{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:41:41Z","timestamp":1792100501167,"version":"4.4.0"},"reference-count":25,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T00:00:00Z","timestamp":1516665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["3U01IP000310-02S1"],"award-info":[{"award-number":["3U01IP000310-02S1"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: To assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated (NI) or not completed (NC) the HPV vaccine series, attitudes and other factors important in promoting the series, and whether attitudes differed by language preference. Design\/Methods: From August 2013\u2013October 2013, we conducted a mail survey among parents of girls aged 12\u201315 years randomly selected from administrative data in a Denver safety net system; 400 parents from each group (NI and NC) were targeted. Surveys were in English or Spanish. Results: The response rate was 37% (244\/660; 140 moved or gone elsewhere; 66% English-speaking, 34% Spanish-speaking). Safety attitudes of NIs and NCs differed, with 40% NIs vs. 14% NCs reporting they thought HPV vaccine was unsafe (p &lt; 0.0001) and 43% NIs vs. 21% NCs that it may cause long-term health problems (p &lt; 0.001). Among NCs, 42% reported they did not know their daughter needed more shots (English-speaking, 20%, Spanish-speaking 52%) and 39% reported that \u201cI wasn\u2019t worried about the safety of the HPV vaccine before, but now I am\u201d (English-speaking, 23%, Spanish-speaking, 50%). Items rated as very important among NIs in the decision regarding vaccination included: more information about safety (74%), more information saying it prevents cancer (70%), and if they knew HPV was spread mainly by sexual contact (61%). Conclusions: Safety concerns, being unaware of the need for multiple doses, and low perceived risk of infection remain significant barriers to HPV vaccination for at-risk adolescents. Some parents\u2019 safety concerns do not appear until initial vaccination.<\/jats:p>","DOI":"10.3390\/ijerph15020185","type":"journal-article","created":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T13:06:51Z","timestamp":1516712811000},"page":"185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Exploring Facilitators and Barriers to Initiation and Completion of the Human Papillomavirus (HPV) Vaccine Series among Parents of Girls in a Safety Net System"],"prefix":"10.3390","volume":"15","author":[{"given":"Sean T.","family":"O\u2019Leary","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA"},{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Lockhart","sequence":"additional","affiliation":[{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Barnard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA"},{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Furniss","sequence":"additional","affiliation":[{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Dickinson","sequence":"additional","affiliation":[{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"},{"name":"Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda F.","family":"Dempsey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA"},{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Stokley","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6457-1481","authenticated-orcid":false,"given":"Steven","family":"Federico","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Denver Health and Hospital Authority, Denver, CO 80204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bronsert","sequence":"additional","affiliation":[{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Kempe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA"},{"name":"The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, CO 80045, USA"},{"name":"The Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1001\/jamapediatrics.2013.2752","article-title":"Barriers to human papillomavirus vaccination among U.S. adolescents: A systematic review of the literature","volume":"168","author":"Holman","year":"2014","journal-title":"JAMA Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1542\/peds.2007-0012","article-title":"Additional health care visits needed among adolescents for human papillomavirus vaccine delivery within medical homes: A national study","volume":"120","author":"Rand","year":"2007","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"784","DOI":"10.15585\/mmwr.mm6429a3","article-title":"National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13\u201317 Years\u2014United States, 2014","volume":"64","author":"Yankey","year":"2015","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ygyno.2008.12.010","article-title":"HPV vaccine: A comparison of attitudes and behavioral perspectives between Latino and non-Latino women","volume":"112","author":"Watts","year":"2009","journal-title":"Gynecol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1158\/1055-9965.EPI-13-0979","article-title":"Provider-Verified HPV Vaccine Coverage among a National Sample of Hispanic Adolescent Females","volume":"23","author":"Reiter","year":"2014","journal-title":"Cancer Epidemiol. Biomark."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1542\/peds.2011-0950","article-title":"Human papillomavirus vaccination series initiation and completion, 2008\u20132009","volume":"128","author":"Dorell","year":"2011","journal-title":"Pediatrics"},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (CDC) (2013). National and state vaccination coverage among adolescents aged 13\u201317 years\u2014United States, 2012. MMWR Morb. Mortal. Wkly. Rep., 62, 685\u2013693."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.acap.2017.03.013","article-title":"Reasons for non-initiation and non-completion of HPV vaccine among English- and Spanish-speaking parents of adolescent girls: A qualitative study","volume":"17","author":"Albright","year":"2017","journal-title":"Acad. Pediatr."},{"key":"ref_9","first-page":"178","article-title":"Immunization registry accuracy: Improvement with progressive clinical application (vol. 24, pg. 276, 2003)","volume":"25","author":"Davidson","year":"2003","journal-title":"Am. J. Prev. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/OLQ.0b013e318248a6d5","article-title":"CHIAS: A standardized measure of parental HPV immunization attitudes and beliefs and its associations with vaccine uptake","volume":"39","author":"Gowda","year":"2012","journal-title":"Sex. Transm. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/0272989X03256005","article-title":"Validation of a decision regret scale","volume":"23","author":"Brehaut","year":"2003","journal-title":"Med. Decis. Mak."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8279","DOI":"10.1016\/j.vaccine.2011.08.106","article-title":"Monitoring the safety of quadrivalent human papillomavirus vaccine: Findings from the Vaccine Safety Datalink","volume":"29","author":"Gee","year":"2011","journal-title":"Vaccine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1001\/archpediatrics.2012.1451","article-title":"Safety of quadrivalent human papillomavirus vaccine administered routinely to females","volume":"166","author":"Klein","year":"2012","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1365-2796.2011.02467.x","article-title":"Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine","volume":"271","author":"Chao","year":"2012","journal-title":"J. Intern. Med."},{"key":"ref_15","unstructured":"Centers for Disease Control and Prevention (2015, October 06). Human Papillomavirus (HPV), Available online: http:\/\/www.cdc.gov\/hpv\/."},{"key":"ref_16","unstructured":"American Academy of Pediatrics (2015, October 06). HPV Vaccine Is Cancer Prevention. Available online: https:\/\/www.aap.org\/en-us\/advocacy-and-policy\/aap-health-initiatives\/immunizations\/HPV-Champion-Toolkit\/Pages\/HPV-Champion-Toolkit.aspx."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1177\/003335491613100304","article-title":"Understanding non-completion of the human papillomavirus vaccine series: Parent-reported reasons for why adolescents might not receive additional doses, United States, 2012","volume":"131","author":"Clark","year":"2016","journal-title":"Public Health Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.vaccine.2009.12.063","article-title":"Predictors of HPV vaccine uptake among women aged 19\u201326: Importance of a physician\u2019s recommendation","volume":"29","author":"Rosenthal","year":"2011","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"164","DOI":"10.2105\/AJPH.2011.300600","article-title":"Health care provider recommendation, human papillomavirus vaccination, and race\/ethnicity in the U.S. National Immunization Survey","volume":"103","author":"Ylitalo","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6163","DOI":"10.1016\/j.vaccine.2014.08.054","article-title":"Parent perceptions important for HPV vaccine initiation among low income adolescent girls","volume":"32","author":"Staras","year":"2014","journal-title":"Vaccine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1080\/21645515.2016.1157673","article-title":"Comparing human papillomavirus vaccine knowledge and intentions among parents of boys and girls","volume":"12","author":"Lindley","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1007\/s10903-015-0225-x","article-title":"HPV vaccine and latino immigrant parents: If they offer it, we will get it","volume":"18","author":"Aragones","year":"2016","journal-title":"J. Immigr. Minor Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s10900-014-9949-0","article-title":"Latino parents\u2019 perceptions of the HPV Vaccine for sons and daughters","volume":"40","author":"Warner","year":"2015","journal-title":"J. Community Health"},{"key":"ref_24","unstructured":"Lauri Markowitz, M. (2015, August 30). Considerations for Recommendations ACIP HPV Vaccines Work Group. Available online: http:\/\/www.nitag-resource.org\/uploads\/media\/default\/0001\/03\/afbc46959fd8e36878fdd71f156afe96d83c916e.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jadohealth.2011.04.010","article-title":"Accuracy of self-reported human papillomavirus vaccine receipt among adolescent girls and their mothers","volume":"50","author":"Stupiansky","year":"2012","journal-title":"J. Adolesc. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/2\/185\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:52:17Z","timestamp":1760194337000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/2\/185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,23]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,2]]}},"alternative-id":["ijerph15020185"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15020185","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,23]]}}}