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

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.