Abstract
Objective
The objective of this study was to investigate the deployment of HPV vaccination (HPVV) discourses and their impact on Canadian girls, parents, nurses and physicians.
Methods
Qualitative methods were favoured and included interviews with participants (n = 146) from four Canadian provinces and diverse socio-cultural locations. Using a poststructuralist discourse analysis, we examined HPVV campaigns as well as interview transcripts to document how girls, parents and health professionals make sense of HPVV as well as how they position themselves within and/or resist discourses coming from industry and public health sources.
Results
The results speak to HPVV campaigns as morally laden, gendered, heteronormative and factually misleading. Emerging from the analysis of interviews is the girls’ and parents’ lack of information regarding HPVV. For mothers, results show how they construct themselves as responsible biocitizens at the cost of the powerlessness, uncertainty, anxiety and fear they feel alongside the perceived imperative to act upon their daughter’s cancer risk. As for health professionals, they generally appropriate dominant HPVV discourses and use fear of HPV infection as a strategy to manufacture consent for HPVV among girls and parents. We discuss the ways in which opportunities for broader dialogue about HPVV and girls’ sexual health are foreclosed and how subject positions for all types of participants are problematic.
Conclusions
We ask whether public health is advanced when HPVV discourses transform healthy bodies into “at-risk” bodies and when the fear of cancer is instrumentalized in the pharmaceuticalization of public health.
Résumé
Objectif
L’objectif était d’étudier le déploiement des discours sur la vaccination contre les VPH (VVPH) et leur impact sur les filles, les parents, les infirmiers/infirmières et les médecins canadiens.
Méthodes
Des entrevues ont été réalisées avec des participant(e)s (n = 146) de quatre provinces canadiennes. Une analyse poststructuraliste du discours a permis d’examiner les campagnes de VVPH et les transcriptions d’entrevues pour documenter la façon dont les participant(e)s interprètent les VVPH et se positionnent comme sujets au sein des discours de l’industrie ou des agences de santé publique.
Résultats
Les campagnes de VVPH sont sexistes, hétéro-normatives et trompeuses. Émergeant de l’analyse des entrevues est le manque d’information des filles et des parents en ce qui a trait à la VVPH. Les mères se construisent en tant que bio-citoyennes responsables, mais au prix de l’impuissance, de l’anxiété et de la peur ressenties parallèlement à l’impératif d’agir pour minimiser le risque de cancer de leur fille. Quant aux professionnel(le)s de la santé, ils s’approprient les discours dominants sur la VVPH et utilisent la peur comme stratégie pour fabriquer le consentement pour la VVPH. Les occasions de dialogue sur la VVPH et la santé sexuelle des filles sont perdues et les positions en tant que sujets sont problématiques pour tous les types de participant.
Conclusions
Nous nous questionnons à savoir si la santé publique est bien servie quand les discours sur la VVPH transforment des corps en santé en corps « à risque » et quand la peur du cancer est instrumentalisée pour la pharmacologisation de la santé publique.
References
Abdelmutti, N., & Hoffman-Goetz, L. (2009). Risk messages about HPV, cervical cancer, and the HPV vaccine Gardasil: a content analysis of Canadian and US national newspaper articles. Women’s Health, 49, 422–490.
Batt, S., & Lippman, A. (2010). Preventing disease: are pills the answer? In A. Rochon Ford & D. Saibil (Eds.), The push to prescribe: women and Canadian drug policy (pp. 47–66). Toronto: Women’s Press.
Blitshteyn, S. (2014). Postural tachycardia syndrome following human papillomavirus vaccination. European Journal of Neurology, 21(1), 135–139.
Bramadat, P., Guay, M., Bettinger, J. A., & Roy, R. (2017). Public health in the age of anxiety: religious and cultural roots of vaccine hesitancy in Canada. Toronto: University of Toronto Press.
Brinth, L. S., Pors, K., Theibel, A. C., & Mehlsen, J. (2015). Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus. Vaccine, 33(22), 2602–2605.
Brown, B., Gabra, M. I., & Pellman, H. (2017). Reasons for acceptance or refusal of human papillomavirus vaccine in a California pediatric practice. Papillomavirus Research, 3, 42–45.
Burns, K., & Davies, C. (2013). Producing responsible girl citizens: an analysis of media discourses around the HPV vaccination programs. In V. Lopez, Y. Katsulis, G. Gillis, & K. Harper (Eds.), Girls sexualities and the media (pp. 139–154). New York: New York University Press.
Burns, K., & Davies, C. (2015). Constructions of young women’s health and wellbeing in neoliberal times: a case study of the HPV vaccination program in Australia. In K. Wright & J. McLeod (Eds.), Rethinking youth wellbeing: critical perspectives (pp. 71–89). Singapore: Springer.
Canadian Cancer Society. (2017). Canadian cancer statistics 2017. Toronto: Canadian Cancer Society.
Cayen, L., Polzer, J., & Knabe, S. (2016). Tween girls, sexuality and the biopolitics of HPV vaccination in English-speaking Canadian magazines. In J. Polzer & E. Power (Eds.), Neoliberal governance and health: duties, risks and vulnerabilities. Montreal: McGill-Queens University Press.
Charles, N. (2014). Injecting and rejecting, framing and failing: the HPV vaccine and the subjectification of citizens’ identities. Feminist Media Studies, 14(6), 1071–1089.
Chow, E. (2015). Factors influencing parental decision making for the human papillomavirus (HPV) vaccine: a literature review. International Journal of Child and Adolescent Health, 8(3), 265–276.
Connell, E., & Hunt, A. (2010). The HPV vaccination campaign: a project of moral regulation in an era of biopolitics. Canadian Journal of Sociology/Cahiers Canadiens de Sociologie, 35(1), 63–82.
Cutts, S., Fanceschi, S., Goldie, S., Castellsague, X., Sanjose, S., Garnett, G., et al. (2007). Human papillomavirus and HPV vaccines: a review. Bulletin of the World Health Organization, 85(9), 719–725.
Davies, C., & Burns, K. (2013). Mediating healthy female citizenship in the HPV vaccination campaigns. Feminist Media Studies, 14(5), 711–726.
Dickinson, J. A., Stankiewicz, A., Popadiuk, C., Pogany, L., Onysko, J., & Miller, A.B. (2012). Reduced cervical cancer incidence and mortality in Canada: national data from 1932 to 2006. BMC Public Health, 12. https://doi.org/10.1186/1471-2458-12-992. Accessed June 12, 2018.
Ferrer, H. B., Trotter, C., Hickman, M., & Audrey, S. (2014). Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis. BioMed Central (BMC) Public Health, 14(1), 700.
Foucault, M. (1969). L’archéologie du savoir. Paris: Gallimar.
Grabiel, M., Reutzel, T. J., Wang, S., Rubin, R., Leung, V., Ordonez, A., Wong, M., & Jordan, E. (2013). HPV and HPV vaccines: the knowledge levels, opinions, and behavior of parents. Journal of Community Health, 38(6), 1015–1021.
Hendry, M., Lewis, R., Clements, A., Damery, S., & Wilkinson, C. (2013). “HPV? Never heard of it!”: a systematic review of girls’ and parents’ information needs, views and preferences about human papillomavirus vaccination. Vaccine, 31(45), 5152–5167.
Herzog, T., Huh, W., Downs, L., Smith, J., & Monk, B. (2008). Initial lessons learned in HPV vaccination. Gynecologic Oncology, 109, S4–S11.
Hilton, S., Hunt, K., Langan, M., Bedford, H., & Petticrew, M. (2010). Newsprint media representations of the introduction of the HPV vaccination programme for cervical cancer prevention in the UK (2005–2008). Social Science and Medicine, 70, 942–950.
Lippman, A., Melnychuk, R., Shimmin, C., & Boscoe, M. (2007). Human papillomavirus, vaccines and women’s health: questions and cautions. Canadian Medical Association Journal, 177(5), 484–487.
Mancuso, F., & Polzer, J. (2010). “It’s your body but…”: young women’s narratives of declining human papillomavirus (HPV) vaccination. Canadian Woman Studies, 28(2–3), 77–81.
Mara, M. (2010). Spreading the (dis)ease: Gardasil and the gendering of HPV. Feminist Formations, 22(2), 124–143.
Mishra, A., & Graham, J. (2012). Risk, choice, and the ‘girl’ vaccine: unpacking human papillomavirus immunization. Health, Risk, and Society, 14(1), 57–69.
Nicol, A. F., Andrade, C. V., Russomano, F. B., Rodrigues, L. L. S., Oliveira, N. S., & Provance, D. W. (2016). HPV vaccines: a controversial issue? Brazilian Journal of Medical and Biological Research, 49(5), 1–5.
Paavonen, J., Jenkins, D., Bosch, F. X., Naud, P., Salmeron, J., Wheeler, C. M., et al. (2007). Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. The Lancet, 369(9589), 2161–2170.
Petherick, L., Norman, M. E., & Rail, G. (2016). Manufacturing (parental) consent: a critical analysis of the HPVV informed consent process in Ontario, Canada. In S. Dagkas & L. Burrows (Eds.), Families, young people, physical activity and health: critical perspectives (pp. 96–113). London: Routledge.
Piedimonte, S., Leung, A., Zakhari, A., Giordano, C., Tellier, P. P., & Lau, S. (2017). Impact of an HPV education and vaccination campaign among Canadian university students. Journal of Obstetrics and Gynaecology Canada. https://doi.org/10.1016/j.jogc.2017.07.028. Accessed 28 January 2018.
Polzer, J., & Knabe, S. (2009). “Good girls do... get vaccinated”: HPV, mass marketing and moral dilemmas for sexually active young women. Journal of Epidemiology and Community Health, 63(11), 869–870.
Polzer, J. C., & Knabe, S. M. (2012). From desire to disease: human papillomavirus (HPV) and the medicalization of nascent female sexuality. Journal of Sex Research, 49(4), 344–352.
Rail, G., Molino, L., Fusco, C., Norman, M.E., Petherick, L., Polzer, J., Moola, F., & Bryson, M. (2017). Overdiagnosis and the construction of “at-risk” girls: HPV vaccination campaigns as rescue missions. Preventing Overdiagnosis conference, Québec, Québec. https://www.preventingoverdiagnosis.net/?page_id=1545. Accessed 28 January 2018.
Remes, O., Whitten, A., Sabarre, K.A., & Phillips, K.P. (2013). Human papillomavirus (HPV) infection and vaccines: Ottawa University students’ knowledge, awareness and vaccine intentions. Journal of Genital System Disorders, S1. https://doi.org/10.4172/2325-9728.S1-006. Accessed 28 January 2018.
Riva, C., & Spinosa, J. P. (2013). Prescrire en questions: vaccin papillomavirus: quelle efficacité, quel risque? La Revue Prescrire, 33(357), 552–556.
Roberts, J., & Mitchell, L. M. (2017). “It’s your body, your decision”: An anthropological exploration of HPV vaccine hesitancy. In P. Bramadat, M. Guay, J. A. Bettinger, & R. Roy (Eds.), Public health in the age of anxiety: religious and cultural roots of vaccine hesitancy in Canada (pp. 293–320). Toronto: University of Toronto Press.
Scott, K., & Batty, M. L. (2016). HPV vaccine uptake among Canadian youth and the role of the nurse practitioner. Journal of Community Health, 41(1), 197–205.
Sellors, J., Karwalajtys, T., Kaczorowski, J., Mahony, J., Lytwyn, A., Sparrow, J., et al. (2003). Incidence, clearance and predictors of human papillomavirus infection in women. Canadian Medical Association Journal, 168(4), 421–425.
Statistics Canada (2017). Leading causes of death, by sex, 2014. Statistics Canada. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36c-eng.htm. Accessed 27 January 2018.
Steben, M., Blake, J., Durand, N., Guichon, J., Mcfaul, S., Ogilvie, G. (2017). A national survey of Canadians on HPV: comparing knowledge, barriers and preventive practices of physicians to those of consumers. Sexually Transmitted Infections (British Medical Journals), 93(S2). https://doi.org/10.1136/sextrans-2017-053264.43. Accessed 28 January 2018.
Stewart, B., & Wild, C.P. (Eds.) (2014). International Agency for Research on Cancer, WHO. World Cancer Report 2014. http://www.thehealthwell.info/node/725845. Accessed: 27 January 2018.
Thompson, M. (2010). Whose guarding what? A post structural feminist analysis of Gardasil discourses. Health Communication, 25, 119–130.
Todorova, I., Alexandrova-Karamanova, A., Panayotova, Y., Dimitrova, E., & Kotzeva, T. (2014). Managing uncertainty: healthcare professionals’ meanings regarding the HPV vaccine. International Journal of Behavioral Medicine, 21(1), 29–36.
Waller, J., Marlow, L., & Wardle, J. (2006). Mothers’ attitudes towards preventing cervical cancer through human papillomavirus vaccination. A qualitative study. Cancer Epidemiological Biomarkers Prevention, 15(7), 1257–1261.
Ward, J. K., Crépin, L., Bauquier, C., Vergelys, C., Bocquier, A., Verger, P., & Peretti-Watel, P. (2017). ‘I don’t know if I’m making the right decision’: French mothers and HPV vaccination in a context of controversy. Health, Risk and Society. https://doi.org/10.1080/13698575.2017.1299856. Accessed 27 January 2018.
Weedon, C. (1997). Feminist practice and poststructuralist theory. London: Blackwell.
World Health Organization (2015). Estimates for 2000–2015, cause-specific mortality. World Health Organization. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html. Accessed 27 January 2018.
Acknowledgements
This paper is part of a broader project on HPV vaccination discourses, practices, and spaces (Rail, G., Fusco, C., Burns, K., Russel, K., Bryson, M., MacDonald, M., Moola, F., Norman, M.E., Petherick, L., and Polzer, J., 2012–2017). The authors dedicate this article to the memory of Dr. Abby Lippman, who inspired them and provided assistance throughout this project.
Funding
The authors acknowledge the generous financial support of the Canadian Institutes of Health Research for this project.
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Rail, G., Molino, L., Fusco, C. et al. HPV vaccination discourses and the construction of “at-risk” girls. Can J Public Health 109, 622–632 (2018). https://doi.org/10.17269/s41997-018-0108-8
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DOI: https://doi.org/10.17269/s41997-018-0108-8