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To measure adolescent girls’ preferences over features of human papillomavirus (HPV) vaccines in order to provide quantitative estimates of the perceived benefits of vaccination and potential vaccine uptake.

A discrete choice experiment (DCE) survey was developed to measure adolescent girls’ preferences over features of HPV vaccines. The survey was fielded to a U.S. sample of 307 girls aged 13–17 years who had not yet received an HPV vaccine in June 2008.

In a latent class logit model, two distinct groups were identified – one with strong preferences against vaccination which largely did not differentiate between vaccine features, and another that was receptive to vaccination and had well-defined preferences over vaccine features. Based on the mean estimates over the entire sample, we estimate that girls’ valuation of bivalent and quadrivalent HPV vaccines ranged between $400 and $460 in 2008, measured as willingness-to-pay (WTP). The additional value of genital warts protection was $145, although cervical cancer efficacy was the most preferred feature. We estimate maximum uptake of 54–65%, close to the 53% reported for one dose in 2011 surveillance data, but higher than the 35% for three doses in surveillance data.

We conclude that adolescent girls do form clear opinions and some place significant value on HPV vaccination, making research on their preferences vital to understanding the determinants of HPV vaccine demand.

DCE studies may be used to design more effective vaccine-promotion programs and for reassessing public health recommendations and guidelines as new vaccines are made available.

The purpose of this research is to investigate how parents and caregivers describe their concerns about the HPV vaccine for their children on open Internet websites. The study examines what the discourse among parents reveals about their concerns regarding the HPV vaccine.

Our exploratory study utilized a grounded theory approach as a method of collecting data and simultaneously formulating research questions based on emerging themes from the data. We used purposeful sampling to select sets of comments posted on websites that provided news, scientific information, or parental support regarding HPV and its vaccine.

Findings suggest support for Bond and Nolan’s (2011) theory that familiarity with a disease is central to parents’ assessment of risk, and that dread of a serious disease such as cervical cancer is weaker than dread of unknown possible side effects in parents’ motivation to give or withhold the vaccine for their children.

Research limitations include our usage of a purposeful convenience sample of websites. The limitation of this sampling technique is that the comments made by website “users” and used in the analysis may not be representative of the wider population, and may include Americans as well as non-Americans.

Our research fills an important gap in the literature by looking at the ways in which parents share their concerns about the HPV vaccine on Internet websites as they consider whether to reject, delay, or consent to the vaccine.

Though it is one of the strongest predictors of vaccine initiation, few studies have examined the social correlates of health care professional (HCP) recommendations of the human papillomavirus (HPV) vaccination. This study employs a “fundamental causes” framework to examine whether family socioeconomic status is associated with parent reports of HPV vaccine uptake and HCP recommendation of the vaccine among female youth aged 12–17.

Using the 2007 National Survey of Children’s Health, a nationally representative sample of parents in the United States, this study documents a clear socioeconomic gradient in HCP recommendation of the HPV vaccine.

Results from a set of logistic regression models demonstrate that lower income families have significantly lower odds of vaccine initiation; however, the effect of household income is mediated by HCP recommendation. Further analyses reveal that lower income and poor families have reduced odds of receiving a HCP recommendation even when other health care related factors such as insurance status, annual preventive care, and a usual source of care are controlled.

The findings suggest that low income and poor families are less likely to receive needed health information regarding the HPV vaccine, thereby reducing the likelihood of vaccine uptake.

Purpose – To provide an overview of racial/ethnic disparities in human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer on domestic and international levels.

Design/methodology/approach – The literature, cervical cancer prevention guidelines, and Centers for Disease Control and Prevention resources were culled to aggregate information on epidemiology, racial/ethnic disparities, and knowledge and attitudes related to HPV, HPV vaccination, and cervical cancer. Original data supplement information about HPV and HPV vaccination knowledge and attitudes.

Findings – Cervical cancer is among the leading causes of female death worldwide, with substantial racial/ethnic and geographic disparities. In the United States, African American and Hispanic women suffer disproportionate cervical cancer incidence and mortality compared to their Caucasian counterparts. Globally, the greatest burden of cervical cancer (and HPV infection) is shouldered by developing regions. Prevention efforts, such as HPV vaccination and adaption of screening programs to resource-poor areas, have the potential to reduce such disparities, but cultural context is critical to successful development and implementation of such interventions.

Research limitations/implications – As this is not a systematic review, but rather a viewpoint on issues related to disparities in cervical cancer, the literature review is not exhaustive.

Practical implications – This chapter provides a context for examining cervical cancer disparities domestically and globally and serves as a starting point for formulating future research.

Originality – This perspective on HPV and cervical cancer presents disparities both within the United States and worldwide. The chapter supplements the literature with new data that provide additional insight into knowledge and attitudes about these health issues.

The disparities of COVID-19 vaccination rates between the rural and urban areas have become apparent during this pandemic. There is a need to understand the root causes of vaccine hesitancy demonstrated by the rural population to increase coverage and to contain the disease spread throughout the United States. This study aimed to explore other factors influencing vaccine hesitancy among rural dwellers besides the geography-related barriers such as poor health care access and individuals having no or suboptimal insurance coverage.

By reviewing existing data and literature about vaccination, health literacy, and behaviors, and prevailing ideologies, we discuss the potential causes of vaccine hesitancy in rural areas that could create barriers for successful public health efforts related to vaccine coverage and provide suggestions to ameliorate the situation.

Geography-related barriers, health literacy, and preconceived notions are key determinants of adopting healthy behaviors and complying with public health authorities' recommendations among rural individuals during a public-health crisis. We argue that ideology, which is much deeper than preconception or misconception on vaccination, should be incorporated as a key factor to redefine the term “vulnerable populations” in public health research.

The limitation of our study is that we have not found an effective way to encourage the populations who hold conservative religious and political ideologies to join the efforts for public health. Even though geography-related barriers may strongly impact the rural dwellers in achieving optimal health, the various forms of ideologies they have toward certain health behaviors cannot be discounted to understand and address vaccine-related disparities in rural areas. There is a need to redefine the term “vulnerable population” particularly as it relates to rural areas in the United States. During large-scale public health disasters, scholars and public health authorities should consider the ideologies of individuals, in addition to other factors such as race/ethnicity, area of residence (rural vs. urban), and socioeconomic factors influencing the existing vulnerabilities and health disparities.

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.