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. 2016 Feb 2;12(6):1491–1497. doi: 10.1080/21645515.2015.1123359

Table 2.

Questionnaire administered to enrolled adolescents.

Has your doctor recommended HPV vaccine? Yes No Do not have a doctor          
HPV vaccine protects against genital warts. True False          
HPV vaccine protects against genital cancer. True False          
HPV vaccine protects against head and neck cancer. True False          
Have you received HPV vaccine? Yes No          
How many doses of HPV vaccine have you received? 0 1 2 3 4 5          
If you have not received all doses, what is the reason for not finishing the HPV vaccine series?          
What is the main reason you accept/decline HPV vaccine?          
What source of HPV information do you trust most? Family/Friends Doctor News Media Social Media
Select one response for each statement
Strongly agree
  Agree
Do not know
  Disagree
Strongly disagree
HPV vaccine is important for the health of girls/women          
HPV vaccine is important for the health of boys/men          
I do not plan to receive HPV vaccine          
I plan to complete the HPV vaccine series          
I have already completed the HPV vaccine series          
HPV vaccine is safe          
HPV vaccine is effective in preventing genital cancers          
HPV vaccine is effective at preventing head/neck cancers          
I have friends who have received HPV vaccine          
I am concerned about short-term side effects          
I am concerned HPV vaccine has long-term health risks          
HPV vaccine is unnecessary          
HPV vaccine costs more than I can afford          
Receiving HPV vaccine will change my sexual behaviors          
It is hard to find time to get all doses of HPV vaccine          
It is hard to find a place to get all doses of HPV vaccine          
I would get HPV vaccine if my doctor recommended it          
I have enough information to make a decision about receiving HPV vaccine.