Designing messages to motivate parents to get their preteenage sons vaccinated against human papillomavirus.

Human papillomavirus (HPV) is the most common STD in the United States and infects approximately 50% of sexually active males and females.1 The virus causes genital warts and is associated with cervical, vaginal, vulvar, anal, penile and oropharyngeal cancers.2–5 Compared with whites, racial and ethnic minorities, including blacks, Hispanics and American Indians, have a higher risk for STDs and HPV-related cancers, because they are more likely to engage in unsafe behaviors and to lack access to quality health care, among other factors.6,7 A vaccine against HPV was approved by the U.S. Food and Drug Administration (FDA) for both females (in 2006) and males (in 2009) aged 9–26 and is most effective when given before exposure to the virus.8 HPV vaccine for females is licensed to protect against genital warts, cervical, vaginal, vulvar and anal cancers; the male vaccine is licensed to protect against genital warts and anal cancers.9 The Advisory Committee on Immunization Practices (ACIP), part of the Centers for Disease Control and Prevention (CDC), recommends that routine HPV vaccination for both females and males aged 11–12 be included in the regular pediatric vaccine schedule.8,10 In 2009, when HPV vaccine for males was first approved by the FDA, ACIP’s recommendation was less emphatic and allowed males (and their parents) to decide, in collaboration with their health care professionals, whether they wanted to be immunized.8 Under this permissive recommendation, the CDC estimates that as of 2010, less than 2% of U.S. males aged 13–17 had had at least one dose of HPV vaccine. By late 2011, new data on the vaccine’s clinical efficacy in preventing anal cancers and estimates of lower-than-expected HPV vaccine uptake in females led ACIP to strengthen its recommendation by including routine vaccinations for boys aged 11–12 and catch-up vaccination in males aged 13–21.10 Underutilization and low parental awareness of the vaccine result in missed opportunities to reduce HPV and associated cancers in males.11–13 The few U.S. studies on parental acceptance of HPV vaccine for boys have been mostly positive.11,14–18 Nevertheless, HPV vaccine uptake among preteenage boys faces important challenges. For example, adolescent males are less likely than adolescent females to receive sexual information from their parents;12 and they visit health care providers less frequently as they get older than do adolescent females who have reproductive health care needs.19 In addition, providers are less likely to recommend HPV vaccine for preteenage patients than for teenagers because of parental refusal or reluctance to discuss sexual issues.14,20,21 Finally, parents have low awareness that the vaccine is recommended for boys.8 The HPV vaccine has been marketed primarily to prevent cervical cancer, rather than STDs.22 And ACIP’s recommendation in 2009 was based in part on the cost-effectiveness of vaccinating both genders mainly to prevent cervical cancer, rather than to improve males’ sexual and reproductive health.12 Thus, parents’ acceptance of the vaccine for their sons varies according to whether they perceive it mainly as preventing cervical cancer in females or as preventing cancers and genital warts in both genders.14 To optimize HPV vaccination in preteenage males, communication strategies are needed to motivate parents and providers to have boys vaccinated. Parents need to learn about the vaccine, why it is important, where to get it and how to pay for it.11 Therefore, providers need to be prepared and willing to discuss HPV vaccine with parents of preteenage boys.14 This article presents qualitative and quantitative data on parents’ knowledge and perceptions of HPV vaccine, and on the kinds of messages and images that best motivate parents to have their preteenage sons vaccinated.