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Ann Epidemiol. 2009 Aug;19(8):531-8. doi: 10.1016/j.annepidem.2009.03.011. Epub 2009 Apr 25.

Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus.

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Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5456, USA.



The objective of this study was to compare the reasons why mothers do or do not have their adolescent daughters vaccinated against HPV.


Mothers of vaccinated and unvaccinated 11- to 17-year-old girls seen during preventive care visits in outpatient family medicine or pediatric clinics underwent an audiotaped structured telephone interview that used open-ended questions to assess the reasons underlying maternal decisions about HPV vaccination. Qualitative methods categorized maternal responses into themes.


Interviews of 52 mothers (19 declining vaccination, 33 accepting) identified several distinct factors underlying their decisions about HPV vaccination. Lack of knowledge about HPV, age-related concerns, and low perceived risk of infection were commonly cited reasons for declining vaccination. Desire to prevent illness, physician recommendation, and a high perceived risk of infection were commonly identified motivating factors. Both groups of mothers had significant concerns about vaccine safety. Locus of control (e.g., mother or daughter) of health-related decisions arose as a novel factor influencing this decision that had not been previously described in the context of HPV vaccination.


Addressing safety concerns, educating parents about the age-specific risk of HPV infection, and promoting strong physician recommendation for vaccination may be the most useful targets for future interventions to increase HPV vaccine utilization.

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