Human papillomavirus (HPV) is a common sexually transmitted infection (STI) and the necessary cause of cervical cancer, which disproportionately affects women of low socioeconomic status (SES). Introduction of the new HPV vaccine, currently available to females 9 to 26 years of age, therefore presents an unprecedented opportunity to eliminate disparities in cervical cancer morbidity and mortality through the primary prevention of the disease. Given the necessity of parental consent for the vaccination of minors, as well as the enhanced efficacy of the vaccine when delivered prior to the onset of the sexual activity, the present study explores decision-making regarding childhood HPV vaccination among low SES mothers of girl 9 to 17 years of age. A popular model of decision-making ' the Decision Support Framework (DSF) ' is used to guide both survey and brief, semi-structured interview questions aimed at determining the factors most predictive of mothers' expressed intentions towards HPV vaccination of their daughters and daughter's actual vaccination status at 8-month follow-up. Particular attention will be paid to modifiable barriers to HPV vaccination and will be used to guide future work to assist low SES mothers in making informed choices for their daughter regarding the vaccine. The ability of the new human papillomavirus (HPV) vaccine to eliminate socioeconomic disparities in cervical cancer will depend, in large part, on acceptability and uptake of the vaccine among low socioeconomic status (SES) mothers on behalf of their daughters, who are among those most at risk for the development of cervical cancer in the future. Given this, the present study explores decision-making about childhood HPV vaccination among low SES mothers of daughter 9 to 17 years of age (i.e., those who are eligible for the vaccine, but unable to provide their own consent for use). We use the Decision Support Framework (DSF) to guide baseline survey questions aimed at predicting mothers' vaccine intentions. Mothers will be recruited from an urban pediatric care clinic serving low income, primarily racial and ethnic minority patients. Eight months after their initial baseline assessment, clinic records will be used to determine daughter's HPV vaccination status, ranging from those who have completed the full series of three doses within 6 months to those who have not started the vaccine. Brief, semi-structured follow-up interviews will be conducted with a subset of mothers in each of the three child vaccination status groups. Questions will also be guided by the DSF and used to address the specific issues, concerns, and barriers that emerged for mothers in reference to pursuing the HPV vaccine for their daughter, including those who were successful completers of the vaccine series. Results from this research will be used to inform decision-making interventions for mothers from low SES backgrounds, many of whom may face unique barriers to vaccinating their daughters against HPV. ? ? ? ?
