Table 1). We also assessed perceived susceptibility to HPV infection and cervical cancer (1 = not at all likely to 6 = very likely) and perceived severity of HPV infection (“Having genital HPV would be upsetting to me”; “Having genital HPV would make it difficult for me to get a long-term sexual partner”; 1 = strongly disagree to 6 = strongly agree).

During the patient education phase, participants were given standardized information about HPV infection (definition, prevalence, transmission methods, signs and symptoms, complications, treatments), cervical cancer, Pap testing, and the forthcoming HPV vaccines. The posteducation interview assessed health beliefs, HPV vaccination attitudes, and intentions to get vaccinated for HPV. Health beliefs and attitudes toward HPV vaccination were assessed on a 6-point scale (1 = disagree strongly to 6 = agree strongly) and included perceived safety, effectiveness, and benefits of the HPV vaccine; perceived barriers to receiving the HPV vaccine (getting the HPV vaccine could be risky, having to get shots, if health insurance will not cover the vaccine); and normative beliefs about the vaccine (perceived physician encouragement for HPV vaccination).

Personal HPV vaccine acceptability was assessed with 4 items: How likely is it that you will: 1) try to get more information about, 2) consider getting, and 3) actually get the HPV vaccine once it is available? Participants also rated 4) the likelihood they will get the HPV vaccine if a healthcare provider offers it to them in the next 3 years (1 = very unlikely to 6 = very likely). The 4 items were averaged to create a composite (α = 0.90). Parents (n = 42; mean age = 28 years, standard deviation [SD] = 9.1) indicated whether they were interested in having their child/children vaccinated for HPV (yes/no).

Back to Top | Article Outline

Results

Personal intentions to get vaccinated for HPV were generally high (mean = 5.40, SD = 0.96). Seventy-six percent had a score of 5 or higher on the composite measure of vaccine acceptability. One hundred percent of parents indicated that they would be interested in having their child/children vaccinated for HPV. Lack of variability on this measure prevented us from examining correlates of parental acceptance.

Correlations between HPV vaccine acceptability and sociodemographic variables, health beliefs, and behavior are given in the first column of Table 2. Correlates of HPV vaccination intentions included perceived susceptibility to HPV, perceived safety of the HPV vaccine, perceived effectiveness of the HPV vaccine (“The vaccine will protect people from getting HPV”), perceived physician encouragement for HPV vaccination, and HIV testing history.

Table 2
Table 2
Image Tools

Variables correlated with HPV vaccination intentions at P <0.05 or better were entered into a multiple regression analysis predicting vaccine acceptability (Table 2, second column). Independent predictors of vaccine acceptability included perceived safety of the HPV vaccine, perceived supportiveness of one's doctor for getting vaccinated, and having been tested for HIV. These variables accounted for 61% of the variance in HPV vaccination intentions (F [5,45] = 14.169, P <0.001).

Back to Top | Article Outline

Discussion

The current study sheds light on underserved women's interest in receiving the forthcoming HPV vaccines. Over three fourths of those interviewed endorsed strong intentions to obtain HPV vaccination. Moreover, 100% of parents were interested in having their child or children vaccinated. These findings run counter to speculations that HPV vaccines will be met with strong opposition because they are intended to prevent an STI. Rather, they provide additional evidence to an emerging body of literature indicating widespread and relatively enthusiastic support for HPV vaccination.

Correlates of vaccine acceptability identified in the present sample of underserved women were consistent with studies conducted in other populations.8,10–13 Results from this study point to the importance of health beliefs and prior behavior in motivating future health-protective actions such as STI vaccination. Women who felt more susceptible to HPV infection reported greater vaccination intentions. Furthermore, greater confidence in the safety and efficacy of the HPV vaccines was associated with higher vaccine acceptability. The strongest correlate of vaccine acceptance was holding the belief that one's physician will encourage HPV vaccination. Three independent predictors of vaccine acceptability were identified: perceived safety of the HPV vaccine, perceived encouragement from one's physician to get vaccinated, and having received an HIV test. That previous HIV testing was associated with greater interest in the HPV vaccine may reflect a general tendency to engage in health-protective behaviors and/or perceptions of risk to STIs more generally.

Given evidence that public knowledge of HPV is quite low,21,22 it is likely that the patient education session of the current study had an important effect on our findings. Studies examining the use of patient education materials for encouraging HPV vaccine acceptance have reported differential success.15,16,23 Nevertheless, to promote widespread acceptance of the HPV vaccine, it will be important for healthcare providers to give patients/parents (at a minimum) basic information about HPV before offering the vaccine.24

Limitations of the current study provide important opportunities for future research. The primary limitation was the small sample size. In addition, lack of variability in parental interest in HPV vaccination limited our ability to examine correlates of parental acceptance. Furthermore, because we did not assess children's ages, we cannot make specific claims about the role of child age in relation to parental acceptance of the HPV vaccines.

HPV vaccination could have an enormous impact on the health and well-being of women worldwide. In addition to reductions in morbidity and mortality from cervical cancer and HPV-related disease, the HPV vaccines may also reduce psychologic distress that often accompanies an abnormal Pap test or diagnosis of genital warts.25 Yet these benefits will only be achieved through widespread acceptance of the vaccines. The current study highlights key correlates of vaccine acceptability that may inform future HPV vaccination campaigns. Our findings suggest that increasing awareness of HPV infection and its clinical sequelae as well as publicizing the safety and efficacy of the HPV vaccines should yield the greatest acceptance. Endorsement of the HPV vaccines from healthcare providers is also likely to result in increased willingness to accept HPV vaccination.

Back to Top | Article Outline

References

1. Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55:244–265.

2. Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol 2005; 32(suppl 1):S16–24.

3. American Cancer Society. What are the key statistics about cervical cancer? Available at: www.cancer.org/docroot/CRI/CRI_0.asp. Accessed February 20, 2005.

4. Harper DM, Franco EL, Wheeler CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial. Lancet 2006; 367:1247–1255.

5. Kahn JA. Vaccination as a prevention strategy for human papillomavirus-related diseases. J Adolesc Health 2005; 37(suppl 6):S10–16.

6. Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: A randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005; 6:271–278.

7. Centers for Disease Control and Prevention. CDC's advisory committee recommends human papillomavirus virus vaccination. Available at: www.cdc.gov/od/oc/media/pressrel/r060629.htm Accessed July 2, 2006.

8. Zimet GD, Mays RM, Fortenberry JD. Vaccines against sexually transmitted infections: Promise and problems of the magic bullets for prevention and control. Sex Transm Dis 2000; 27:49–52.

9. Zimet GD. Improving adolescent health: Focus on HPV vaccine acceptance. J Adolesc Health 2005; 37(suppl 6):S17–23.

10. Boehner CW, Howe SR, Bernstein DI, Rosenthal SL. Viral sexually transmitted disease vaccine acceptability among college students. Sex Transm Dis 2003; 30:774–778.

11. Kahn JA, Rosenthal SL, Hamann T, Bernstein DI. Attitudes about human papillomavirus vaccine in young women. Int J STD AIDS 2003; 14:300–306.

12. Rosenthal SL, Lewis LM, Succop PA, Bernstein DI, Stanberry LR. College students' attitudes regarding vaccination to prevent genital herpes. Sex Transm Dis 1999; 26:438–443.

13. Zimet GD, Fortenberry JD, Fife KH, Tyring SK, Herne K, Douglas JM. Acceptability of genital herpes immunization. The role of health beliefs and health behaviors. Sex Transm Dis 1997; 24:555–560.

14. Zimet GD, Mays RM, Winston Y, Kee R, Dickes J, Su L. Acceptability of human papillomavirus immunization. J Womens Health Gend Based Med 2000; 9:47–50.

15. Davis K, Dickman ED, Ferris D, Dias JK. Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents. J Low Genit Tract Dis 2004; 8:188–194.

16. Dempsey AF, Zimet GD, Davis RL, Koutsky L. Factors that are associated with parental acceptance of human papillomavirus vaccines: A randomized intervention study of written information about HPV. Pediatrics 2006; 117:1486–1493.

17. Lazcano-Ponce E, Rivera L, Arillo-Santillán E, Salmerón J, Hernández-Avila M, Muñoz N. Acceptability of a human papillomavirus (HPV) trial vaccine among mothers of adolescents in Cuernavaca, Mexico. Arch Med Res 2001; 32:243–247.

18. Zimet GD, Mays RM, Sturm LA, Ravert AA, Perkins SM, Juliar BE. Parental attitudes about sexually transmitted infection vaccination for their adolescent children. Arch Pediatr Adolesc Med 2005; 159:132–137.

19. Zimet GD, Perkins SM, Sturm LA, Bair RM, Juliar BE, Mays RM. Predictors of STI vaccine acceptability among parents and their adolescent children. J Adolesc Health 2005; 37:179–186.

20. Wallston BS, Wallston KA. Social psychological models of health behavior: An examination and integration. In: Baum A, Taylor SE, Singer JE, eds. Handbook of Psychology and Health: Social Psychological Aspects of Health, vol 4. Hillsdale, NJ: Lawrence Erlbaum Associates Inc, 1984:23–53.

21. Holcomb B, Bailey JM, Crawford K, Ruffin MT. Adults' knowledge and behaviors related to human papillomavirus infection. J Am Board Fam Pract 2004; 17:26–31.

22. Yacobi E, Tennant C, Ferrante J, Pal N, Roetzheim R. University students' knowledge and awareness of HPV. Prev Med 1999; 28:535–541.

23. Gerend MA, Shepherd JE. Using message framing to promote acceptance of the human papillomavirus vaccine. Health Psychol. In press.

24. Zimet GD. Understanding and overcoming barriers to human papillomavirus vaccine acceptance. Curr Opin Obstet Gynecol 2006; 18(suppl 1):S23–28.

25. Mayeaux EJ Jr. Harnessing the power of prevention: Human papillomavirus vaccines. Curr Opin Obstet Gynecol 2006; 18(suppl 1):S15–21.

Cited By:

This article has been cited 33 time(s).

Health Psychology
The Multidimensional Nature of Perceived Barriers: Global Versus Practical Barriers to HPV Vaccination
Gerend, MA; Shepherd, MA; Shepherd, JE
Health Psychology, 32(4): 361-369.
10.1037/a0026248
CrossRef
Journal of Pediatric Nursing-Nursing Care of Children & Families
Testing a Model for Parental Acceptance of Human Papillomavirus Vaccine in 9- to 18-Year-Old Girls: A Theory-Guided Study
Reynolds, D; O'Connell, KA
Journal of Pediatric Nursing-Nursing Care of Children & Families, 27(6): 614-625.
10.1016/j.pedn.2011.09.005
CrossRef
Maternal and Child Health Journal
Inter-State Variation in Human Papilloma Virus Vaccine Coverage Among Adolescent Girls in the 50 US States, 2007
Kramer, MR; Dunlop, AL
Maternal and Child Health Journal, 16(): S102-S110.
10.1007/s10995-012-0999-6
CrossRef
Journal of Pediatric and Adolescent Gynecology
Health Care Decision Making by Mothers for their Adolescent Daughters Regarding the Quadrivalent HPV Vaccine
Hertweck, SP; LaJoie, AS; Pinto, MD; Flamini, L; Lynch, T; Logsdon, MC
Journal of Pediatric and Adolescent Gynecology, 26(2): 96-101.
10.1016/j.jpag.2012.10.009
CrossRef
Vaccine
Literature review of human papillomavirus vaccine acceptability among women over 26 years
Black, LL; Zimet, GD; Short, MB; Sturm, L; Rosenthal, SL
Vaccine, 27(): 1668-1673.
10.1016/j.vaccine.2009.01.035
CrossRef
Vaccine
Attitudes toward and intention to receive the human papilloma virus (HPV) vaccination and intention to use condoms among female Korean college students
Kang, HS; Moneyham, L
Vaccine, 28(3): 811-816.
10.1016/j.vaccine.2009.10.052
CrossRef
Women & Health
Singaporean Women's Knowledge of Human Papillomavirus (HPV) and Attitudes Toward HPV Vaccination
Pitts, M; Smith, A; Croy, S; Lyons, A; Ryall, R; Garland, S; Wong, ML; Tay, EH
Women & Health, 49(4): 334-351.
10.1080/03630240903158420
CrossRef
American Journal of Preventive Medicine
Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination
Pruitt, SL; Schootman, M
American Journal of Preventive Medicine, 38(5): 525-533.
10.1016/j.amepre.2010.01.018
CrossRef
Sexually Transmitted Infections
Is use of the human papillomavirus vaccine among female college students related to human papillomavirus knowledge and risk perception?
Licht, AS; Murphy, JM; Hyland, AJ; Fix, BV; Hawk, LW; Mahoney, MC
Sexually Transmitted Infections, 86(1): 74-78.
10.1136/sti.2009.037705
CrossRef
Journal of Womens Health
HPV vaccine acceptability in a rural Southern area
Fazekas, KI; Brewer, NT; Smith, JS
Journal of Womens Health, 17(4): 539-548.
10.1089/jwh.2007.0489
CrossRef
Journal of Adolescent Health
Awareness, knowledge, and beliefs about human papillomavirus in a racially diverse sample of young adults
Gerend, MA; Magloire, ZF
Journal of Adolescent Health, 42(3): 237-242.
10.1016/j.jadohealth.2007.08.022
CrossRef
Preventive Medicine
Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007
Jain, N; Euler, GL; Shefer, A; Lu, PJ; Yankey, D; Markowitz, L
Preventive Medicine, 48(5): 426-431.
10.1016/j.ypmed.2008.11.010
CrossRef
Vaccine
Singaporean men's knowledge of cervical cancer and human papillomavirus (HPV) and their attitudes towards HPV vaccination
Pitts, M; Smith, A; Croy, S; Lyons, A; Ryall, R; Garland, S; Wong, ML; Hseon, TE
Vaccine, 27(): 2989-2993.
10.1016/j.vaccine.2009.02.101
CrossRef
Journal of Adolescent Health
Parental Response to Human Papillomavirus Vaccine Availability: Uptake and Intentions
Gerend, MA; Weibley, E; Bland, H
Journal of Adolescent Health, 45(5): 528-531.
10.1016/j.jadohealth.2009.02.006
CrossRef
Journal of Womens Health
Moving forward: Human papillomavirus vaccination and the prevention of cervical cancer
Vetter, KM; Geller, SE
Journal of Womens Health, 16(9): 1258-1268.
10.1089/jwh.2007.0493
CrossRef
Cancer
Human Papillomavirus Vaccination in Survivors of Childhood Cancer
Klosky, JL; Gamble, HL; Spunt, SL; Randolph, ME; Green, DM; Hudson, MM
Cancer, 115(): 5627-5636.
10.1002/cncr.24669
CrossRef
Journal of Adolescent Health
Acceptance of the HPV Vaccine for Adolescent Girls: Analysis of State-Added Questions from the BRFSS
Christian, WJ; Christian, A; Hopenhayn, C
Journal of Adolescent Health, 44(5): 437-445.
10.1016/j.jadohealth.2008.09.001
CrossRef
Turkiye Klinikleri Tip Bilimleri Dergisi
Knowledge on and Attitude Toward Human Papillomavirus Infection and Its Vaccine in a Turkish Subpopulation
Onan, A; Ozkan, S; Korucuoglu, U; Aksakal, N; Taskiran, C; Aygun, R; Guner, H
Turkiye Klinikleri Tip Bilimleri Dergisi, 29(3): 594-598.

Health Psychology
Behavioral Interventions to Increase HPV Vaccination Acceptability Among Mothers of Young Girls
Cox, DS; Cox, AD; Sturm, L; Zimet, G
Health Psychology, 29(1): 29-39.
10.1037/a0016942
CrossRef
Bmc Public Health
Drivers and barriers to acceptance of human-papillomavirus vaccination among young women: a qualitative and quantitative study
Mortensen, GL
Bmc Public Health, 10(): -.
ARTN 68
CrossRef
Journal of Womens Health
HPV Vaccine Acceptance among Latina Mothers by HPV Status
Sanderson, M; Coker, AL; Eggleston, KS; Fernandez, ME; Arrastia, CD; Fadden, MK
Journal of Womens Health, 18(): 1793-1799.
10.1089/jwh.2008.1266
CrossRef
Applied Nursing Research
Testing of a prototype Web based intervention for adolescent mothers on postpartum depression
Logsdon, MC; Barone, M; Lynch, T; Robertson, A; Myers, J; Morrison, D; York, S; Gregg, J
Applied Nursing Research, 26(3): 143-145.
10.1016/j.apnr.2013.01.005
CrossRef
Vaccine
Female human papillomavirus (HPV) vaccination: Global uptake and the impact of attitudes
Hopkins, TG; Wood, N
Vaccine, 31(): 1673-1679.
10.1016/j.vaccine.2013.01.028
CrossRef
Journal of Health Communication
Parental Decisional Strategies Regarding HPV Vaccination Before Media Debates: A Focus Group Study
Hofman, R; van Empelen, P; Vogel, I; Raat, H; van Ballegooijen, M; Korfage, IJ
Journal of Health Communication, 18(7): 866-880.
10.1080/10810730.2012.757390
CrossRef
European Journal of Public Health
Human Papillomavirus awareness, knowledge and vaccine acceptance: A survey among 18-25 year old male and female vocational school students in Berlin, Germany
Blodt, S; Holmberg, C; Muller-Nordhorn, J; Rieckmann, N
European Journal of Public Health, 22(6): 808-813.
10.1093/eurpub/ckr188
CrossRef
International Journal of Epidemiology
Inequalities in the uptake of Human Papillomavirus Vaccination: a systematic review and meta-analysis
Fisher, H; Trotter, CL; Audrey, S; MacDonald-Wallis, K; Hickman, M
International Journal of Epidemiology, 42(3): 896-908.
10.1093/ije/dyt049
CrossRef
Plos One
Knowledge, Attitude, Practice and Barriers on Vaccination against Human Papillomavirus Infection: A Cross-Sectional Study among Primary Care Physicians in Hong Kong
Wong, MCS; Lee, A; Ngai, KLK; Chor, JCY; Chan, PKS
Plos One, 8(8): -.
ARTN e71827
CrossRef
Bmc Public Health
Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study
van Keulen, HM; Otten, W; Ruiter, RAC; Fekkes, M; van Steenbergen, J; Dusseldorp, E; Paulussen, TWGM
Bmc Public Health, 13(): -.
ARTN 111
CrossRef
Sexually Transmitted Diseases
The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): Scale Development and Associations With Intentions to Vaccinate
McRee, A; Brewer, NT; Reiter, PL; Gottlieb, SL; Smith, JS
Sexually Transmitted Diseases, 37(4): 234-239.
10.1097/OLQ.0b013e3181c37e15
PDF (254) | CrossRef
Obstetrics & Gynecology
Rates of Human Papillomavirus Vaccination, Attitudes About Vaccination, and Human Papillomavirus Prevalence in Young Women
Kahn, JA; Rosenthal, SL; Jin, Y; Huang, B; Namakydoust, A; Zimet, GD
Obstetrics & Gynecology, 111(5): 1103-1110.
10.1097/AOG.0b013e31817051fa
PDF (232) | CrossRef
Sexually Transmitted Diseases
Intention to Obtain Human Papillomavirus Vaccination Among Taiwanese Undergraduate Women
Hsu, Y; Fetzer, SJ; Hsu, K; Chang, Y; Huang, C; Chou, C
Sexually Transmitted Diseases, 36(11): 686-692.
10.1097/OLQ.0b013e3181ad28d3
PDF (234) | CrossRef
Sexually Transmitted Diseases
Human Papillomavirus Vaccine Acceptability Among Young Adult Men
Gerend, MA; Barley, J
Sexually Transmitted Diseases, 36(1): 58-62.
10.1097/OLQ.0b013e31818606fc
PDF (183) | CrossRef
Current Opinion in Obstetrics and Gynecology
Human papillomavirus vaccine and adolescents
Dempsey, AF; Zimet, GD
Current Opinion in Obstetrics and Gynecology, 20(5): 447-454.
10.1097/GCO.0b013e3283086719
PDF (120) | CrossRef
Back to Top | Article Outline

© Copyright 2007 American Sexually Transmitted Diseases Association

Login