Regional voices, different choices: Parents' and caregivers' HPV vaccine attitudes in the northeast and Southeast United States.

BACKGROUND: Human papillomavirus (HPV) vaccination remains a critical public health priority. However, disparities in vaccine uptake persist across gender, racial/ethnic, and regional lines. The COVID-19 pandemic disrupted routine immunizations and exacerbated vaccine hesitancy, further impacting HPV vaccination rates among adolescents.

METHODS: An online survey was completed by 2088 caregivers of children aged 9-17 in the Northeast and Southeast/Mid-Atlantic U.S. The Human Papillomavirus Attitudes and Beliefs Scale (HABS) assessed HPV vaccine attitudes, and the COVID-VAC scale assessed COVID-19 vaccine acceptance. Chi-squared analyses, logistic regression, ANOVA, and independent samples t-tests examined associations between vaccine hesitancy and caregiver gender, race, ethnicity, and urbanicity.

RESULTS: Over half (55.7 %) of caregivers were vaccine-hesitant. Male caregivers (OR = 1.50, p < 0.001), American Indian/Alaska Native (OR = 5.16, p < 0.001), and Asian caregivers (OR = 1.59, p = 0.02) were more hesitant than White female caregivers. Hesitancy was higher in the Southeast/Mid-Atlantic (χ2 = 7.99, p = 0.005). Hispanic caregivers showed greater hesitancy on key HABS subscales (Affordability, Harms, Communication; all p < 0.05). Social strata analyses revealed significantly higher hesitancy among BIPOC urban males and White urban males. COVID-19 vaccine attitudes were correlated but not statistically significant.

CONCLUSIONS: HPV vaccine hesitancy is shaped by intersecting identities and regional contexts. Gender-specific and culturally tailored public health strategies are needed, focusing on male caregivers and racial/ethnic minority populations. Future interventions must address mistrust and misinformation, especially in the Southeast/Mid-Atlantic and among AI/AN and Asian American families.