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BackgroundParental attitudes play a key role in their decisions to vaccinate adolescents against the human papillomavirus (HPV). Little is known, however, about the formative experiences that shape parents’ attitudes about the HPV vaccine.MethodsWe conducted semi-structured interviews with 25 parents of 11–17 year old adolescents in Wisconsin who changed their HPV vaccine attitudes (per prior surveys) over one year. A modified grounded theory approach was then used to generate primary themes of attitudinal determinants.ResultsParticipants were predominately mothers. We identified three major themes that shaped parents’ HPV attitudes: (1) the perceived likelihood of the HPV vaccine preventing cancer, (2) agency in adolescence and gauging their adolescent child’s intent for sexual activity, (3) the credibility of HPV vaccine information sources. General messaging around cancer prevention did not always supersede some parents’ concerns about the vaccine’s perceived link to sexual activity. Parents often viewed their adolescent child’s feelings about the HPV vaccine as a gauge of their (child’s) intent for sexual activity. Interviewees felt a sense of responsibility to educate themselves about the HPV vaccine using multiple sources and particularly looked to their medical provider to filter conflicting information.ConclusionsMore family-specific (vs. disease-prevention) messaging and recommendations may be needed in the clinical environment to sway some parents’ negative attitudes about the HPV vaccine. Future research should explore additional strategies to improve HPV vaccine attitudes, such as situating the vaccine in the context of a monogamous lifestyle that many parents wish to impart to their children.

IMPORTANCEIn the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation.OBJECTIVE To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. DESIGN, SETTING, AND PARTICIPANTSThe study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth.EXPOSURES Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity.MAIN OUTCOMES AND MEASURES Prevalence of early and persistent childhood wheeze and asthma incidence. RESULTSOf 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. CONCLUSIONS AND RELEVANCEAdjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood-and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.

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