HPV vaccine initiation among adolescents in North Carolina: How do correlates and concerns differ for boys?

Background: Guidelines now recommend both male and female adolescents receive human papillomavirus (HPV) vaccine to prevent several types of cancer and genital warts. Because little is known about uptake among boys, we assessed HPV vaccine initiation in a population-based sample of adolescents. Methods: We analyzed weighted data from 751 parents of 11- to 17-year-old adolescents who completed the 2010 North Carolina Child Health Assessment and Monitoring Program survey. Stratified multivariate logistic regression analyses identified correlates of having initiated HPV vaccination separately for boys and girls. For unvaccinated adolescents, we also assessed parents' main reason for not vaccinating their child against HPV. Results: Only 14% of sons had received one or more doses of HPV vaccine compared to 44% of daughters (p<0.01). For both sons and daughters, vaccine initiation correlated with being older and having received meningococcal vaccine. Among sons, initiation was lower for those living in high income households (odds ratio [OR] = 0.22, 95% CI, 0.09-0.53) and higher for those whose race was reported as neither white nor black (OR = 3.26, 95% CI, 1.06-10.04). The most common reason for not vaccinating sons against HPV was not receiving a provider's recommendation (27%) or not being aware the vaccine was available for boys (17%). The most common reason for not vaccinating daughters was concern about safety (19%). Conclusions: HPV vaccine correlates and concerns differed for parents of boys and girls. To improve very low levels of uptake among boys, providers should recommend HPV vaccine alongside other adolescent vaccines.