This study guides social marketing campaigns to increase human papillomavirus (HPV) vaccination among young women by elaborating the health belief model (HBM). A self-administered, anonymous, web-based questionnaire was e-mailed to all entering female college students at a large, public university in the mid-Atlantic region of the United States. Findings elaborate the HBM constructs of perceived threat, benefits, barriers, and cues to action. Almost all participants had heard about the HPV vaccine and the majority of first-year students had received at least one shot in the vaccination series. Results expand understandings of perceived threat in relation to the HPV vaccine by explicating misinformation and knowledge gaps. Participants indicated that parents and physicians were their most trusted sources of vaccine information. Television and Internet cues to action were negatively associated with HPV vaccination among these women. Structural equation modeling results affirmed the HBM's fit (comparative fit index ¼ 0.935, normative fit index ¼ 0.921, and root mean square error of approximation ¼ 0.077). This finding suggests the importance of multimodal sources of information, expanding the dichotomous internal and external cues to action. Perceptions of vaccine safety remained a significant barrier to the uptake of HPV vaccination among participants. Racial disparities between White and non-White students could have a considerable impact on the established inequality in HPV vaccination rates in the United States. Results inform future social marketing campaign messages and strategies based on the HBM.

Since introduction of the human papillomavirus (HPV) vaccine, there remains low uptake compared to other adolescent vaccines. There is limited information postapproval about parental attitudes and barriers when presenting for routine care. This study evaluates HPV vaccine uptake and assesses demographics and attitudes correlating with vaccination for girls aged 11–12 years. A prospective cohort study was performed utilizing the University of Virginia (UVA) Clinical Data Repository (CDR). The CDR was used to identify girls aged 11–12 presenting to any UVA practice for a well-child visit between May 2008 and April 2009. Billing data were searched to determine rates of HPV vaccine uptake. The parents of all identified girls were contacted four to seven months after the visit to complete a telephone questionnaire including insurance information, child’s vaccination status, HPV vaccine attitudes, and demographics. Five hundred and fifty girls were identified, 48.2% of whom received at least one HPV vaccine dose. White race and private insurance were negatively associated with HPV vaccine initiation (RR 0.72, 95% CI 0.61–0.85 and RR 0.85, 95% CI 0.72–1.01, respectively). In the follow-up questionnaire, 242 interviews were conducted and included in the final cohort. In the sample, 183 (75.6%) parents reported white race, 38 (15.7%) black race, and 27 (11.2%) reported other race. Overall 85% of parents understood that the HPV vaccine was recommended and 58.9% of parents believed the HPV vaccine was safe. In multivariate logistic regression, patients of black and other minority races were 4.9 and 4.2 times more likely to receive the HPV vaccine compared to their white counterparts. Safety concerns were the strongest barrier to vaccination. To conclude, HPV vaccine uptake was higher among minority girls and girls with public insurance in this cohort.