Journal of Community Health

, Volume 37, Issue 6, pp 1157–1163

Ohio Appalachia Public Health Department Personnel: Human Papillomavirus (HPV) Vaccine Availability, and Acceptance and Concerns Among Parents of Male and Female Adolescents

Original Paper


Public health departments (n = 48) serving the 32 counties of Ohio Appalachia were contacted to determine human papillomavirus (HPV) vaccine availability and to assess patient and parental attitudes, perceived barriers, and decisional differences about vaccination for male and female adolescents. Nurses or nursing supervisors in 46 of 48 health departments agreed to participate with 45 (97.8 %) reporting that HPV vaccines were available for males and females. HPV vaccination barriers reported most frequently were lack of knowledge about the vaccines, concerns about potential side effects, the newness of the HPV vaccines, and parents believing their children were not sexually active or were too young to receive an HPV vaccine. Provider reports of the primary differences in the acceptability of an HPV vaccine among parents of males compared to the parents of females were lack of awareness that an HPV vaccine was available for males, not understanding why the vaccine should be given to males, and fear of vaccination increasing sexual promiscuity among female adolescents. Half of the health departments (n = 24) reported that parents of females were more receptive toward HPV vaccination, 16 health departments reported no difference in acceptability based on gender of the child, and 5 health departments reported that parents of males were more receptive. This study suggests that there are different informational needs of males and females and parents of male and female children when making an informed decision about HPV vaccination. Findings highlight content to include in strategies to increase HPV vaccination rates among Appalachia Ohio residents.


HPV vaccines Cervical cancer Health care disparities Adolescent Appalachian region 


  1. 1.
    Hariri, S., Unger, E. R., Sternberg, M., et al. (2011). Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. Journal of Infectious, 204(4), 566–573.CrossRefGoogle Scholar
  2. 2.
    Nyitray, A. G., da Silva, R. J., Baggio, M. L., et al. (2011). The prevalence of genital HPV and factors associated with oncogenic HPV among men having sex with men and men having sex with women and men: The HIM study. Sexually Transmitted Diseases, 38(10), 932–940.PubMedCrossRefGoogle Scholar
  3. 3.
    Walboomers, J. M., Jacobs, M. V., Manos, M. M., et al. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. Journal of Pathology, 189(1), 12–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Munoz, N., Castellsague, X., de Gonzalez, A. B., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24(Suppl 3), S3/1–S3/10.Google Scholar
  5. 5.
    Lacey, C. J., Lowndes, C. M., & Shah, K. V. (2006). Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine, 24(Suppl 3), 35–41.CrossRefGoogle Scholar
  6. 6.
    Gillison, M. L., Chaturvedi, A. K., & Lowy, D. R. (2008). HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer, 113(10 Suppl), 3036–3046.PubMedCrossRefGoogle Scholar
  7. 7.
    Huang, B., Wyatt, S. W., Tucker, T. C., Bottorff, D., Lengerich, E., & Hall, H. I. (2002). Cancer death rates–Appalachia, 1994–1998. MMWR: Morbidity and Mortality Weekly Report, 51(24), 527–529.Google Scholar
  8. 8.
    Hopenhayn, C., Bush, H., Christian, A., & Shelton, B. J. (2005). Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states. Preventative Medicine, 41(5–6), 859–864.CrossRefGoogle Scholar
  9. 9.
    Lengerich, E. J., Tucker, T. C., Powell, R. K., et al. (2005). Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia. Journal of Rural Health, 21(1), 39–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Hopenhayn, C., King, J. B., Christian, A., Huang, B., & Christian, W. J. (2008). Variability of cervical cancer rates across 5 Appalachian states, 1998–2003. Cancer, 113(10 Suppl), 2974–2980.PubMedCrossRefGoogle Scholar
  11. 11.
    Wingo, P. A., Tucker, T. C., Jamison, P. M., et al. (2008). Cancer in Appalachia, 2001–2003. Cancer, 112(1), 181–192.PubMedCrossRefGoogle Scholar
  12. 12.
    Marmot, M., & Wilkinson, R. G. (2005). Social determinants of health. New York, NY: Oxford University Press.CrossRefGoogle Scholar
  13. 13.
    Warnecke, R. B., Oh, A., Breen, N., et al. (2008). Approaching health disparities from a population perspective: The National Institutes of Health Centers for Population Health and Health Disparities. American Journal of Public Health, 98(9), 1608–1615.PubMedCrossRefGoogle Scholar
  14. 14.
    Wewers, M. E., Katz, M., Fickle, D., & Paskett, E. D. (2006). Risky behaviors among Ohio Appalachian adults. Preventing Chronic Disease, 3(4), A127.PubMedGoogle Scholar
  15. 15.
    Yabroff, K. R., Lawrence, W. F., King, J. C., et al. (2005). Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment? Journal of Rural Health, 21(2), 149–157.PubMedCrossRefGoogle Scholar
  16. 16.
    Katz, M. L., Wewers, M. E., Single, N., & Paskett, E. D. (2007). Key informants’ perspectives prior to beginning a cervical cancer study in Ohio Appalachia. Qualitative Health Research, 17(1), 131–141.PubMedCrossRefGoogle Scholar
  17. 17.
    Schoenberg, N. E., Hopenhayn, C., Christian, A., Knight, E. A., & Rubio, A. (2005). An in-depth and updated perspective on determinants of cervical cancer screening among central Appalachian women. Journal of Women’s Health, 42(2), 89–105.Google Scholar
  18. 18.
    Lyttle, N. L., & Stadelman, K. (2006). Assessing awareness and knowledge of breast and cervical cancer among Appalachian women. Preventing Chronic Disease, 3(4), A125.PubMedGoogle Scholar
  19. 19.
    Markowitz, L. E., Dunne, E. F., Saraiya, M., Lawson, H. W., Chesson, H., & Unger, E. R. (2007). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR: Recommendations and Reports, 56(RR-2), 1–24.PubMedGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention. (2010). FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR: Morbidity and Mortality Weekly Report, 59(20), 626–629.Google Scholar
  21. 21.
    Centers for Disease Control and Prevention. (2010). FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR: Morbidity and Mortality Weekly Report, 59(20), 630–632.Google Scholar
  22. 22.
    Usher, W. T. (2012). Australian health professionals’ social media (Web 2.0) adoption trends: Early 21st century health care delivery and practice promotion. Australian Journal of Primary Health, 18(1), 31–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention. (2011). Recommendations on the use of quadrivalent human papillomavirus vaccine in males—Advisory Committee on Immunization Practices (ACIP). MMWR: Morbidity and Mortality Weekly Report, 60(50), 1705–1708.Google Scholar
  24. 24.
    Dorell, C., Stokley, S., Yankey, D., Liang, J., & Markowitz, L. (2010). National and state vaccination coverage among adolescents aged 13 through 17 years—United States. MMWR: Morbidity and Mortality Weekly Report, 60(33), 1117–1123.Google Scholar
  25. 25.
    Reiter, P. L., McRee, A. L., Kadis, J. A., & Brewer, N. T. (2011). HPV vaccine and adolescent males. Vaccine, 29(34), 5595–5602.PubMedCrossRefGoogle Scholar
  26. 26.
    Abramson, R., & Haskell, J. (2006). Encyclopedia of Appalachia. Knoxville, TN: University of Tennessee Press.Google Scholar
  27. 27.
    Campos-Outcalt, D., Jeffcott-Pera, M., Carter-Smith, P., Schoof, B. K., & Young, H. F. (2010). Vaccines provided by family physicians. The Annals of Family Medicine, 8(6), 507–510.CrossRefGoogle Scholar
  28. 28.
    Katz, M. L., Reiter, P. L., Kluhsman, B. C., et al. (2009). Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states. Vaccine, 27(24), 3195–3200.PubMedCrossRefGoogle Scholar
  29. 29.
    Omurtag, K., Jimenez, P. T., Ratts, V., Odem, R., & Cooper, A. R. (2012). The ART of social networking: How SART member clinics are connecting with patients online. Fertility and Sterility, 97(1), 88–94.PubMedCrossRefGoogle Scholar
  30. 30.
    Ohio Department of Health. (2012). Ohio Department of Health. Retrieved August 24, 2012, from
  31. 31.
    Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks, CA: Sage Publications.Google Scholar
  32. 32.
    Ohio Department of Health. (2012). Immunization summary for child care, head start, pre-school and school attendance. Ohio Administrative Code 5101:2-12-37 and Ohio Revised Code 3313.671 for school attendance. Retrieved August 24, 2012, from
  33. 33.
    Vadaparampil, S. T., Kahn, J. A., Salmon, D., et al. (2011). Missed clinical opportunities: Provider recommendations for HPV vaccination for 11–12 year old girls are limited. Vaccine, 29(47), 8634–8641.PubMedCrossRefGoogle Scholar
  34. 34.
    Daley, E. M., Vamos, C. A., Buhi, E. R., et al. (2010). Influences on human papillomavirus vaccination status among female college students. Journal of Women’s Health, 19(10), 1885–1891.PubMedCrossRefGoogle Scholar
  35. 35.
    Conroy, K., Rosenthal, S. L., Zimet, G. D., et al. (2009). Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. Journal of Women’s Health, 18(10), 1679–1686.PubMedCrossRefGoogle Scholar
  36. 36.
    Fernandez, M. E., Allen, J. D., Mistry, R., & Kahn, J. A. (2010). Integrating clinical, community, and policy perspectives on human papillomavirus vaccination. Annual Review of Public Health, 31, 235–252.PubMedCrossRefGoogle Scholar
  37. 37.
    Zimet, G. D., Weiss, T. W., Rosenthal, S. L., Good, M. B., & Vichnin, M. D. (2010). Reasons for non-vaccination against HPV and future vaccination intentions among 19–26 year-old women. BMC Women’s Health, 10, 27.PubMedGoogle Scholar
  38. 38.
    Ford, C. A., English, A., Davenport, A. F., & Stinnett, A. J. (2009). Increasing adolescent vaccination: Barriers and strategies in the context of policy, legal, and financial issues. Journal of Adolescent Health, 44(6), 568–574.PubMedCrossRefGoogle Scholar
  39. 39.
    Jain, N., Euler, G. L., Shefer, A., Lu, P., Yankey, D., & Markowitz, L. (2009). Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007. Preventive Medicine, 48(5), 426–431.PubMedCrossRefGoogle Scholar
  40. 40.
    Caskey, R., Lindau, S. T., & Alexander, G. C. (2009). Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey. Journal of Adolescent Health, 45(5), 453–462.PubMedCrossRefGoogle Scholar
  41. 41.
    Reiter, P. L., Brewer, N. T., & Smith, J. S. (2010). Human papillomavirus knowledge and vaccine acceptability among a national sample of heterosexual men. Sexually Transmitted Infections, 86(3), 241–246.PubMedCrossRefGoogle Scholar
  42. 42.
    Zimet, G. D., & Rosenthal, S. L. (2010). HPV vaccine and males: Issues and challenges. Gynecologic Oncology, 117(2 Suppl), S26–S31.PubMedCrossRefGoogle Scholar
  43. 43.
    Katz, M. L., Krieger, J. L., & Roberto, A. J. (2011). Human papillomavirus (HPV): College male’s knowledge, perceived risk, sources of information, vaccine barriers and communication. Journal of Men’s Health, 8(3), 175–184.PubMedCrossRefGoogle Scholar
  44. 44.
    Berenson, A. B., & Rahman, M. (2012). Gender differences among low income women in their intent to vaccinate their sons and daughters against human papillomavirus infection. Journal of Pediatric and Adolescent Gynecology, 25(3), 218–220.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.College of Public HealthThe Ohio State UniversityColumbusUSA
  2. 2.Division of Cancer Prevention and Control, Department of Internal Medicine, College of MedicineThe Ohio State UniversityColumbusUSA
  3. 3.Comprehensive Cancer CenterThe Ohio State UniversityColumbusUSA

Personalised recommendations