Factors influencing the willingness of US women to vaccinate their daughters against the human papillomavirus to prevent cervical cancer

Disparities in HPV and the HPV Vaccine Knowledge Among Non-Hispanic Black Adults in the US - HINTS 2017-2020

Disparities persists in HPV awareness and vaccination among different racial and ethnic groups. We assessed disparities in awareness of HPV and the HPV vaccine among non-Hispanic Black US adults. We analyzed the nationally representative data from the Health Information National Trends Survey of US adults 18 years or older (n = 16,092) administered by the National Cancer Institute (HINTS5-Cycle 1,2,3,4) for the years 2017-2020, of which 2,011 (n = 2,011) were non-Hispanic Black adults. Weighted Poisson regression models were used to estimate disparities in HPV and HPV vaccination awareness among non-Hispanic Black US adults. In the US, 63.2% of non-Hispanic Black adults had heard of HPV and 57.6% were aware of the HPV vaccine. Black females had 1.3 and 1.5 times the prevalence of HPV and the HPV vaccine awareness compared to males (PR = 1.3; 95% CI = 1.2-1.4; P ≤ 0.001) and (PR = 1.5; 95% CI = 1.4-1.6; P ≤ 0.001) respectively. Blacks with a college education had 1.8 and 2.2 times the prevalence of HPV and HPV vaccine awareness (PR = 1.8; 95% CI = 1.4-2.4; P ≤ 0.001) and (PR = 2.2; 95% CI = 1.8-2.7; P ≤ 0.001) respectively, compared to those with less than a high school education. Compared to 2017, Black adults with ≤ $35K income were less aware about HPV in 2020. There was evidence of disparities in HPV and HPV vaccine awareness among non-Hispanic Blacks. To foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers, future interventions must target men and disadvantaged populations, for whom awareness gaps exist.

The association between YouTube use and knowledge of human papillomavirus-related cancers

Objective

To examine the association between YouTube usage and HPV-related cancer knowledge (cervical, anal, oral and penile).

Study design

Cross-sectional study using data from the Health Information National Trends survey conducted between 2017 and 2020 (N = 16,092). Logistic regression was used to analyze the independent effect of YouTube use on cancer knowledge, controlling for sociodemographic characteristics.

Results

Respondents' knowledge of HPV-related cancers varied: 49.9% about cervical, 18% anal, 20.1% oral and 20.4% penile cancers. YouTube use was associated with increased knowledge for all cancers (cervical: OR 2.66, 95% CI 2.04, 3.46; anal: OR 1.83, 95% CI 1.32, 2.53; oral: OR 1.89, 95% CI 1.37, 2.61; penile OR 2.00, 95% CI 1.44, 2.77) in models adjusted for all covariates. Other independent predictors of HPV-related cancer knowledge included female gender, younger age, a higher income, and higher education.

Conclusions

YouTube could play an important role in educating people about HPV-related cancers and should also target other populations, such as males and those with less formal education.

Innovation

The study provides novel insights into the potential of YouTube as an educational tool for promoting cancer knowledge with the goal of cancer prevention.

Identifying Barriers to HPV Vaccination for Patients With Sickle Cell Disease and Childhood Cancer Survivors

Human papillomavirus (HPV) vaccination prevents the development of HPV-associated malignancies. Adolescent and young adult survivors of childhood cancers and patients with sickle cell disease (SCD) are vulnerable patient populations who would significantly benefit from HPV vaccination. In this multimethod study, a retrospective chart review found a notable difference between the rate of HPV vaccinations and other age-appropriate vaccinations in 177 childhood cancer survivors and in 70 patients with SCD. We then sought to describe patient and caregiver beliefs regarding HPV vaccination, through semistructured interviews with 21 patients and 48 caregivers. Interviews were analyzed with a thematic content approach to understand attitudes regarding the HPV vaccination. Qualitative interviews noted that many caregivers and adolescents had baseline misconceptions regarding the HPV vaccination in general and in context with their chronic illness. It was found that a strong recommendation from a trusted subspecialty provider would create reassurance about vaccination and reduce misconceptions and concerns about side effects in the context of a chronic illness. Counseling from subspecialists could have a strong impact on understanding the HPV vaccine in the context of chronic illness. This would likely help overcome many of the barriers to vaccination that are encountered by patients with SCD or oncology survivors.

Disparities in awareness of the HPV vaccine and HPV-associated cancers among racial/ethnic minority populations: 2018 HINTS

OBJECTIVES

Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults.

DESIGN

Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January-May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis.

RESULTS

About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07-0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35-0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36-0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18-45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine.

CONCLUSION

Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers.

Sociodemographic and clinical correlates of human papillomavirus vaccine attitudes and receipt among Wisconsin adolescents

Few studies have assessed adolescent human papillomavirus (HPV) vaccine attitudes and whether they are associated with vaccination uptake. This study characterized HPV vaccine attitudes among male and female adolescents, identified factors associated with attitude changes, and examined associations between attitudes and vaccination receipt. Surveys were administered to adolescents aged 15-16 years who had not completed the HPV vaccine series. A modified version of the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) was employed to assess barriers, harms, ineffectiveness, and uncertainties scores. Surveys were available from 108 participants; 63% were male and 33% had initiated the HPV vaccine series at baseline. CHIAS scores significantly decreased (i.e., became more favorable) between baseline and follow-up for barriers (p = 0.01) and uncertainties (p < 0.01). At least one sociodemographic/clinical factor was associated with changes in each score. Attitude changes were not associated with receipt of HPV vaccine, although adolescents with higher baseline harms scores were significantly less likely to receive an HPV vaccine dose (OR = 0.67). Adolescents' HPV vaccine attitudes slightly improved over a one-year period during which an intervention was implemented. More research is needed to learn how parent and adolescent HPV vaccine attitudes form, and how best to address concerns about vaccine harms.

Determinants of human papillomavirus vaccine attitudes: an interview of Wisconsin parents

Background

Parental attitudes play a key role in their decisions to vaccinate adolescents against the human papillomavirus (HPV). Little is known, however, about the formative experiences that shape parents’ attitudes about the HPV vaccine.

Methods

We conducted semi-structured interviews with 25 parents of 11–17 year old adolescents in Wisconsin who changed their HPV vaccine attitudes (per prior surveys) over one year. A modified grounded theory approach was then used to generate primary themes of attitudinal determinants.

Results

Participants were predominately mothers. We identified three major themes that shaped parents’ HPV attitudes: (1) the perceived likelihood of the HPV vaccine preventing cancer, (2) agency in adolescence and gauging their adolescent child’s intent for sexual activity, (3) the credibility of HPV vaccine information sources. General messaging around cancer prevention did not always supersede some parents’ concerns about the vaccine’s perceived link to sexual activity. Parents often viewed their adolescent child’s feelings about the HPV vaccine as a gauge of their (child’s) intent for sexual activity. Interviewees felt a sense of responsibility to educate themselves about the HPV vaccine using multiple sources and particularly looked to their medical provider to filter conflicting information.

Conclusions

More family-specific (vs. disease-prevention) messaging and recommendations may be needed in the clinical environment to sway some parents’ negative attitudes about the HPV vaccine. Future research should explore additional strategies to improve HPV vaccine attitudes, such as situating the vaccine in the context of a monogamous lifestyle that many parents wish to impart to their children.

Factors that Predict Parental Willingness to Have Their Children Vaccinated against HPV in a Country with Low HPV Vaccination Coverage

Background: Adolescent HPV (Human Papilloma Virus) vaccination is yet to be introduced as a mandatory program in Poland. Polish literature on factors associated with adolescent HPV vaccination is scant, despite the fact that uptake is one of the poorest in the European Union. Objectives: To assess HPV awareness and identify independent predictors for parental willingness to have their children vaccinated against HPV. Methods: All parents of first grade students from three selected high schools in Zgorzelec, Poland, who participated in parent–teacher meetings at the time the study was conducted, had their children unvaccinated regarding HPV, and who gave informed consent to participate were included. There were 600 first grade students; 9 were vaccinated against HPV. This left 591 parents who met the eligibility criteria; the response rate was 76.1%. Results: Awareness of HPV was reported by 55.3% of 450 parents (mean age 42 years, 70.9% females); 85.1% expressed their willingness to vaccinate their children against HPV; 31.3% identified HPV as a sexually transmitted pathogen, and 36.2% identified it as a risk factor of cervical cancer. Multivariable logistic regression analyses indicated that being employed (OR 2.09; 95% CI: 1.10–3.86), having positive attitudes toward vaccines (OR 3.02; 95% CI: 1.34–6.49), previous information about HPV (OR 2.02; 95% CI: 1.17–3.51), and concerns about the side effects of the HPV vaccine (OR 0.60; 95% CI: 0.35–0.99) were independent predictors of parents’ willingness to vaccinate. Conclusions: Attitudes regarding their child being vaccinated against HPV were positive among Polish parents, even though awareness and knowledge of HPV in this group were low. Most of the significant factors that influenced their willingness were modifiable, such as being informed about HPV and having positive attitudes toward vaccines. Future interventions should focus specifically on vulnerable subgroups, such as unemployed parents.

Association between parent attitudes and receipt of human papillomavirus vaccine in adolescents

Background

Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. This study examined the association between changes in parents’ vaccine attitudes and HPV vaccine receipt in their adolescent children.

Methods

A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11–17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties) from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents’ adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion.

Results

There were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents’ uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion.

Conclusions

Reductions in parents’ uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine’s safety profile.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

Purpose: Gaps remain in the public's knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults.

METHODS

Data from the Health Information National Trends Survey 4 Cycle 3 (September - December 2013) and Cycle 4 (August - November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.

RESULTS

Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 - 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 - 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 - 0.96) and 44% (95% CI: 0.39 - 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 - 1.02) and 53% (95% CI: 0.34 - 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively.

CONCLUSIONS

There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.

Prioritizing US Cervical Cancer Prevention With Results From a Geospatial Model

PURPOSE

To determine if differences in screening and vaccination patterns across the population may accentuate ethnic and geographic variation in future burden of disease.

METHODS

Using Cancer in North America data provided by the North American Association of Central Cancer Registries, county cervical cancer incidence trends from 1995 to 2009 were modeled for the entire United States using ecologic covariates. Rates for health service areas were also modeled by ethnicity. State-level incidence was mapped together with Papanicolaou (Pap) screening, past 3 years (women ≥ 18 years old), and three-dose human papillomavirus (HPV) vaccine coverage (girls 13 to 17 years old) to identify potential priority areas for preventive services.

RESULTS

US cervical cancer incidence decreased more during the periods 1995 to 1999 and 2000 to 2004 than during the period 2005 to 2009. During these 15 years, the most affected areas became increasingly confined to Appalachia, the lower Mississippi Valley, the Deep South, Texas, and Florida. Hispanic and black women experienced a higher incidence of cervical cancer than both white and Asian and Pacific Islander women during each period. Women in 10 of 17 states/districts with a high incidence (≥ 8.14/100,000) reported low Pap testing (< 78.5%), HPV vaccine coverage (< 33.9%), or both prevention technologies.

CONCLUSION

The decline in cervical cancer incidence has slowed in recent years. Access to HPV vaccination, targeted screening, and treatment in affected populations is needed to reduce cervical cancer disparities in the future.

Vaccine Misconceptions and Low HPV Vaccination Take-up Rates in Singapore

BACKGROUND

HPV vaccination in Singapore is voluntary and physician prescription-based. This study investigated the current status and intention for HPV vaccination among Singapore nurses.

MATERIALS AND METHODS

All female nurses in a general hospital were given an anonymous questionnaire on HPV vaccination experience and intention of vaccinating their daughters. The influence of age, knowledge and perceived-risk of cervical cancer, and cultural background on mother's intention of vaccinating their daughters was analyzed.

RESULTS

Of 2,000 nurses, 1,622 (81.1%) responded and analysis was performed on 1,611 with valid data. They showed good awareness on association of cervical cancer with multiple sexual partners (81.9%), history of sexually transmissible diseases (78.2%), and history of genital warts/HPV infection (73.5%), and on cervical cancer preventive effects of HPV vaccination (54.6%). The prevailing misconceptions of the vaccines were: investigational nature (38.9%), side effects (27.9%) and indicated for women at high risk for cervical cancer (20.5%).

CONCLUSIONS

Misconceptions on the nature, role and safety of HPV vaccines low vaccine up-take rates and daughters. Dissemination of adequate and accurate HPV vaccine information and a review for school-based vaccination are needed for optimal delivery of HPV vaccines in Singapore.

Predictors of human papillomavirus awareness and knowledge in 2013: gaps and opportunities for targeted communication strategies

BACKGROUND

Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical cancers. Greater cervical cancer mortality has been observed among women of lower SES and those living in rural, versus urban, areas. African American and Hispanic women are significantly more likely to die from cervical cancer than non-Hispanic white women.

PURPOSE

To assess current population awareness of and knowledge about HPV and the HPV vaccine, as well as the contribution of sociodemographic characteristics to disparities in HPV awareness and knowledge.

METHODS

Cross-sectional data were obtained from the National Cancer Institute's 2013 Health Information National Trends Survey (HINTS; N=3,185). Multivariable logistic regression was employed to identify gaps in awareness and knowledge by sex, education, income, race/ethnicity, geographic area, and other important sociodemographic characteristics. Analyses were conducted in 2014.

RESULTS

Sixty-eight percent of Americans had heard of HPV and the HPV vaccine. Consistent with the Knowledge Gap Hypothesis, awareness and knowledge were patterned by sex, age, education, and other important sociodemographic factors. Those in rural areas were less likely than those in urban areas to know that HPV causes cervical cancer. Less than 5% of Americans were aware that HPV often clears on its own without treatment.

CONCLUSIONS

Although awareness and knowledge of HPV is increasing, there are opportunities to target communication with populations for whom knowledge gaps currently exist, in order to promote dialogue about the vaccine among patients and their providers.

Beta-test Results for an HPV Information Web site: GoHealthyGirls.org - Increasing HPV Vaccine Uptake in the United States

A web site, GoHealthyGirls, was developed to educate and inform parents and their adolescent daughters about human papillomavirus (HPV) and HPV vaccines. This article provides an overview of web site development and content followed by the results of a beta-test of the web site. 63 New Mexican parents of adolescent girls tested the site. Results indicated that GoHealthyGirls was a functioning and appealing web site. During this brief educational intervention, findings suggest that the web site has the potential to increase HPV vaccine uptake. This research supports the Internet as a valuable channel to disseminate health education and information to diverse populations.