The University of Arizona, Tucson, Arizona

Public Unease Surrounds Disease

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Since approval of two vaccines against the human papilloma virus– Gardasil® in 2006 and Cevarix® in 2009—more than 40 states have implemented or considered implementing HPV-related legislation. In Arizona, for example, SB 1093 included the amendment that HPV vaccine is not to be required for school attendance. The controversy over legislation requiring females entering 6th grade to be vaccinated against HPV has been heated to say the least.

To date, only Virginia and Washington, D.C. have implemented such a mandate.

Maggie Pitts, Ph.D., assistant professor in the department of communication at the University of Arizona College of Social and Behavioral Sciences, has been studying the development of this national conversation and its effects on how families are processing the information.

The UA Department of Communication is nationally regarded as one of the top institutions for research on interpersonal communication, that is, talk that happens within people's relationships with family, friends, romantic partners, and the like.

“In light of the significance the HPV vaccine controversy has for public health outcomes and the fervor with which the vaccine is being debated,” she says, “it’s critical to know how parents with young daughters are responding to these issues.”

Throughout Pitts’ career, her research has focused on how families come together to make decisions on big issues like retirement, organ donation and end-of-life choices. Since it touches on already sensitive topics such as sexual activity and sexually transmitted disease, the HPV vaccine debate represented a uniquely interesting and impactful topic of study.

Fuel for the Fire

Human papillomavirus or HPV is responsible for almost all cases of cervical cancer in the world. The Center for Disease Control estimates that approximately 20 million people are infected every year, and that at least 50 percent of sexually active adults will contract the disease in their lives. The virus causes genital warts, and has been linked to a number of other types of cancer.

While vaccines represent opportunities to control the spread of HPV, they were promoted through marketing and a strong lobby, which have created a backlash of skepticism. Further events have added fuel to the debate.

In September 2011, Republican presidential candidate Michele Bachmann criticized Texas Governor Rick Perry for his 2007 executive order requiring 6th grade girls to get the vaccine before attending school. At the time, Bachmann called the vaccine dangerous, linking it to serious side effects, even retardation.

In response to her comments, the American Academy of Pediatrics denounced her description of adverse effects, clarifying the safety and efficacy of the vaccine, and offering support for widespread vaccine adoption.

Even Saturday Night Live capitalized on the controversy, creating a parody commercial for the “Little Poundcake Doll,” who spontaneously injects girls under ten with the vaccine.

Such debate has deeply affected public perception of the vaccine. All of these messages– from the strong statements from national leaders to the comedic parodies of SNL– have created deep concern in parents across the nation and turned many away from the idea of having their children vaccinated.

Uncovering Communications

Pitts and her co-principal investigator, Kimberley Adams Tufts, DNP, FAAN, associate professor in the School of Nursing at Old Dominion University in Norfolk, Virginia, began work on the topic when Pitts was an assistant professor there. Since Virginia is the only state in the union with a vaccine mandate, the two were interested in the implications of a state mandated vaccine, and parents’ attitudes and responses to such a mandate.

“Our goals were to uncover how families were discussing, framing, and making decisions about the vaccine,” she says. “We compared parents’ needs for information about the virus and the vaccine with their feelings about the mandate.”

The Opt-Out Option

“Despite the fact that most parents see the potential benefits of the HPV vaccine,” says Pitts, “the very fact that the state has mandated it for their 6th grade daughter has made them very hesitant to have their daughters vaccinated.” According to their study, parents feel skeptical, frustrated and uninformed about all aspects of the virus, the vaccine and the mandate.

“They feel caught in a catch-22 about whether they would be doing more damage to their daughters by vaccinating her or not vaccinating her.”

From the beginning Pitts’ goal has been to learn about the problems with how the entire HPV vaccine conversation has developed, and use that to create recommendations for improving such communications in the future. Their findings show that parents simply want to be given three things: 1) objective information to make an informed decision, 2) time, and 3) the choice to opt out.  

“Parents in our study were most concerned with the state taking away their right to make a decision,” she says. “An informed opt-out provision would ensure that parents could maintain the right while emphasizing the importance of the vaccine.”

The Blue Pill or the Red Pill

In the end, Pitts’ research is building better tomorrows by helping families communicate more effectively at the most important moments of life.

“As I research how we communicate, I’m interested in lifespan communication decisions, these turning points when we take the blue pill or the red pill,” she says. “They impact our lives and our family’s lives.”