Negotiating Uncertainty: Risk, Responsibility, and the Unsettled Facts of HPV Vaccination in the ...

228 Pages·2014·2.28 MB·English

by  Kate Rendle

Negotiating Uncertainty: Risk, Responsibility, and the Unsettled Facts of
HPV Vaccination in the United States

By

Katharine Alice Sheets Rendle

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Social Work and Anthropology)
in the University of Michigan
2014

Doctoral Committee:

Associate Professor Elizabeth F. S. Roberts, Co-Chair
Professor & Associate Dean Michael S. Spencer, Co-Chair
Lecturer Holly Peters-Golden
Professor Elisha P. Renne
Professor Emertia Kristine A. Siefert
© Katharine Alice Sheets Rendle 2014
To my family

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ACKNOWLEDGMENTS

I would like to thank all the parents who so generously offered their time, insight, and
expertise with me. I truly enjoyed hearing your stories, and while I tried to remain true to the
information you shared, any misrepresentations or potential errors in this text are solely the
product of my own misunderstanding.
I would also like to acknowledge and thank those organizations who funded this
research and my doctoral training, including: The Wenner-Gren Foundation, Dissertation
Fieldwork Grant; University of Michigan, Rackham Graduate Student Research Grant;
University of Michigan, Rackham One-Term Dissertation Grant; University of Michigan
School of Social Work, Summer Funding; University of Michigan School of Social Work,
W. K. Kellogg Family Endowed Fellowship; and University of Michigan, Rackham Regents
Fellowship. I am grateful for your support.
I am thankful and indebted to the members of my committee, who have not only
supported me by offering intellectual and emotional guidance across the years, but also
encouraged me to think critically at each step of the way. I am grateful for my fellow
students with whom I have shared laughter, tears, panic, and joy, and especially to the
unsung heroes—Todd Huynh, Laura Thomas, and Laurie Marx—for always being there to
assist, support, and encourage.
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Lastly, I am eternally grateful and lucky to be surrounded by such amazing friends
and family, who have made this journey possible. To my parents, for always being my
biggest fan and giving me more opportunities and love that I could never have imagined. To
my friends for reminding me to enjoy the ride. To my daughter for her spirit and laughter.
And lastly to Edward, for your patience, support, love, and inspiration. We win.

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TABLE OF CONTENTS

DEDICATION ii
ACKNOWLEDGMENTS iii
LIST OF TABLES vii
LIST OF FIGURES viii
LIST OF APPENDICES x
ABSTRACT xi

CHAPTER ONE: INTRODUCTION 1
I. BACKGROUND: DESIGN, MARKETING, AND CONTROVERSIES OF THE HPV
2
VACCINE
II. THEORETICAL FRAMEWORK AND LITERATURE REVIEW 5
III. RESEARCH DESIGN 28
IV. DATA COLLECTION AND ANALYSIS 33
V. OUTLINE OF CHAPTERS 37
VI. RESEARCH IMPLICATIONS 40
VII. FUTURE DIRECTIONS AND OPPORTUNITIES IN U.S. HEALTHCARE 42

CHAPTER TWO: MAKING AND UNMAKING PATTERNS 46
I. PARENTAL DECISION-MAKING AND HPV VACCINATION IN THE UNITED
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STATES
II. REVIEW OF DISSERTATION FINDINGS 50
III. IMPACT OF PUBLIC CONTROVERSIES AND CULTURAL ANXIETIES 54
IV. THE STORY OF JENNY TETLOCK 64
V. VACCINE SAFETY 66
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VI. DOCTORS KNOW BEST…SOMETIMES 69
VII. UNMAKING MODELS 71
VIII. LOCATING PEOPLE AMID THEORY 74

CHAPTER THREE: EMPOWERMENT, AMBIVALENCE, AND PHARMACEUTICAL
81
MARKETING
I. PHARMACEUTICAL INTERESTS AND VACCINE DEVELOPMENT 82
II. PROMISE OF EMPOWERMENT: INITIAL MARKETING OF THE HPV VACCINE 84
III. PUBLIC DEBATES, CONTROVERSIES AND RESISTANCE TO HPV VACCINATION 94
IV. CONTINUED CONTROVERSIES: PERRY, BACHMANN, AND DR. MERCOLA 102
V. IMPACT OF MEDIA ON HPV VACCINATION DECISIONS 108
VI. HOPE AND HARM: REFLECTIONS ON THE PHARMACEUTICAL INDUSTRY 112
VII. GROWING OPPORTUNITIES FOR SOCIAL WORKERS IN HEALTHCARE 117

CHAPTER FOUR: TEMPORALITY, SEX, AND DESIRES TO DELAY 121
I. FUNDAMENTAL CAUSE THEORY AND COUNTERVAILING MECHANISMS 122
II. POPULATION PATTERNS AND HPV VACCINATION IN THE UNITED STATES 124
III. ASSESSMENTS OF TIME, SEX, RISK, AND SCIENCE 129
IV. DEBATING THE ‘RIGHT TIME’ TO VACCINATE 133
V. FUTURE DIRECTIONS & CONCLUSIONS 136

CHAPTER FIVE: MORAL RESPONSIBILITIES, INDIVIDUAL RIGHTS, AND
139
COLLECTIVE GOOD
I. PARENTAL RIGHTS AND MANDATORY VACCINATION 140
II. MORAL ASSESSMENTS 147
III. RESPONSIBILITY TO PROTECT 149
IV. VULNERABILITY, RISK, AND NEW MORALITIES 152

CHAPTER SIX: FUTURE DIRECTIONS 156
APPENDICES 161
REFERENCES CITED 188
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LIST OF TABLES

1. Interview Participant Characteristics 50
2. Five-Items Examining Trust in Healthcare Professionals 69

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LIST OF FIGURES
1. Children aged 11 or older of enrolled participants, by age, gender and 53
vaccination status
2. Parental responses to “The HPV vaccine may cause children to have sex at 55
an earlier age” by vaccination status
3. Parental responses to “The HPV vaccine is being pushed to make money for 59
drug companies” by vaccination status
4. Parental responses to “The HPV vaccine may cause mental retardation” by 62
vaccination status
67
5. Parental responses to “The HPV vaccine is safe” by vaccination status
6. Parental responses to “There is not enough scientific evidence that the HPV 68
vaccine is safe” by vaccination status
84
7. Gardasil poster targeting young women
86
8. Print images from Merck’s One Less Campaign
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9. Gardasil commercial targeting adolescents: Screenshot A
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10. Gardasil commercial targeting adolescents: Screenshot B
89
11. Gardasil commercial targeting adolescents: Screenshot C
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12. Gardasil commercial targeting young adult women: Screenshot A
91
13. Gardasil commercial targeting young adult women: Screenshot B
95
14. Anti-vaccination poster from 1890s
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15. CounterThink Editorial Cartoon
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16. Wasserman Editorial Cartoon
101
17. Gardasil poster targeting young adolescent boys and girls
102
18. Image of Gardasil website
105
19. Branch Editorial Cartoon
20. Parental responses to “In general, have you heard positive, negative, or 109
neutral stories about the HPV vaccine in the media?” by vaccination status
126
21. Estimated HPV vaccine coverage among U.S. adolescents, aged 13-17
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22. Estimated HPV vaccine coverage among U.S. adolescents, aged 13-17—by 127
poverty level
23. Estimated HPV vaccine coverage among U.S. adolescents, aged 13-17—by 128
race
24. Parental responses to “Which of the following statements do you agree with 142
more a) government should let parents decide for themselves how best to
protect their children even if it means they don’t always do the right thing;
b) government should pass laws to ensure all children are protected even if
it sometimes interferes with parents’ rights to make their own decisions?”
by vaccination status

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