A sequential logit model of caretakers' decision to vaccinate children for the human papillomavirus virus in the general population

Abstract

Objectives: This study explores the predisposing, enabling, and need-based factors associated with parents' or guardians' decision to have their child initiate, continue, and complete the human papillomavirus (HPV) vaccine.

Methods: Parents and guardians of children between the ages of 9 and 17years who completed the 2010 Behavioral Risk Factor Surveillance System survey collected by the Center for Disease Control (CDC, 2010) were analyzed. Utilizing Andersen's health care beliefs model, we explored the sequential nature of the decision to vaccinate (i.e., the decision to receive the first, second, and third dose), thereby allowing the independent variables to vary across each transition.

Results: Among all children, 3.7% received exactly 1 shot, 16.3% received at least one shot, and 8.9% received all three shots. Among those who received at least one shot, 22.4% received exactly one shot, 23.7% received exactly 2 shots, and 54.9% completed all 3 shots. A differential impact was observed across transitions. Predisposing factors, such as being Hispanic (OR=1.9) and child age (OR=1.4), significantly predicted the decision to receive the first dose but enabling factors, such as having a regular physician (OR=4.5) and income (OR=.74) were more important for predicting completion.

Conclusions: The decision to initiate and complete HPV vaccination depends on a specific mix of enabling, predisposing, and need-based factors. Our analysis underscores the importance of modeling the vaccination decision in a manner that is consistent with how primary caregivers navigate real-life health care decisions for their children.

Keywords: Andersen's Socio-Behavioral Health Model; Cervical cancer; Human papillomavirus; Racial disparities in health; Vaccination.