HPV vaccine and adolescent males
Introduction
Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States (U.S.) [1]. Prevalence estimates of infection among asymptomatic males are typically over 20% and range as high as 73% [2]. Although infection is generally less common among adolescent and young adult males compared to older males [3], [4], [5], infection often occurs soon after sexual debut or the introduction of new sexual partners [6]. HPV infections have the potential to cause various adverse health outcomes in males, including genital warts [7], [8] and some types of cancer (anal, penile, and oral cancers) [9]. HPV concordance levels are high among sexual partners [10], so infected males also put their female partners at increased risk of cervical disease [11], [12].
The U.S. Food and Drug Administration (FDA) approved a quadrivalent HPV vaccine against HPV types 6, 11, 16, and 18 for use in males ages 9–26 in October 2009 [13]. Soon after, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation, allowing for the administration of the 3-dose vaccine series to males ages 9–26 but not making it part of their routine vaccination schedule [13]. The ACIP also recommended HPV vaccine be covered by the Vaccines for Children (VFC) program for eligible males ages 18 or younger [14]. Coverage of the vaccine for males is less clear for private health insurance plans, though not all plans currently provide coverage [15]. The FDA has approved HPV vaccine for genital warts and anal cancer prevention in males [16], [17], while the ACIP recommends the vaccine to reduce the likelihood of genital warts in males [13] and is considering its potential to prevent cancer in males. In addition to these individual health benefits, vaccinating males ages 9–26 against HPV also has considerable public health and economic benefits [18].
Studies conducted in the U.S. before HPV vaccine licensure for males found relatively high levels of parental acceptability of the vaccine for their adolescent sons [19]. Our own research conducted soon after vaccine licensure also showed many parents were willing to get their adolescent sons free HPV vaccine [20]. No studies we are aware of, however, have assessed actual HPV vaccine uptake among adolescent males in the U.S. Furthermore, although research has examined vaccine acceptability to male college students and other young adult males [19], [21], [22], [23], we are not aware of data on acceptability of HPV vaccine to younger adolescent males. Examining vaccine acceptability among this age group is important because HPV vaccine is most effective if given prior to HPV exposure through sexual contact [13], many adolescents are involved in deciding whether they get vaccinated [24], and younger adolescents are the target group for adolescent vaccination platforms [25]. To address these gaps in the existing literature, we collected dyadic data on HPV vaccine uptake and acceptability from parents and their adolescent sons.
Section snippets
Study design
The HPV Immunization in Sons (HIS) study surveyed parents and their 11–17-year-old sons to examine their attitudes and beliefs about HPV vaccination for males. Parents were existing members of a national panel of U.S. households maintained by a survey company [26]. The national panel is a probability-based sample of US households constructed through a dual frame approach (list-assisted, random-digit dialing supplemented by address-based sampling). The survey company provides a laptop and free
Sample characteristics
Most parents were younger than 45 years of age (61%), non-Hispanic white (67%), and married or living with a partner (82%) (Table 1). About half of parents were female (54%), had at least some college education (56%), and reported a household income of at least $60,000 (49%). The sample included parents from all four geographic regions of the U.S. and primarily from urban areas (83%). Most sons who completed a survey were non-Hispanic white (61%) and had seen their healthcare provider in the
Main findings
Almost a year after HPV vaccine was licensed and first recommended for males [13], we found that only 2% of adolescent males had received any doses of HPV vaccine. To our knowledge, this represents the first estimate of HPV vaccine uptake among adolescent males in the U.S. The observed uptake rate is noticeably lower than that among adolescent females about a year after HPV vaccine licensure occurred for them (10–30% in 2007) [35], [36], [37], [38]. Vaccination rates among adolescent females
Conclusions
In this first examination of HPV vaccine uptake among adolescent males, only 2% had received any doses of HPV vaccine nearly a year after the vaccine was licensed and first recommended for males. Parents and sons reported moderate levels of vaccine acceptability, and the identified correlates underscore potentially important factors affecting their HPV vaccination decisions. Future interventions are needed to increase HPV vaccine acceptability and uptake among adolescent males.
Acknowledgements
Supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Additional support provided by the American Cancer Society (MSRG-06-259-01-CPPB) and the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726).
Conflict of interest statement: A research grant to NTB and PLR from
References (61)
- et al.
Impact of vaccinating boys and men against HPV in the United States
Vaccine
(2010) - et al.
Acceptability of human papillomavirus vaccine for males: a review of the literature
J Adolesc Health
(2010) - et al.
HPV vaccine for adolescent males: acceptability to parents post-vaccine licensure
Vaccine
(2010) - et al.
College men's knowledge, attitudes, and beliefs about the human papillomavirus infection and vaccine
J Adolesc Health
(2009) - et al.
Vaccinating adolescent girls against human papillomavirus-Who decides?
Prev Med
(2010) - et al.
Adolescent immunizations: a position paper of the Society for Adolescent Medicine
J Adolesc Health
(2006) - et al.
Potential barriers to HPV vaccine provision among medical practices in an area with high rates of cervical cancer
J Adolesc Health
(2008) - et al.
Parents’ health beliefs and HPV vaccination of their adolescent daughters
Soc Sci Med
(2009) - et al.
Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer
J Adolesc Health
(2009) - et al.
Knowledge and early adoption of the HPV vaccine among girls and young women: results of a national survey
J Adolesc Health
(2009)
Stage of adoption of the human papillomavirus vaccine among college women
Prev Med
The HPV vaccine and the media: how has the topic been covered and what are the effects on knowledge about the virus and cervical cancer?
Patient Educ Couns
Present choices, future outcomes: anticipated regret and HPV vaccination
Prev Med
Predictors of HPV vaccine acceptability: a theory-informed, systematic review
Prev Med
Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services
Am J Prev Med
Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000
Perspect Sex Reprod Health
Prevalence of HPV infection among men: a systematic review of the literature
J Infect Dis
HPV 6/11, 16, 18 seroprevalence in men in two US cities
Sex Transm Dis
Epidemiologic factors associated with seropositivity to human papillomavirus type 16 and 18 virus-like particles and risk of subsequent infection in men
Cancer Epidemiol Biomarkers Prev
Population seroprevalence of human papillomavirus types 6, 11, 16, and 18 in men, women, and children in Australia
Clin Infect Dis
Genital human papillomavirus infection in men: incidence and risk factors in a cohort of university students
J Infect Dis
Detection of multiple human papillomavirus types in Condylomata acuminata lesions from otherwise healthy and immunosuppressed patients
J Clin Microbiol
Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease
Vaccine
Meta-analysis of human papillomavirus infection concordance
Cancer Epidemiol Biomarkers Prev
Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain
J Natl Cancer Inst
Risk factors for incident and recurrent condylomata acuminata among women. A population-based study
Sex Transm Dis
FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP)
MMWR Morb Mortal Wkly Rep
HPV disease in males and vaccination: Implications and opportunities for pediatricians
Infect Dis Child
Cited by (126)
Associations of Maternal Age, Education, and Marital Status with HPV Vaccine Uptake and Hesitancy among United States Youth: A Cross-Sectional Analysis of the 2020 National Immunization Survey
2023, Journal of Pediatric and Adolescent GynecologyService quality and parents' willingness to get adolescents HPV vaccine from pharmacists
2018, Preventive MedicineDo both anticipated relief and anticipated regret predict decisions about influenza vaccination?
2024, British Journal of Health PsychologyRaising the HPV Vaccination Rate in Rural Northern New England Using Local Opinion Leaders
2023, Critical Reviews in Eukaryotic Gene Expression