Parents of older, non-white, female teens are more likely to inaccurately report the human papillomavirus (HPV) vaccination status of their adolescent children, according to research published in Vaccine. Additionally, households with lower maternal education and income status were also more likely to inaccurately report HPV vaccination status, according to study results published in Vaccine.

The investigators of this cross-sectional study sought to understand how potential multilevel factors affect the accuracy of parental reports of adolescent HPV vaccination status. These factors include adolescent individual-level and parental/household characteristics, the number of healthcare providers seen, and factors related to policy or community-level characteristics.

The investigators analyzed data from a national survey asking the parents of 19,683 teens about HPV vaccine coverage and verified vaccination reports with the adolescents’ care providers. The primary outcome of interest was parental inaccuracy in reporting HPV vaccination status using 3 dependent variables: vaccination initiation (≥1 dose), vaccination completion (3 doses), and whether the number of doses was underreported, overreported, or accurately reported. Multilevel models were used to determine the association of inaccurate reporting with independent variables, including adolescent characteristics (age, gender, race/ethnicity), parental/household factors (maternal education, poverty status), the number of care providers seen, state-level median income, and state-level HPV vaccine policy.

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Of the total sample, 76.15% of parents accurately reported vaccination initiation and 75.18% accurately reported vaccination completion. In addition, 60.97% of parents accurately reported the number of vaccine doses, while 27.78% underreported and 11.24% overreported the number of doses. In multivariate analyses, parents of older adolescents were more likely to inaccurately report vaccination initiation (adjusted odds ratio [aOR], 1.03) and completion (aOR, 1.1) data and were more likely to underreport (aOR, 1.06) and overreport (aOR, 1.06) the number of vaccine doses. Parents of girls were less likely to inaccurately report vaccination initiation (aOR, 0.93) but more likely to inaccurately report vaccination completion (aOR, 1.38), as well as underreport (aOR, 1.11) and overreport (aOR, 1.21) the number of doses.

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Parents of racial or ethnic minority adolescents were more likely to inaccurately report vaccination initiation (aOR range, 1.43-1.76), completion (aOR range, 1.45-1.75), underreport doses (aOR range, 1.98-2.05), or overreport doses (aOR range, 1.17-1.41). Households in which the mother achieved higher education and households with higher income were less likely to inaccurately report vaccination initiation (aOR, 0.7 maternal education, 0.54 income), completion (aOR, 0.92, 0.62), underreport doses (aOR, 0.79, 0.5), and overreport doses (aOR, 0.8, 0.7). Parents whose adolescent children saw more providers were also less likely to inaccurately report vaccination initiation and completion, but more likely to overreport the number of doses. In adjusted analyses, state-level factors did not influence the accuracy of reporting HPV vaccination status.

Limitations to the study design included the inability to infer causation and only including participants with provider-verified data, which may prevent the generalizability of the findings. The investigators did not consider respondent characteristics, specifically the relationship to the adolescent (mother/female guardian, father/male guardian, grandparent or other family members), which may have impacted parental recall.

“Having accurate reporting of vaccination status is crucial for identifying under-vaccinated populations and to monitor vaccine coverage,” the researchers concluded, adding that future studies should examine the source of inaccuracies such as low health literacy, recall, or social desirability.


Vu M, Luu M, Haardörfer R, Berg CJ, Escoffery C, Bednarczyk RA. A multilevel analysis of factors influencing the inaccuracy of parental reports of adolescent HPV vaccination status [published online January 6, 2019]. Vaccine. doi: 10.1016/j.vaccine.2018.12.032