Male Undergraduates’ HPV Vaccination Behavior: Implications for Achieving HPV-Associated Cancer Equity

Influences on male college students' patient-provider communications and uptake behaviors related to the human papillomavirus vaccine

OBJECTIVE

We assessed the psychosocial influences on college males' human papillomavirus (HPV) vaccine patient-provider communication and their uptake of one or more HPV vaccine doses.

METHODS

We conducted a cross-sectional survey with college males attending one large southwestern university. We used logistic regressions to explore the relationships between psychosocial and demographic variables on patient-provider communication and HPV vaccine uptake.

RESULTS

Patient-provider communication had the most significant influence on HPV vaccine uptake. However, most college males reported never discussing the HPV vaccine with their healthcare providers. HPV vaccine awareness, perceived subjective norms to vaccinate, and behavioral control to talk to healthcare providers about the vaccine significantly influenced college males' patient-provider communication and vaccine uptake.

CONCLUSION

HPV vaccine awareness, perceived behavioral control to communicate about the vaccine, and subjective norms to vaccinate are all addressable factors that influence HPV vaccine communication and uptake. Future intervention work should specifically target these factors for college men.

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations

BACKGROUND

Genital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15-25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low.

METHODS

Accordingly, our study utilized a comprehensive - Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18-26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes.

RESULTS

Overall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: 'knowledge' (82% of included studies), 'environmental context and resources' (53%), 'beliefs about consequences' (53%), 'unrealistic optimism' (50%) and 'pessimism' (6%), 'emotion' (50%), 'social influences' (50%), 'beliefs about capabilities' (41%), 'intention' (24%), 'reinforcement' (18%), 'social professional role and identity'(12%), and 'behavioral regulation' (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers' recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines.

DISCUSSION

Our study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.

Human papillomavirus (HPV) knowledge, beliefs, and vaccine uptake among United States and international college students

Objective: The purpose of this study was to compare knowledge about human papillomavirus (HPV) and HPV vaccine, college student's beliefs toward HPV, and HPV vaccine uptake between US and international college students studying in the US. Participants: The study was conducted using a sample (N = 588) of college students from a university in the South Central US. Methods: Study measures was derived from previously validated measures. Data were collected via an online survey using Qualtrics. Results: Significant differences were found in HPV awareness, HPV vaccine awareness, and HPV vaccine uptake between US and international college students. Conclusion: This study showed existing disparities between US and international college students regarding HPV and HPV vaccine awareness, and HPV vaccine uptake. College health centers can play a crucial role in raising awareness of HPV and HPV vaccination rates by organizing various intervention programs to reduce these disparities.

A 10-year systematic review of theory-driven approaches to increasing catch-up HPV vaccination rates among young adult males in colleges/university settings

OBJECTIVE

To describe rates and identify factors associated with human papillomavirus (HPV) vaccination among young adult males in college/university settings.

METHODS

Study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched for empirical studies published between 2009 and 2019 and focused on predictors for HPV vaccine uptake. Studies' methodological quality scores ranged between 12 and 23 points.

RESULTS

Five hundred and ninety eight titles/abstracts and 154 full-text articles were screened. Eighteen studies were included for final analysis. Results depicted participants' attitude, perceived susceptibility, severity, benefits, and barriers in receiving HPV vaccine. Many participants did not perceive themselves to be susceptible to HPV infection, and barriers to receiving HPV vaccine outweighed benefits. HPV knowledge and vaccination rates were relatively low among respondents.

CONCLUSION

Prevention campaigns that increase knowledge, promote positive attitudes, change perception of susceptibility, and address barriers may result in higher HPV vaccination rates among males in college/university settings.

Human Papillomavirus Vaccination in Male University Students in Turkey: Coverage Rate, Barriers, and Associated Factors

The human papillomavirus (HPV) vaccine is one of the most effective public health measures for preventing HPV-related cancers and other diseases. However, vaccination coverage is not at the desired level, especially among men. In this context, we aimed to determine HPV vaccination rates, barriers, and some related demographic and personal factors among male university students in Turkey. We shared an online questionnaire prepared by the authors in line with the relevant literature on social media platforms and included 1723 male university students in this cross-sectional study. Only 4.9% of the students stated that they were vaccinated against HPV, and the most important obstacle to vaccination was not knowing when to be vaccinated (49.5%). Additionally, marital status, sexual orientation, chronic diseases, family history of cervical cancer, and having heard of HPV were significant predictors of HPV vaccination.

Social-contextual factors interact with masculinity to influence college men's HPV vaccination intentions: The role of descriptive norms, prototypes, and physician gender

Men’s low HPV vaccination uptake and HPV-related disease incidence are public health issues; gendered social–contextual factors likely play a role. In Study 1, college men (N = 130; M_age = 19.55; white = 58.1%) reported their social cognitions (male-referent descriptive norms and prototypes), self-reliance masculinity ideology, and vaccination intentions. In Study 2, college men (N = 106; M_age = 19.32; white = 61.3%) were randomly assigned to receive HPV vaccination information from a man or woman physician-avatar. Descriptive norms and favorable prototypes (bs ≥ .337; ps ≤ .016) were associated with higher HPV vaccination intentions. Men with higher self-reliance masculinity had higher HPV vaccination intentions with a man physician and when they perceived greater vaccination among men (ps ≤ .035). Men with higher self-reliance masculinity are more sensitive to gendered social–contextual effects in HPV vaccination decision-making. Gendered social–contextual factors should be integrated into public health interventions to increase college men’s HPV vaccination uptake.

Factors Associated with Human Papillomavirus Vaccination and the Intention among Undergraduate Nursing Students: A Cross-Sectional, Correlational Study

PURPOSE

To examine factors associated with overall human papillomavirus (HPV) vaccination status, completion of HPV vaccination, and intention to receive vaccination among nursing students.

DESIGN

A Cross-sectional, correlational study.

METHODS

Data from 86 students were analyzed using logistic and multiple regression.

FINDINGS

Among knowledge, attitudes and beliefs, and recommendation, more positive attitudes and beliefs were the only factors associated with initiation and/or completion of HPV vaccination and the intention to receive HPV vaccination.

CONCLUSIONS

More positive attitudes and beliefs need to be enhanced for HPV vaccination.

CLINICAL EVIDENCE

Changes in attitudes and beliefs can be important targets of interventions to increase HPV vaccination.

Human papillomavirus (HPV) and HPV vaccine knowledge, the intention to vaccinate, and HPV vaccination uptake among male college students

ObjectiveThis systematic mixed studies review aims to summarize the results of available research on knowledge of the human papillomavirus (HPV) and HPV vaccine, the intention to vaccinate, and HPV vaccination uptake among male college students. Methods: PubMed, ProQuest, EBSCO, PsycINFO, JSTOR, MEDLINE, and Google Scholar searches were performed to identify studies. A total of 39 studies were included in this review. Results: Most studies were cross-sectional (n = 27) and used convenience samples (n = 18). Although many students were aware of HPV and the HPV vaccine, gaps in their knowledge about the mode of transmission, symptoms, risk factors, and HPV vaccine mechanism were evident. The cost of HPV vaccination and concerns about safety and side effects were the most frequently reported barriers to obtaining the vaccination. Conclusion: More effort to increase knowledge about HPV and the uptake of the HPV vaccination among college men in the United States is necessary.

An instrument assessing attitudes and beliefs toward human papillomavirus vaccination

OBJECTIVES

The purpose of this study was to test the psychometric properties of a brief attitudes and beliefs toward human papillomavirus (HPV) vaccination instrument in college students.

DESIGN

Cross-sectional, observational study.

SAMPLE

Eighty-six nursing students.

MEASUREMENTS

The Attitudes and Beliefs Toward Human Papillomavirus Vaccination was used to test the reliability (Cronbach's alpha), homogeneity (item-analyses), and validity (factor analysis and correlations).

RESULTS

The reliability of this 8-item instrument was supported by a Cronbach's alpha of .854. Item homogeneity was supported by coefficients for all items > .30. Convergent validity was supported by significant correlations of attitudes and beliefs assessed by this instrument to attitudes, subjective norm, and perceived behavioral control assessed by different instruments (all ps < .001). Construct validity was supported by exploratory and confirmatory factor analyses (all factor loadings ≥ .40). Predictive validity was supported by a significant relationship of attitudes and beliefs to completion of the vaccination (p < .001).

CONCLUSIONS

The Attitudes and Beliefs Toward Human Papillomavirus Vaccination Questionnaire was a reliable and valid instrument. This short instrument can be used to assess and improve attitudes and beliefs toward HPV vaccination, and, in turn, to facilitate the completion of the vaccination.

mHealth video gaming for human papillomavirus vaccination among college men-qualitative inquiry for development

BACKGROUND

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Persistent infection with HPV can cause various cancers; however, HPV vaccination can prevent infections associated with high risk, cancerous strains of the virus. As it relates to HPV, college age men have been identified as one of the catch-up vaccination groups. Among college age men, gaming is an extremely popular extracurricular activity. Further, video games have emerged as a popular public health intervention tool. Therefore, this study aims to collect qualitative data on how to develop, implement and evaluate the effectiveness of a gaming intervention to increase HPV risk perceptions, improve self-efficacy and increase intention to receive the HPV vaccine among male college students (18-26 years old).

METHODS

Four focus group sessions ranging from eight to ten individuals were conducted among male college students from one large research-intensive university in the South. Using grounded theory, data from focus group interviews were coded using NVivo software to identify emergent themes.

RESULTS

Participants emphasized that although customization was not viewed as important by college aged males, the ability to tailor in game experiences or experience different things each time they played (creative freedom) was more important. They encouraged that the digital game be created on a mobile platform, incorporate health messages, and be informative to reach their population. Furthermore, they suggested innovative way to disseminate the game, which included having health department/health care providers prescribe the game to patients as an end of clinical interaction strategy.

CONCLUSIONS

College age men, are natural avid gamers, enjoy game play, and can engage in learning online or offline. While platform preference varies among gamer type, college age men in our study emphasized that mobile based gaming is the most advantageous way to increase knowledge/awareness and encourage positive in game behavior which can impact out of game behaviors such as vaccination. Because of the level of access and natural disposition of mHealth technology seen as an "extension of the self", games for health developers should consider the mobile platform as the ideal for the target demographic.

Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood

PURPOSE

Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university.

METHODS

We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination.

RESULTS

Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.

CONCLUSIONS

Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.

Race and sex differences in adverse childhood experiences among Asian/Pacific Islander college students

Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.

College males' behaviors, intentions, and influencing factors related to vaccinating against HPV

In the US, individuals between ages 18 and 26 have the highest incidence of new human papillomavirus (HPV) infections, the most common sexually transmitted infection worldwide. HPV infection can cause genital warts, and persistent infection with cancerous strains can develop into multiple types of cancers. In 2011, the Centers for Disease Control and Prevention recommended that both men and women receive the vaccine. However, young adult men, including college-aged men, have been slow to initiate and complete the vaccine series. Our cross-sectional study, guided by the Theory of Planned Behavior, explores college men's vaccination uptake and series completion behaviors and their intentions to vaccinate. Using logistic regression, we examined how students' attitudes, perceived behavioral control, and subjective norms impacted their HPV vaccine-related behaviors and intentions. Subjective norms, followed by perceived behavioral control to communicate with a provider about the HPV vaccine, had the largest impact on students' HPV vaccine uptake and completion behaviors and intentions to vaccinate. Both subjective norms and positive attitudes about the vaccine impacted students' intentions to vaccinate against HPV. Based on these findings, we make various recommendations including campus interventions and policies that could increase HPV vaccine uptake and completion behaviors among college men.

Reported rationales for HPV vaccination vs. Non-vaccination among undergraduate and medical students in South Carolina

Objective: We sought to identify factors that influence Human Papillomavirus (HPV) vaccination rates in individuals at two higher education institutions in South Carolina (SC).Participants: We surveyed 1007 students with a mean age and standard deviation of 20.3 ± 3.3 from September 2018 to December 2018.Methods: Participants answered 13 questions, assessing HPV vaccination rates, demographics, and rationales for vaccination vs. non-vaccination.Results: Of 1007 respondents, 700 received HPV vaccination, 165 were unvaccinated, 75 received partial vaccination and 138 were uncertain. Commonalities in HPV vaccination existed between females (p = 0.037), individuals who received standard childhood vaccinations (p = 0.04), and those not native-born in SC (p < 0.001). Of non-vaccinated individuals, 37% "never thought about vaccination," 32% did not perceive a need for vaccination, and 31% reported vaccine safety as reasons for not receiving the vaccine.Conclusions: Promotion of HPV vaccination may benefit from targeting SC natives, males, and individuals who are under-vaccinated or unvaccinated.

Prevalence and sociodemographic correlates of anogenital Human Papillomavirus (HPV) carriage in a cross-sectional, multi-ethnic, community-based Asian male population

Background

Addressing the burden of HPV-associated diseases among men is increasingly becoming a public health issue. The main objective of this study was to determine HPV prevalence among a healthy community-based Malaysian men.

Method

This was a cross-sectional study that recruited 503 healthy males from 3 community-based clinics in Selangor, Malaysia. Genital and anal samples were collected from each participant for 14 high risk and 2 low risk HPV DNA detection and genotyping. All participants responded to a set of detailed sociodemographic and sexual behaviour questionnaire.

Results

The median age at enrolment was 40 years old (IQR: 31–50). The anogenital HPV6/11 prevalence was 3.2% whereas high risk HPV prevalence was 27.1%. The genital HPV prevalence for HPV6/11 was 2.9% while high risk HPV was 18.8%. HPV6/11 prevalence in the anal canal was 1.6% and high risk HPV was 12.7%. HPV 18 was the most prevalent genotype detected in the anogenital area. There was a significant independent association between genital and anal HPV infections.

Conclusion

Anogenital HPV infection is common among Malaysian men. These findings emphasize the ubiquity of HPV infection and thus the value of population-wide access to HPV prevention.

HPV Vaccine and College-Age Men: A Scoping Review

The human papillomavirus (HPV) potentially affects every sexually active man in the United States and Canada. In 2017, the vaccine became publicly funded in Canada for males ages 9-26, and was integrated into school vaccination programs. In 2019, HPV vaccination was recommended as routine for all U.S.-based males and females ages 9 through 26, and a shared decision for adults >26 years; however, since the approval of the vaccine in 2006 for females only, the age and dosing recommendations for males have followed a complicated and changing trajectory. Current adherence rates are low among college and university age males (18-26 years); therefore, understanding and addressing the barriers and facilitators for men's HPV vaccination is critically important. The purpose of the current scoping review is to provide a synthesis of recent literature pertaining to HPV in college and university age men, as a means to guiding health-care providers (HCPs). Drawing from 15 published articles, three thematic findings were inductively derived. Theme one, lack of awareness, was underpinned by men's knowledge deficits about their eligibility for, and the availability of HPV vaccines. Theme two, underestimating and embodying risk, included men's engagement in sexual activities while misinformed or denying the risk for contracting HPV. The third theme, strategies for increasing men's awareness, summarizes messaging strategies used to lobby young men to vaccinate. The review findings indicate gender-sensitive interventions targeting college-age men, including early, frequent, and consistent messaging on HPV are key.

A significant portion of college students are not aware of HPV disease and HPV vaccine recommendations

There is limited data on the HPV immunization status of Latino/Hispanic youth in the USA. In Los Angeles County in 2015, 54,973 (34.3%) college students were of Latino/Hispanic background. We examined Los Angeles County college students’ awareness of HPV and HPV-related disease, HPV vaccine recommendations, and their vaccination status. This study surveyed 212 Los Angeles college students from January to April 2018. In a convenience sampling study, a 31-question, IRB-approved survey was administered face-to-face to college students 18 years and older at California State University settings in Los Angeles County. Almost two-thirds of the male (65%) and half of the female (51.6%) respondents did not know that the HPV vaccine is recommended through 26 years of age, and 47.6% did not know they can get the HPV vaccine at the college student health center or youth-friendly clinics. Ethnicity, family income, and the highest level of education in the family had a significant impact on immunization rates. Self-reported and actual HPV knowledge levels were significantly associated with vaccination status. Educational strategies focusing on the logistics of receiving the HPV vaccine and HPV vaccine catch-up eligibility for college students may be effective in decreasing racial disparities in vaccine receipt.

Examining HPV Awareness, Sexual Behavior, and Intent to Receive the HPV Vaccine Among Racial/Ethnic Male College Students 18-27 years

Human papillomavirus (HPV) awareness and vaccination among males in the general population is low. Men in general, but particularly racial/ethnic men, are disproportionately affected by HPV. The purpose of this article is to examine college males' (a) HPV awareness, (b) sexual behaviors, and (c) intention to receive the HPV vaccination. A non-probability sample of all students who self-reported their race/ethnicity and were attending a university in Southeastern United States were contacted by the university registrar's office and recruited to participate in the 15-minute survey. Males, ages 18-27 years ( N = 190), were identified for this study. χ2, t-tests, and binomial logistic regression analyses assessed the relationship between knowing about HPV and HPV vaccine and the intent to receive the HPV vaccination. Findings indicated that 67.4% of the sample identified as Hispanic or Black. Among all men, 73.2% reported previous sexual experience and 49.5% were currently sexually active. There were 79.5% who had previous knowledge about HPV and 55.8% had knowledge about the HPV vaccine; 71.1% of the sample did not intend to receive the vaccine. Hispanic and Black men were less likely to identify as virgins, more likely to be sexually active, and more likely to have sexual experiences at an earlier age compared to White, Asian, and other men. Men with previous HPV vaccine knowledge (28.4%) were more likely to intend to receive the vaccine compared to men who did not have previous knowledge about the vaccine (14.9%). Providing males with information about HPV, its transmission, and possible HPV-related outcomes may increase HPV vaccine uptake.