Do Default Policies Affect Parents' Consent Decisions for HPV Vaccination at School?

BACKGROUND: Although defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of default policies on parents' consent to their sons hypothetically receiving HPV vaccine at school.

METHODS: A national sample of 404 parents of adolescent sons ages 11-17 participated in an online 3x2 between-subjects factorial experiment during Fall 2010. One factor varied the default consent policy for sons receiving HPV vaccine at school (opt-in, opt-out, or neutral). The second factor varied the default number of vaccines sons would receive (HPV vaccine alone or HPV vaccine with two other recommended adolescent vaccines). The outcome was parents' consent to sons hypothetically receiving HPV vaccine at school. Analyses used factorial logistic regression.

RESULTS: Consent for sons to receive HPV vaccine was higher in the opt-in condition than the opt-out condition (OR=2.72, 95% CI: 1.06–7.00), among parents wanting their sons to get vaccinated in the next year. These parents were also more likely to provide consent if the request included other recommended adolescent vaccines than if it was for HPV vaccine alone (OR=2.21, 95% CI: 1.03–4.74). Defaults had no effect among parents undecided about HPV vaccination for their sons in the next year.

CONCLUSIONS: Parents' consent for school-located HPV vaccination may be higher when presented as an opt-in decision and other vaccines are included. Such low-cost, sustainable strategies may be particularly effective among parents wanting to vaccinate their sons.

FUNDING: Supported by a research grant from Merck, with support from UNC Lineberger.