1. Issues Associated with Acceptability of Viral STD Vaccines Susan L. Rosenthal, Ph.D

2. Overview  Theoretical models of health behaviors  Influences on attitudes  Characteristics of the vaccines  Review of studies using health belief models  Future research questions

3. Theoretical Model of Health Behaviors

4. Important Health Beliefs  Perceived severity  Perceived susceptibility  Barriers to implementing the behavior  Important others’ beliefs

5. Health Beliefs  Perceived Severity – Seriousness of the disease – Consequences of the disease  Perceived Susceptibility – Risk of acquiring the disease – Expectation that behavior would reduce the likelihood of harm (What will be the impact of partial efficacy?)

6. Health Beliefs  Barriers to Implementing the Behavior – Access – Need for shots – Concerns about real or imagined side effects  Beliefs of Important Others – Normative beliefs – Motivation to comply with preferences of relevant others

7. Influences on Attitudes

8. Health Care Providers  Health Care Providers – Comfort with talking about sexuality – Knowledge about disease – Knowledge about side effects – Expectations about parental attitudes and need for consent

9. Mrs. Smith, now that your daughter is 13, it’s time for her to get vaccinated for gonorrhea, chlamydia, and herpes Zimet, 2000

10. Societal/Cultural Beliefs  Beliefs about immunization in general  Risk behavior and STDs

11. Societal/Cultural Beliefs  National Vaccine Injury Compensation Program – “If you believe that you or a loved one has been injured as a result of a vaccination, we may be able to help.“  The National Vaccine Information Center – “NVIC is dedicated to the prevention of vaccine injuries and deaths through public education”

12. Psychosocial/Behavioral Factors and Vaccine Effectiveness Vaccine Accepted Disease Incidence Decreased? False Reassurance re: Target STD False Reassurance re: Other STD Increased Risk Behaviors Zimet, 2000

13. Characteristics of the Vaccine

14. Vaccine Characteristics  Method of delivery – Shot – Frequency  Efficacy  Cost

15. HPV Vaccine Characteristics  Characteristics of the vaccine: – Cost (150, 50, free) – Efficacy (50% or 90%) – Disease targeted (genital warts, cervical cancer, both) – Physician recommended  Results for adolescents and young women: – Most acceptable: 90% efficacy, physician recommended, and moderately priced – Disease target made no difference Zimet, et al, 2000

16. HPV/HSV Vaccine Acceptability Among College Students  Provided reproductive, sexual, and combined cues in description of the vaccine  Cue did not predict acceptance and there was no gender/cue interaction. Boehner, et al, 2002

17. Predictors of Vaccine Acceptance

18. HBV Immunization Among Adolescents  Predictors for adolescents’ acceptance – Perception that immunization was important to parents – Belief that it is important for everyone to be vaccinated  Predictors for parents’ acceptance – Perception that immunization was important to provider – Concern about adolescent’s risk for HBV Rosenthal, et al, 1995

19. HIV Vaccine Acceptability in Adolescents  Generic HIV vaccine acceptable – Mean 5.12 out of 6  Greater vaccine acceptability associated with: – Susceptibility to HIV – Benefits of being vaccinated  Lower vaccine acceptability – Fear of vaccine causing HIV – Not being a member of risk group – Fear of needles Zimet, et al, 1999 and Webb, et al, 1999

20. Herpes Vaccine Acceptability in College Students  Number (%) accepting the vaccine – 207 (40% ) would get vaccine – 211 (41%) not sure – 100 (19%) would not  Greater likelihood of acceptance – Low cost – Belief that it would work (for yes/not sure) – All teens – All sexually experienced individuals (yes/no) Rosenthal, et al., 1999

21. Other Findings  Different predictors of vaccine acceptance for HPV and HSV vaccine acceptance among college students  For vaccine trial participants, acceptance of HSV vaccine was related to decreased exercise and lower alcohol use  For vaccine trial participants, acceptance of HPV vaccine was influenced by perceptions of support from church/synagogue

22. Chain of Vaccine Acceptance Professional Organizations’ Recommendations  Health Care Providers  Parents  Adolescents  STD Vaccine Acceptance

23. Summary of STD Vaccine Acceptability Studies  Positive attitudes about STD vaccines across populations  Vaccine efficacy is important, but probably not disease targeted  Acceptability associated with positive and negative health beliefs, but less so with health behaviors

24. Issues for Future Research

25.  Efficacy – Level at which acceptance decreases – People’s understanding of partial efficacy – Physicians response in terms of recommendations

26. Issues for Future Research  Access/provider issues – Enhancing access – Cost to patient – Increasing provider comfort  Universal recommendation – Developing policy to accomplish