Elsevier

Vaccine

Volume 29, Issue 34, 5 August 2011, Pages 5595-5602
Vaccine

HPV vaccine and adolescent males

https://doi.org/10.1016/j.vaccine.2011.06.020Get rights and content

Abstract

In 2009, the United States approved quadrivalent HPV vaccine for males 9–26 years old, but data on vaccine uptake are lacking. We determined HPV vaccine uptake among adolescent males, as well as stage of adoption and vaccine acceptability to parents and their sons. A national sample of parents of adolescent males ages 11–17 years (n = 547) and their sons (n = 421) completed online surveys during August and September 2010. Analyses used multivariate linear regression. Few sons (2%) had received any doses of HPV vaccine, and most parents and sons were unaware the vaccine can be given to males. Parents with unvaccinated sons were moderately willing to get their sons free HPV vaccine (mean = 3.37, SD = 1.21, possible range 1–5). Parents were more willing to get their sons vaccinated if they perceived higher levels of HPV vaccine effectiveness (β = 0.20) or if they anticipated higher regret about their sons not getting vaccinated and later developing an HPV infection (β = 0.32). Vaccine acceptability was also modest among unvaccinated sons (mean = 2.98, SD = 1.13, possible range 1–5). Sons were more willing to get vaccinated if they perceived higher peer acceptance of HPV vaccine (β = 0.39) or anticipated higher regret about not getting vaccinated and later developing an HPV infection (β = 0.22). HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males. Vaccine acceptability was moderate among both parents and sons. Efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.

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

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