Parental intention to have daughters receive the human papillomavirus vaccine

Abstract

Concerns have been raised that parents may be reluctant to have their daughters receive the human papillomavirus (HPV) vaccine, because of a belief that doing so might be interpreted as condoning earlier and more frequent sexual activity. We determined intentions regarding vaccination among Canadian parents and factors that predicted parental intention to have their daughters vaccinated against HPV.
Parents of children 8-18 years of age, recruited from across Canada, were asked to respond to questions in the context of a grade 6, publicly funded, school-based HPV vaccine program. We performed backward logistic regression analysis to identify factors predictive of parents' intention to have their daughters vaccinated against HPV.
Of the 1350 respondents with female children, more than 70% (73.8%; 95% confidence interval [CI] 71.5%-76.1%) intended to have their daughters undergo vaccination against HPV. In multivariable modelling, parents who had positive attitudes toward vaccines (odds ratio [OR] 9.9, 95% CI 4.7-21.1), those who were influenced by subjective norms (OR 9.2, 95% CI 6.6-12.9), those who felt that the vaccine had limited influence on sexual behaviour (OR 3.2, 95% CI 2.2-4.6) and those who thought someone they knew was likely to get cervical cancer (OR 1.5, 95% CI 1.1-2.1) were more likely to intend that their daughters receive the HPV vaccine. Parents who were older (v. younger) (OR 0.6, 95% CI 0.4-0.8) and those who resided in British Columbia or Yukon Territory (v. Atlantic Canada) (OR 0.5, 95% CI 0.3-0.9) were less likely to intend that their daughters receive the HPV vaccine.
Most of the parents surveyed intended that their daughters would receive vaccination against HPV. Overall attitudes toward vaccines in general and toward the HPV vaccine in particular constituted the most significant predictor of parental intention with regard to vaccination.

Full text

Research
CMAJ • December 4, 2007 • 177(12)
© 2007 Canadian Medical Association or its licensors
11550066
T
he vaccine against the human papillomavirus (HPV)
represents a major step toward the prevention of cer-
vical cancer.
1,2
HPV is a sexually acquired virus, and
mathematical modelling and economic analyses have
demonstrated that the vaccine’s maximum benefit in terms
of preventing cervical cancer is achieved when vaccination
programs target female and possibly male adolescents be-
fore their sexual debut, likely before the age of 12 years.
3
The
clinical efficacy and safety of the currently available HPV
vaccine have been established,
4
but concerns have been
raised that parents may be reluctant to have their children
undergo vaccination at this age, because of a belief that do-
ing so might be interpreted to mean that they are condoning
or even promoting earlier and more frequent sexual activity.
Since parental attitudes play a crucial role in vaccination up-
take and can provide direction for messaging and education
in support of vaccination uptake,
5
we sought to determine
parental intentions to have daughters vaccinated against
HPV and the factors that predict those intentions.
Methods
Recruitment
Invited participants were men and women at least 19 years of
age who were parents or guardians of children between 8 and
18 years of age and who could respond to questions in Eng-
lish or French. The participants were recruited from across
Canada between June 2006 and March 2007 by random-digit
dialling. Respondents were offered an opportunity to partici-
pate in a draw for a gift.
Development of survey tool
The survey was based on the theory of planned behaviour.
6
In
brief, this psychological model of behaviour change parses
out the elements that contribute to an actual behaviour or the
most proximate measure of behaviour change, known as be-
DOI:10.1503/cmaj.071022
Gina S. Ogilvie MD MSc, Valencia P. Remple PhD, Fawziah Marra PharmD, Shelly A. McNeil MD,
Monika Naus MD MHSc, Karen L. Pielak MSN, Thomas G. Ehlen MD, Simon R. Dobson MD,
Deborah M. Money MD, David M. Patrick MD MHSc
Parental intention to have daughters receive the human
papillomavirus vaccine
Background: Concerns have been raised that parents may
be reluctant to have their daughters receive the human pa-
pillomavirus (HPV) vaccine, because of a belief that doing so
might be interpreted as condoning earlier and more fre-
quent sexual activity. We determined intentions regarding
vaccination among Canadian parents and factors that pre-
dicted parental intention to have their daughters vaccinated
against HPV.
Methods: Parents of children 8–18 years of age, recruited
from across Canada, were asked to respond to questions in
the context of a grade 6, publicly funded, school-based HPV
vaccine program. We performed backward logistic regres-
sion analysis to identify factors predictive of parents’ inten-
tion to have their daughters vaccinated against HPV.
Results: Of the 1350 respondents with female children, more
than 70% (73.8%; 95% confidence interval [CI] 71.5%–
76.1%) intended to have their daughters undergo vaccina-
tion against HPV. In multivariable modelling, parents who
had positive attitudes toward vaccines (odds ratio [OR] 9.9,
95% CI 4.7–21.1), those who were influenced by subjective
norms (OR 9.2, 95% CI 6.6–12.9), those who felt that the
vaccine had limited influence on sexual behaviour (OR 3.2,
95% CI 2.2–4.6) and those who thought someone they knew
was likely to get cervical cancer (OR 1.5, 95% CI 1.1–2.1) were
more likely to intend that their daughters receive the HPV
vaccine. Parents who were older (v. younger) (OR 0.6, 95%
CI 0.4–0.8) and those who resided in British Columbia or
Yukon Territory (v. Atlantic Canada) (OR 0.5, 95% CI 0.3–0.9)
were less likely to intend that their daughters receive the
HPV vaccine.
Interpretation: Most of the parents surveyed intended that
their daughters would receive vaccination against HPV.
Overall attitudes toward vaccines in general and toward the
HPV vaccine in particular constituted the most significant
predictor of parental intention with regard to vaccination.
Abstract
CMAJ
2007;177(12):1506-12
From the University of British Columbia (Ogilvie, Remple, Marra, Naus,
Ehlen, Dobson, Money, Patrick), Vancouver, BC; the Canadian Centre for
Vaccinology (McNeil), Dalhousie University, Halifax, NS; the British Colum-
bia Centre for Disease Control (Ogilvie, Naus, Pielak, Patrick), Vancouver,
BC; and the Women’s Health Research Institute (Money), Provincial Health
Services Authority, Vancouver, BC
Une version française de ce résumé est disponible à l’adresse
www.cmaj.ca/cgi/content/full/177/12/1506/DC1

Research
CMAJ • December 4, 2007 • 177(12)
11550077
haviour intention. The survey tool was developed inductively,
with content created through an extensive literature search
exploring factors that affect vaccine-related behaviour
4,7–9
and
through an elicitation survey of 10 parents to determine the
key beliefs and attitudes related to their intention to have a
child vaccinated against HPV. A focus group of 10 parents
pilot-tested a draft version of the survey, providing feedback
on its content, their comprehension and domains of rele-
vance. The final survey was translated into French, and the
translation was verified by having the French version back-
translated into English; no significant errors were noted.
For each participant, the following demographic character-
istics were assessed: age and sex of the respondent; region of
residence; number of children and their sex and age; respon-
dent’s education, cultural background and religious affiliation;
and household composition (e.g., 1- or 2-parent household).
At the start of the survey, each participant was asked about ad-
herence to recommended vaccination schedules for his or her
children, about knowledge of cervical cancer and HPV, and
about the likelihood that someone the participant knows will
get cervical cancer (assessed by means of a 7-point Likert scale,
where 1 = strongly disagree, 4 = neutral and 7 = strongly agree).
One of several trained research interviewers then read a stan-
dardized script, providing the participant with information
about HPV, the HPV vaccine, the role of HPV in cervical cancer,
the nature of HPV transmission and the efficacy of the HPV vac-
cine. The vaccine description did not use proprietary names,
was not product specific and referred to the efficacy of the vac-
cine against HPV related to cervical cancer and not HPV related
to genital warts. The participant was next asked to respond to a
series of questions in the context of a grade 6 (students 11–12
years of age), publicly funded, school-based HPV vaccination
program, including a question about the intention to have his
or her daughter receive the HPV vaccine. The participant was
also asked about 4 specific psychological constructs that could
predict an intention to vaccinate: attitudes toward vaccines in
general and toward the HPV vaccine in particular, subjective
norms about HPV vaccination (perceptions of others’ recom-
mendations about whether one should have a daughter un-
dergo vaccination), perceived behavioural control over HPV
vaccination (perceptions about the relative ease or difficulty of
having a daughter vaccinated against HPV) and attitudes to-
ward the influence of HPV vaccination on the sexual behaviour
of adolescents. For each construct, 2–6 items were assessed by
means of a 7-point Likert scale, as described earlier.
The study received ethics approval from the Behavioural
Research Ethics Board at the University of British Columbia.
Sample size
Previous studies have reported that 70% of parents intend to
have their children vaccinated against HPV.
7–9
To generate a
national estimate of parental intention with a 95% confidence
interval of ± 3%, at least 896 participants were needed.
Analysis
We conducted descriptive analyses of demographic character-
istics. We calculated mean values for the psychological con-
struct scales and established item reliability for the scales us-
ing Cronbach’s α, values of at least 0.6 indicating acceptable
internal consistency. For scale items, aggregated scores were
dichotomized, with a mean value of 4.5 as a cutoff and scores
of 4.5 or greater indicating a generally positive value (i.e., a
positive attitude, perception of behavioural control or subjec-
tive norm). We conducted bivariate analyses to compare the
responses of parents who intended to have their daughters
vaccinated against HPV with those of parents who did not in-
tend to do so. For these remaining analyses, we defined in-
tention to vaccinate as a response of 5 or greater on the Likert
scale to the statement “I intend to have my daughter(s) re-
ceive the HPV vaccine (once it becomes available).” Respon-
dents who did not agree with this statement or gave a neutral
response were coded as not intending to vaccinate. We in-
cluded variables that achieved
p
< 0.05 in a multivariable
model to achieve a best-fit model. We performed backward
logistic regression analysis to calculate adjusted odds ratios
(ORs) to identify the factors predictive of parents’ intention to
have their daughters vaccinated against HPV.
Results
Between June 2006 and March 2007, calls were made to a total
of 32 834 in-service telephones across Canada. Of the 23 969
homes where an answer was obtained within 4 calls, 3979 had
eligible candidates, of whom 2109 (53.0%) consented to par-
ticipate and 2083 completed the survey. About three-quarters
of the respondents were female, and most had no more than 3
children; about half had heard of HPV but only one-quarter
knew that the virus is transmitted through sexual contact
(Table 1). Of the 1350 (64.8%) respondents with one or more
female children, 73.8% (95% CI 71.5%–76.1%) reported that
they intended to have their daughters vaccinated against HPV.
In different regions of the country, the intention to vaccinate
varied, from a low of 62.8% (95% CI 60.2–65.4) in British Co-
lumbia and Yukon Territory to a high of 82.6% (95% CI
80.6–84.6) in Atlantic Canada (
p
< 0.01) (Table 2).
The internal reliability of the psychological constructs was
acceptable (Cronbach’s α≥0.6) for the 3 constructs and lim-
ited for perceived behavioural control (Table 3). In the bivari-
ate analysis, we found that the intention to vaccinate was
associated with age, sex and region of residence of the respon-
dent, household composition, uptake of childhood vaccina-
tion, awareness and knowledge of HPV, belief that someone
the respondent knew would get cervical cancer, overall atti-
tudes toward vaccines and the HPV vaccine, subjective norms,
perceived behavioural control of the decision to vaccinate and
perceived influence of vaccination on sexual behaviour (Table
4). Cultural background, education, religious affiliation and
role of religious beliefs in daily decisions were not associated
with intention to vaccinate. In addition to the variables that
were significant in bivariate modelling, we included the role of
religion in daily decisions in the multivariable modelling,
given perceptions that this variable would have an important
role in decision-making related to the HPV vaccine.
10,11
In the
multivariable modelling, we found that parents who had posi-
tive attitudes toward vaccines in general and the HPV vaccine
in particular, those who were influenced by subjective norms,

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CMAJ • December 4, 2007 • 177(12)
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those who felt that the vaccine had limited influence on sexual
behaviour, those who believed that someone they knew would
get cervical cancer, those who were younger, and those resid-
ing in Atlantic Canada (v. British Columbia or the Yukon Terri-
tory) were significantly more likely to intend that their daugh-
ters undergo HPV vaccination (Table 4).
Interpretation
More than 70% of the parents of girls between the ages of 8
and 18 years who were surveyed in this national study indi-
cated an intention to have their daughters receive the HPV
vaccine in school-based, publicly funded vaccination pro-
grams for girls 11 and 12 years of age. This estimate, although
consistent with published international estimates,
7,9,11–14
is
probably conservative, because parents who reported that
they were “neutral” on the issue of having their daughters re-
ceive the vaccine were coded in our analysis as not intending
to vaccinate. The strongest predictor of parental intention to
vaccinate was parental attitudes toward vaccines in general
and toward the HPV vaccine in particular. Recommendations
in favour of HPV vaccination from health care professionals
(physicians in particular), family and friends, and community
leaders also constituted an important predictor of parental in-
Table 1: Baseline characteristics, knowledge and attitudes of study participants (n = 2083)
Characteristic
No. (%) of
participants Characteristic
No. (%) of
participants
Age, yr
19–29
30–39
40–49
50–59
≥ 60
Data missing
Region of residence
British Columbia or Yukon Territory
Prairie provinces (Alberta, Saskatchewan,
Manitoba), Nunavut or Northwest Territories
Ontario
Quebec
Atlantic Canada
Data missing
Sex
Male
Female
Data missing
Cultural background (self-identified)
White
Aboriginal
Other
Educational level
High school diploma or less
More than high school diploma
No. of children
1
> 1
Data missing
Household composition
Single parent
2 parents
Guardian, extended, blended
Data missing
40
619
1140
249
18
17
407
402
675
343
203
53
493
1530
60
1738
47
298
558
1525
891
1184
8
359
1555
145
24
(1.9)
(29.7)
(54.7)
(12.0)
(0.9)
(0.8)
(19.5)
(19.3)
(32.4)
(16.5)
(9.7)
(2.5)
(23.7)
(73.5)
(2.9)
(83.4)
(2.3)
(14.3)
(26.8)
(73.2)
(42.8)
(56.8)
(0.4)
(17.2)
(74.7)
(7.0)
(1.2)
Religious affiliation
None
Catholic Christian
Protestant Christian
Muslim
Jewish
Other
Data missing
Religion guides daily decisions
Disagree
Agree
Data missing
Children received childhood vaccines
No
Some or all
Data missing
Ever heard of HPV
No
Yes
Data missing
Knowledge of HPV transmission
No
Yes
Ever received a diagnosis of cancer
No
Yes
Missing
Know anyone who has had cancer
No
Yes
Data missing
Likely that someone you know will get
cancer of cervix in her lifetime
No
Yes
414
684
360
39
22
552
12
504
1035
544
14
2061
8
971
1108
4
1520
563
1955
127
1
211
1867
5
617
1466
(19.9)
(32.8)
(17.3)
(1.9)
(1.1)
(26.5)
(0.6)
(24.2)
(49.7)
(26.1)
(0.7)
(98.9)
(0.4)
(46.6)
(53.2)
(0.2)
(73.0)
(27.0)
(93.9)
(6.1)
(< 0.1)
(10.1)
(89.6)
(0.2)
(29.6)
(70.4)
Note: HPV = human papillomavirus.

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Table 3: Results of psychological construct scales
Attitude or norm Mean score* (SD)
Cronbach’s α†
Attitudes toward vaccines in general and the HPV vaccine in particular
(n = 2021)
Childhood vaccines are beneficial 6.2 (1.1)
HPV vaccine is beneficial for girls 6.0 (1.3)
HPV vaccine is beneficial for boys 5.8 (1.4)
Cervical cancer is a serious illness 6.7 (0.7)
HPV vaccine is effective in preventing cervical cancer 5.4 (1.2)
HPV vaccine is safe 4.6 (1.1)
Overall 5.8 (0.8) 0.8
Subjective norms (n = 1546)
Physician’s recommendation to vaccinate is influential 6.2 (1.4)
Public health nurse’s recommendation to vaccinate is influential 5.7 (1.6)
Recommendations of friends or family to vaccinate are influential 4.8 (1.7)
Teacher’s or principal’s recommendation to vaccinate is influential 4.6 (1.7)
Spiritual leader’s recommendation to vaccinate is influential 4.1 (1.9)
Overall 5.1 (1.4) 0.9
Direct perceived behavioural control (n = 2072)
Respondent is confident that he or she could have children receive
vaccine 6.0 (1.1)
Decision to have child undergo vaccination is within parent’s control 5.8 (1.7)
Overall 5.9 (1.1) 0.3
Attitudes toward influence of HPV vaccine on sexual behaviour (n = 2062)
Important that children be vaccinated against HPV before sexual debut 5.9 (1.4)
HPV vaccine will not make children sexually active at an earlier age 5.8 (1.6)
Adolescents who receive the HPV vaccine will not be encouraged
to engage in unsafe sex 5.5 (1.7)
Adolescents who receive HPV vaccine will not have a higher number
of sexual partners
5.7 (1.5)
Adolescents who practise safe sex will avoid HPV acquisition 4.2 (1.9)
Overall 5.4 (1.0) 0.6
Note: HPV = human papillomavirus, SD = standard deviation.
*Responses relate to a 7-point Likert scale.
†Item reliability for the psychological construct scales was established by means of Cronbach’s α, where a value of at least 0.6 indicates
acceptable internal consistency.
Table 2: Regional representation and crude estimates of parental intention to have daughters receive HPV vaccine
Region of Canada % of sample (no.) % of population*
Parental intention to have daughters
receive HPV vaccine (95% CI)†
British Columbia or Yukon Territory 19.5 (407) 13.3 62.8 (60.2–65.4)
Prairie provinces, Nunavut or
Northwest Territories 19.3 (402) 17.0 77.4 (75.2–79.6)
Ontario 32.4 (675) 38.9 75.3 (73.0–77.6)
Quebec 16.5 (343) 23.5 77.5 (75.3–79.7)
Atlantic Canada 9.7 (203) 7.3 82.6 (80.6–84.6)
Overall 73.8 (71.5–76.1)
Note: HPV = human papillomavirus, CI = confidence interval.
*According to data from Statistics Canada for 2005.
17
†Estimates and 95% CIs are based on responses from the 1350 participants who had female offspring.

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tention to vaccinate. In contrast, cultural background, educa-
tion, religious affiliation and role of religious beliefs in daily
decisions, all of which might be expected to influence such
decisions, were not associated with parental intention to
vaccinate.
Just over 20% of the parents of girls (285/1350) expressed
concerns about the influence of the HPV vaccine on sexual be-
haviour. Along with parental age, such concerns represented
a significant predictor of the intention to vaccinate. This find-
ing may be related to different attitudes among younger ver-
sus older parents regarding the implications of sexual health
initiatives on the sexual behaviours of youth. Parents need re-
assurance that sexual health initiatives and receipt of a vac-
cine for a sexually acquired virus that causes cancer is unlikely
to promote unsafe sexual activity.
15,16
Intention to vaccinate varies by region, from about 63% in
British Columbia or the Yukon Territory to over 80% in At-
lantic Canada (Table 2).
17
Regional variations in vaccination
rates are not unusual,
18,19
although childhood vaccination
rates in British Columbia are comparable to those in other
provinces where such assessments are conducted. These
findings could be due in part to the dynamic backdrop of the
marketing of the HPV vaccine Gardasil (Merck) in North
America in the past year.
20
However, our analysis did not re-
veal any significant difference in intention to vaccinate with
the HPV vaccine between parents recruited in the first half of
the study and those recruited in the latter half (data not
shown), and knowledge of HPV was included in the multi-
variable modelling. Further assessment is required to under-
stand the reasons underpinning the difference in parental at-
Table 4: Bivariate and multivariable analysis of predictors of intention to have daughters receive the HPV vaccine (part 1)
Characteristic
No. (%) with intention
to vaccinate
Unadjusted odds ratio
(95% CI)
Adjusted odds ratio* (95% CI)
n = 1269
Age, yr n = 1341
≤ 39
339 (80.3) 1.0 1.0
> 40 652 (70.9) 0.6 (0.5–0.8)† 0.6 (0.4–0.8)
Region of residence n = 1324
British Columbia or Yukon Territory 169 (62.8) 0.4 (0.2–0.6)† 0.5 (0.3–0.9)
Prairie provinces, Nunavut or Northwest
Territories
205 (77.4) 0.7 (0.4–1.2) 1.5 (0.8–2.8)
Ontario 324 (75.3) 0.6 (0.4–1.0) 1.3 (0.7–2.3)
Quebec 172 (77.5) 0.7 (0.4–1.2) 1.6 (0.8–3.1)
Atlantic Canada 114 (82.6) 1.0 1.0
Sex n = 1308
Male 299 (68.6) 1.0
Female 759 (75.2) 1.4 (1.0–1.8)†
Cultural background n = 1350
White 845 (74.4) 1.0
Aboriginal 23 (79.3) 1.3 (0.5–3.3)
Other 128 (68.8) 0.8 (0.5–1.1)
Education level n = 1350
High school diploma or less 265 (76.8) 1.0
More than high school diploma 731 (72.7) 0.8 (0.6–1.0)
No. of children n = 1344
1 334 (75.6) 1.0
> 1 660 (73.2) 0.9 (0.7–1.1)
Household composition n = 1338
2 parents 741 (72.5) 1.0
Not 2 parents 250 (79.1) 1.4 (1.1–1.9)†
Religious affiliation n = 1350
None 196 (75.4) 1.0
Any 800 (73.4) 0.9 (0.7–1.2)
Religion guides daily decisions n = 1350
Disagree 509 (74.9) 1.0
Agree 487 (72.7) 0.9 (0.7–1.1)

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titudes toward the HPV vaccine in British Columbia and the
Yukon Territory compared with Atlantic Canada.
There were some limitations to our study. We used a
random-digit dialling method, which can result in a recruit-
ment bias toward more educated individuals
21
and may under-
recruit participants from rural or remote regions. In addition,
the response rate (about 55%) was slightly less than that re-
ported by others; however, given the large sample size in our
study, this likely does not represent a threat to the validity of
the findings. The internal consistency of one scale item, per-
ceived behavioural control, was poor (Cronbach’s α = 0.3)
(Table 3). However, this scale just achieved significance in the
bivariate analysis and was not significant in the multivariable
modelling. In contrast, the scales that were highly significant
in the multivariable modelling were also highly internally con-
sistent. In addition, there was overrepresentation of respon-
dents from some regions (Atlantic Canada, Prairie provinces,
and British Columbia or the Yukon Territory) and underrepre-
sentation of respondents from the other regions, relative to
their representation in the national population (Table 2). Re-
gardless, given the relatively narrow confidence intervals for
the estimates of intended vaccination uptake in these regions,
our study provides precise estimates of intended vaccination
rates in these areas. Despite these limitations, our findings are
consistent with existing international literature, including our
observation that most parents intend to have their daughters
receive the HPV vaccine
13
and our findings as to key predictors
of intention to vaccinate.
11,12,14,22,23
The HPV vaccine is an important element in efforts to pre-
vent cervical cancer in Canada. Recent funding announce-
Table 4: Bivariate and multivariable analysis of predictors of intention to have daughters receive the HPV vaccine (part 2)
Characteristic
No. (%) with intention
to vaccinate
Unadjusted odds ratio
(95% CI)
Adjusted odds ratio* (95% CI)
n = 1269
Children have received childhood vaccines n = 1344
No 1 (9.1) 1.0
Some or all 992 (74.4) 29.0 (3.7–228.0)†
Ever heard of HPV n = 1348
No 420 (69.4) 1.0
Yes 575 (77.4) 1.5 (1.2–1.9)†
Knowledge of HPV transmission n = 1350
No 699 (71.7) 1.0
Yes 297 (79.2) 1.5 (1.1–2.0)†
Ever received a diagnosis of cancer n = 1350
No 936 (73.5) 1.0
Yes 60 (77.9) 1.3 (0.7–2.2)
Know anyone who has had cancer n = 1348
No 92 (71.9) 1.0
Yes 903 (74.0) 1.1 (0.7–1.7)
Likely that someone you know will get cancer of cervix n = 1350
No 264 (64.7) 1.0 1.0
Yes 732 (77.7) 1.9 (1.5–2.5)† 1.5 (1.1–2.1)
Attitudes toward vaccines and HPV vaccine n = 1350
Negative 10 (10.1) 1.0 1.0
Positive 986 (78.8) 33.2 (17.0–64.6)† 9.9 (4.7–21.1)
Subjective norms n = 1349
Not influential 162 (39.7) 1.0 1.0
Influential 833 (88.5) 11.7 (8.8–15.5)† 9.2 (6.6–12.9)
Perceived behavioural control n = 1349
Not able to control 145 (66.2) 1.0
Able to control 850 (75.2) 1.6 (1.1–2.1)†
Perceived influence of vaccine on sexual behaviour n = 1350
Negative influence 144 (50.5) 1.0 1.0
Limited influence 852 (80.0) 3.9 (3.0–5.2)† 3.2 (2.2–4.6)
Note: HPV = human papillomavirus, CI = confidence interval.
*Adjusted for variables that were significant in bivariate analyses and for the role of religion in daily decisions.
†p < 0.05.

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ments by the federal government
24
and announcements of
HPV vaccine programs by the Ontario
25
and Nova Scotia
26
governments underscore the need to expeditiously define key
contributors to optimal HPV vaccine uptake in Canada. In
this national survey, we found that the majority of responding
parents would have their daughters vaccinated against HPV in
the context of a publicly funded, school-based program of-
fered in grade 6. Specific parental characteristics were associ-
ated with the intention to not have daughters vaccinated.
Health policy-makers and practitioners should ensure that
planning for HPV vaccine implementation addresses these is-
sues to ensure optimal uptake of this efficacious vaccine.
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This article has been peer reviewed.
Competing interests: None declared for Monika Naus, Karen Pielak, Thomas
Ehlen, Deborah Money or David Patrick. Gina Ogilvie received research grants
from Merck Frosst to conduct other HPV-related studies. Valencia Remple has
given several HPV-related talks and has co-chaired a series of classes and re-
search planning workshops on HPV that were sponsered through educational
grants from Merck Frosst and GlaxoSmithKline. Fawziah Marra received an
honorarium and travel payment from Merck Frosst to give a talk in May 2007
at the Canadian Pharmacists Association on vaccination by pharmacists.
Shelly McNeil received honoraria from Merck Frosst and GlaxoSmithKline for
speaking to physician groups about HPV vaccines, and she received unre-
stricted grant funding from GlaxoSmithKline to conduct research about
physician attitudes regarding HPV vaccines. Simon Dobson received hono-
raria and travel assistance from Merck Frosst and GlaxoSmithKline.
Contributors: The study was conceived by all of the authors. Study design
was led by Gina Ogilvie and Valencia Remple, with assistance from the other
authors. Gina Ogilvie and Valencia Remple supervised the study and con-
ducted the data analysis. The manuscript was prepared by Gina Ogilvie with
assistance from Valencia Remple. All of the authors revised the manuscript
and approved the final version of the submitted publication.
Acknowledgements: Funding for the study was provided by the Public Health
Agency of Canada and the BC Centre for Disease Control.
Correspondence to: Dr. Gina S. Ogilvie, Associate Director,
Division of STI/HIV Prevention and Control, BC Centre for
Disease Control, 655 West 12th Ave., Vancouver BC V5Z 4R4;
fax 604 775-0808; gina.ogilvie@bccdc.ca
For a series of articles that examine the consequences of human
papillomavirus (HPV) and the efficacy of HPV vaccines, see the
August 28 issue of
CMAJ
(available at www.cmaj.ca). A series of
letters on this subject may be found on page 1524 in the current issue.