{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:46:34Z","timestamp":1788317194716,"version":"build-2803163510"},"reference-count":59,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T00:00:00Z","timestamp":1750464000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Cancer Institute","award":["R37CA234030"],"award-info":[{"award-number":["R37CA234030"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Human papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers, yet vaccination rates remain suboptimal, particularly in Florida. Social influence, including family and peer support, may shape parental decisions to vaccinate their children. In this study, we examined the role of social networks (online and offline) in parental intention to vaccinate their 11- to 12-year-old children against HPV. Methods: We conducted a cross-sectional survey among 746 parents in Florida as part of the Text &amp; Talk trial (2022\u20132023). Among other questions, parents reported on their intention to vaccinate, perceived social norms, and support received from up to three reported confidants. We performed logistic regression and multivariable analyses to assess the relationship between network support, social norms, and vaccination intent. Results: Seventy percent of parents intended to vaccinate their children. Greater support from the first reported confidant was significantly associated with higher vaccination intention (OR = 1.30, p &lt; 0.0001). Perceived norms among friends (p = 0.01) and higher overall network support (p &lt; 0.0001) were also predictive of intent. The higher the percentage of reported family members, the higher the support received for the vaccine (p = 0.04). Conclusions: Social support, particularly from close confidants and peers, plays a critical role in shaping parental HPV vaccination decisions while accounting for perceived social norms. Public health interventions can leverage peer networks alongside family support to enhance HPV vaccine uptake.<\/jats:p>","DOI":"10.3390\/vaccines13070667","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T09:08:44Z","timestamp":1750669724000},"page":"667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Role of Personal Social Networks in Parental Decision-Making for HPV Vaccination: Examining Support and Norms Among Florida Parents"],"prefix":"10.3390","volume":"13","author":[{"given":"Georges E.","family":"Khalil","sequence":"first","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-4278","authenticated-orcid":false,"given":"Carla L.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6027-444X","authenticated-orcid":false,"given":"Xiaofei","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta D.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1813-7456","authenticated-orcid":false,"given":"Gabriela","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gurka","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Virgina, Charlottesville, VA 22903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A. S.","family":"Staras","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"724","DOI":"10.15585\/mmwr.mm6833a3","article-title":"Human Papillomavirus\u2013Attributable Cancers\u2014United States, 2012\u20132016","volume":"68","author":"Senkomago","year":"2019","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"708","DOI":"10.15585\/mmwr.mm7333a1","article-title":"National Vaccination Coverage Among Adolescents Aged 13\u201317 Years\u2014National Immunization Survey-Teen, United States, 2023","volume":"73","author":"Pingali","year":"2024","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (CDC) (2025, April 23). TeenVaxView, Available online: https:\/\/www.cdc.gov\/teenvaxview\/interactive\/index.html."},{"key":"ref_4","unstructured":"U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), and National Cancer Institute (NCI) (2025, April 21). Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, Available online: https:\/\/gis.cdc.gov\/cancer\/USCS\/#\/AtAGlance\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.15585\/mmwr.mm6832a3","article-title":"Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices","volume":"68","author":"Meites","year":"2019","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_6","unstructured":"Monta\u00f1o, D.E., and Kasprzyk, D. (2015). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health Behavior: Theory, Research, and Practice, Jossey-Bass. [5th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2069959","DOI":"10.1080\/21645515.2022.2069959","article-title":"Parental intention to vaccinate adolescents with HPV vaccine in selected communities in Ibadan, Southwest Nigeria: An application of Integrated Behavioral Model","volume":"18","author":"Balogun","year":"2022","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.vaccine.2019.01.012","article-title":"An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling","volume":"37","author":"Degarege","year":"2019","journal-title":"Vaccine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105968","DOI":"10.1016\/j.ypmed.2019.105968","article-title":"Factors associated with adolescent HPV vaccination in the U.S.: A systematic review of reviews and multilevel framework to inform intervention development","volume":"131","author":"Rodriguez","year":"2020","journal-title":"Prev. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1348\/014466607X269748","article-title":"Do as we say and as we do: The interplay of descriptive and injunctive group norms in the attitude-behaviour relationship","volume":"47","author":"Smith","year":"2008","journal-title":"Br. J. Soc. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wang, Y., Chen, Y., and Bao, S. (2023). The impact of exposure to HPV related information and injunctive norms on young women\u2019s intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.1102590"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s10900-020-00837-5","article-title":"Self-efficacy and HPV Vaccine Attitudes Mediate the Relationship Between Social Norms and Intentions to Receive the HPV Vaccine Among College Students","volume":"45","author":"Stout","year":"2020","journal-title":"J. Community Health"},{"key":"ref_13","first-page":"253","article-title":"The Effect of Family Support and Immunization Services Access on Mothers Attitudes in Providing Basic Immunization","volume":"5","author":"Handinis","year":"2018","journal-title":"Int. J. Public Health Clin. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1397","DOI":"10.1542\/peds.2012-2452","article-title":"The impact of social networks on parents\u2019 vaccination decisions","volume":"131","author":"Brunson","year":"2013","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1097\/AOG.0b013e31817051fa","article-title":"Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women","volume":"111","author":"Kahn","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1542\/peds.2005-1381","article-title":"Factors That Are Associated with Parental Acceptance of Human Papillomavirus Vaccines: A Randomized Intervention Study of Written Information About HPV","volume":"117","author":"Dempsey","year":"2006","journal-title":"Pediatrics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.socscimed.2016.04.028","article-title":"Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review","volume":"159","author":"Galbraith","year":"2016","journal-title":"Soc. Sci. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/OLQ.0b013e3181f12dbf","article-title":"Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area","volume":"38","author":"Brewer","year":"2011","journal-title":"Sex. Transm. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jadohealth.2019.01.029","article-title":"Social Networks for Human Papillomavirus Vaccine Advice Among African American Parents","volume":"65","author":"Fu","year":"2019","journal-title":"J. Adolesc. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2953","DOI":"10.1111\/add.15427","article-title":"Social norms as a predictor of smoking uptake among youth: A systematic review, meta-analysis and meta-regression of prospective cohort studies","volume":"116","author":"East","year":"2021","journal-title":"Addiction"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1353\/sof.2005.0036","article-title":"Counting on Kin: Social Networks, Social Support, and Child Health Status*","volume":"83","author":"Donato","year":"2005","journal-title":"Soc. Forces"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/j.jadohealth.2014.11.024","article-title":"Increasing Human Papillomavirus Vaccine Initiation Among Publicly Insured Florida Adolescents","volume":"56","author":"Staras","year":"2015","journal-title":"J. Adolesc. Health"},{"key":"ref_23","unstructured":"U.S. Department of Health and Human Services (DHHS), and National Center for Immunization and Respiratory Diseases (2025, April 21). The 2019 National Immuization Survey-Teen, Available online: https:\/\/www.cdc.gov\/nis\/media\/pdfs\/2024\/11\/NIS-TEEN-PUF19-DUG.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1207\/s15327752jpa5503&4_17","article-title":"Psychometric characteristics of the Multidimensional Scale of Perceived Social Support","volume":"55","author":"Zimet","year":"1990","journal-title":"J. Pers. Assess."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Valente, T.W. (2010). Social Networks and Health: Models, Methods, and Applications, Oxford University Press.","DOI":"10.1093\/acprof:oso\/9780195301014.001.0001"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1016\/j.vaccine.2012.02.007","article-title":"Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006\u20132008 National Survey of Family Growth","volume":"30","author":"Liddon","year":"2012","journal-title":"Vaccine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/10410236.2012.734914","article-title":"A Serial Mediation Model of Message Framing on Intentions to Receive the Human Papillomavirus (HPV) Vaccine: Revisiting the Role of Threat and Efficacy Perceptions","volume":"28","author":"Krieger","year":"2013","journal-title":"Health Commun."},{"key":"ref_28","unstructured":"Valente, T.W. (2010). Appendix B: Sample Sociometric Survey. Social Networks and Health: Models, Methods, and Applications, Oxford University Press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.drugalcdep.2013.08.008","article-title":"A longitudinal examination of alcohol, marijuana, and cigarette perceived norms among middle school adolescents","volume":"133","author":"Pedersen","year":"2013","journal-title":"Drug Alcohol. Depend."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"430","DOI":"10.17730\/humo.65.4.08mwg9d3nfy8w9th","article-title":"Who knows your HIV status II? Information propagation within social networks of seropositive people","volume":"65","author":"Shelley","year":"2006","journal-title":"Hum. Organ."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Perry, B.L., Pescosolido, B.A., and Borgatti, S.P. (2018). Sociocentric and Egocentric Approaches to Networks. Egocentric Network Analysis, Cambridge University Press.","DOI":"10.1017\/9781316443255"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/0192513X11406228","article-title":"Will Marriage Matter? Effects of Marriage Anticipated by Same-Sex Couples","volume":"33","author":"Shulman","year":"2012","journal-title":"J. Fam. Issues"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1037\/adb0000218","article-title":"Briefer assessment of social network drinking: A test of the Important People Instrument-5 (IP-5)","volume":"30","author":"Hallgren","year":"2016","journal-title":"Psychol. Addict. Behav."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1080\/15236803.2012.12001706","article-title":"The Influence of Teaching Methodology on Student Social Interaction","volume":"18","author":"Varda","year":"2012","journal-title":"J. Public Aff. Educ."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/03637751.2011.564638","article-title":"Confirmation and Weight Management: Predicting Effective Levels of Acceptance and Challenge in Weight Management Messages","volume":"78","author":"Dailey","year":"2011","journal-title":"Commun. Monogr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1188\/21.ONF.371-389","article-title":"Factors Associated with African American Mothers\u2019 Perceptions of Human Papillomavirus Vaccination of Their Daughters: An Integrated Literature Review","volume":"48","author":"Freysteinson","year":"2021","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.ygyno.2018.03.047","article-title":"Black mother\u2019s intention to vaccinate daughters against HPV: A mixed methods approach to identify opportunities for targeted communication","volume":"149","author":"Forbes","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/1090198120901497","article-title":"Diffusion\/Contagion Processes on Social Networks","volume":"47","author":"Valente","year":"2020","journal-title":"Health Educ. Behav."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e484","DOI":"10.1016\/S2468-2667(20)30139-0","article-title":"Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: A nationwide, cross-sectional survey","volume":"5","author":"Sonawane","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_40","unstructured":"American Association for Public Opinion Rsearch (AAPOR) (2025, April 14). Response Rates Calculator. Available online: https:\/\/aapor.org\/response-rates\/."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1037\/amp0000129","article-title":"Interpersonal mechanisms linking close relationships to health","volume":"72","author":"Pietromonaco","year":"2017","journal-title":"Am. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s10865-011-9323-y","article-title":"Interpersonal influences on patients\u2019 surgical decision making: The role of close others","volume":"34","author":"Rini","year":"2011","journal-title":"J. Behav. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e063057","DOI":"10.1136\/bmjopen-2022-063057","article-title":"Community engagement to support COVID-19 vaccine uptake: A living systematic review protocol","volume":"12","author":"Gilmore","year":"2022","journal-title":"BMJ Open"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Yewell, D., Bentley, R.A., and Horne, B.D. (2024). Perceived Social Influence on Vaccination Decisions: A COVID-19 Case Study. arXiv.","DOI":"10.1007\/s43545-024-00929-2"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1136\/jech-2016-208313","article-title":"Twenty years of social capital and health research: A glossary","volume":"71","author":"Moore","year":"2017","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_46","first-page":"A106","article-title":"Using the Family to Combat Childhood and Adult Obesity","volume":"6","author":"Gruber","year":"2009","journal-title":"Prev. Chronic Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/geronb\/gbs050","article-title":"Intergenerational relationship quality across three generations","volume":"67","author":"Birditt","year":"2012","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1037\/hea0000722","article-title":"Interactions Among Perceived Norms and Attitudes About Health-Related Behaviors in U.S. Adolescents","volume":"38","author":"Rice","year":"2019","journal-title":"J. Health Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/oso\/9780195083316.003.0007","article-title":"Social Integration, Social Networks, Social Support, and Health","volume":"1","author":"Berkman","year":"2000","journal-title":"Soc. Epidemiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/13557858.2017.1332758","article-title":"HPV vaccine acceptance among African-American mothers and their daughters: An inquiry grounded in culture","volume":"24","author":"Lechuga","year":"2019","journal-title":"Ethn. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10464-007-9100-9","article-title":"The relationship between self-reported received and perceived social support: A meta-analytic review","volume":"39","author":"Haber","year":"2007","journal-title":"Am. J. Community Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/0022-1031(77)90049-X","article-title":"The \u201cfalse consensus effect\u201d: An egocentric bias in social perception and attribution processes","volume":"13","author":"Ross","year":"1977","journal-title":"J. Exp. Soc. Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1037\/hea0000771","article-title":"Reports of social circles\u2019 and own vaccination behavior: A national longitudinal survey","volume":"38","author":"Parker","year":"2019","journal-title":"Health Psychol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1016\/j.vaccine.2021.03.018","article-title":"Social norms and vaccine uptake: College students\u2019 COVID vaccination intentions, attitudes, and estimated peer norms and comparisons with influenza vaccine","volume":"39","author":"Graupensperger","year":"2021","journal-title":"Vaccine"},{"key":"ref_55","unstructured":"Florida Department of Health (2025, June 06). Population Atlas Dashboard, Available online: https:\/\/www.flhealthcharts.gov\/ChartsReports\/rdPage.aspx?rdReport=PopAtlas.PopulationAtlasDASHBOARD&rdRequestForwarding=Form."},{"key":"ref_56","unstructured":"National Academies of Sciences, Engineering, and Medicine, Policy and Global Affairs, Committee on Women in Science, Engineering, and Medicine, and Committee on Policies and Practices for Supporting Caregivers Working in Science, Engineering, and Medicine (2024). Supporting Family Caregivers in STEMM: A Call to Action, National Academies Press."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"114043","DOI":"10.1016\/j.socscimed.2021.114043","article-title":"The mediating role of vaccine hesitancy between maternal engagement with anti- and pro-vaccine social media posts and adolescent HPV-vaccine uptake rates in the US: The perspective of loss aversion in emotion-laden decision circumstances","volume":"282","author":"Argyris","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e38297","DOI":"10.2196\/38297","article-title":"Social Media Perceptions and Internet Verification Skills Associated with Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey","volume":"5","author":"Thompson","year":"2022","journal-title":"JMIR Pediatr. Parent."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e12441","DOI":"10.2196\/12441","article-title":"Partnering with Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention","volume":"21","author":"Wright","year":"2019","journal-title":"J. Med. Internet Res."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/7\/667\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:56:08Z","timestamp":1760032568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/7\/667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,21]]},"references-count":59,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["vaccines13070667"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13070667","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,21]]}}}