Parents Who Decline HPV Vaccination: Who Later Accepts and Why?

Melanie L. Kornides, Annie Laurie McRee, Melissa B. Gilkey

    Research output: Contribution to journalComment/debatepeer-review

    69 Scopus citations


    Objective: Parental declination contributes to low human papillomavirus (HPV) vaccination coverage among US adolescents, resulting in missed opportunities for cancer prevention. We sought to characterize parents’ acceptance of HPV vaccination after declination (“secondary acceptance”). Methods: In September 2016, we conducted an online survey with a national sample of parents of children ages 11 to 17 years. For those who reported having ever declined HPV vaccination for their children (n = 494), our survey assessed whether they accepted the vaccine at a subsequent visit. We used multivariable logistic regression to assess correlates of secondary acceptance. Results: Overall, 45% of parents reported secondary acceptance of HPV vaccination, and an additional 24% intended to vaccinate in the next 12 months. In multivariable analyses, secondary acceptance was associated with receiving follow-up counseling about HPV vaccination from a health care provider (odds ratio, 2.16; 95% confidence interval, 1.42–3.28). However, only 53% of parents overall reported receiving such counseling. Secondary acceptance was also associated with receiving a higher quality HPV vaccine recommendation from a provider during the initial discussion and greater satisfaction with provider communication, as well as higher vaccination confidence. Among the reasons for secondary acceptance, parents most commonly reported the child getting older (45%), learning more about HPV vaccine (34%), and receiving a provider recommendation (33%). Conclusions: Our findings suggest secondary acceptance of HPV vaccination is common, with more than two-thirds of parents in this national sample accepting or intending to accept HPV vaccination after declination. Providers should seek to motivate secondary acceptance by delivering repeated, high-quality recommendations for HPV vaccination.

    Original languageEnglish (US)
    Pages (from-to)S21-S22
    JournalAcademic Pediatrics
    Issue number2
    StatePublished - Mar 2018

    Bibliographical note

    Funding Information:
    Financial disclosure : Publication of this article was supported by the Centers for Disease Control and Prevention. This study was supported by a grant from the National Cancer Institute ( K22 CA186979 for M.B.G.).

    Publisher Copyright:
    © 2017 Academic Pediatric Association


    • adolescent health
    • human papillomavirus infections/prevention and control
    • human papillomavirus vaccine
    • vaccine hesitancy
    • vaccine refusal

    PubMed: MeSH publication types

    • Journal Article
    • Research Support, N.I.H., Extramural
    • Research Support, U.S. Gov't, P.H.S.


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