Background: Human papillomavirus (HPV) immunization requirements for school entry could increase HPV vaccine uptake but are controversial. This study assessed parents' attitudes about HPV immunization requirements. Methods: During October 2007 to June 2008, we conducted telephone surveys with 484 parents of girls attending middle/high schools serving communities in Los Angeles County with elevated cervical cancer rates. Results: Parents were mostly Hispanic (81%) or African American (15%); 71% responded in Spanish. Many parents did not know if HPV vaccine works well (42%) or is unsafe (41%). Overall, 59% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea." In multivariable analysis, African Americans and Hispanics responding in English were less likely than Hispanics responding in Spanish to agree (aOR 0.1, 95% CI: 0.1-0.3; aOR 0.4, 95% CI: 0.2-0.8, respectively). Parents were less likely to agree with these laws if they did not believe the vaccine works well (aOR 0.2, 95% CI: 0.1-0.5) but more likely to agree if they believed the vaccine is not "too new for laws like these" (aOR 4.5, 95% CI: 2.6-8.0). Agreement with laws increased to 92% when including agreement that "these laws are okay only if parents can opt out." Conclusions: In this at-risk community, more than half of the parents agreed with HPV immunization requirements generally, and the vast majority agreed when including opt-out provisions. Impact: Support for HPV vaccine requirements may depend on race/ethnicity and inclusion of opt-out provisions. Information about vaccine efficacy and safety may increase support and reduce uncertainty about HPV vaccine in high-risk populations.
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