Academic journal article Health Sociology Review

Beyond Health Beliefs: The Role of Trust in the HPV Vaccine Decision-Making Process among American College Students

Academic journal article Health Sociology Review

Beyond Health Beliefs: The Role of Trust in the HPV Vaccine Decision-Making Process among American College Students

Article excerpt

Introduction

The Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the world (Markowitz et al., 2016). Although most infections clear up on their own, HPV can cause warts on the hands, feet, and genital area and cancers of the cervix, head, neck, anus, penis, mouth, vagina, and vulva (Saraiya et al., 2015). Given the high prevalence of HPV and its association with several cancers, in particular cervical cancer, the first HPV vaccine that was introduced in the United States in 2006 held great promise to reduce the incidence of HPV-related cancers/other diseases.

The quadrivalent HPV vaccine, hailed as the 'first cervical cancer vaccine,' debuted on the United States market in 2006 as the most expensive and only gender-specific vaccine in history (Bryan, 2007). Administered in 3 doses, the vaccine protects against four of the over 100 strains of HPV, including two of 'high risk' strains that account for 70% of cervical cancer and two strains that are responsible for 90% of genital warts (Saraiya et al., 2015). The HPV vaccine is estimated to potentially prevent a majority of cervical, anal, oropharyngeal, and vaginal cancers, as well as some penile and vulvar cancers (Saraiya et al., 2015). Currently, there is also a 9-valent HPV vaccine that protects against an additional 5 strains of HPV that can lead to cancers, but neither vaccine can provide complete protection, as not all cancers are caused by the 4/9 HPV strains, or by HPV at all. Nonetheless, if widely adopted, the vaccines have the potential to significantly reduce HPV-related cancer prevalence.

Clinical trials established that the quadrivalent HPV vaccine is 99% effective in preventing HPV among women who have never had sexual intercourse, but only 44% effective for those who are sexually active and thus potentially already exposed to HPV (Ault, 2007). With only approximately 7% of American adolescents reporting having sex before the age of 13, the Center for Disease Prevention and Control (CDC) recommended the vaccine be administered to girls ages 11 and 12 in 2006 (Cavazos-Rehg et al., 2009). Subsequently, in 2011, the CDC expanded their recommendation to include boys aged 11/12 years old (CDC, 2011). In 2014, the CDC updated their recommendations to include the 9-valent vaccine and, in 2016, the routine HPV vaccination schedule was reduced from three to two doses (Meites, Kempe, & Markowitz, 2016). Approximately ten years after the release of the first HPV vaccine, only about 30% of girls and less than 2% of boys are vaccinated against HPV in the United States (Rahman, Islam, & Berenson, 2015). These estimates of HPV vaccination rates are considerably lower than the goal of 80% vaccination, which is approximately the percentage that is necessary to eradicate a disease by achieving herd immunity, in which enough people are vaccinated to protect those who are not vaccinated (Anderson & May, 1985). Thus, the potential of the HPV vaccine to significantly reduce HPV-related cancers and other disease incidence has been hindered by vaccination rates that are well below those needed for herd immunity.

To address low HPV vaccination, it is important to identify the factors that are correlated with HPV vaccination. One of the possible factors that contributes to low HPV vaccination is that the HPV vaccine incited a great deal of socio-political controversy. There were competing claims about the vaccine's side effects, compulsory HPV vaccination, adolescent female sexuality, and limited/unequal access to the expensive vaccine that necessitated 3 doctor visits (Siers-Poisson, 2008). Furthermore, pharmaceutical company Merck's mass marketing campaigns were accused of being overly aggressive and deceptive by 'making this vaccine's target disease cervical cancer, the sexual transmission of HPV was minimised, the threat of cervical cancer to all adolescents maximised, and the subpopulations most at risk practically ignored' (Rothman & Rothman, 2009, p. …

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