Journal of Behavioral Medicine

, Volume 39, Issue 3, pp 429–440 | Cite as

The role of anticipated regret and health beliefs in HPV vaccination intentions among young adults

  • Shannon M. Christy
  • Joseph G. Winger
  • Elizabeth W. Raffanello
  • Leslie F. Halpern
  • Sharon Danoff-Burg
  • Catherine E. Mosher


Although cognitions have predicted young adults’ human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. This study examined whether anticipated regret was associated with young adults’ intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.


Human papillomavirus vaccination Health behavior Anticipated regret Health Belief Model Sexual health 



The work of the first author was funded initially by R25CA117865 (V. Champion, PI) and subsequently by R25CA090314 (P. Jacobsen, PI) from the National Cancer Institute. The work of the second author was funded by a fellowship from the Behavioral Cooperative Oncology Group Center for Symptom Management and the Walther Cancer Foundation. The work of the last author was funded by K07CA168883 (C. Mosher, PI) and K05CA175048 (V. Champion, PI) from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Compliance with ethical standards

Conflict of interest

Shannon M. Christy, Joseph G. Winger, Elizabeth W. Raffanello, Leslie F. Halpern, Sharon Danoff-Burg, and Catherine E. Mosher declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


  1. Anderson, C. J. (2003). The psychology of doing nothing: Forms of decision avoidance result from reason and emotion. Psychological Bulletin, 129, 139–167. doi: 10.1037/0033-2909.129.1.139 CrossRefPubMedGoogle Scholar
  2. Bennett, K. K., Buchanan, J. A., & Adams, A. D. (2012). Social-cognitive predictors of intention to vaccinate against the human papillomavirus in college-age women. Journal of Social Psychology, 152, 480–492. doi: 10.1080/00224545.2011.639408 CrossRefPubMedGoogle Scholar
  3. Btoush, R. M., Brown, D. R., Fogarty, S., & Carmody, D. P. (2015). Initiation of Human Papillomavirus vaccination among predominantly minority female and male adolescents at inner-city community health centers. American Journal of Public Health. doi: 10.2105/AJPH.2015.302584 PubMedGoogle Scholar
  4. Bynum, S. A., Brandt, H. M., Friedman, D. B., Annang, L., & Tanner, A. (2011). Knowledge, beliefs, and behaviors: Examining human papillomavirus-related gender differences among African American college students. Journal of American College Health, 59, 296–302. doi: 10.1080/07448481.2010.503725 CrossRefPubMedGoogle Scholar
  5. Centers for Disease Control and Prevention. (2008). 2008 National Immunization Survey-Teen Hard Copy Questionnaire. Hyattsville, MD: Centers for Disease Control and Prevention.Google Scholar
  6. Centers for Disease Control and Prevention. (2015). Genital HPV infection—Fact sheet. Retrieved September 9, 2015, from
  7. Chambers, J. A., O’Carroll, R. E., Cook, A., Cavanagh, J., Archibald, D., & Millar, R. (2014). A pilot telephone intervention to increase uptake of breast cancer screening in socially deprived areas in Scotland (TELBRECS): Study protocol for a randomised controlled trial. BMC Public Health, 14, 824. doi: 10.1186/1471-2458-14-824 CrossRefPubMedPubMedCentralGoogle Scholar
  8. Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research and practice (pp. 45–66). San Francisco, CA: Jossey-Bass/Wiley.Google Scholar
  9. Chapman, G. B., & Coups, E. J. (2006). Emotions and preventive health behavior: Worry, regret, and influenza vaccination. Health Psychology, 25, 82–90. doi: 10.1037/0278-6133.25.1.82 CrossRefPubMedGoogle Scholar
  10. Cody, R., & Lee, C. (1990). Behaviors, beliefs, and intentions in skin cancer prevention. Journal of Behavioral Medicine, 13, 373–389. doi: 10.1007/BF00844885 CrossRefPubMedGoogle Scholar
  11. Courtenay, W. H., McCreary, D. R., & Merighi, J. R. (2002). Gender and ethnic differences in health beliefs and behaviors. Journal of Health Psychology, 7, 219–231. doi: 10.1177/1359105302007003216 CrossRefPubMedGoogle Scholar
  12. Donadiki, E. M., Jiménez-García, R., Hernández-Barrera, V., Sourtzi, P., Carrasco-Garrido, P., López de Andrés, A., & Velonakis, E. G. (2014). Health Belief Model applied to non-compliance with HPV vaccine among female university students. Public Health, 128, 268–273. doi: 10.1016/j.puhe.2013.12.004 CrossRefPubMedGoogle Scholar
  13. Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.CrossRefPubMedGoogle Scholar
  14. Fisher, W. A., Kohut, T., Salisbury, C. M., & Salvadori, M. I. (2013). Understanding human papillomavirus vaccination intentions: Comparative utility of the theory of reasoned action and the theory of planned behavior in vaccine target age women and men. The Journal of Sexual Medicine, 10, 2455–2464. doi: 10.1111/jsm.12211 CrossRefPubMedGoogle Scholar
  15. Fontenot, H. B., Fantasia, H. C., Charyk, A., & Sutherland, M. A. (2014). Human papillomavirus (HPV) risk factors, vaccination patterns, and vaccine perceptions among a sample of male college students. Journal of American College Health, 62, 186–192. doi: 10.1080/07448481.2013.872649 CrossRefPubMedGoogle Scholar
  16. Fu, L. Y., Bonhomme, L. A., Cooper, S. C., Joseph, J. G., & Zimet, G. D. (2014). Educational interventions to increase HPV vaccination acceptance: A systematic review. Vaccine, 32, 901–920. doi: 10.1016/j.vaccine.2014.01.091 CrossRefGoogle Scholar
  17. Gilbert, P., Brewer, N. T., Reiter, P. L., Ng, T. W., & Smith, J. S. (2011). HPV vaccine acceptability in heterosexual, gay, and bisexual men. American Journal of Men’s Health, 5, 297–305. doi: 10.1177/1557988310372802 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Gottlieb, S. D. (2013). The patient–consumer–advocate nexus: The marketing and dissemination of Gardasil, the Human Papillomavirus Vaccine in the United States. Medical Anthropology Quarterly, 27, 330–347. doi: 10.1111/maq.12046 CrossRefPubMedGoogle Scholar
  19. Gross, M. S., Tran, C. H., Sutherland, K. H., Castagno, J. C., & Amdur, R. J. (2014). Pilot study: Can an educational intervention increase Human Papillomavirus vaccination in female college students? Obstetrics and Gynecology, 123, 1–2. doi: 10.1097/01.AOG.0000447062.94587.52 CrossRefGoogle Scholar
  20. Hochbaum, G. M. (1958). Public participation in medical screening programs: A sociopsychological study. Washington, D.C.: US Government Printing Office.Google Scholar
  21. Janssen, E., Waters, E. A., van Osch, L., Lechner, L., & de Vries, H. (2014). The importance of affectively-laden beliefs about health risks: The case of tobacco use and sun protection. Journal of Behavioral Medicine, 37, 11–21. doi: 10.1007/s10865-012-9462-9 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education & Behavior, 11, 1–47. doi: 10.1177/109019818401100101 CrossRefGoogle Scholar
  23. Kester, L. M., Shedd-Steele, R. B., Dotson-Roberts, C. A., Smith, J., & Zimet, G. D. (2014). The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18–26 year old young adults. Gynocologic Oncology, 132, S9–S12. doi: 10.1016/j.ygyno.2013.12.033 CrossRefGoogle Scholar
  24. Krawczyk, A. L., Perez, S., Lau, E., Holcroft, C. A., Amsel, R., Knäuper, B., & Rosberger, Z. (2012). Human papillomavirus vaccination intentions and uptake in college women. Health Psychology, 31, 685–693. doi: 10.1037/a0027012 CrossRefPubMedGoogle Scholar
  25. Lindley, L. L., Elkind, J. S., Landi, S. N., & Brandt, H. M. (2013). Receipt of the human papillomavirus vaccine among female college students in the United States, 2009. Journal of American College Health, 61, 18–27. doi: 10.1080/07448481.2012.750607 CrossRefPubMedGoogle Scholar
  26. Loewenstein, G. F., Weber, E. U., Hsee, C. K., & Welch, N. (2001). Risk as feelings. Psychological Bulletin, 127, 267–286. doi: 10.1037//0033-2909.127.2.267 CrossRefPubMedGoogle Scholar
  27. McQueen, A., Vernon, S. W., Meissner, H. I., & Rakowski, W. (2008). Risk perceptions and worry about cancer: Does gender make a difference? Journal of Health Communications, 13, 56–79. doi: 10.1080/10810730701807076 CrossRefGoogle Scholar
  28. McRee, A. L., Katz, M. L., Paskett, E. D., & Reiter, P. L. (2014). HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults. Vaccine, 32, 4736–4742. doi: 10.1016/j.vaccine.2014.07.001 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Mehta, P., Sharma, M., & Lee, R. C. (2013). Designing and evaluating a Health Belief Model-based intervention to increase intent of HPV vaccination among college males. International Quarterly of Community Health Education, 34, 101–117. doi: 10.2190/IQ.34.1.h CrossRefPubMedGoogle Scholar
  30. Patel, D. A., Grunzweig, K. A., Zochowski, M. K., Dempsey, A. F., Carlos, R. C., & Dalton, V. K. (2013). Human papillomavirus vaccine stages of change among male and female university students: Ready or not? Journal of American College Health, 61, 336–346. doi: 10.1080/07448481.2013.811244 CrossRefPubMedGoogle Scholar
  31. Ratanasiripong, N. T. (2015). Factors related to Human Papillomavirus (HPV) vaccination in college men. Public Health Nursing,. doi: 10.1111/phn.12198 PubMedGoogle Scholar
  32. Reimer, R. A., Schommer, J. A., Houlihan, A. E., & Gerrard, M. (2014). Ethnic and gender differences in HPV knowledge, awareness, and vaccine acceptability among White and Hispanic men and women. Journal of Community Health, 39, 274–284. doi: 10.1007/s10900-013-9773-y CrossRefPubMedGoogle Scholar
  33. Reiter, P. L., Brewer, N. T., McRee, A. L., Gilbert, P., & Smith, J. S. (2010a). Acceptability of HPV vaccine among a national sample of gay and bisexual men. Sexually Transmitted Diseases, 37, 197–203. doi: 10.1097/OLQ.0b013e3181bf542c CrossRefPubMedPubMedCentralGoogle Scholar
  34. Reiter, P. L., Brewer, N. T., & Smith, J. S. (2010b). Human papillomavirus knowledge and vaccine acceptability among a national sample of heterosexual men. Sexually Transmitted Infections, 86, 241–246. doi: 10.1136/sti.2009.039065 CrossRefPubMedPubMedCentralGoogle Scholar
  35. Reiter, P. L., Gilkey, M. B., & Brewer, N. T. (2013). HPV vaccination among adolescent males: results from the National Immunization Survey-Teen. Vaccine, 31, 2816–2821. doi: 10.1016/j.vaccine.2013.04.010 CrossRefPubMedPubMedCentralGoogle Scholar
  36. Richard, R., van der Pligt, J., & de Vries, N. (1995). Anticipated affective reactions and prevention of AIDS. British Journal of Social Psychology, 34, 9–21. doi: 10.1111/j.2044-8309.1995.tb01045.x CrossRefPubMedGoogle Scholar
  37. Rolnick, S. J., Parket, E. D., Nordin, J. D., Hedblom, B. D., Wei, F., et al. (2013). Self-report compared to electronic medical record across eight adult vaccines: Do results vary by demographic factors? Vaccine, 31, 3928–3935. doi: 10.1016/j.vaccine.2013.06.041 CrossRefPubMedPubMedCentralGoogle Scholar
  38. Rosenstock, I. M. (1960). What research in motivation suggests for public health. American Journal of Public Health and the Nation’s Health, 50, 295–302. doi: 10.2105/AJPH.50.3_Pt_1.295 CrossRefPubMedPubMedCentralGoogle Scholar
  39. Satterwhite, C. L., Torrone, E., Meites, E., Dunne, E. F., Mahajan, R., Ocfemia, M. C., et al. (2013). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sexually Transmitted Diseases, 40, 187–193. doi: 10.1097/OLQ.0b013e318286bb53 CrossRefPubMedGoogle Scholar
  40. Schmidt, S., & Parsons, H. M. (2014). Vaccination interest and trends in human papillomavirus vaccine uptake in young adult women aged 18 to 26 years in the United States: An analysis using the 2008-2012 National Health Interview Survey. American Journal of Public Health, 104, 946–953. doi: 10.2105/AJPH.2013.301828 CrossRefPubMedPubMedCentralGoogle Scholar
  41. Schwarz, N. (2000). Emotion, cognition, and decision making. Cognition and Emotion, 14, 433–440. doi: 10.1080/026999300402745 CrossRefGoogle Scholar
  42. US Food and Drug Administration. (2011). Vaccines, blood & biologics: Gardasil. Retrieved May 6, 2014, from
  43. US Food and Drug Administration. (2013). Vaccines, blood & biologics: Cervarix. Retrieved May 6, 2014, from
  44. US Food and Drug Administration. (2015). Vaccines, blood & biologics: Gardasil 9. Retrieved August 24, 2015, from
  45. Wang, X. (2011). The role of anticipated negative emotions and past behavior in individuals’ physical activity intentions and behaviors. Psychology of Sport and Exercise, 12, 300–305. doi: 10.1016/j.psychsport.2010.09.007 CrossRefGoogle Scholar
  46. Weinstein, N. D., Kwitel, A., McCaul, K. D., Magnan, R. E., Gerrard, M., & Gibbons, F. X. (2007). Risk perceptions: Assessment and relationship to influenza vaccination. Health Psychology, 26, 146–151. doi: 10.1037/0278-6133.26.2.146 CrossRefPubMedGoogle Scholar
  47. Winer, R. L., Lee, S., Hughes, J. P., Adam, D. E., Kiviat, N. B., & Koutsky, L. A. (2003). Genital Human Papillomavirus infection: Incidence and risk factors in a cohort of female university students. American Journal of Epidemiology, 157, 218–226. doi: 10.1093/aje/kwf180 CrossRefPubMedGoogle Scholar
  48. Zimet, G. D., Weiss, T. W., Rosenthal, S. L., Good, M. B., & Vichnin, M. D. (2010). Reasons for non-vaccination against HPV and future vaccination intentions among 19–26 year-old women. BMC Women’s Health, 10, 27. doi: 10.1186/1472-6874-10-27 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Shannon M. Christy
    • 1
    • 2
  • Joseph G. Winger
    • 2
  • Elizabeth W. Raffanello
    • 3
  • Leslie F. Halpern
    • 3
  • Sharon Danoff-Burg
    • 4
  • Catherine E. Mosher
    • 2
  1. 1.Health Outcomes and Behavior Program, Division of Population ScienceMoffitt Cancer Center and Research InstituteTampaUSA
  2. 2.Department of PsychologyIndiana University-Purdue University IndianapolisIndianapolisUSA
  3. 3.Department of PsychologyUniversity at Albany-SUNYAlbanyUSA
  4. 4.New Knowledge OrganizationOceansideUSA

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