Parental perspectives on vaccinating children against sexually transmitted infections

Abstract

Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents’ risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies.

This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8–17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents’ reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents.

Introduction

Currently, hepatitis B vaccine is the only vaccine available that prevents a sexually transmitted infection (STI). However, a number of other STI vaccines are in various stages of development and testing, including those for the prevention of chlamydia (CT), gonorrhea (GC), genital herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV) (Barbosa-Cesnik, Gerbase, & Heymann, 1997; Hines, Ghim, & Jenson, 1998; Koutsky et al., 2002; Letvin, 1998; McLean et al., 1994; Stanberry et al., 2002). These are all infections for which the health and economic costs are enormous. For example, chlamydia infection can cause sterility in females; genital herpes is painful and, if transmitted to a newborn, can be life-threatening; and gonorrhea, if left untreated, can cause infections in other parts of the body. The progression of HIV infection into the fatal disease of AIDS is well known; however, HPV has become recognized as a key factor in the development of another life-threatening disease, cervical cancer. Therefore, it is clear that, once developed and made available, STI vaccines would have the potential to be invaluable tools for disease prevention (Stratton, Durch, & Lawrence, 2000).

Adolescents have been identified as a group at risk for STI because of high rates of sexual intercourse, inconsistent condom use, and multiple sexual partners (Centers for Disease Control and Prevention, 2002). In fact, research has documented that adolescents as a group are infected disproportionately with STIs, such as syphilis, gonorrhea, and chlamydia (Burstein et al., 1998). Early adolescents and preadolescents, therefore, would be excellent candidates for STI immunization. Further, there are several reasons that parents of adolescents are ideal participants in a study of STI vaccine acceptability. Firstly, research indicates that parents and their adolescent children agree that parents should have the authority to decide about health-related issues (Smetana, 1994). In addition, a study found that the best predictor of hepatitis B vaccine acceptance among adolescents was their perception that parents believed hepatitis B vaccination was important (Rosenthal, Kottenhahn, Biro, & Succop, 1995).

In light of these issues and the likely requirement for parents to consent for STI immunization of their children, the evaluation of parental attitudes will be central to understanding determinants of STI vaccine acceptance. This article presents findings from a qualitative study that used in-depth individual interviews to explore parents’ attitudes toward vaccines for genital herpes, HIV, HPV, and gonorrhea (GC) for their children. An understanding of these attitudes will be useful in informing educational interventions to promote the acceptance of STI vaccines once they become accessible to the public.