Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer.
We assessed human papillomavirus (HPV) vaccination of adolescent girls living in communities with elevated cervical cancer rates. During July to October 2007, we conducted interviews with a probability sample of parents (or guardians) of 10- to 18-year-old girls in five North Carolina counties with cervical cancer rates substantially higher than the national average. Estimates are weighted. We interviewed 889 (73%) of 1220 eligible parents; 38% were black. Overall, 10.3% (95% confidence interval [CI] 7.7%-13.5%) of daughters had received at least 1 dose of HPV vaccine. Only 6.4% of 10- to 12-year-olds had initiated vaccination, versus 17.5% of 16- to 18-year-olds (odds ratio [OR] 3.1, 95% CI 1.4-6.9). Older age of daughters and doctor's recommendation were the only factors independently associated with vaccine initiation. Main reasons reported for not initiating HPV vaccine were: needing more information (22%) or never having heard of the vaccine (14%), believing daughter is too young (16%) or not yet sexually active (13%), and not having gone to the doctor yet (13%). Only 0.5% of parents cited concern about HPV vaccine making a teenage girl more likely to have sex as a main reason for not vaccinating. Of 780 parents with unvaccinated daughters, 62% reported their daughters "probably" or "definitely" will, and 10% reported their daughters "definitely won't" get HPV vaccine in the next year. Approximately 1 year after its introduction, HPV vaccine had been initiated by only 10% of adolescent girls in an area with elevated cervical cancer rates; however, most parents intended for their daughters to be vaccinated. Additional efforts are needed to ensure that parents' intentions to vaccinate are realized.