Di Lun

Background:Family and friends play a dual role in supporting and hindering young adults’ decisions about the human papillomavirus (HPV) vaccine. However, the mechanisms by which anticipated HPV vaccination stigma from these social circles affects vaccination intent remain largely understudied. This study applied the Information–Motivation–Behavioral Skills model to examine how anticipated HPV vaccination stigma from family and friends influences vaccination intent and its underlying mechanisms.Methods:Unvaccinated young adults (N = 728) ages 18 to 26 years in Texas completed a survey to assess anticipated HPV vaccination stigma from family and friends, vaccination intent, and mediators. Two parallel path analyses evaluated the association between anticipated HPV vaccination stigma from family and friends and vaccination intent, with self-efficacy, beliefs about sexual activity and vaccination need, and intent to consult a doctor as hypothesized skill- and belief-based mediators, controlling for demographics.Results:Indirect effects showed that stronger anticipated HPV vaccination stigma from family and friends was linked to weaker vaccination intent through reduced self-efficacy and a strengthened belief that limited sexual activity reduces vaccination need (total indirect effect for family: β = −0.050, P = 0.003). Stronger anticipated stigma from friends—not family—predicted weaker intent through reduced intent to consult a doctor (total indirect effect for friends: β = −0.079, P = 0.005).Conclusions:Anticipated HPV vaccination stigma undermines vaccination intent by weakening vaccination skills and reinforcing beliefs that discourage vaccination, with its influence differing by source.Impact:Tailored messaging is needed to equip young adults with the confidence and resources to overcome HPV vaccination stigma from family and friends, with each source addressed uniquely.

Supplemental Table 2 displays covariances among variables included in Path Analysis 1, which examined anticipated HPV vaccination stigma from friends. Standardized coefficients, p-values, and 95% confidence intervals are shown for both the saturated model (all pathways) and the trimmed model (significant pathways only).

Supplemental Table 1 presents all study variables, including the number of items per scale, item-level prompts, response ranges, aggregation methods, and internal consistency reliability (Cronbach’s α, where applicable).

Supplemental Table 4 summarizes total and specific indirect effects for age and sexual activity status in the trimmed model of Path Analysis 2 (anticipated HPV vaccination stigma from family). Both standardized and unstandardized coefficients are reported, along with p-values and 95% confidence intervals for unstandardized effects.

Supplemental Table 3 presents covariances among variables included in Path Analysis 2, which examined anticipated HPV vaccination stigma from family. The table reports standardized coefficients, p-values, and 95% confidence intervals for both the saturated model (including all pathways) and the trimmed model (including only significant pathways).

Background: Family and friends play a dual role in supporting and hindering young adults’ decisions about the human papillomavirus (HPV) vaccine. However, the mechanisms by which anticipated HPV vaccination stigma from these social circles affects vaccination intent remain largely understudied. This study applied the Information–Motivation–Behavioral Skills model to examine how anticipated HPV vaccination stigma from family and friends influences vaccination intent and its underlying mechanisms. Methods: Unvaccinated young adults (N = 728) ages 18 to 26 years in Texas completed a survey to assess anticipated HPV vaccination stigma from family and friends, vaccination intent, and mediators. Two parallel path analyses evaluated the association between anticipated HPV vaccination stigma from family and friends and vaccination intent, with self-efficacy, beliefs about sexual activity and vaccination need, and intent to consult a doctor as hypothesized skill- and belief-based mediators, controlling for demographics. Results: Indirect effects showed that stronger anticipated HPV vaccination stigma from family and friends was linked to weaker vaccination intent through reduced self-efficacy and a strengthened belief that limited sexual activity reduces vaccination need (total indirect effect for family: β = −0.050, P = 0.003). Stronger anticipated stigma from friends—not family—predicted weaker intent through reduced intent to consult a doctor (total indirect effect for friends: β = −0.079, P = 0.005). Conclusions: Anticipated HPV vaccination stigma undermines vaccination intent by weakening vaccination skills and reinforcing beliefs that discourage vaccination, with its influence differing by source. Impact: Tailored messaging is needed to equip young adults with the confidence and resources to overcome HPV vaccination stigma from family and friends, with each source addressed uniquely.