Improving adolescent health: focus on HPV vaccine acceptance

School children's perceptions about being offered the HPV vaccination - A focus group study

AIM

There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.

METHODS

We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis.

RESULTS

This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents.

CONCLUSION

We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.

Factors Affecting Human Papillomavirus Vaccine Trends in the United States of America

Background Routine immunization of both girls and boys starting from nine years of age with the human papillomavirus (HPV) vaccine is the current recommendation. The objective of this retrospective study using National Health and Nutrition Examination Survey data was to evaluate the influence of sociodemographic factors on the series initiation and completion of the HPV vaccine from 2011 to 2020. Methodology The chi-square test was used to examine the statistical significance of the association between categorical variables and receipt of the HPV vaccine. The Cochran-Armitage test for trend was employed to assess the statistical significance of temporal trends in risk factors associated with rates of HPV vaccination. These trends were further quantified by a significant rate ratio by comparing them against the most recent survey years. Results HPV vaccine uptake was higher in the 9-14-year age group across survey years and had increased for both males and females over that time. The first dose of the HPV vaccine was most likely to be received by the 11-18-year age group. In the most recent survey of 2017-2020, the highest number of vaccination series completion was achieved for Gardasil®. Conclusions Improved physician efforts and strategies to vaccinate males, low socioeconomic strata patients, and ethnic minorities in more numbers are needed.

Assessing the Effectiveness of Web-Based Modules on Human Papillomavirus Among Dental and Dental Hygiene Students

Literature suggests that deficiencies among dental professional students in both knowledge and awareness of human papillomavirus (HPV) and its association with oropharyngeal cancers (OPC), as well as its risk factors implicating the prevalence of HPV, may be due to the lack of HPV-related education during professional schooling. The aim of this study was to assess the effectiveness of an online learning tool to educate dental and dental hygiene students about HPV and its association with OPC, rapidly evolving disease patterns, and dental professionals' role in HPV-associated OPC prevention efforts. A three-section online learning module was developed to improve dental professionals' comfort levels with, and knowledge of, HPV. The participants were recruited to participate in surveys before and after the intervention. Descriptive statistics and chi-square analysis were computed to study the effectiveness of the modules in improving the knowledge of students about this topic. Pre-intervention survey participants totaled 142, and 107 participants answered the post-intervention survey. The majority of the study participants had some baseline understanding of HPV prior to accessing the modules. After reviewing the modules, there was a statistically significant increase in the proportion of respondents who identified OPC (p = 0.01), vaginal cancer (0.02), vulvar cancer (0.04), and penile cancer (0.01) as associated with HPV. A gap in the understanding of HPV vaccine-eligible groups was noted in almost half of the participants; while most participants could correctly identify that boys and girls aged 9-12 years were eligible to get the vaccine, the gap in knowledge in this regard was related to "25-year-old with an abnormal pap result." Due to the evolving nature of this topic, there is a need to find new and effective methods of disseminating HPV-related information among the existing and future dental workforce.

A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan

Globally, Japan has the lowest rate of vaccine confidence. The persistent parental vaccine hesitancy has been attributed to safety and efficacy concerns and is primarily driven by the negative experience with human papillomavirus (HPV) vaccines. This literature review aimed to identify factors associated with HPV vaccine uptake and potential strategies to reduce vaccine hesitancy among Japanese parents. Articles published in English or Japanese between January 1998 and October 2022 that examined Japanese parental factors for HPV vaccine uptake were identified from PubMed, Web of Science, and Ichushi-Web. In total, 17 articles met the inclusion criteria. Four key themes which affected HPV vaccine hesitancy and acceptance were identified: perceptions of risk and benefits, trust and recommendation, information and knowledge, and sociodemographic characteristics. While governmental and healthcare provider recommendations are important factors, efforts to improve parental confidence in the HPV vaccine are required. Future interventions to counteract HPV vaccine hesitancy should actively disseminate information on vaccine safety and effectiveness, along with information on the severity and susceptibility of HPV infection.

“I’m scared that if I have the vaccine, it’s going to make my lung condition worse, not better.” COVID-19 vaccine acceptance in adults with underlying health conditions – a qualitative investigation

Background

Sustained uptake of COVID-19 vaccines, including booster doses, will continue to be key to minimising morbidity and mortality caused by COVID-19. Because hesitancy can affect people’s motivation to get vaccinated, understanding and addressing factors influencing acceptance is critical to achieving high uptake. This is especially the case for adults with underlying health conditions, who are at increased risk of severe illness from COVID-19. The aim of this study was to investigate barriers and facilitators of COVID-19 vaccine acceptance in adults with underlying health conditions during the initial rollout of COVID-19 vaccines in Australia.

Methods

We conducted semi-structured, qualitative interviews with 15 adults with underlying health conditions in New South Wales (NSW) in April 2021, focusing on their previous vaccination experiences and feelings about COVID-19 vaccination. We categorised participants as accepting, hesitant or refusing. We analysed interviews thematically, informed by the World Health Organization (WHO) Behavioural and Social Drivers of Vaccination framework.

Results

Most (12/15) participants were hesitant about COVID-19 vaccination. Barriers to COVID-19 vaccine acceptance included concerns about vaccine safety and effectiveness; heightened perceptions of risk regarding the vaccines; low perceptions of COVID-19 risk; and negative social influences. Facilitators included perceived benefits of vaccination and positive social influences.

Conclusions

For some adults with underlying health conditions, perceptions of heightened vulnerability to COVID-19 vaccine side effects contributed to vaccine hesitancy during the initial rollout of COVID-19 vaccines. We recommend supporting GPs and specialists to proactively reach out and recommend COVID-19 vaccination to this population; encouraging chronic disease organisations to act as trusted advocates of COVID-19 vaccination; and actively communicating evolving knowledge about vaccine safety.

Human papillomavirus vaccine beliefs and practice characteristics in rural and urban adolescent care providers

BACKGROUND

The human papillomavirus (HPV) vaccine is recommended for all adolescents age 11-12 years. HPV vaccine coverage remains suboptimal in the United States though, particularly in rural areas. We surveyed adolescent immunization providers in two Midwestern states to assess rural vs. urban differences in HPV vaccine resources, practices, and attitudes.

METHODS

A cross-sectional survey was sent to all licensed adolescent care providers in a subset of urban and rural counties in Minnesota and Wisconsin during 2019. Multivariable regression was used to identify attitudes and practices that differentiated rural vs. urban providers.

RESULTS

There were 437 survey respondents (31% rural). Significantly fewer rural providers had evening/weekend adolescent vaccination appointments available (adjusted odds ratio (aOR) = 0.21 [95% confidence interval (CI): 0.12, 0.36]), had prior experience with adolescent vaccine quality improvement projects (aOR = 0.52 [95% CI: 0.28, 0.98]), and routinely recommended HPV vaccine during urgent/acute care visits (aOR = 0.37 [95% CI: 0.18, 0.79]). Significantly more rural providers had standing orders to administer all recommended adolescent vaccines (aOR = 2.81 [95% CI: 1.61, 4.91]) and reported giving HPV vaccine information to their patients/families before it is due (aOR = 3.10 [95% CI: 1.68, 5.71]).

CONCLUSIONS

Rural vs. urban differences in provider practices were mixed in that rural providers do not implement some practices that may promote HPV vaccination, but do implement other practices that promote HPV vaccination. It remains unclear how the observed differences would affect HPV vaccine attitudes or adolescent vaccination decisions for parents in rural areas.

HPV Vaccination in Young Males: A Glimpse of Coverage, Parental Attitude and Need of Additional Information from Lombardy Region, Italy

Background: In the Lombardy Region, Italy, HPV vaccination is recommended and offered free of charge to 12-years-old males since 2017. The expected vaccination thresholds are still far to be reached. Methods: A cross-sectional survey to investigate parents’ attitudes towards the HPV vaccine and knowledge about HPV was administered to parents of boys aged 6 to 18 years attending a large pediatric hospital for outpatient specialistic evaluations. Two parallel multiple logistic regression analyses were conducted to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for attitude towards HPV vaccination and perceived need for more information about HPV vaccination. Results: A positive attitude towards HPV vaccination was found in 74% of interviewed parents. Knowledge of HPV, having a generally positive attitude toward vaccination, and mothers filling in the survey were positively associated with a positive attitude to the HPV vaccine. Parents’ perceived need for more information about HPV vaccination was positively associated with the child’s age, general positive attitude toward vaccination, Christian religion, and positive attitude toward HPV vaccination; knowing that HPV vaccination is free of charge significantly reduced the risk of asking for more information on HPV vaccination. Conclusions: The majority of parents of male children and adolescents in our study have a positive attitude toward HPV vaccination. Attitude toward HPV vaccination and perceived need for more information on HPV vaccination were directly related to a positive attitude toward vaccines in general. In addition, knowledge of HPV and related pathologies favors a positive attitude toward HPV vaccination. Future health programs should target an even wider diffusion of evidence-based information on vaccines in general and on the HPV vaccine in young males, to support a positive attitude toward vaccines in the general population.

Factors Influencing COVID-19 Vaccine Acceptance in High Income Countries Prior to Vaccine Approval and Rollout: A Narrative Review

Objectives: Acceptance and high uptake of COVID-19 vaccines continues to be critical for controlling the COVID-19 pandemic. This narrative review aimed to summarise findings on factors influencing acceptance of COVID-19 vaccines in the period leading up to the approval and rollout. Methods: We conducted a narrative review of literature published in 2020 on factors influencing acceptance of hypothetical COVID-19 vaccines in adults in high income countries with well-established health systems. Results: Facilitators of acceptance included confidence in vaccine safety and effectiveness, high COVID-19 disease risk perception and trust in health authorities and other vaccine stakeholders, including government. Barriers included safety and effectiveness concerns, perceived scientific uncertainty, low disease risk perception, and low trust in authorities and other stakeholders. Conclusion: Evidence on facilitators and barriers to COVID-19 vaccine acceptance, at a time prior to vaccine rollout, can help health authorities address hesitancy and may inform approaches to support acceptance of novel pandemic vaccines in the future. Future research should include in-depth qualitative research to gather more nuanced evidence.

U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents: an exploration of practice-, provider-, and patient-level influences

U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents’ HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020–12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9–18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor’s degree. Around half of adolescents were female (51%) and 13–18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a “sexually transmitted infection (STI)-preventing vaccine.” Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.

Parents attitudes toward the human papilloma virus (HPV) vaccine: A new concept in the State of Qatar

Background

Human papillomavirus (HPV) is one of the leading causes of cervical and genital cancer in both genders.

Purpose

To delineate parental attitude regarding HPV in Qatar.

Methods

A cross-sectional study using a questionnaire was conducted at Sidra Medicine, Qatar.

Results

A total of 334 questioners were completed. More than 60% of the parents were not aware that HPV can cause cervical and genital cancer. When asked about the level of comfort in giving their children a vaccine that would prevent them from getting genital cancer, 77% of the participants answered "very comfortable." Interestingly, less than 4% of the parents stated that their children's primary care physicians ever mentioned that such a vaccine exists. When asked about the most preferable mode of receiving information regarding the HPV vaccine, 54% preferred the clinician's office, followed by 34% of whom preferred social media. In terms of the preferred age to receive the vaccine, 45% of the participants preferred to administer the vaccine to their children before they were mature enough to understand sexual relations, while 22% recommended vaccination right before marriage and 15% preferred to wait till they were grown up and decide for themselves. Furthermore, only 42% of the caregivers agreed that it is important to explain to their children that the vaccine can protect against some of the sexually transmitted infections. Finally, approximately 20% of the participants were not convinced about the HPV vaccine.

Conclusion

A large proportion of parents residing in Qatar have a positive perception regarding the HPV vaccine. TheParents' attitudes and perceptions are considered indispensable targets for community health intervention. We will share the result of our study with the ministry of public health in Qatar with a goal to incorporate the HPV vaccine in the National Immunization Schedule.

Human papillomavirus vaccine and risky sexual behavior: Regression discontinuity design evidence from Brazil

This study aims to analyze the hypothesis of moral hazard caused by vaccination against human papillomavirus (HPV), regarding girls' beginning of sex life and, once they have begun their sex life, to understand whether it reduces the probability of girls using a condom in their first sexual intercourse. The data are from the 2015 National Survey of School Health (PeNSE). The model used is the regression discontinuity, with the discontinuity in the age of the girls who were able to participate in the public vaccination campaign. The results of the so-called Fuzzy-RDD show that the campaign was effective in increasing the likelihood of vaccination by 26.7-27.6 percentage points. There is no observable effect on young women initiating their sex lives or refraining from using condoms. The results are tested by several robustness methods. This is the first work to use quasi-experimental models in a developing country with low vaccination coverage in Latin America and show that it is necessary to increase awareness campaigns with parents, so they will know that there is no effect of vaccination on the beginning of sex life and condom use.

Human papillomavirus vaccine acceptability among healthcare workers, parents, and adolescent pupils: a pilot study in public health centers of Bali, Indonesia

Introduction

Knowledge and acceptability of HPV vaccination should be identified for supporting the HPV vaccine program in public health centers. Qualitative research approach is one approach that can be developed for increasing the acceptance and use of HPV vaccines in the community. Perceptions of health workers, parents, teachers, and adolescents related to HPV immunization can be explored in depth. This study was performed to explore the perception and meaning of the HPV vaccine acceptability among healthcare professionals, parents, and adolescent pupils in Bali, Indonesia.

Methods

A mixed method study was conducted among 176 elementary school children. In-depth interviews were performed with five of the parents and eight of the teachers. Then, four focus group discussions among 19 health professionals were performed for supporting data. A self-administered questionnaire was used to measure knowledge of HPV and acceptability of HPV vaccine among participants. An interview of standard guidelines was performed to identify the perception of the HPV vaccine.

Results

The study identified that perception about HPV knowledge and HPV vaccine was low among adolescents and teachers for all of the questions. However, knowledge on HPV and HPV vaccine among parents and healthcare professionals were higher. Meanwhile, the acceptability of the HPV vaccine and the personal experience of women were more positive for the healthcare professionals.

Conclusions

Knowledge and perception regarding HPV and HPV vaccination among adolescents and teachers in Indonesia, particularly in Denpasar, Bali, are still insufficient. However, the perception of vaccine administration is acceptance for parents and healthcare professionals. Therefore, socialization of HPV vaccine programs in school and community are needed to improve health promotion about the importance of the HPV vaccine.

Health Culture and Presenting a Paradigmatic Model Focusing on Human Papillomavirus Disease

Objective: In this study, we developed a paradigmatic model focusing on human papillomavirus (HPV) diseases, in order to formulate a theory by investigating pathology in health culture using Grounded Theory, as an inductive and exploratory research method.

Materials and methods: It was a qualitative study, and data were collected using in-depth interviews with 20 people (10 men and 10 women) with cultural and religious specialties (clergy). In total, twenty interviews were conducted (mean duration = 45 min) using a semi-structured guide consisting of open-ended questions. All recordings were transcribed verbatim in Persian. All items were extracted based on the participants' responses and related literature. After data collection, the basic theory analysis was performed in terms of the three steps as follows: free coding, axial encryption, the implementation, refinement, and writing the theories in line with selective coding theoretical models. Finally, the paradigm model was determined from the presented models.

Results: The paradigm model emerged from professors, clergy, and authorized people, showed that religious taboos about sexually transmitted diseases; lack of wise management, comprehensive supervision, compliance with health standards in the country, proper legislation regarding sexually transmitted diseases as causal factors, awareness, health education in the country, public demand for health, individual dignity, punishment for health detractors, familiarity with individual rights as intervening factors, concern for human lives, health, and belief in fatalism; ethnic differences; irresponsibility; risk perception; high cost of HPV vaccine; immorality in health speech; disregard for people's lives; gender differences as contextual factors; and the consequences is increasing burden of diseases due to sexually transmitted disease such as (HPV).

Conclusion: It seems the overall lack of a health-based approach could be a major concern due to the weakness of cultural management in society that requires the involvement and intervention of all policymakers, health planners, authorized people, professors, elites, and clerics to control this major cultural health problem.

Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management

Background

In the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling.

Results

The ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction.

Conclusion

With an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.

HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine

Papua New Guinea has among the highest estimated burden of cervical cancer globally, but currently lacks national cervical screening or human papillomavirus (HPV) vaccination programmes. The Papua New Guinean government is committed to introducing the HPV vaccine for primary prevention, but locally-relevant research evidence is not available to guide implementation. Experience from earlier Papua New Guinean health programmes suggests that appropriate engagement with local health cosmologies and cultures for health/wellbeing, illness/disease, and recognition of the role of ‘outsiders’ in preventing, promoting or contributing to sickness, are essential to the successful introduction of biomedical interventions in this setting. We describe findings from a multi-site qualitative study undertaken in three provinces in Papua New Guinea (2012-14). Twenty-one gender specific focus group discussions and 82 semi-structured interviews, with a total of 208 participants, were conducted. There was strong community support for the introduction of the HPV vaccine for cervical cancer prevention in Papua New Guinea. Significantly, and despite being officially discussed in the context of a planned future intervention focusing on vaccinating young girls to prevent cervical cancer, the intervention was de-feminised, where both girls and boys were supported to be vaccinated in any HPV programme in Papua New Guinea.

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First study of HPV vaccine acceptability in Papua New Guinea and the Pacific.

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Evidence of strong support for the vaccination of both girls and boys against HPV in Papua New Guinea.

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Local beliefs and concerns about HPV immunisation may impact acceptability in Papua New Guinea.

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Suspicion of Western medicine and health care workers reported in rural areas.

HPV vaccine coverage in Australia and associations with HPV vaccine information exposure among Australian Twitter users

Introduction: Human papillomavirus (HPV) vaccine coverage in Australia is 80% for females and 76% for males. Attitudes may influence coverage but surveys measuring attitudes are resource-intensive. The aim of this study was to determine whether Twitter-derived estimates of HPV vaccine information exposure were associated with differences in coverage across regions in Australia.

Methods: Regional differences in information exposure were estimated from 1,103,448 Australian Twitter users and 655,690 HPV vaccine related tweets posted between 6 September 2013 and 1 September 2017. Tweets about HPV vaccines were grouped using topic modelling; an algorithm for clustering text-based data. Proportional exposure to topics across 25 regions in Australia were used as factors to model HPV vaccine coverage in females and males, and compared to models using employment and education as factors.

Results: Models using topic exposure measures were more closely correlated with HPV vaccine coverage (female: Pearson’s R = 0.75 [0.49 to 0.88]; male: R = 0.76 [0.51 to 0.89]) than models using employment and education as factors (female: 0.39 [−0.02 to 0.68]; male: 0.36 [−0.04 to 0.66]). In Australia, positively-framed news tended to reach more Twitter users overall, but vaccine-critical information made up higher proportions of exposures among Twitter users in low coverage regions, where distorted characterisations of safety research and vaccine-critical blogs were popular.

Conclusions: Twitter-derived models of information exposure were correlated with HPV vaccine coverage in Australia. Topic exposure measures may be useful for providing timely and localised reports of the information people access and share to inform the design of targeted vaccine promotion interventions.

Racial Disparities in HPV-related Knowledge, Attitudes, and Beliefs Among African American and White Women in the USA

The objective of this study was to assess the differences in HPV-related knowledge, attitudes, and beliefs among African American and non-Hispanic white women and to determine their communication preferences for cancer-related information. Data was obtained from the National Cancer Institute's (NCI) 2014 Health Interview National Trends Survey (HINTS), a cross-sectional survey of US adults 18 years of age or older. Descriptive statistics, bivariate, and multivariate logistic regression were used to identify differences in awareness and knowledge. Data was collected in 2014 and analyzed in 2016. HPV awareness (71 vs. 77%) and knowledge that HPV causes cervical cancer (64 vs. 81%) were significantly lower among blacks. Additionally, there were significant disparities in awareness of the HPV vaccine (66 vs. 79%), with only 25% of Black women indicating that they or a family member was recommended the HPV vaccine by a health care professional. There were also differences in cancer communication preferences. Blacks were more likely than Whites to trust cancer information from family (OR 2.7, confidence interval [CI] 0.725-10.048), television (OR 3.0, 95% [CI] 0.733-12.296), government health agencies (OR 5.8, [CI] 0.639-52.818), and religious organizations (OR 6.4, 95% [CI] 1.718-23.932). Study results indicate that racial/ethnic differences exist in HPV knowledge/awareness and cancer communication preferences. These results highlight the need to increase HPV prevention and education efforts using methods that are tailored to Black women. To address HPV/cervical cancer disparities, future interventions should utilize preferred communication outlets to effectively increase HPV knowledge and vaccine awareness.

Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008-2016)

BACKGROUND

Human papillomavirus (HPV) vaccination is expected to reduce HPV-related disease and cancer in the US. However, many parents are hesitant to obtain the vaccine for their children. The purpose of this study is to examine how the reasons for refusing the HPV vaccine vary across regions of the US, across time, and by race/ethnicity.

METHODS

This study used data on 13-17 year old adolescents collected by the National Immunization Survey - Teen (NIS-Teen) annually between 2008 and 2016. We evaluated the frequencies of parents who did not intend to vaccinate their children in the next year among unvaccinated children. Among these non-intenders, we evaluated how reasons for HPV vaccine hesitancy changed across time, by region of the US, and race/ethnicity.

RESULTS

The proportion of non-intenders among unvaccinated decreased from 72% in 2010 to 58% in 2016. The most frequent reason for vaccine hesitancy was that parents felt HPV vaccination was not necessary (22.4%), followed by lack of provider recommendation (16.2%), and lack of knowledge (15.6%). Lack of provider recommendation increased in frequency as a reason for HPV vaccine hesitancy until 2012, then decreased in frequency through 2016. Cost was one reason that was elevated in all regions compared to the Northeast. Black non-intenders were less likely to report safety, costs, or their children's fear as reasons for not intending to vaccinate their children compared to white non-intenders. Hispanic non-intenders were more likely to report lack of knowledge and that the vaccine is not a school requirement as reasons not to vaccinate their children compared to white non-intenders.

CONCLUSIONS

National advocacy for improving provider recommendation for HPV vaccination likely contributed to a sharp decline in HPV vaccine hesitancy due to lack of provider recommendation. Results indicate the need for multifaceted interventions to increase HPV vaccination.

Socio-cognitive factors influencing Greek lyceum female students' intention to receive a Pap smear and a vaccine against HPV

BACKGROUND

The human papillomavirus (HPV) is responsible for 99.7% of cervix cancers worldwide. As this is a preventable and treatable cancer, if diagnosed early, it is important to explore not only young women's related knowledge, but also their intentions for prevention activities, through a theoretical perspective.

OBJECTIVE

To investigate the role of the Health Belief Model (HBM) and the Health Locus of Control theory (HLC) (social cognitive models) to act as potentially influencing factors for the prevention intentions among lyceum female students.

METHODS

This cross-sectional study took place from January to May 2014, among 1129 female students, who attended lyceums in six islands of the Cyclades Region, Greece. Students filled-in a self-complementary questionnaire, after the necessary approval was provided by the relevant authorities.

RESULTS

Intention to take the Pap smear was determined by student's level of knowledge (p < 0.001) about Pap smears, their age (p = 0.004), HPV susceptibility (p < 0.001), subjective obstacles of taking the Pap smear (p < 0.001) and subjective benefits of the Pap smear (p < 0.001). The vaccination intention against HPV was influenced by the subjective benefit from vaccination (p < 0.001) and the level of knowledge of the vaccine (p < 0.001).

CONCLUSIONS

Knowledge, age and HBM variables were significantly associated with students' intention for vaccination and screening on HPV. The study demonstrates the importance of raising awareness through specific education programmes in schools and theory-based tailored health programmes on HPV aspects (transmission, prevention, treatment) to increase the intention for prevention.

Parents' uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies

OBJECTIVE

To examine factors associated with parents' uptake of human papillomavirus (HPV) vaccines for their children.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017.

METHODS

We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent.

RESULTS

Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents' uptake of HPV vaccines for their children was 41.5% (range: 0.7%-92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents' uptake, followed by HPV vaccine safety concerns (r=-0.31 (95% CI -0.41 to -0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents' belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=-0.15 (95% CI -0.22 to -0.07)) had significant effects on uptake. We found significant moderator effects for sex of child.

CONCLUSIONS

Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents' positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.

Focus Group Study of Chinese International Students' Knowledge and Beliefs About HPV Vaccination, Before and After Reading an Informational Pamphlet About Gardasil(®)

An increasing need for Human Papillomavirus (HPV) vaccines in China remains unmet in the mainland and the knowledge and intentions of Chinese youth regarding vaccination is unknown. In the fall of 2013, 44 Chinese international students (CIS) attending a university in the United States Midwest participated in 10 focus group discussions (five female and five male). Result showed that participants have limited awareness and knowledge about HPV infection and vaccination, participants erroneously believed that the causes of cervical cancer are abortion and miscarriage. Participants rely heavily on informal sources such as Chinese-based social media platforms and personal social networks for information on sexually transmitted infections. Sexual cultures and behaviors are perceived differently between CIS born in the 1990s and 1980s. Interestingly, participants' perceived stigma about HPV infection decreased with improving knowledge level during group discussions. In conclusion, HPV vaccine should be further promoted alongside sex education among CIS.

Improving Physician Recommendations for Human Papillomavirus Vaccination: The Role of Professional Organizations

BACKGROUND

To address low human papillomavirus (HPV) vaccination coverage, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have launched national campaigns encouraging physicians to deliver strong HPV vaccine recommendations. We surveyed family physicians and pediatricians to examine the impact of these efforts on physicians' recommendation practices.

METHODS

A national sample of family physicians and pediatricians (n = 776) completed our online survey in 2014. The survey assessed reach, content, and influence of AAFP and AAP communications about HPV vaccination. The survey also assessed quality of physicians' communication practices for recommending HPV vaccination.

RESULTS

Forty-seven percent of family physicians reported receiving information on HPV vaccination from AAFP, whereas 62% of pediatricians reported receiving information from AAP. Among physicians reached by AAFP or AAP, most reported receiving the message to give strong recommendations to adolescent boys (71%) and girls (78%). Although receiving information was not associated with HPV vaccine recommendation quality, receiving the message to give strong recommendations correlated with delivering higher-quality recommendations for boys (odds ratio, 4.19, 95% confidence interval, 2.64-6.64) and girls (odds ratio, 3.15, 95% confidence interval, 1.91-5.18). Over half of physicians reported improving their HPV vaccine communication after receiving information from AAFP (69%) or AAP (53%).

CONCLUSIONS

Our findings suggest that it is important for AAFP and AAP to communicate the need for strong HPV vaccine recommendations. Given that many physicians reported improving their recommendation practices, professional organizations stand to contribute to increasing HPV vaccination coverage, but they will likely need to increase the intensity of quality improvement efforts to do so.

White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the National Immunization Study - teen

BACKGROUND

Human Papillomavirus (HPV) vaccination coverage is below national goals in the United States. Research is needed to inform strategically designed interventions that target sociodemographic groups with underutilization of HPV vaccination.

METHODS

Secondary data analysis of the National Immunization Survey-Teen 2013 measured association of sociodemographic factors (e.g., ethnicity/race, insurance) with HPV vaccination among females and males ages 13-17 (N = 18,959). Chi-square and multivariable Poisson regressions were conducted using survey-weighted statistics.

RESULTS

Having a mother ≥35 years, a mother with some college, being of "Other" ethnicity/race, and having no providers who order vaccines from health departments was negatively associated with females initiating HPV vaccination. Having a mother with some college, being of Non-Hispanic White or "Other" ethnicity/race, and having some or no providers who order vaccines from health departments was negatively associated with males initiating HPV vaccination. These same factors were negatively associated with males completing HPV vaccination with the exception of "Other" ethnicity/race. In contrast, having an unmarried mother, being ages 15-17, having a hospital based provider, and receiving other adolescent vaccinations were positively associated with females initiating and completing HPV vaccination. Having an unmarried mother, health insurance that is not employer or union sponsored, and influenza and meningitis vaccinations was positively associated with male's initiating HPV vaccination. For males, being 15 or 17 years old and having other adolescent vaccinations was positively associated with vaccine completion. All findings p ≤ 0.05.

CONCLUSIONS

Future HPV vaccination interventions may benefit from targeting certain sociodemographic groups that were negatively associated with HPV vaccination in this study.

Motivos para recusa da vacina contra o Papilomavírus Humano entre adolescentes de 11 a 14 anos no município de Maringá-PR

Introdução: O Ministério da Saúde incluiu a vacina contra o Papilomavírus Humano (HPV) no calendário básico de imunizações em 2014 com a meta vacinar pelo menos 80% das adolescentes entre 11 e 13 anos de idade. Objetivos: Frente à baixa adesão à campanha nacional de vacinação contra o HPV no município de Maringá, PR, em 2014, o presente estudo teve como objetivos: 1) identificar o nível de conhecimento das adolescentes acerca do vírus e da vacina; e 2) descrever os motivos pelos quais elas não se vacinaram. Métodos: Trata-se de um estudo observacional transversal, do tipo inquérito domiciliar com delineamento descritivo, conduzido com 58 adolescentes que não tomaram a 1ª e/ou a 2ª dose da vacina dentro do prazo estipulado pela campanha vacinal de 2014. Para coleta de dados, foi aplicado questionário por meio de entrevistas face a face. Resultados: 86% das adolescentes já ouviram falar do vírus, 74% sabe que sua transmissão é sexual, 49% conhece sua relação com o câncer de colo de útero e 88% já ouviu falar da vacina. A maior parte das meninas entrevistadas não se vacinou por recusa por parte dos pais. Conclusão: Os resultados do presente estudo sugerem que o desconhecimento sobre a infecção pelo HPV e sobre a campanha de vacinação entre as entrevistadas e seus responsáveis, bem como o medo de efeitos colaterais da vacina, como apontado pela população do estudo, interferiram negativamente na tomada de decisão.

Working to Increase Vaccination for Human Papillomavirus: A Survey of Wisconsin Stakeholders, 2015

Introduction

Infection with human papillomavirus (HPV) is common and can progress to various types of cancer. HPV infection can be prevented through vaccination; however, vaccination rates among adolescents are low. The objective of this study was to assess efforts among Wisconsin stakeholders in HPV vaccination and organizational capacity for future collaborative work.

Methods

We conducted a cross-sectional online survey of 277 stakeholders in HPV vaccination activities, from April 30, 2015, through June 30, 2015. Stakeholders were public health professionals, health care providers, educators, quality improvement professionals, researchers, and advocates identified as engaged in HPV vaccination work.

Results

Of the 277 invited stakeholders, 117 (42%) responded to the survey. Findings showed that most current HPV vaccination activities targeted 3 groups: adolescents and parents, clinical and health professionals, and communities and health systems. The main activities directed at these groups were providing printed educational materials, professional education, and media campaigns to raise awareness. Common barriers reported were lack of understanding about the link between HPV and cancer, requests to delay vaccination, difficulty completing the 3-dose vaccine series, and reluctance to discuss sexuality.

Conclusion

HPV vaccination rates are far below those of other vaccinations administered to adolescents in Wisconsin. Our study showed that various local efforts were being made to increase HPV vaccination uptake; however, many barriers exist to initiation and completion of the vaccine series. Future interventions should address barriers and employ evidence-based strategies for increasing HPV vaccination rates.

Knowledge and Attitudes Towards Human Papillomavirus (HPV) Among Academic and Community Physicians in Mangalore, India

Cervical cancer is the most common cancer found in Indian women. Two human papillomavirus (HPV) vaccines were approved for use in India in 2006; however, neither has become readily accepted. Physician attitudes and recommendations are crucial in the uptake of HPV vaccines among adolescent women in the USA; thus, we ought to investigate provider attitudes and practices related to HPV vaccination in India via a survey administered to 210 Indian physicians. Of the 210 physicians, 46 % were community physicians and 54 % were academic physicians. The correct response to HPV knowledge questions was identified around 50 % of the time in 6/11 questions. Only 47 % of the physicians knew that there was an HPV vaccine approved for use in India. Only 11 % and 15 % of physicians strongly agree that the HPV vaccine will lead to long-lasting immunity and has a safe side effect profile, respectively. A total of 30 % of those surveyed reported that they would recommend the HPV vaccine to their patients, while 73 % agreed that the cost of the HPV vaccine is a major barrier to acceptance. After multivariate analysis, there were two significant variables independently associated with a physician's decision to recommend HPV vaccine. These variables were as follows: "whether the vaccine was freely available from the government sector" and "uncertainty about whether HPV must be persistent to cause cervical cancer vs not." Given the lack of knowledge among practicing physicians in Mangalore, increasing the education about HPV infection and HPV vaccination towards health care providers has the potential to increase vaccine recommendations.

Human Papillomavirus Vaccination Among Adults and Children in 5 US States

CONTEXT

The Centers for Disease Control and Prevention Advisory Committee for Immunization Practices has recommended human papillomavirus (HPV) vaccines for use in children and young adults for preventing HPV-related diseases, but HPV vaccine coverage is low in the United States.

OBJECTIVE

To assess HPV vaccination among US adults and children and to identify characteristics associated with HPV vaccination.

METHODS

We used the 2010 Behavioral Risk Factors Surveillance System data to examine HPV vaccine initiation and completion among adults aged 18 to 26 years and children aged 9 to 17 years in 5 US states. We performed a multivariate logistic regression to evaluate factors associated with HPV vaccination.

RESULTS

We assessed the HPV vaccination status of 706 women and 560 men and 2201 girls and 2292 boys. In 2010, a total of 258 (41.6%) women and 21 (4.3%) men had initiated HPV vaccination. Of those vaccinated women, 182 (75%) completed the 3-dose vaccine series. Rural residence (adjusted odds ratio [aOR] = 0.37) and not having a Papanicolaou test (aOR = 0.44) were negatively associated with HPV vaccine initiation among women. Women who were aged 18 to 20 years (aOR = 2.93) were more likely to complete HPV vaccination. A total of 612 (24.6%) girls and 86 (5.2%) boys received 1 or more doses of HPV vaccines; 308 (50.3%) vaccinated girls and 14 (10.8%) vaccinated boys completed the vaccine series. Younger age (9-12 years: aOR = 0.09) and not receiving a seasonal influenza vaccine (aOR = 0.44) were negatively related to HPV vaccine initiation in girls. Girls were less likely to initiate and complete HPV vaccination if their parents did not have a routine checkup within 1 year.

CONCLUSION

HPV vaccination in the United States remains below the Healthy People 2020 objective (80%). To increase HPV vaccination, strategies still need to focus on improving access to HPV vaccines and utilization of health services.

Women's intention to screen and willingness to vaccinate their daughters against cervical cancer - a cross sectional study in eastern Uganda

BACKGROUND

The World Health Organization recommends cervical cancer screening and vaccination programmes as measures to combat cervical cancer. The uptake of these measures remains low in Uganda, most especially in rural areas. An understanding of the factors that influence women's decision to attend screening, and willingness to have their daughters vaccinated against cervical cancer is essential for any attempts to increase uptake of these services. This study assessed the factors associated with intention to screen for cervical cancer among women in eastern Uganda, and willingness to have their daughters vaccinated against the disease.

METHODS

This cross sectional study involved 900 females aged 25 to 49 years in Bugiri and Mayuge districts in eastern Uganda. Data were collected using a pretested semi-structured questionnaire, entered in Epidata version 3.02 and analysed in STATA version 12.0. Unadjusted and adjusted prevalence ratios (PR) were computed using a generalized linear model with Poisson family, and a log link with robust standard errors.

RESULTS

Majority 819 (91.0%) of respondents stated that they intended to go for cervical cancer screening in the subsequent six months. Among them, 603 (73.6%) wanted to know their status, 256 (31.3%) thought it was important, 202 (24.7%) wanted to reduce their chances of getting the disease, and 20 (2.4%) had been told to do so by a health worker. Majority 813 (90.4%) of respondents were willing to vaccinate their daughters against cervical cancer. Higher income (adjusted PR = 1.11, 95% CI: 1.03-1.20), cervical cancer screening status (adjusted PR = 0.81, 95% CI: 0.67-0.99) and knowledge of at least one test for cervical cancer (adjusted PR = 0.92, 95% CI: 0.85-0.98) were significantly associated with intention to screen for cervical cancer. No socio-demographic characteristic was associated with willingness to vaccinate daughters among women.

CONCLUSION

There is a very high intention to screen and willingness to vaccinate daughters against cervical cancer among women in eastern Uganda. To take advantage of this, there is need to avail opportunities for women to access cervical cancer screening and vaccinations particularly among rural communities.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study

OBJECTIVES

This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them.

STUDY DESIGN

This is a cross-sectional, multicentre study.

METHODS

Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013.

RESULTS

Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination.

CONCLUSIONS

Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

The Student Human Papillomavirus Survey: Nurse-Led Instrument Development and Psychometric Testing to Increase Human Papillomavirus Vaccine Series Completion in Young Adults

BACKGROUND AND PURPOSE

The Student Human Papillomavirus Survey (SHPVS) was developed to examine students' perceived benefits or barriers to human papillomavirus (HPV) vaccination.

METHODS

Survey development included (a) 2-phase integrative literature reviews; (b) draft of survey items based on the literature; (c) critique of survey items by young adults, nursing and psychology faculty, and health care providers; and (d) pilot testing. The psychometric properties of the SHPVS were evaluated using classical item analysis and exploratory factor analysis (EFA) among a sample of 527 university students' ages 18-24 years.

RESULTS

The estimated Cronbach's alpha for the SHPVS is .74.

CONCLUSIONS

The SHPVS is a measure of young adults HPV perceived vulnerability, perceived severity, perceived barriers, and perceived benefits of HPV vaccination.

Factors Associated with Increased HPV Vaccine Use in Rural-Frontier U.S. States

OBJECTIVE

This study sought to examine sociodemographic factors surrounding human papillomavirus (HPV) vaccine initiation and three-dose completion rates in the Intermountain West (IW).

DESIGN AND SAMPLE

Analysis of the Centers for Disease Control and Prevention's 2012 National Immunization Survey-Teen dataset was conducted with a survey-weighted Pearson chi-square test and multivariable Poisson regression to produce bivariate and multivariate analyses. Participants with daughters aged 13-17 with provider-verified immunization records were included. Dual-frame adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were produced with provider-phase sampling weights.

MEASURES

Factors included parents' and adolescents' sociodemographic and healthcare usage variables. Outcome measures included adolescents' receipt and completion of the HPV vaccine.

RESULTS

Older parental ages (45 years and above) showed lower prevalence of adolescent HPV vaccine initiation (PR = 0.73, 95% CI = 0.59-0.87, p = .003) and completion (PR = 0.65, 95% CI = 0.44-0.96, p = .031) compared with parents younger than 35. Seventeen-year-old adolescents demonstrated highest prevalence of initiating (PR = 1.88, 95% CI = 1.47-2.39, p < .001) and completing (PR = 2.92, 95% CI = 1.97-4.33, p < .001) the vaccination series compared to 13-year olds. Those who had received meningitis vaccinations had high prevalence of initiating (PR = 1.93, 95% CI = 1.50-2.48, p < .001) and completing the HPV vaccine (PR = 2.52, 95% CI = 1.64-3.86, p < .001).

CONCLUSION

This study highlights parental, adolescent, and health care characteristics related to use of the HPV vaccine. Future research to investigate specific barriers and strategies for addressing HPV vaccination use in the IW is recommended.

Design and efficacy of a multilingual, multicultural HPV vaccine education intervention

BACKGROUND

The human papillomavirus (HPV) is the precursor and the single, most important risk factor for cervical cancer. It is also the most commonly sexually transmitted infection in the United States. An estimated 20 million persons are currently infected with the virus, with an estimated 6 million new infections occurring annually and 12,000 new cervical cancer cases and 4,000 cervical cancer deaths annually. The human papillomavirus (HPV) vaccine is thus an especially important preventive measure for racial/ethnic groups who bear an unequal burden of cervical cancer mortality.

PURPOSE

This study aimed to develop a culturally and linguistically appropriate intervention to educate and empower Latino and Korean Americans to make an informed HPV vaccination decision for their minor children.

METHODS

A parent-focused HPV vaccine education DVD was developed through focus groups and cognitive interviews with Latino and Korean Americans parents of children ages 11-17. A randomized controlled efficacy trial was subsequently conducted with 708 Latino and Korean Americans parents to assess knowledge gains, decisional conflict, decision self-efficacy and informed decision-making resulting from viewing the intervention DVD.

RESULTS

Differences between treatment and control groups for pre-post changes in knowledge, informed decision-making and decisional conflict were statistically significant among the parents exposed to the education intervention DVD.

CONCLUSION

The study demonstrated that a culturally and linguistically appropriate intervention DVD designed to educate parents about the risks and benefits of the HPV vaccine promoted informed decision-making regarding HPV vaccination among at-risk populations.

School Nurses' Professional Practice in the HPV Vaccine Decision-Making Process

Because U.S. human papillomavirus (HPV) vaccination rates remain low, we evaluated school nurses' knowledge, attitudes, perceptions of their role as opinion leaders, self-efficacy, intention, and professional practice regarding the HPV vaccine and determined if these variables influenced their professional practice concerning the HPV vaccine. We utilized a cross-sectional design by recruiting Ohio Association of School Nurses (OASN) members. Participants (n = 145) completed a paper survey during the OASN annual conference. Structural equation modeling was used to examine the proposed model. Our model yielded a well-fitting solution, χ2 = 1.118 (degrees of freedom = 2, p = .57). Knowledge had positive effects on intention and self-efficacy. Attitude had a positive effect on perception of role as opinion leaders. Intention to provide HPV vaccine education had a positive effect on professional practice. To develop school nurses' practice, interventions should center on increasing knowledge, attitudes, and intention toward providing HPV vaccine education.

Individual- and regional-level determinants of human papillomavirus (HPV) vaccine refusal: the Ontario Grade 8 HPV vaccine cohort study

Background

Studies on the determinants of human papillomavirus (HPV) vaccine use have generally focused on individual-level characteristics, despite the potentially important influence of regional-level characteristics. Therefore, we undertook a population-based, retrospective cohort study to identify individual- and regional-level determinants of HPV vaccine refusal (non-receipt) in Ontario’s (Canada) Grade 8 HPV Immunization Program.

Methods

Ontario’s administrative health and immunization databases were used to identify girls eligible for free HPV vaccination in 2007–2011 and to ascertain individual-level characteristics of cohort members (socio-demographics, vaccination history, health care utilization, medical history). The social and material characteristics of the girl’s region (health unit) were derived from the 2006 Canadian Census. Generalized estimating equations (binomial distribution, logit link) were used to estimate the population-average effects of individual- and regional-level characteristics on HPV vaccine refusal.

Results

Our cohort consisted of 144,047 girls, 49.3% of whom refused HPV vaccination. Factors associated with refusal included a previous diagnosis of Down’s syndrome (OR = 1.37, 95% CI 1.16-1.63) or autism (OR = 1.60, 95% CI 1.34-1.90), few physician visits (OR = 1.45, 95% CI 1.35-1.55), and previous refusal of mandatory (OR = 2.23, 95% CI 2.07-2.40) and optional (OR = 3.96, 95% CI 3.87-4.05) vaccines. Refusal was highest among the lowest and highest income levels. Finally, a previous diagnosis of obesity and living in an area of high deprivation were associated with lower refusal (OR = 0.87, 95% CI 0.83-0.92 and OR = 0.82 95%, CI 0.79-0.86, respectively).

Conclusions

Studies on HPV vaccine determinants should consider regional-level factors. Efforts to increase HPV vaccine acceptance should include vulnerable populations (such as girls of low income) and girls with limited contact with the healthcare system.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1047) contains supplementary material, which is available to authorized users.

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.

Knowledge levels of adolescent girls about human papilloma virus and its vaccine

AIM

The aim of our study was to evaluate the level of knowledge of the adolescent girls who presented to our clinic about human papilloma virus (HPV) infection and HPV vaccine.

MATERIAL AND METHODS

Five hundred and one adolescent girls aged between 13 and 18 years who presented to the gynecology outpatient clinic between March 2012 and March 2013 were asked to answer the questions of the questionnaire about HPV and HPV vaccine. The "Participant Information Form" and "HPV Information Assessment Form" were used by examination of the related literature by the investigators. The data obtained were entered into the computer using the SPSS 16.5 program and evaluated. Descriptive statistics were shown with mean, standard deviation, number and percentage values.

RESULTS

The mean age of 501 subjects who were included into the study was 15.92 years. 390 subjects (77.8%) who were included in the study had no information about HPV. 111 subjects (22.2%) stated that they heard of HPV before or had information about HPV. The mean age of the subjects who had information about human papilloma virus was found to be 16.52 years. The mean age of 390 subjects (77.8%) who had no information about human papilloma virus was 15.75 years. It was found that only one of the subjects (0.9%) was vaccinated with HPV vaccine. When the subjects who did not wish to be vaccinated were asked for the reason, 40.9% stated that the reason was inadequate information, 26.4% stated that the reason was high cost, 16.4% stated that the reason was the fact that they did not consider themselves at risk and 16.4% stated that the reason was the fact that they were afraid of side effects.

CONCLUSIONS

In our study, it was found that the adolescent girls who constituted our study group had insufficient information about HPV and HPV vaccine. Verbal, written and visual communication tools and internet should be used intensively and efficiently for the objective of introducing HPV vaccine and teaching the precautions related with prevention of cervix cancer in terms of public health. Primarily pediatrician and gynecologists and family physicians who give service for the adolescence age group should be supported to develop appropriate attitudes and behaviors related with HPV vaccine and infection.

Factors associated with the persuasiveness of direct-to-consumer advertising on HPV vaccination among young women

This quantitative study explored young women's response to direct-to-consumer pharmaceutical advertising (DTCA) for a human papillomavirus (HPV) vaccine. In particular, the study examined (a) the association of factors stemming from consumer research with actual and intended behavioral responses to DTCA for HPV and (b) key elements drawn from commonly used health-related theories to determine the strongest associations with behavioral intentions regarding the HPV vaccine. Survey findings showed that vaccinated women indicated that DTCA played a role in their decision to get vaccinated against HPV more so than those who were not vaccinated. Trust in DTCA for an HPV vaccine brand was significantly related to intentions to seek more information about the vaccine. Also, perceived barriers had the only significant association with behavioral intentions when taking into account perceived threat and response efficacy. These results provide practical implications for key industry decision makers and health communication professionals on the design of effective theory-based health communication message content for an HPV vaccine brand with consequent social implications.

The influence of deductible health plans on receipt of the human papillomavirus vaccine series

PURPOSE

To evaluate whether enrollment in deductible health plans (DHP) with higher patient cost-sharing requirements than traditional health maintenance organization plans (HMP) decreased initiation and completion of the human papillomavirus (HPV) vaccine series recommended for prevention of cervical cancer.

METHODS

This was a retrospective observational study of 9- to 26-year-old females at Kaiser Permanente Georgia and Kaiser Permanente Colorado who were HPV vaccine naive at time of enrollment in a self-pay DHP or HMP in 2007. Estimates of rates of initiation and completion of the HPV vaccine series from plan enrollment in 2007 through December 2009 were obtained using Cox proportional hazards regressions (accounting for censoring) on samples matched on the propensity to enroll in a DHP versus HMP.

RESULTS

Initiation of the HPV vaccine series was 22.2% and 24.4% in the DHP and HMP groups, respectively, at Kaiser Permanente Georgia; completion was 12.3% and 14.4% in the DHP and HMP groups, respectively. Human papillomavirus vaccine series initiation was higher at Kaiser Permanente Colorado, but completion was lower. In the Cox proportional hazards regressions, rates of initiation and completion of the HPV vaccine series did not differ significantly (p ≤ .05) by plan type (DHP vs. HMP) at both sites. The primary care visit rate included in these regressions had a significant, positive association with initiation and completion of the HPV vaccine series.

CONCLUSIONS

Enrollment in a DHP versus an HMP did not directly affect initiation or completion of the HPV vaccine series among age-eligible females. Independent of plan type, more frequent primary care visits increased initiation and completion rates.

Seroprevalence of HSV-1 and HSV-2 antibodies in Canadian women screened for enrolment in a herpes simplex virus vaccine trial

Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) infections continue to be among the most common and unrecognized sexually transmitted infections in the world. Although treatable, HSV-1 and HSV-2 infections remain incurable. Hence, there is interest in the development of a vaccine to prevent genital herpes. As part of a multicentre, randomized, placebo-controlled trial to test such a vaccine, healthy women 18-30 years were enrolled as volunteers in several Canadian centres between 2005 and 2007. This study reports the seroprevalence of HSV-1 and HSV-2 antibodies in this group. A total of 2694 adult female volunteers in Canada with no known history of herpes simplex were screened for HSV antibodies using Western blot assay (the gold standard for diagnosis of HSV) for potential participation in a randomized, double-blind efficacy field trial of a herpes simplex vaccine. This trial provides a unique opportunity to examine the prevalence of antibodies to HSV-1 and of antibodies to HSV-2 in women with no known history of herpes simplex infection. The prevalence of antibodies to HSV-1 and to HSV-2 is compared with that found in previous Canadian studies that focused on a more general population. The overall seroprevalence of antibody to HSV-1 was 43%; that of HSV-2 was 2.5% and seropositivity to both was 2%. The prevalence of antibody to both HSV-1 and to HSV-2 increased with age. Seronegativity to both HSV-1 and HSV-2 was 56% in participating centres with populations under 250,000 and 46% in participating centres with populations over 250,000. Significant racial differences in seropositivity to HSV-1 and to HSV-2 were noted. The likelihood of participants being seropositive to HSV-1 and to HSV-2 was found to increase with age and to positively correlate with the population of the city in which they resided. Hypotheses are proposed to account for differences in racial seropositivity to HSV-1 and to HSV-2.

Perceived behavioral control, intention to get vaccinated, and usage of online information about the human papillomavirus vaccine

Objective: Human papillomavirus (HPV) and the HPV vaccine have been examined through multiple lenses over the past several years, though there is little work examining the role of perceived behavioral control (PBC) and its impact on potential recipients retrieving, understanding, and using online information with regard to the vaccine. Method: This study used survey data to examine the role of PBC as a moderator between attitudes and intention, and subjective norms (SN) and intention to get the HPV vaccine; and PBC as a moderator when seeking out Facebook, YouTube, and Twitter as information sources about HPV. Support was found for each prediction. Results: The interaction term of SN × PBC in particular had a strong influence on intention to get the vaccine. Discussion: Planned behavior variables explain intention to get the HPV vaccine, but data also suggest a need to root this research within intervention-based strategies.

Focusing on flu: adolescents' perspectives on school-located immunization programs for influenza vaccine

INTRODUCTION

To describe adolescents' perspectives regarding the use of school-located immunization programs (SLIP) for influenza vaccination. More importantly, adolescents were asked what factors would make them more or less likely to use a SLIP offering influenza vaccine.

RESULTS

Participants were generally found to be knowledgeable about influenza and to have positive attitudes toward receiving the vaccine via SLIP. Students were more willing to participate in a SLIP if it were low cost or free, less time-consuming than going to a doctor, and if they felt they could trust vaccinators. Overall, high school and middle school students ranked the benefits of SLIP similarly to each other.

METHODS

Focus groups using nominal group method were conducted with middle and high school students in a large, urban school district. Responses were recorded by each school, and then, responses were ranked across all participating schools for each question.

CONCLUSIONS

A wide range of issues are important to middle and high school students when considering participation in SLIPs including convenience, public health benefits, trust in the program, program safety, and sanitary issues. Further research will be needed regarding the generalizability of these findings to larger populations of students.

Sources of HPV vaccine hesitancy in parents

Despite strong national recommendations to vaccinate adolescents against the human papillomavirus (HPV), only 14% of teenage girls completed all 3 doses in 2010. Parental hesitancy may be one of the strongest reasons behind this low uptake rate. This review investigates sources of parental hesitancy including parental concerns associated with vaccinations in general, parental knowledge as a basis of HPV vaccine hesitancy, social qualms parents may have with regards to the HPV vaccine, and parental attitudes toward allowing their sons to be vaccinated against HPV. By better understanding these sources of hesitancy, we can focus research efforts towards addressing them in an attempt to improve HPV vaccine uptake.

Knowledge and Awareness of HPV Infection and Vaccination Among Urban Adolescents in India: A Cross-Sectional Study

AIM OF THE STUDY

To assess the level of awareness and knowledge of HPV infection and vaccination among 1,000 adolescent girls from secondary schools and colleges in five metro cities of India-Ahmedabad, Cuttack, Lucknow, Gwalior, and Visakhapatnam. To evaluate participants own interest and barriers toward HPV vaccination for cervical cancer prevention.

MATERIALS

This cross-sectional study was conducted by Adolescent Health Committee of FOGSI from April 2009 to March 2010 under the project "protecting young girls." Girls of 13-19 years, with an average of 16 years are targeted.

METHODS

A written questionnaire with two parts has been applied. A preliminary written questionnaire included questions of knowledge on cancer cervix and HPV awareness. Then, health talk on HPV is given by the researcher and group discussions lasting for 20 min. Second questionnaire was then applied to evaluate effectiveness of the talk.

RESULTS

The study group participants are poorly aware about HPV infection and vaccination but are intensely willing to know about it and get vaccinated. 72 % of them did not know about cervical cancer or HPV. 77.2 % were not aware of the virus that causes cancer cervix. After the health talks. there is an overall significant positive improvement in both knowledge and awareness. 74.4 % of them agreed to get vaccinated.

CONCLUSIONS

This study brings out the unawareness about HPV infection and vaccination in urban adolescent girls in five metro cities in India. Results show a changing positive trend of acceptance toward HPV vaccination. Adolescent understanding of HPV is needed to have successful vaccination programs in India.

Implications of the Virginia human papillomavirus vaccine mandate for parental vaccine acceptance

In 2009, Virginia became the first state in the United States to enact a school vaccine mandate for the human papillomavirus (HPV), putting it at the forefront of the national HPV vaccine mandate controversy. It is critical to explore the public response and sensemaking where the mandate has already been enacted. Thus, we conducted 8 focus group discussions among 33 Virginia parents to explore how they conceptualized the virus and vaccine and their responses to the mandate. Findings suggest that many parents are skeptical of and reluctant to follow a state-mandated vaccine requirement, choosing instead to opt out of the vaccine until they decide the time is right for their daughter and/or until they feel confident in their knowledge about the virus, vaccine, and the impetus for the mandate. Study results can inform future legislation among states considering HPV-related mandates and aid in the development of health-promotion materials within the context of a state mandate.

Hispanic mothers' and high school girls' perceptions of cervical cancer, human papilloma virus, and the human papilloma virus vaccine

PURPOSE

Cervical cancer incidence and mortality are higher for Hispanic women than for women in other population groups. However, the incidence could be reduced if teenaged Hispanic girls received the human papillomavirus (HPV) vaccine before they become sexually active. Unfortunately, few Hispanic girls receive this vaccine, which prevents cervical cancer. This study assessed Hispanic mothers' and girls' perceptions about cervical cancer, HPV, and the HPV vaccine. Results show factors that affect whether Hispanic high school girls receive the vaccine.

METHODS

Twenty-four Hispanic mothers and 28 Hispanic girls from an urban school district in southeast Texas each participated in one of eight focus groups. Bilingual moderators facilitated the mothers' groups in English and Spanish and the girls' groups in English. We analyzed transcripts of the discussions and identified themes using the grounded theory approach.

RESULTS

Our analysis found several themes that affect whether Hispanic girls get the HPV vaccine: gaps in knowledge; fears and concerns about the vaccine; sociocultural communication practices; and decision-making about HPV vaccination. Both mothers and girls had limited knowledge about cervical cancer, HPV, and the vaccine. Some girls who received the vaccine said they wished their mothers had involved them in making the decision.

CONCLUSIONS

Findings may help in developing school or community-based educational programs for Hispanic families. Such programs should provide information on the HPV vaccine and the link between HPV and cervical cancer, and they should assist mothers and girls in communicating to make informed decisions about the vaccine.

Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study

BACKGROUND

The Dutch government recently added universal Human Papilloma Virus (HPV) vaccination for 12-year-old girls to the existing national immunization program. The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower (47%) than expected (70%). To inform future HPV information campaigns, this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009.

METHODS

A random sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate (n = 5,998 mothers and daughters). In addition, a random sample was recruited via an online panel by a marketing research company (n = 650 mothers; n = 350 daughters). Both groups were asked to complete a web-based questionnaire with questions on social demographic characteristics, social-psychological factors and HPV vaccination intention. Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention.

RESULTS

Data from 952 mothers (14%) and 642 daughters (10%) were available for the intended analyses. The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers (ΔR² = .01; p = .007), but not significant for daughters (ΔR² = .02; p = .17) after controlling for HPV vaccination uptake and the sample. In addition, social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers (ΔR² = .35; p < .001) and daughters (ΔR² = .34; p < .001). Attitudes, beliefs, subjective norms and habit strength were significantly associated with participants' HPV vaccination intentions.

CONCLUSIONS

Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters, future communication strategies targeting HPV vaccination uptake should address attitudes, beliefs, subjective norms and habit strength. There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study.

Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey-Teen, 2010

OBJECTIVES

We aim to describe factors that influence parental decisions to vaccinate their adolescents.

METHODS

Data from the July to December 2010 National Immunization Survey-Teen Parental Concerns Module were analyzed to determine factors that influence parental decisions to vaccinate their adolescents.

RESULTS

Parents reported that their adolescent's health care provider recommended tetanus toxoid/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Td/Tdap; 74.4%), meningococcal conjugate (MenACWY; 60.3%), and human papillomavirus (HPV; 71.3%). Vaccination coverage estimates were significantly higher among parents who reported receiving a provider recommendation: 85.2% versus 76.7% (Td/Tdap), 77.3% versus 49.7% (MenACWY), and 62.2% versus 21.5% (HPV). Compared with Td/Tdap and MenACWY, fewer HPV vaccination conversations included recommendations for vaccination. Other than health care providers, school requirements (46.1%), news coverage (31.2%), and family (31.0%) were most frequently reported influences on parental vaccination decisions.

CONCLUSIONS

Many factors influence parental decisions to vaccinate their adolescents; one of the most important factors is the provider recommendation. Missed opportunities for vaccination persist when strong vaccination recommendations are not given or are delayed.