1
|
Orya EE, Bello KK, Sampson S, Envuladu EA, Okagbue HI. Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria. BMC Public Health 2024; 24:1548. [PMID: 38849788 PMCID: PMC11162061 DOI: 10.1186/s12889-024-19068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state. METHODS The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25. RESULTS Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. CONCLUSIONS This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.
Collapse
Affiliation(s)
| | | | | | | | - Hilary I Okagbue
- Sydani Institute for Research and Innovation, Sydani Group, Abuja, Nigeria.
| |
Collapse
|
2
|
Zambrano VC, Christensen JL. Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2373-2382. [PMID: 33400905 DOI: 10.1080/07448481.2020.1862853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use. METHODS A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university. RESULTS Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents. CONCLUSIONS Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.
Collapse
Affiliation(s)
- Viviana C Zambrano
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - John L Christensen
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
3
|
Vamos CA, Vázquez-Otero C, Kline N, Lockhart EA, Wells KJ, Proctor S, Meade CD, Daley EM. Multi-level determinants to HPV vaccination among Hispanic farmworker families in Florida. ETHNICITY & HEALTH 2021; 26:319-336. [PMID: 30260243 DOI: 10.1080/13557858.2018.1514454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Background: HPV vaccination is the primary prevention method for HPV-related cancers, although among Hispanic populations, migrant farmworkers may experience exacerbated challenges to HPV vaccination due to intersecting political, social, and personal contexts. This study explored multi-level determinants of HPV vaccination among Hispanic migrant farmworker families.Methods: Using a community-engaged approach and guided by the socio-ecological model, Intervention Mapping, and PRECEDE-PROCEED constructs, we recruited parents who had a daughter and/or son age 9-15 years from a rural, faith-based, community organization in Florida. Three focus groups (n = 13) were conducted in Spanish and constant comparison methods were used to analyze qualitative data.Results: Micro-level determinants included moderate HPV vaccine knowledge, desire for more HPV vaccine information, concerns about HPV vaccine completion, health/preventive motivations, past experiences with the healthcare system, and parental gender roles related to health care. Macro-level determinants included facilitators (e.g. transportation services, clinics open after work hours, governmental programs) and barriers (e.g. supervisor/employment inflexibility, long clinic wait times) to accessing health care and vaccination in general (including HPV vaccination). Participants shared their preferences for future interventions that would meet the needs of this community, and discussed potential content and mechanisms for receiving HPV information, as well as what might facilitate their overall access, uptake, and completion of the HPV vaccine series.Discussion: Determinants to HPV vaccination emerged and underscore the importance of addressing the multi-level factors when designing and delivering an HPV vaccine intervention for this Hispanic migrant farmworker population. Improving HPV vaccination rates requires responding to situational and structural hardships that disproportionately impact this group. Thus, community-tailored and culturally appropriate multi-level interventions are needed, while emphasizing existing knowledge assets and preferences favorable towards HPV vaccination, with the ultimate goal of the decreasing HPV-related disparities. Findings suggest interventions must reach beyond the individual level to account for this unique population's lived experiences.
Collapse
Affiliation(s)
- Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Coralia Vázquez-Otero
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Elizabeth A Lockhart
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Sara Proctor
- Catholic Mobile Medial Services, Catholic Charities Diocese of St. Petersburg, Inc., San Jose Mission, Dover, FL, USA
| | - Cathy D Meade
- Division of Population Science, Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| |
Collapse
|
4
|
Mburu A, Itsura P, Mabeya H, Kaaria A, Brown DR. Knowledge of Cervical Cancer and Acceptability of Prevention Strategies Among Human Papillomavirus-Vaccinated and Human Papillomavirus-Unvaccinated Adolescent Women in Eldoret, Kenya. Biores Open Access 2019; 8:139-145. [PMID: 31475078 PMCID: PMC6715544 DOI: 10.1089/biores.2019.0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cervical cancer is a critical public health concern in sub-Saharan Africa. Adolescents are key targets in primary prevention strategies. Following a human papillomavirus (HPV) vaccination initiative (Gardasil) in Eldoret, Kenya, the knowledge and source of information of cervical cancer and acceptance of prevention strategies among vaccinated and unvaccinated adolescents were evaluated. A cross-sectional comparative study enrolled 60 vaccinated and 120 unvaccinated adolescent women. Institutional ethical approval was obtained and signed consent was obtained from the parents. Data collection was performed using interviewer-administered questionnaires derived from factual statements based on information from print material used for community sensitization on cervical cancer. The median age of the participants was 14.0 years (interquartile range [IQR] = 13.0–15.0). Of 60 vaccinated adolescents, 56 (93.3%) had heard of the HPV vaccine compared with 6 (5%) of unvaccinated participants (p < 0.001). Of 60 vaccinated participants, 58 (96.7%) had heard of cervical cancer compared with 61 (50.8%) unvaccinated participants (p < 0.001). Both cohorts identified the school as the main source of information for cervical cancer. The two groups also showed similarity in their selection of cervical cancer prevention strategies acceptable to them such as delaying sexual debut, limiting number of sexual partners, and use of condoms for protection against sexually transmitted infections. Of 120 unvaccinated participants, 63.7% expressed willingness to be vaccinated. Exposure to the HPV vaccine was associated with a higher knowledge of cervical cancer. The adolescents predominantly rely on the school for health information. Both cohorts of adolescents showed remarkable acceptability for cervical cancer prevention strategies.
Collapse
Affiliation(s)
- Anisa Mburu
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Peter Itsura
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Hillary Mabeya
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | | | - Darron R Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
5
|
Association between human papillomavirus and chlamydia trachomatis infection risk in women: a systematic review and meta-analysis. Int J Public Health 2019; 64:943-955. [DOI: 10.1007/s00038-019-01261-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
|
6
|
Vatopoulou A, Papanikolaou A, Diavatis S, Goulis DG. Human papilloma virus vaccination and attitudes towards contraception: a cross-sectional study. EUR J CONTRACEP REPR 2019; 24:182-187. [PMID: 30966837 DOI: 10.1080/13625187.2019.1595573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Human papilloma virus (HPV) vaccination may result in misconceptions that encourage young women to adopt risky contraceptive practices. The purpose of this article was to investigate whether HPV vaccination status was associated with choice of contraceptive method and adoption of risky sexual behaviour. Methods: Vaccinated and non-vaccinated visitors to a university department paediatric and adolescent gynaecology clinic were asked to anonymously fill in a survey comprising questions on sociodemographic characteristics, sexual history, opinions on contraception and attitudes towards contraception. Results: A total of 191 women were studied, 75 (39.3%) of whom had received the HPV vaccination and 116 (60.7%) of whom had not. The main contraceptive methods used in both groups were male condom (46%), emergency contraception (14%) and coitus interruptus (12%). The vaccinated group was less religious and had better educated mothers compared with the non-vaccinated group (relative risk [RR] 0.64; 95% confidence interval [CI] 0.45, 0.93; p = .016 vs RR 1.91; 95% CI 1.01, 3.63; p = .027, respectively). They also had an earlier sexual debut (RR 1.94; 95% CI 1.06, 3.55; p = .015), agreed that vaccination increased the safety of sex (RR 1.45; 95% CI 1.02, 2.05; p = .039) and considered the HPV vaccine a prerequisite to initiation of a sexual relationship (RR 1.87; 95% CI 1.34, 2.63; p < .001). Conclusion: HPV vaccination did not affect sexual behaviour, attitudes to condom use or choice of contraceptive method.
Collapse
Affiliation(s)
- Anastasia Vatopoulou
- a Paediatric and Adolescent Gynaecology Clinic, First Department of Obstetrics and Gynaecology , Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Alexios Papanikolaou
- b First Department of Obstetrics and Gynaecology , Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Dimitrios G Goulis
- b First Department of Obstetrics and Gynaecology , Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| |
Collapse
|
7
|
Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
8
|
Holway GV, Hernandez SM. Oral Sex and Condom Use in a U.S. National Sample of Adolescents and Young Adults. J Adolesc Health 2018; 62:402-410. [PMID: 29174873 DOI: 10.1016/j.jadohealth.2017.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE The objective of this study was to examine correlates associated with condom use at the last oral sex, as well as oral sex behavior, among adolescents and young adults (AYAs) aged 15-24 years in the U.S. METHODS Descriptive statistics, logistic regression, and multinomial logistic regression were conducted using data collected from 3,816 females and 3,520 males in the 2011-2015 National Survey of Family Growth. RESULTS More than half of AYAs had engaged in oral sex with an opposite-sex partner. Most youth reported having at least one oral sex partner in the last 12 months, with 16% of females and 24% of males reporting two or more partners. Condom use at the last oral sex was quite low (8% for females and 9% for males). Black males (adjusted odds ratio [AOR] = 3.46), black females (AOR = 2.65), and females of other race/ethnicities (AOR = 2.40) were more likely to use a condom at the last oral sex. Females aged 20-24 years (AOR = .31), females whose mothers had a college education or more (AOR = .43), and males and females who reported no intercourse experience were less likely to use a condom at the last oral sex (AORs = .46 and .20, respectively). CONCLUSIONS Our study suggests that oral sex with an opposite-sex partner is a normative behavior for AYAs; however, condom use during this sexual activity is uncommon. Interactive workshops and physician-patient discussions focused on the health risk risks associated with oral sex, as well as appropriate methods of protection, may help to increase condom uptake.
Collapse
Affiliation(s)
- Giuseppina Valle Holway
- Department of History, Sociology, Geography and Legal Studies, The University of Tampa, Tampa, Florida.
| | - Stephanie M Hernandez
- Department of Demography, The University of Texas at San Antonio, San Antonio, Texas
| |
Collapse
|
9
|
Mullins TLK, Rosenthal SL, Zimet GD, Ding L, Morrow C, Huang B, Kahn JA. Human Papillomavirus Vaccine-Related Risk Perceptions Do Not Predict Sexual Initiation Among Young Women Over 30 Months Following Vaccination. J Adolesc Health 2018; 62:164-169. [PMID: 29198772 PMCID: PMC5803391 DOI: 10.1016/j.jadohealth.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE We examined longitudinally the relationship between human papillomavirus (HPV) vaccine-related risk perceptions and initiation of sexual activity among adolescent women over 30 months after HPV vaccination. METHODS Participants included 91 sexually inexperienced women aged 13-21 years receiving the HPV vaccine who completed at least three of five study visits. At every visit, participants completed surveys assessing HPV vaccine-related risk perceptions (perceived risk of sexually transmitted infections [STIs] other than HPV, perceived need for safer sexual behaviors), and sexual initiation. Outcomes were sexual initiation and age of sexual initiation. Associations between risk perceptions and outcomes were examined using ordered logistic regression models for sexual initiation and interval censored survival analyses for age of sexual initiation. RESULTS Mean age at baseline was 14.9 years (standard deviation [SD] 1.4). Most participants perceived themselves to be at risk of STIs other than HPV (mean scale score = 4.0/10; SD 2.1) and perceived a need for safer sexual behaviors (mean scale score = 1.5/10; SD 1.5). By 30 months, 65 participants (78%) initiated sex. Perceived risk of STIs and perceived need for safer sexual behaviors were not associated with sexual initiation or age of sexual initiation. Older age at baseline was associated with sooner sexual initiation (p = .02) and older age at sexual initiation (p < .001). Results of ordered logistic regression and survival analyses were unchanged when controlling for baseline age. CONCLUSIONS HPV vaccine-related risk perceptions were not associated with sexual initiation or age of sexual initiation, providing further support that HPV vaccine-related risk perceptions are unlikely to lead to riskier sexual behaviors.
Collapse
Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
| | - Susan L. Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University and New York Presbyterian Morgan Stanley Children’s Hospital, 622 West 168 Street, PH17th floor, room 102a, New York, NY 10032, USA
| | - Gregory D. Zimet
- Division of Adolescent Medicine, Indiana University, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Charlene Morrow
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
| |
Collapse
|
10
|
HPV Unvaccinated Status and HPV Sexual Risk Behaviour are Common among Canadian Young Adult Women and Men. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:410-417. [PMID: 29276162 DOI: 10.1016/j.jogc.2017.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The current research focuses on sexual risk behaviour among young adult Canadians who have not been vaccinated against HPV. METHODS Six hundred and forty-six Canadian university undergraduates completed a self-administered survey assessing HPV vaccination status and sexual risk behaviour. RESULTS Five hundred and thirty-seven participants (154 men and 383 women aged 17-23) who met eligibility criteria were analyzed. 48.5% (n = 185) of female and 89.6% (n = 138) of male participants had not been vaccinated against HPV. In the unvaccinated cohort, 51.4% (n = 95) of women were coitally experienced, 49.2% (n = 91) reported experience with oral sex, and 6.5% (n = 12) reported experience with receptive anal intercourse. 55.1% (n = 76) of men were coitally experienced, 22.5% (n = 31) of men reported receptive oral sex, and 2.9% (n = 4) of men reported receptive anal intercourse. Using validated sexual risk behaviour cut-offs, we determined that in the female unvaccinated population, the proportion at significantly increased risk for genital warts, cervical, anal, and oropharyngeal cancer was 11.0%, 30.0%, 6.5%, and 49.2% respectively. In the male unvaccinated population, the proportion at significantly elevated risk for genital warts and anal cancer was 27.2% and 2.9% respectively. CONCLUSION Unvaccinated young Canadian women and men commonly engaged in sexual risk behaviours for HPV infection, engaged in sexual risk behaviours at a similar level as their vaccinated counterparts, and a substantial number were at elevated risk of HPV related morbidities at a young age. Findings contribute to an evidence-based case for redoubling efforts to encourage HPV vaccination among unvaccinated young Canadians who are at risk of HPV infection.
Collapse
|
11
|
Daley EM, Vamos CA, Thompson EL, Zimet GD, Rosberger Z, Merrell L, Kline NS. The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:142-148. [PMID: 28720448 PMCID: PMC5883212 DOI: 10.1016/j.pvr.2017.04.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.
Collapse
Affiliation(s)
- Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & Departments of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada.
| | - Laura Merrell
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA.
| | - Nolan S Kline
- Department of Anthropology, Rollins College, Winter Park, FL, USA.
| |
Collapse
|