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Demographic Factors Associated with School Nurses’ Role Regarding the

HPV Vaccine for Youth
Lee Owens, Brittany L. Rosen, and Hannah P. Catalano

ABSTRACT

The aim of this study was to examine the association between school nurses’ demographic
characteristics and their knowledge, attitudes, perception of role as opinion leader and professional
practice regarding the HPV vaccine. Participants were randomly selected and completed an online
survey. ANOVA tested group differences in geographic population, grade level being served, and
geographic region. School nurses working in metropolitan areas had positive attitudes and stronger
perceptions of being an opinion leader than in rural areas. School nurses serving high schools exhibited
stronger perceptions than nurses serving elementary level. These results suggest interventions should
focus on strengthening HPV vaccine attitudes and perceptions of their role as opinion leaders for rural
th
school nurses, and those serving K-8 grade levels.
Keywords: HPV vaccine, school nurses, knowledge, attitudes, opinion leaders

INTRODUCTION Unfortunately, HPV vaccine uptake for adolescents
was relatively low with 62.8% of girls and 49.8% of boys
A major advancement in combating human aged 13-17 years old having received the first dose of the
papillomavirus (HPV)-associated diseases came in 2006 three dose HPV vaccine series in 2014 (Reagan-Steiner et
for females (U.S. Department of Health and Human al., 2016). However, there was an update to the HPV
Services, 2016a) and 2009 for males (U.S. Department of vaccine dosing schedule in November 2016; the CDC
Health and Human Services, 2016b) when the HPV recommends that 11 to 12 year olds receive only two doses
vaccine gained approval for public administration by the of the HPV vaccine, but still requires three doses for those
Food and Drug Administration. This vaccine has afforded initiating between 15 and 26 years old (CDC, 2016).
adolescents and young adults the ability to prevent certain Although HPV vaccination rates are steadily improving,
types of HPV-associated health outcomes, including current rates still fall below the Healthy People 2020 goal
genital warts and various cancers. The recommended age of achieving 80% HPV vaccination coverage for the entire
for initiation of the vaccination series in both boys and girls series among 13 to15 year old boys and girls. Furthermore,
is between 11 and 12 years old (Markowitz et al., 2014). HPV vaccination rates are lower than other recommended
This age recommendation is based on the notion that in adolescent vaccination rates, including the tetanus-
order to prevent HPV infection, vaccination must occur diptheria-acellular pertussis vaccine with an uptake rate of
prior to initial sexual exposure (Centers for Disease 85.3% in 2012 and the meningococcal conjugate vaccine
Control and Prevention [CDC], 2015). In addition, the with an uptake rate of 73.8% in 2012 (Curtis et al., 2013).
rationale for vaccinating adolescents between 11 and 12 Consequently, there is a need to improve HPV vaccine
years of age is based on evidence that adolescents in this uptake among adolescents to reduce incidence of genital
age group achieve higher HPV antibody titers compared to warts and cancers associated with the virus.
older adolescents who receive the vaccine (Markowitz et
al., 2014). There are a variety of reasons for lower than desired
HPV vaccination rates, with the key factors being weak and

THE HEALTH EDUCATION MONOGRAPH SERIES, Volume 34, Number 1, 2017 1