Do correlates of HPV vaccine initiation differ between adolescent boys and girls?

Background: Guidelines now recommend that adolescents routinely receive human papillomavirus (HPV) vaccine. Because little is known about uptake among boys, we assessed HPV vaccine initiation in a population-based sample of adolescent boys and girls. Methods: We analyzed weighted data from 751 parents who reported on an 11- to 17-year-old son or daughter for the 2010 North Carolina Child Health Assessment and Monitoring Program survey. Stratified multivariate logistic regression analyses identified correlates of HPV vaccine initiation separately for boys and girls. 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 age and having received meningococcal vaccine. Among sons, initiation of HPV vaccine 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 neither white nor black (OR = 3.26, 95% CI, 1.06-10.04). When asked to give the main reason for not vaccinating their child against HPV, parents of unvaccinated sons were more likely than those of daughters to report not getting a provider's recommendation or not being aware that the vaccine was available for their child, but less likely to report concern about safety (p< 0.01). At least 86% of unvaccinated children had missed an opportunity to receive HPV vaccine. Conclusions: HPV vaccine correlates and concerns varied for parents of boys and girls. To improve very low levels of uptake among boys, providers should recommend HPV vaccine concomitant with other adolescent vaccines.