Factors associated with the human papillomavirus (HPV) vaccination across three countries following vaccination introduction

Web and theory-based motivational interviews in encouraging mothers for HPV vaccination of their daughters: A randomized controlled study

BACKGROUND

Mothers' intentions regarding the Human Papillomavirus (HPV) vaccination of their daughters are crucial, especially in societies that prioritize cultural and religious values.

OBJECTIVES

This study aimed to encourage mothers to vaccinate their daughters against HPV by enhancing their perceptions of the vaccine's benefits, susceptibility, severity, and knowledge levels, while reducing their barriers through web-based interventions and Health Belief Model-based motivational interviews.

METHODS

The study was designed as a pre-mid-post test randomized controlled experimental study. The sample included 63 mothers of female high school students (31 in the experimental group, 32 in the control group). Data were collected using a "Demographical and Descriptive Characteristics Information Form", "Health Belief Model Scale for Human Papillomavirus and Its Vaccination" and "Human Papillomavirus Knowledge Scale". Mothers in the experimental group received three HBM-based motivational interviews, web support, and follow-up.

CLINICALTRIALS

gov code is NCT04992741.

RESULTS

Following the interventions, the experimental group exhibited higher levels of knowledge, benefit, susceptibility, and severity perception of HPV vaccination, and lower perceptions of barriers compared to the control group. At the end of the study, 24 mothers from the experimental group and 5 mothers from the control group decided to vaccinate their daughters against HPV.

CONCLUSIONS

Motivational interviews, along with web support and monitoring, significantly enhanced mothers' knowledge and beliefs.

IMPLICATIONS FOR PRACTICES

This study provides evidence for the applicability of theory-based motivational interviewing in the acceptance of HPV vaccine by mothers. It enables the dissemination of HPV vaccination and encourages community health nurses to use theory-based motivational interviewing to recommend HPV vaccination.

Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity

Importance

Understanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake.

Objective

To investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality.

Design, Setting, and Participants

This cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data (January 26, 2017, to June 15, 2020). The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis.

Main Outcomes and Measures

Weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test.

Results

A total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58 (IQR, 44-69) years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race or ethnicity). Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment.

Conclusions and Relevance

Disparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination.

Natural and synthetic drugs and formulations for intravaginal HPV clearance

BACKGROUND

Except for a few preventative Human Papillomavirus (HPV) vaccines, there is currently no cure for HPV infection. There are a number of cutting-edge strategies and potent medications or herbal formulations that can be applied topically for early clearance of HPV infection before HPV DNA gets integrated into host cell genome. This is facilitated due to cervical cancer having distinct and well-recognized long precancerous stages.

OBJECTIVES

This review aims to outline every possible medication and formulation, both natural and synthetic, that can be applied topically as intravaginal application to help remove HPV infection at an early precancerous stage.

RESULTS

Several anti-HPV/HPV clearance compounds and formulations for high-grade lesions are undergoing clinical trials. However, the majority of compounds are still in the early stages of development and require additional research to become viable HPV clearance candidates. Synthetic drugs may be more promising because they may have a more targeted effect; however, they may also have significant adverse effects. On the other hand, natural medications are safer to use. They are less specific, but have minimal to no adverse effects.

CONCLUSIONS

This article may serve as a valuable resource of information for managing and preventing precancerous carcinogenic HPV infections. Research could be directed toward developing candidate drugs to make evidence-based decisions about advancing them to clinical trials and, eventually, to the market for potential use in the prevention and control of cervical cancer, which is almost always preventable or even curable if detected early.

Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Cervical cancer is an international public health issue. Nearly all cases of cervical cancer are caused by the human papillomavirus. The HPV vaccine prevents more than 75% of cervical cancer. The extent to which adolescent girls' knowledge and uptake of the HPV vaccine have to be investigated in order to build effective promotion strategies and increase the uptake of the vaccine. The evidence that is currently available in this area is controversial and inconclusive. Hence, this study has estimated the pooled proportion of good knowledge, positive attitude, and uptake of the HPV vaccine and its associated factors among adolescent schoolgirls in Ethiopia.

METHODS

PubMed, Google Scholar, AJOL, ScienceDirect, and DOAJ were used to search relevant studies. A total of 10 studies were included. The data were extracted by two reviewers using Microsoft Excel and exported to STATA Version 17 for analysis. A random effects model was applied during the analysis. Heterogeneity and publication bias across the studies were evaluated using I² statistics and Egger's test, respectively. The PROSPERO registration number for the review is CRD42023414030.

RESULT

A total of eight studies comprising 3936 study participants for knowledge and attitude and five studies with 2,481 study participants for uptake of HPV were used to estimate the pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine, respectively. The pooled proportions of good knowledge, positive attitude, and uptake of the HPV vaccine were 55.12%, 45.34%, and 42.05%, respectively. Being an urban resident (OR = 4.17, 95% CI = 1.81, 9.58), having good knowledge (OR = 6.70, 95% CI = 3.43, 13.07), and a positive attitude (OR = 2.04, 95% CI = 1.51, 2.74), were significantly associated with the uptake of the vaccine.

CONCLUSION

The pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine were low in Ethiopia. Being an urban resident and having good knowledge and a positive attitude towards the HPV vaccine were significantly associated with the uptake of the HPV vaccine. We recommend increasing adolescent knowledge, positive attitudes, and uptake of HPV vaccination through school-based seminars, health education, and community mobilization.

Beliefs and knowledge related to human papillomavirus (HPV) vaccine among African Americans and African immigrants young adults

BACKGROUND

Despite the disparate human papillomavirus (HPV) infection rates among sexually active Black young adults, HPV vaccine uptake remains low among this population. This study aimed to explore HPV beliefs, attitudes, and knowledge among Black young adults and provide recommendations on ways to improve vaccine uptake.

METHODS

We used a mixed-method, convergent design to conduct five focus groups and administered a 40-item electronic survey that was developed with health belief model (HBM) constructs. We assessed HPV and vaccine knowledge, barriers, and attitudes toward vaccination. We analyzed quantitative data using descriptive statistics and bivariate methods. Focus group transcripts were analyzed using content analysis. Results were integrated to obtain a better understanding of the topic.

RESULTS

Forty individuals participated in the study. The mean age was 22.2 ± 4.5 years and 55% identified as African immigrants. Integrated data revealed themes mapped to relevant HBM constructs. Almost one third (32.5%) of participants were unaware of their susceptibility to HPV infection and its severity. From focus group discussions, the majority (75%) believed that vaccines are beneficial. Major cues to action include promoting HPV vaccine uptake via community wide informational sessions, provider recommendation, and social and mass media campaigns.

CONCLUSION

Barriers to vaccine uptake, limited HPV knowledge, and lack of vaccine recommendation are important factors contributing to low vaccine uptake among Black young adults. Interventions to decrease barriers to HPV vaccination, increase HPV knowledge, address misconceptions, and unfavorable beliefs are needed to promote HPV vaccine uptake.

Perceptions, Knowledge and Attitudes among Young Adults about Prevention of HPV Infection and Immunization

Introduction: Human papilloma virus (HPV) is one of the most common sexually transmitted infections and is widely known as the main causative agent for cervical cancer. The aim of this study was to investigate the perceptions, knowledge and attitudes of young Greek adults concerning prevention of HPV infection and HPV immunization. Material and Methods: This constitutes a cross-sectional online survey. A convenience sample of young Greek adults (n = 883) residing in Greece, aged 17 to more than 35 years was surveyed from December 2020 to March 2021. Two validated questionnaires were used to collect data. Results: Participants demonstrated moderate knowledge about HPV infection and vaccination, with a mean knowledge score of 53.26 (SD ± 20.65) and 38.92 (SD ± 17.58), respectively. Cronbach’s alpha value was 0.77 and 0.80. Female participants were better informed than males. Approximately 52.3% of respondents had been vaccinated and 65.5% were willing to get vaccinated in the future. Vaccination rate was significantly associated with gender (OR = 11.99; 99% CI = 6.59–21.84), knowledge about the HPV vaccine (OR = 1.04; 99% CI = 1.03–1.04) and age (OR = 0.07; 99% CI = 0.03–0.15). Reasons for vaccine refusal were insufficient information (36.8%) and fear of side effects (19%). Correlates of positive vaccination intention were knowledge about HPV (OR = 1.02; 99% CI = 1.01–1.02). Conclusions: The findings suggest that the Greek government’s continuing HPV promotion efforts and education on the risks of HPV infection among young people are likely to increase vaccination acceptance among this group.

Analysis of HPV Vaccination Willingness amongst HIV-Negative Men Who Have Sex with Men in China

Objective: Men who have sex with men (MSM) are high-risk groups of human papillomavirus (HPV) infection, the best measure to prevent this is the HPV vaccine. However, few studies have investigated HPV vaccination willingness in the MSM population in China. We aimed to explore the willingness of human immunodeficiency virus (HIV)-negative MSM for HPV vaccination and the factors affecting their willingness to vaccinate. Methods: We adopted a non-probability sampling method to recruit HIV-negative MSM volunteers. Participants completed a questionnaire, including sociodemographic characteristics, sexual behavior characteristics, HPV infection and vaccine-related knowledge, risk perception, and HPV vaccination willingness and promotion attitudes. Results: Of the 406 HIV-negative MSM surveyed, 86.21% were willing to receive HPV vaccine. HPV infection and vaccine-related knowledge (odds ratio [OR] = 2.167, 95% confidence interval [CI] = 1.049–4.474), HPV infection risk perception (OR = 5.905, 95% CI = 1.312–26.580), and HPV vaccine promotion attitude (OR = 6.784, 95% CI = 3.164–14.546) were all related to HPV vaccination willingness. Conclusion: MSM have a high willingness for HPV vaccination. Strengthening health education for MSM, raising their awareness of HPV infection and vaccines, and promoting their risk perception of HPV infection will help increase their willingness for HPV vaccination.

Provider communication and HPV vaccine uptake: A meta-analysis and systematic review

Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.

Influences on HPV vaccination across levels of the social ecological model: perspectives from state level stakeholders

Nationally, human papillomavirus (HPV) vaccination rates fall short of the Healthy People 2020 goal of 80% completion. Although strategies to increase these rates exist, low rates persist. We used concept mapping with state-level stakeholders to better understand barriers and facilitators to HPV vaccination. Concept mapping is a participatory research process in which respondents brainstorm ideas to a prompt and then sort ideas into piles. We present results of the brainstorming phase. We recruited participants identified by researchers' professional connections (n = 134) via e-mail invitations from five states (Iowa, South Dakota, Minnesota, Oregon, and Washington) working in adolescent health, sexual health, cancer prevention and control, or immunization. Using Concept Systems' online software we solicited participants' beliefs about what factors have the greatest influence on HPV vaccination rates in their states. From the original sample 58.2% (n = 78) of participants completed the brainstorming activity and generated 372 statements, our team removed duplicates and edited statements for clarity, which resulted in 172 statements. We coded statements using the Social Ecological Model (SEM) to understand at what level factors affecting HPV vaccination are occurring. There were 53 statements at the individual level, 22 at the interpersonal level, 21 in community, 51 in organizational, and 25 in policy. Our results suggest that a tiered approach, utilizing multi-level interventions instead of focusing on only one level may have the most benefit. Moreover, the policy-level influences identified by participants may be difficult to modify, thus efforts should focus on implementing evidence-based interventions to have the most meaningful impact.

Human papillomavirus knowledge and vaccine acceptability among male medical students in Saudi Arabia

Human papillomavirus (HPV), the most common sexually transmitted infection worldwide, is responsible for a variety of cancers. HPV vaccines can help prevent this infection and its potentially devastating carcinogenic outcomes. Although the incidence of HPV-related oropharyngeal cancers among males is increasing, few studies have been published on HPV knowledge and vaccine acceptability among males. In this cross-sectional study, we assessed knowledge about HPV and the vaccine, as well as its acceptability, among third- and fourth-year male medical students in Jeddah, Saudi Arabia. Respondents were enrolled in any of the medical colleges in Jeddah from February to December 2018. A validated survey was used to collect information on HPV infection and vaccine knowledge and to ask questions assessing vaccine acceptability. HPV knowledge scores were created, and vaccine acceptability predictors were assessed with logistic regression. We collected data from 517 participants. Approximately 74% of the students had heard of HPV, with a mean knowledge score of 5.9 ± 4.6 out of 16; only 42% had heard of the HPV vaccine, with a mean knowledge score of 0.9 ± 1.6 out of 7. Among the respondents, 48.9% were interested in receiving the HPV vaccine. Although HPV infection and vaccine knowledge did not correlate with vaccine acceptability, those who had previously received the hepatitis B vaccine were more interested in receiving the HPV vaccine. In conclusion, male medical students had low HPV knowledge. Improving their HPV knowledge is important, as they are future health-care providers. The promotion of HPV vaccines in this potentially influential group is crucial for achieving effective disease prevention.

Declining awareness of HPV and HPV vaccine within the general US population

Programs aimed at boosting human papillomavirus (HPV)-related awareness are considered one of the most effective strategies for increasing vaccination uptake and eliminating HPV-associated cancers. Several US states have made strong commitments to this effort through legislation and dedicated funds. However, it is not known if these efforts have resulted in population-level increments in HPV awareness overtime. Using the Health Information National Trends Survey data, we examined the awareness of HPV and HPV vaccine in the US, between 2008 and 2018. Prevalence estimates and confidence intervals were calculated for HPV and HPV vaccine awareness. Further, we assessed awareness after stratifying by key sociodemographic characteristics. Overall, the awareness of HPV and HPV vaccine declined over time. The lowest awareness was among racial minorities, rural residents, male respondents, those aged 65 years and older, as well as those with the lowest educational and socioeconomic standing. Between 2013 and 2018, the awareness of HPV and HPV vaccine declined by almost 10% among males, those with a high school level of education or lower, and those who earned less than USD 35,000 per annum. In 2018, the awareness of HPV and HPV vaccine was highest among non-Hispanic whites (65.8% and 66.5%) and female adults (70.5% and 71.4%); however, these figures represented declines of about 5% from rates observed in 2008. Amidst a background of sub-optimal HPV vaccination uptake and a growing incidence of HPV-associated cancers in the US, HPV-related awareness within the general US population has declined over time. This calls for stricter enforcement of legislation aimed at boosting HPV awareness, as well as frequent evaluation of government-funded HPV awareness programs.

Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis

BACKGROUND

The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination.

METHODS

Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey.

RESULTS

Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile.

CONCLUSIONS

Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis

BACKGROUND

The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination.

METHODS

Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey.

RESULTS

Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile.

CONCLUSIONS

Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.

Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine

BACKGROUND

Cervical cancer is considered the second most common type of cancer in women worldwide, with a reported 570,000 incident cases documented each year. Infection with certain types of the Human Papillomavirus (HPV) has been found to be associated with more than 99% of cervical cancers. The HPV vaccine can prevent HPV infection and most cases of cervical cancers; however the uptake of this vaccine remains low in Saudi Arabia. Physicians can play a vital role in providing their patients with objective information regarding the HPV vaccine, yet little is known about their knowledge, attitudes, and practices in this area.

MATERIALS AND METHODS

We conducted a cross-sectional study in King Abdul-Aziz Medical City (KAMC), Central Region, Saudi Arabia where data were collected through an online questionnaire to assess the knowledge, attitudes, and practices of physicians.

RESULTS

Most physicians (61%) displayed a good level of knowledge about cervical cancer; 94% were knowledgeable of the causative link between (HPV) infection and cervical cancer. Family medicine physicians had better knowledge regarding cervical cancer, HPV, and HPV vaccination than pediatricians (p=0.023). Physicians with >10 years of practice had better knowledge of cervical cancer than other respondents (p=0.041). 80% of the sample thought it was important for women to receive the HPV vaccine and 82% stated they would allow their daughters to be given the HPV vaccine. Lack of parental knowledge of the vaccine was significantly (p=0.034) associated with a lack of knowledge about HPV, and this was one of the most common barriers preventing recommendation of the HPV vaccine.

CONCLUSION

With the increasing prevalence of HPV infections, better knowledge of HPV infection, HPV-related diseases, and the availability of HPV vaccinations from health professionals will assist with the implementation of effective prevention and treatment programmes.

The factors associated with maternal consent to human papillomavirus vaccination among adolescents in Israel

Purpose: To evaluate the knowledge and attitudes toward the human papillomavirus (HPV) vaccine among mothers of 8th graders in Israel, and to determine the factors associated with maternal consent to the HPV vaccine.Methods: We conducted a cross-sectional study among mothers of 8th grade students in 27 schools in Haifa and Northern districts of Israel during the 2016-17 school year. Data were collected using a structured telephone questionnaire.Results: 313 mothers answered the questionnaire (response rate = 91.8%). The mean knowledge level score was low (3.96 points [out of 10] ±2.68). Knowledge level was positively associated with Jewish nationality, being secular in religious practice and higher education. The attitude mean score was low-moderate (11.22 points [out of 18] ± 5.01). Attitude score was positively associated with Arab nationality. No significant association was found between knowledge level and attitudes. According to multivariate analysis, mothers' consent to the HPV vaccine was associated with the knowledge level score (OR = 0.82; 95%CI 0.68-0.98), the attitude score (OR = 1.76; 95%CI 1.53-2.02) and nationality (OR = 27.86, 95%CI 3.41-227.56).Conclusions: The knowledge level and attitudes toward the HPV vaccine were found to be unsatisfactory with racial disparities between Arabs and Jews. Jewish mothers compared with Arab mothers, mothers with a higher knowledge level or less positive attitudes were less likely to consent to the vaccine. These findings could contribute toward adapting programs to the different Israeli sectors in order to improve the rates of HPV vaccine receipt among adolescents.

Parental knowledge gaps and barriers for children receiving human papillomavirus vaccine in the Rio Grande Valley of Texas

Purpose: Despite its availability for more than a decade, the human papillomavirus (HPV) vaccine has low uptake in Texas (49%). The objective of this study was to understand parental knowledge and attitudes about HPV and the HPV vaccine as well as child experience with the HPV vaccine among a medically underserved, economically disadvantaged population.

Methods: As part of a Cancer Prevention Research Institute of Texas-funded project to improve HPV vaccination rates, we surveyed parents / guardians of 4^th–12^th graders (ages 9–17) in the Rio Grande City Consolidated Independent School District (RGCCISD). Descriptive statistics were used to describe parents’ knowledge and attitude and children’s vaccine experience.

Results: Of the 7,055 surveys distributed, 622 (8.8%) were returned. About 84% of the respondents were female. About 57.1% of the parents /guardians had female RGCCISD students with a mean age of 11.7 ± 1.8 years. Overall, 43.9% reported receiving a healthcare provider recommendation and 32.5% had their child vaccinated. Higher percentages were reported if the respondent was female and had a female child aged ≥15 years old. Among survey respondents, 28.2% reported their child initiated the HPV vaccine and 18.8% completed the series. Barriers of uptake included work / school schedule conflicts and no healthcare provider recommendation.

Conclusions: There are still prominent gaps in parents’ and students’ complete understanding of HPV vaccination, gender preferences for vaccination, and provider recommendations. Future interventions must target men and minority populations in order to increase knowledge and awareness about HPV, the HPV vaccine, and HPV-associated cancers.

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons

Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9-16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the 'decided not to vaccinate' stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.