Article| Volume 24, ISSUE 1, P14-24, January 2010

Participation in the Decision to Become Vaccinated Against Human Papillomavirus by California High School Girls and the Predictors of Vaccine Status



      State and national policymakers are actively debating the merits of legally mandating the human papillomavirus (HPV) vaccine.


      This was a cross-sectional pilot study designed to identify factors associated with HPV vaccination in 170 high school girls and the decision making by girls about vaccination.


      Overall, 48.4% participated in the vaccination decision making and 37.8% were vaccinated, but there were significant vaccine-related knowledge gaps. Girls often lacked basic knowledge necessary to make vaccine decisions. Vaccination was significantly associated with older age, vaccine information sources, and higher vaccine-related knowledge, but not with estimates of risk of HPV-related diseases, religion, or frequency of health care visits.


      This paper describes the first study to have identified factors associated with HPV vaccination among California high school girls and to have documented that a high percentage are participating in the vaccination decision making. These findings have implications for adolescent health education and nursing practice and provide new information relevant to the current public policy debates about mandatory vaccination.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Health Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brewer N.T.
        • Fazekas K.I.
        Predictors of HPV vaccine acceptability: A theory-informed, systematic review.
        Preventive Medicine. 2007; 45: 107-114
        • Brody J.L.
        • Annett R.D.
        • Scherer D.G.
        • Perryman M.L.
        • Cofrin K.M.
        Comparisons of adolescent and parent willingness to participate in minimal and above-minimal risk pediatric asthma research protocols.
        Journal of Adolescent Health. 2005; 37: 229-235
        • Dickey S.B.
        • Deatrick J.
        Autonomy and decision making for health promotion in adolescence.
        Pediatric Nursing. 2000; 26: 461-467
        • Dunne E.F.
        • Unger E.R.
        • Sternberg M.
        • McQuillan G.
        • Swan D.C.
        • Patel S.S.
        • et al.
        Prevalence of HPV infection among females in the United States.
        Journal of the American Medical Association. 2007; 297: 813-819
        • English A.
        • Shaw F.E.
        • McCauley M.M.
        • Fishbein D.B.
        Legal basis of consent for health care and vaccination for adolescents.
        Pediatrics. 2008; 121: S85-S87
      1. Gerberding, J. L. (2004). Report to Congress: Prevention of genital human papillomavirus infection. Department of Health and Human Services, Center for Disease Control and Prevention (Eds.), Atlanta, GA.

        • Future II Study Group
        Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection.
        Journal of Infectious Diseases. 2007; 196: 1438-1446
      2. Houppert, K. (2007, March 26). Who's afraid of Gardasil? The Nation. Retrieved September 13, 2008, from

        • Marshall H.
        • Ryan P.
        • Roberton D.
        • Baghurst P.
        A cross-sectional survey to assess community attitudes to introduction of human papillomavirus vaccine.
        Australian and New Zealand Journal of Public Health. 2007; 31: 235-242
        • Merck & Company
        Gardasil [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] full prescribing information. Author, Whitehouse Station, NJ2007
      3. National Center for Youth Law. (2006). California: minor consent rules for adolescent health care. Retrieved September 13, 2008, from

        • Raley J.C.
        • Followwill K.A.
        • Zimet G.D.
        • Ault K.A.
        Gynecologists' attitudes regarding human papilloma virus vaccination: A survey of Fellows of the American College of Obstetricians and Gynecologists.
        Infectious Diseases in Obstetrics and Gynecology. 2004; 12: 127-133
        • Runeson I.
        • Hallstrom I.
        • Elander G.
        • Hermeren G.
        Children's participation in the decision-making process during hospitalization: An observational study.
        Nursing Ethics. 2002; 9: 583-598
        • Runeson I.
        • Martenson E.
        • Enskar K.
        Children's knowledge and degree of participation in decision making when undergoing a clinical diagnostic procedure.
        Pediatric Nursing. 2007; 33: 505-511
        • Sandler A.D.
        • Watson T.E.
        • Levine M.D.
        A study of the cognitive aspects of sexual decision making in adolescent females.
        Journal of Developments and Behavioral Pediatrics. 1992; 13: 202-207
      4. SEER Cancer Statistics Review, 1975-2004. National Cancer Institute, Bethesda, MD2006
        • Steele C.M.
        • Aronson J.
        Stereotype threat and the test performance of academically successful African Americans.
        in: Jencks C. Phillips M. The Black-White test score gap (chapter 11, pp. 401–430). Brookings Institution Press, Washington, DC1998
        • Weiss J.A.
        Let us talk about it: Safe adolescent sexual decision making.
        Journal of the American Academy of Nurse Practitioners. 2007; 19: 450-458
        • Zimet G.D.
        • Mays R.M.
        • Sturm L.A.
        • Ravert A.A.
        • Perkins S.M.
        • Juliar B.E.
        Parental attitudes about sexually transmitted infection vaccination for their adolescent children.
        Archives of Pediatric and Adolescent Medicine. 2005; 159: 132-137


      Maya B. Mathur, Student, Castilleja School, Palo Alto, CA.


      Vandana S. Mathur, President, MathurConsulting, Woodside, CA.


      David B. Reichling, Researcher, University of California–San Francisco, San Francisco, CA.