Intention of parents to have male children vaccinated with the human papillomavirus vaccine ; G S Ogilvie, 1,3 V P Remple, 1 F Marra, 1,3 S A McNeil, 2 M Naus, 1,3 K Pielak, 3 T Ehlen, 1 S Dobson, 1 D M Patrick, 1,3 D M Money 1,4 1 University of British Columbia, Canada; 2 Canadian Centre for Vaccinology, Dalhousie University, Canada; 3 British Columbia Centre for Disease Control, Canada; 4 Women’s Health Research Institute, British Columbia Women’s Hospital, Canada Correspondence to: Gina Ogilvie, th Associate Director, Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Assistant Professor, Department of Family Practice, University of British Columbia, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4; gina.ogilvie@bccdc.ca Accepted 9 April 2008 Published Online First ABSTRACT Background: Although already approved for use in males in some jurisdictions, there is little information about parental attitudes toward having their sons receive the human papillomavirus (HPV) vaccine. The goal of this study was to ascertain parental intentions to vaccinate their sons with an HPV vaccine and to determine factors that predict this intention. Methods: Parents of children aged 8–18 years were recruited from across Canada through random digit dialling. Participants were asked to respond to a series of questions in the context of a Grade 6 (age 11/12 years old), publicly funded school-based HPV vaccine pro- gramme, including their intention to vaccinate their sons with the HPV vaccine. Parents were also asked about a series of characteristics thought to predict intention to vaccinate as well as demographic characteristics. Backwards logistic regression was conducted to calculate adjusted odds ratios (AOR) to identify the factors that are predictive of parents’ intention to vaccinate their son(s) against HPV. Results: Of the 1381 respondents with male children, 67.8% (95% CI 65.3 to 70.3) intend to vaccinate their son(s) against HPV. Parents who had positive attitudes toward vaccines and the HPV vaccine in particular (AOR 41.5, 95% CI 9.5 to 181.7), parents who were influenced by subjective norms (AOR 7.8, 95% CI 5.8 to 10.5), parents who felt that the vaccine had limited influence on sexual behaviour (AOR 2.3, 95% CI 1.6 to 3.3) and parents who were aware of HPV (AOR 1.4, 95% CI 1.1 to 2.0) were significantly more likely to report an intention to vaccinate boys against HPV. In contrast, residence in British Columbia compared to Atlantic Canada (AOR 0.4, 95% CI 0.2 to 0.8) and higher education (AOR 0.7, 95% CI 0.5 to 0.9) were negatively associated with intention to vaccinate. Parents who reported an intention to vaccinate their daughters were also highly likely to report an intention to vaccinate their sons (k = 0.9, p,0.001). Discussion: The majority of Canadian parents would intend to have their male children receive the HPV vaccine in the context of a publicly funded school-based immunisation programme. Overall attitudes toward vaccine, recommendations from health professionals and impact of the vaccine on sexual practices are important predictors of intention to have a male child receive the HPV vaccine. Although well understood to be a highly prevalent sexually transmitted virus for both men and women, 12 the role and acceptability of the currently available human papillomavirus (HPV) vaccine to prevent HPV infection in boys and men remains unclear. Men are at risk for acquisition of both low risk HPV types, mostly responsible for genital warts, and high risk HPV types, responsible in part for development of anal and other HPV associated cancers. Men are also able to spread oncogenic HPV virus to women without having disease manifestations themselves. 34 The efficacy of the HPV vaccine in preventing acquisition and development of HPV-related lesions in men is not yet known, but is being examined in ongoing clinical trials. 3 However, it has been shown that young men demonstrate significant antibody responses to the HPV vaccine comparable to the responses seen in women. 56 Because HPV is a sexually acquired virus, and because it is necessary for the HPV vaccine to be received prior to HPV exposure for it to offer a preventive benefit against HPV infection and cervical cancer, mathematical modelling and economic analyses have demon- strated that the maximum benefit from the vaccine is obtained when population-based HPV vaccine strategies are targeted to adolescents prior to their sexual debut, likely before the age of 12 years. 78 In Canada, the HPV vaccine Gardasil was approved in August 2006 for young women aged 9–26 years, 9 and in February 2007 the Canadian National Advisory Committee on Immunizations recommended the HPV vaccine for all women aged 9–26 years, 10 with an emphasis on vaccinating young women prior to sexual debut. Currently, three provinces have publicly funded school-based HPV vaccine programmes for young women and additional provinces will be embarking on pro- grammes for young women in September 2008. 11 To date, given the lack of clinical efficacy data for the HPV vaccine in men, the HPV vaccine has not been approved or recommended for males in Canada, although some jurisdictions such as Australia have done so. 4 However, given the burden of illness of HPV in men, and the strong serological response of young men to the HPV vaccine, the HPV vaccine will likely offer a benefit to males as well. In anticipation of this approval, it will be important to determine if parents are willing to vaccinate their sons with the HPV vaccine, given concerns that have been raised about the acceptability to recipients and parents. 12 The goal of this study was to ascertain parental intentions to vaccinate their sons against HPV in Canada and to determine factors that predict parental intention to vaccinate their sons against HPV. METHODS Recruitment Men and women who were parents of children between the ages of 8–18 years, were at least 19 st29389 Module 1 Sexually Transmitted Infections 27/4/08 18:14:29 Topics: Original article Sex Transm Infect 2008;000:1–7. doi:10.1136/sti.2007.029389 1