Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls

Am J Public Health. 2009 Jun;99(6):1137-42. doi: 10.2105/AJPH.2008.147876. Epub 2009 Apr 16.


Objectives: We investigated whether maternal attitude toward prevention, as indicated by history of seeking Papanicolaou (Pap) tests and contracting sexually transmitted infections, influenced human papillomavirus (HPV) vaccine uptake among their adolescent daughters.

Methods: We linked the electronic health records of girls aged 9 to 17 years with their mothers at Kaiser Permanente Southern California (n = 148 350 mother-daughter pairs). Personal identifying information was removed from the data set after the matching of daughters and mothers was completed. We used logistic regression models to detect associations between mothers' history of Pap tests and abnormal results, genital or anal warts, and other sexually transmitted infections and daughters' HPV vaccine initiation and 3-dose regimen completion.

Results: Mothers' testing history was associated with daughters' likelihood for vaccination across ethnic and neighborhood socioeconomic strata (overall odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.43, 1.52). Mothers' history of sexually transmitted infections was only modestly associated with daughters' vaccination. Mothers' testing history was positively associated with daughters' regimen completion (overall OR = 1.42; 95% CI = 1.31, 1.54).

Conclusions: Mothers' attitude toward prevention may influence HPV vaccine uptake among adolescent girls. The impacts of targeting mothers should be considered by HPV vaccination programs and investigated by further research.

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Child
  • Female
  • Humans
  • Logistic Models
  • Mothers / psychology*
  • Papanicolaou Test
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / therapeutic use*
  • Patient Acceptance of Health Care*
  • Preventive Health Services / statistics & numerical data
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / prevention & control
  • Socioeconomic Factors
  • Vaginal Smears


  • Papillomavirus Vaccines