Factors Affecting First-Generation Immigrant Parents' Decisions on Human Papillomavirus (HPV) Vaccine Uptake for 11-12-Year-Old Girls

Backgrounds and Purposes: Cervical cancer is the fourth most frequent cancer among women worldwide. Cervarix® and Gardasil® are two available HPV vaccines that proved by clinical trials to be safe and nearly 100% efficacious against pre-cancerous lesions in a naïve population. The recommended age by US Centers for Disease Control to uptake HPV immunization for boys and girls is at 11-12. The literature has documented factors impacting the uptake and completion of HPV vaccines series, including having health insurance, more healthcare utilization, positive vaccine attitudes , race, education level of parents, and family income. However, little knowledge is available about the HPV vaccine uptake for the second-generation immigrant children at the recommended age and the decision-making process by their first-generation immigrant parents on this issue. The present study is to analyze factors impacting the first-generation immigrant parents’ decisions on the HPV vaccine uptake for their 11-12-year-old daughters.

Methods: Analysis was conducted on the Health Information National Trends Survey (HINTS), 2008. The sample in this analysis included 784 first-generation immigrant parents who had 11- to 12-year-old girls in the US. Binomial logistic regression was conducted to examine the likelihood of HPV vaccine uptake decisions for 11- to 12-year-old girl among first-generation immigrant parents by demographic characteristics and HPV literacy.

Results: Analysis of the sample showed that approximately 52% of immigrant parents had HPV vaccine for their 11- to 12-year-old daughters, and about 49% of immigrant parents did not have HPV vaccine for their daughter. Immigrant parents who resident longer time in the US (OR=.977, p<.01) showed significant lower likelihood to have HPV vaccine for their daughter. Participants who were married or partnered (OR=1.709, p<.05) indicated 1.7 times higher than participants who were single in uptake HPV vaccine for their daughter. More importantly, immigrant parents with a high level of HPV awareness (OR=1.740, p<.05) showed 1.74 times higher than immigrant parents with a low level of HPV awareness in uptake HPV vaccine for their 11- to 12-year-old daughters.

Conclusions and Implications: The findings showed that in general, approximate half of first-generation immigrant parents made decisions to vaccine their daughters. Vaccine uptake was more common among those first-generation immigrant parents who resident shorter time in the U.S., who were married or partnered, and who have a high level of HPV awareness. Consist with the broad population, the status of being married and high level of HPV awareness and a positive attitude towards vaccines positively impacted the immigrants’ decisions for their children’s vaccine uptake. One critical predictor specific for first-generation immigrant parents is their residential time in the U.S. This might result from the shift of the composition of immigrants, from low-skilled immigrants in the past to educated immigrants in recent years. To promote cervical cancer prevention among second-generation immigrant girls, HPV vaccination programs should focus on narrowing disparities in new and old immigrants and on providing correct information by a reliable source, such as healthcare providers.