Appendix B.

Questionnaire administered to all participants.

Item	Response options
How many 11-to 14-year-old children do you have?	1, 2, 3, 4, 5, 6, 7, 10 or more
According to the answer you provided, you have [INSERT] children ages 11 to 14. Please think about the one who most recently had a birthday when you answer the questions in this survey. According to the answer you provided, you have one child ages 11 to 14. Please think about this child when you answer the questions in this survey.
To help the survey work better, please give a name that you would like us to use for your child. (This information is only for the survey. You can give initials or a nickname —whatever you will remember.)
Is [TEEN] …	1 = Male 2 = Female 3= Other (born female, now male) (Note missing n=12)
You indicated “other” when asked about the gender of your child, so we’d like to just gather a little more information. First, what was [TEEN]’s biological sex at birth?	1=Female 2 = Male
Second, what is the preferred gender pronoun for [TEEN]?	1 = “He” 2 = “She”
How old is [TEEN]?	1 = 11 years old 2 = 12 years old 3 = 13 years old 4 = 14 years old 5=10 years or younger 6=15 years or older
In your household, who is the main person who makes decisions about [TEEN]’s health care?	1 = You 2 = Your spouse or partner 3 = You and your spouse/partner share equally in the decision-making 4=Someone else
Now we would like to ask vour oninion about vaccines given to nreteens and teenagers under the age of 18. Please tell us how much you disagree or agree with the following statements.
Vaccines are necessary to protect the health of teenagers.	1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree 5 = Strongly agree
Vaccines do a good job in preventing the diseases they are intended to prevent.	1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree 5 = Strongly agree
Vaccines are safe.	1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree 5 = Strongly agree
If I do not vaccinate my teenager, he or she may get a disease such as meningitis.	1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree 5 = Strongly agree
Now we will ask about [TEEN]’s health care, including vaccines [HE/SHE] may have gotten.
Did [TEEN] receive the flu vaccine this most reason flu season?	1 = Yes 2 = No 3 = Not sure/Don’t know
Has [TEEN] ever received a tetanus booster shot? There are two main types of tetanus booster shots: Td and Tdap.	1 = Yes 2 = No 3 = Not sure/Don’t know
Has [TEEN] ever received a meningitis (meningococcal) vaccine? It’s also called Menactra.	1 = Yes 2 = No 3 = Not sure/Don’t know
How many shots of the HPV vaccine has [TEEN] had? It’s also called the human papillomavirus vaccine, Gardasil, or Gardasil 9.	1 = None 1 = 1 shot 2 = 2 shots 3 = At least one shot but I don’t know how many
Item	Response options
Now we’d like to ask you some questions about your perspectives on the HPV vaccine specifically. How likely are you to get [TEEN] the HPV vaccine sometime in the next 12 months? Would you say you …	1 = Definitely will 2 = Not sure / I have questions or concerns
Please select all reasons [TEEN] mav not receive HPV vaccine in the next 12 months:	1 = I need more information about the vaccine 2 = My child is too young 3 = I am concerned about the long-tenn effects of the vaccine 4 = My child’s health care provider did not recomnend it or said my child could wait 5 = The vaccine is not required for school 6 = Other / none of the above
Please select the MAIN reason [TEEN] mav not receive HPV vaccine in the next 12 months:	1 = I need more information about the vaccine 2 = My child is too young 3 = I am concerned about the long-tenn effects of the vaccine 4 = My child’s health care provider did not recoimnend it or said my child could wait 5 = The vaccine is not required for school 6 = Other / none of the above (please explain):
Item	Response options
The next questions are about [TEEN]’s health care.
Please select ALL reasons [TEEN] will likely receive the HPV vaccine in the next 12 months. OR Please select ALL reasons [TEEN] received the HPV vaccine.	1 = My provider recoimnended it 2 = I read or heard about it 3 = I believe in the effectiveness of vaccines and want to keep my child up to date 4 = I want to protect my child from HPV and diseases caused by HPV 5 = Family members or friends recoimnended it 6 = Other/None of the above (please explain):
Where have you gotten information about HPV vaccine? Select all that apply.	1=Social media 2=Google search 3=Television 4=Family/Friends 5=School or other parents 6=Healthcare professionals 7=Other (Fill in blank ____)
Of the sources of information you selected, what would you say has been your main source of information? Select one.	[Populate from above]
Other than a healthcare provider, please select all people you’ve had conversations with about the HPV vaccine [SELECT ALL THAT APPLY]	1 = Family members 2 = Friends 3 = Other parents 4 = Classmates/ friends of [TEEN] 5 = Co-workers 6 = Social network contacts 7 = Other [Fill in blank ___] 8 = None of the above
Other than a healthcare provider, please select the person who has had the most influence in your decision to get the HPV vaccine for [TEEN] [Response options carried forward from those selected in D60]	1 = Family members 2 = Friends 3 = Other parents 4 = Classmates/ friends of [TEEN] 5= Co-workers 6 = Social network contacts 7 = Other [Fill in blank ___] 8 =None of the above
How many of [TEEN]’s friends do you think have received HPV vaccine, or may receive the vaccine in the next year? Give your best estimate.	1=None 2=Some 3=About half 4=Most 5= All
Now we’d like to learn a little more about [TEEN]’s primary care provider (doctor, nurse practitioner, or physician assistant), the clinic, and the clinic staff.
[TEEN]’s providers office uses an computer charting system (electronic medical record).	1=Yes 2=No 3=Not sure
[TEEN]’s provider’s office provides appointment reminders	1= Yes 2=No
How are the appointment reminders given? Check all that apply	1 = Phone 2 = Email 3 = Text message 4 =Social Media 5 = Online Patient portal 6 = Appointment reminder card 7 = Postcard or mailed letter 8 = Other (Please explain):
The next questions are about [TEEN]’s healthcare provider and their office staff
I trust [TEEN]’s primary healthcare provider (doctor, nurse practitioner, or physician assistant).	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
I trust the nurses and other providers who work alongside [TEEN]’s primary provider.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
[TEEN]’s healthcare provider is on time to the appointment	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
The office staff are friendly and helpful.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
When I call the [TEEN]’s healthcare provider’s office, I get the help I need.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
Continue to think about [TEEN]’s healthcare provider and the office staff as you answer this next set of questions
[TEEN]’s healthcare provider remembers [him/her] at each visit.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
[TEEN]’s provider cares about [him/her] and wants what is best for [his/her] health.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
The staff at [TEEN]’s healthcare provider’s office remembers [him/her] at each visit.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
The staff at [TEEN]’s provider’s office cares about [him/her] and wants what is best for [his/her] health.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
For the next questions, continue to think about [TEEN]’s primary healthcare provider.
Did [TEEN]’s provider discuss HPV vaccine with you at a previous visit?	1 = Yes 2 = No 3 = Not sure/ don’t remember
At the first visit [TEEN]’s healthcare provider brought up HPV vaccine, about how old was [TEEN]? [DISPLAY ONLY IF D200=1]	1 = 10 years old or younger 2 = 11 years old 3 = 12 years old 4 = 13 years old 5 = 14 years old 6 = Not sure/ don’t remember
Did the provider discuss HPV vaccine along with other shots [TEEN] was due for, or did he/she discuss HPV vaccine separately? [DISPLAY ONLY IF D200=1 AND A160 >1]	1 = Discussed with other shots 2 = Discussed separately from other shots 3 = [TEEN] was not due for other shots 4 =Not sure/don’t remember
[IF A160 > 0 then show, otherwise skip] Where did [TEEN] receive [his/her] first HPV shot?	1 = Provider’s office 2 = Emergency room 3 = Health Department 4 = Elementary/Middle/High school 5 = Pharmacy or Drag store 6 = Other clinic or health center (please explain): 7 = Other/none of the above (please explain):
Did [TEEN] receive any of the following vaccines at the same visit as the HPV shot? Select all that apply	1 = Tetanus booster 2 = Meningitis vaccine 3 = Flu shot 4 = None of these 5 = Not sure
How important did the provider say the HPV vaccine was for [TEEN]?	1 = Not important 2 = Somewhat important 3 = Very important 4 = Did not discuss
What did the provider say the HPV vaccine could prevent? Select all that apply.	1 = HPV infection 2=Cervical cancer 3 = Other cancers 4 = Genital warts 5 = None of these 6 = Not sure/ don’t remember
Did the provider tell you [TEEN] should get the HPV vaccine?	1 = No 2 = Yes
When did the provider tell you [TEEN] should get the HPV vaccine?	1 = At the visit that is was first discussed 2 = At a later visit 3 = The provider gave me a choice about when to get it 4 = The provider didn’t say when to get it
Did the provider give you the opportunity to ask questions about the HPV vaccine?	1 = Yes 2 = No 3=Not sure/don’t remember
Did the provider give you the opportunity to ask questions about all the shots your child was receiving at that visit?	1 = Yes 2 = No 3=Not sure/don’t remember
How satisfied were you with the way [TEEN]’s primary healthcare provider answered your questions?	1 = Very unsatisfied 2 = Somewhat unsatisfied 3 = Neither satisfied nor dissatisfied 4 = Somewhat satisfied 5 = Very satisfied 6 = I didn’t ask any questions
HPV vaccine is approved for children ages 9 and older. If [TEEN]’s primary healthcare provider had recoimnended that your child get the first HPV shot at age 9, how likely would you have been to follow this recomnendation?	1 = Very unlikely 2 = Somewhat unlikely 3 = Neither 4 = Somewhat likely 5 = Very likely
How likely is it that [TEEN] will receive another HPV shot in the next 12 months? Would you say …	1 = Very unlikely 2 = Somewhat unlikely 3= Neither 4 = Somewhat likely 5 = Very likely
Item	Response options
The last set of questions on this survey will help us understand more about [TEEN]’s general background and experiences in the healthcare system.
Did [TEEN] have an 11-12 year old physical exam or general check-up?	1 = Yes 2 = No 3 = I don’t know / not sure
How old was [TEEN] at [his/her] last physical exam or general check-up? Please do not include visits for medical treatment or illnesses.	1 = 7 years or younger 2 = 8 years old 3 = 9 years old 4 = 10 years old 5 = 11 years old 6 = 12 years old 7 = 13 years old 8 = 14 years old
During the past 12 months, how many times has [TEEN] seen a doctor or other health care professional at a provider’s office, a clinic, or some other place? Do not include times [TEEN] was hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits or phone calls with the clinic staff.	1 = None 2 = 1 3 = 2-3 4 = 4-5 5 = 5+
For the following statement, indicate how frequently this happens: I must take time off work to take [TEEN] to the doctor or healthcare provider.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
How long is the commute to [TEEN]’s healthcare provider’s office?	1 = Less than 10 minutes 2= Between 10-30 minutes 3 = Between 30-60 minutes 4 = More than an hour
[TEEN] dreads going to the doctor or healthcare provider.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
[TEEN] dreads getting shots.	1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always
Is [TEEN] Hispanic or Latino/Latina?	1 = No 2 = Yes
What is [TEEN]’s race? (Check all that apply.)	1 = White 2 = Black or African American 3 = Asian 4 = Native Hawaiian or Pacific Islander 5 = American Indian or Alaska Native 6 = Other, please specify: [open ended]
Does [TEEN] have any form of health insurance? This could include private insurance or government plans like Medicaid.	1=No 2=Yes
Do you have other children who have received any number of doses (1,2, or 3) the HPV vaccine?	1=Yes 2=No 3=Not applicable
How old was your other child/children when he/she received his/her first shot of HPV vaccine? If you have more than one child who has received the vaccine, please think of the child with the most recent birthday. [Display if E150=1 otherwise skip]	1=Ages 9-10 2=Ages 11-12 3=Ages 13-14 4=Ages 14-15 5=Ages 16-17 6=Ages 18 or older
The next few auestions are about your background.
What is the highest level of formal education you completed?	1 = Less than high school 2 = High school 3 = Some college or vocational training 4 = Bachelor’s degree or higher
How old are you?	1=21-25 years old 2=25-30 3=31-35 4=36-40 5=41-45 6=46-50 7=51-55 8=56-60 9=61-65 10=66-70 11=70-75 12=76 or older
Have you received HPV vaccine?	1 = Yes 2 = No
How many doses of the HPV vaccine have you received? [DISPLAY if E130=1 otherwise skip]	1 = 1 2 =2 3 = 3 or more 4 = At least one shot, but I don’t know how many
What is your gender?	1 = Male 2 = Female 3 = Other
What is your annual household income?	1 = Under $25,000 2 = $25,000 to $49,999 3 = $50,000 to $74,999 3 = $75,000 to $99,999 4 = $100,000 or above
How many adults ages 18 and older live in your household?	1 = 1 2 = 2 3 = 3 or more
How many children under age 18 live in your household?	1 = 1 2 = 2 3 = 3 4 = 4 5 = 5 6 = 6 or more
What is your state of residence?	1=Alabama 2=Alaska 3=Arizona 4=Arkansas 5=California 6=Colorado 7=Connecticut 8=Delaware 9=District of Columbia 10=Florida 11=Georgia 12=Hawaii 13=Idaho 14=Illinois 15=Indiana 16=Iowa 17=Kansas 18=Kentucky 19=Louisiana 20=Maine 21=Maryland 22=Massachusetts 23=Michigan 24=Minnesota 25=Mississippi 26=Missouri 27=Montana 28=Nebraska 29=Nevada 30=New Hampshire 31=New Jersey 32=New Mexico 33=New York 34=North Carolina 35=North Dakota 36=Ohio 37=Oklahoma 38=Oregon 39=Pennsylvania 40=Puerto Rico 41=Rhode Island 42=South Carolina 43=South Dakota 44=Tennessee 45=Texas 46=Utah 47=Vermont 48=Virginia 49=Washington 50=West Virginia 51=Wisconsin 52=Wyoming 53=I do not reside in the United States
Are you Hispanic or Latino[a]?	1 = No 2 = Yes
What is your race? (check all that apply)	1 = White 2 = Black or African American 3 = Asian 4 = Native Hawaiian or Pacific Islander 5 = American Indian or Alaska Native 6 = Other, please specify: [open ended]