Background. Mother-daughter communication about sex is associated with healthier behavior during adolescence. This dissertation explores human papillomavirus (HPV) vaccine as a potential opportunity for communication about sexual health.

Methods. Data are from a national sample of mothers of adolescent girls aged 11-14 in the United States who completed an online survey in December 2009. Analyses incorporated sample weights to yield nationally-representative estimates. The first set of analyses examined HPV vaccine discussions as an opportunity for mothers (n=900) to deliver messages about sexual health to their early adolescent children. The second set of analyses described mothers' (n=902) communication with health care providers about HPV vaccine and assessed these conversations as an opportunity to offer mothers information about sexual health.

Results. Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that talking about the vaccine led to a conversation about sex. Mothers who talked with their daughters about HPV vaccine were more likely to also have talked with them about sex topics (92% vs. 74%, OR=3.07, CI=1.44-6.54.), in multivariate analyses. Just half (55%) of all mothers reported ever talking with their daughters' providers about HPV vaccine, and only a quarter (25%) of those said the conversations included sex topics. Provider discussions about HPV vaccine that included messages about sex were associated with mothers talking with their daughters about sex topics both in the context of HPV vaccine discussions (OR= 3.34 95% CI: 1.59-7.00) and overall (OR= 6.21, 95% CI: 1.76-21.94).

Discussion. HPV vaccine discussions provide an acceptable opportunity for mothers to talk with their daughters about sex at an age when such communication is most influential. Health care provider discussions with mothers about HPV vaccine could help promote parent-child communication about sexual health.