We sent a questionnaire to 38% (1084) of 2817 parents whose daughters had been offered human papillomavirus vaccination and who had agreed to participate. Of these, 60% (651) returned a questionnaire. Responses suggested that fact sheets and parent information evenings confirmed, rather than changed, consent decisions. The views of active refusers on safety and efficacy may be difficult to change, lowering vaccine coverage. British Journal of Cancer (2008Cancer ( ) 99, 1908Cancer ( -1911 In the United Kingdom, routine human papillomavirus (HPV) vaccination for 12 -13-year-old girls to prevent cervical cancer has begun. The highest possible vaccine uptake is required to achieve maximum impact on future cancer incidence and to ensure cost effectiveness (Goldhaber-Fiebert et al, 2008). Two parental acceptability studies in the UK anticipated an uptake of about 80% (Brabin et al, 2006;Marlow et al, 2007a), which would be similar to the coverage achieved by the cervical screening programme. As those girls who are not vaccinated may include some who would not take advantage of future cervical screening, reducing non-acceptance is important (Jit et al, 2008).A school-based programme increases the possibility of high coverage, but the acceptability of vaccinating adolescents against a sexually transmitted infection remains uncertain, and the general public is relatively uninformed, or even misinformed, about cervical cancer and its prevention (Friedman and Shepheard, 2007;Marlow et al, 2007b). We assessed vaccine acceptability in a feasibility study ahead of the national vaccine programme. Two primary care trusts (PCTs) in Greater Manchester that offered Cervarix (GlaxoSmithKline, Rixensart, Belgium) to girls attending 36 secondary schools achieved a 71% uptake of the first HPV vaccine dose . Here we present the results of a parental questionnaire survey shortly after the second dose, which focussed on factors that had influenced the parents' vaccine decision and included a small group of respondents who had declined vaccination.
MATERIALS AND METHODSThe North Manchester NHS Research Ethics Committee approved the study. Cervarix was offered at 0, 1 and 6 months to 2817 girls aged 12 -13 years between October 2007 and July 2008 . In the covering letter, parents were informed that the funding source was GlaxoSmithKline and that Cervarix was one of two licensed vaccines; it explained that the vaccine for the future national immunisation programme and the policy for vaccinating older girls had not yet been determined. Parents received information about cervical cancer and the vaccine, a flier summarising the content of an educational film for girls (Vallely et al, 2008), details of parent evenings and a separate consent form for the follow-up research questionnaire. Information evenings provided an overview of HPV vaccines and the study aims; the educational film was shown, followed by a question and answer session facilitated either by school nurses or by a consultant in communicable diseases.Primary care trusts forwarded...