Pap screening behavior in mothers and HPV vaccine uptake in adolescent girls

The newly approved human papillomavirus (HPV) vaccine for girls and young women presents an opportunity for the prevention of cervical cancer and other HPV-related conditions. Unlike many childhood vaccinations, however, it is not required, thus begging the question of the determinants for vaccine uptake. We investigated the hypothesis that mother's attitude towards preventive measures as indicated by her Pap screening behavior and history of sexually transmitted infections (STI) influence HPV vaccine uptake. Method: We identified girls ages 9-17 years who were Kaiser Permanente Southern California health plan members between Oct 2006-Sep 2007, and linked their records to their mothers'. The daughter's HPV vaccination status was determined along with the mother's history of Pap screening, abnormal pap results, genital/anal warts, and other STIs. We assessed the association between these maternal characteristics and vaccination status in logistic regression models adjusting for demographics, provider specialty, and length of membership. Analyses were stratified by ethnicity and neighborhood income and education level. Results: Mother's Pap screening behavior was consistently associated with daughter's likelihood for HPV vaccination (overall odds ratio (OR)=1.66, 95% CI=1.43-1.52). Adjustment for ethnicity and neighborhood socioeconomic status did not change the results. Mother's histories of abnormal pap result, genital/anal warts, and other STIs were only moderately associated with HPV vaccination status (OR=1.11 [1.08-1.15], 1.18 [1.10-1.28], and 1.12 [1.03-1.21], respectively), with some suggestion of effect modification by ethnicity and socioeconomic status. Conclusion: These findings suggest that mother's attitude toward preventive measures and histories of STI may influence decisions about their daughter's HPV vaccination.