Provider recommendation mediates the relationship between parental human papillomavirus (HPV) vaccine awareness and HPV vaccine initiation and completion among 13- to 17-year-old U.S. adolescent children

Clin Pediatr (Phila). 2015 Apr;54(4):371-5. doi: 10.1177/0009922814551135. Epub 2014 Sep 19.


Objectives: To examine the association between parental human papillomavirus (HPV) awareness and HPV vaccine initiation/completion based on 13- to 17-year-old US adolescent children and to explore whether these associations were mediated by provider recommendation.

Methods: We used publicly available National Immunization Survey-Teen 2011 data (11 236 adolescent girls and 12 328 boys).

Results: Weighted logistic regression analysis showed that parental HPV awareness and provider recommendation predicted HPV vaccine initiation and completion separately among both girls and boys, after adjusting for demographic and health care use variables. When provider recommendation and parental HPV awareness were entered in the model simultaneously, only provider recommendation was independently associated with HPV vaccine initiation and completion, demonstrating a mediation effect of provider recommendation.

Conclusions: Future studies are needed to better understand why physicians may not provide a recommendation for the HPV vaccine as well as to identify strategies to improve providers' ability to effectively communicate their recommendations.

Keywords: HPV vaccine completion; HPV vaccine initiation; human papillomavirus (HPV); mediation effects; parental HPV vaccine awareness; provider recommendation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel / psychology*
  • Humans
  • Male
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Infections / psychology
  • Papillomavirus Vaccines / therapeutic use*
  • Parents / psychology*
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data
  • Physicians
  • United States


  • Papillomavirus Vaccines