Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers

Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among United States adults, aged 27-45 years

In 2018, the Food and Drug Administration expanded the age of eligibility for the human papillomavirus (HPV) vaccine to 27 to 45 years. However, it is unclear if there are racial/ethnic disparities in HPV vaccine uptake for this age-group following this expanded recommendation. We aimed to identify any disparities in HPV vaccine in 27 to 45 year-olds based on sociodemographic factors. We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9440). Logistic regression models estimated the odds of vaccine uptake (receipt of ≥1 vaccine dose) based on sociodemographic factors. Participants were mostly Non-Hispanic Whites (60.7%) and females (50.9%). In adjusted models, females had over three times greater odds of vaccine uptake compared to males (aOR = 3.58; 95% CI 3.03, 4.23). Also, compared to Non-Hispanic Whites, Non-Hispanic Blacks were 36% more likely (aOR = 1.36; 95% CI 1.09, 1.70), and Hispanics were 27% less likely (aOR = 0.73; 95% CI 0.58, 0.92) to receive the vaccine. Additionally, individuals without a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (aORhigh school = 0.62; 95% CI 0.50, 0.78; aORsome college = 0.83; 95% CI 0.70, 0.98). There are disparities in HPV vaccine uptake among 27 to 45 year-olds, and adult Hispanics have lower odds of receiving the vaccine. Given the vaccine's importance in cancer prevention, it is critical that these disparities are addressed and mitigated.

Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria

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.

Associations Between Risk Perception and HPV Knowledge and Vaccine Uptake: Highlighting the LGBTQ+ Population

INTRODUCTION

Gay and bisexual males and other LGBTQ+ communities are more frequently exposed to factors associated with an increased risk of human papillomavirus (HPV) acquisition. Vaccination is critical to protect against HPV+ head and neck cancer (HNC). We characterized the association of perceived level of risk of contraction with HPV knowledge, and vaccine decision-making.

STUDY DESIGN

Cross-sectional cohort.

SETTING

LGBTQ and general survey Reddit forums (control).

METHODS

A survey was shared amongst the online forums. Descriptive statistics characterized the data. Multivariable logistic regression was used to understand factors associated with vaccination, self-perceived high risk, and knowledge of HPV + HNC.

RESULTS

Of 718 respondents, most were female (41.09%), Caucasian (59.89%), college-educated (33.01%), and insured (77.15%) with a mean age of 30.75 years. Half were vaccinated (49.16%), with most unvaccinated endorsing interest (60.58%). Few dependents were vaccinated (25.91%), with interest in vaccination among parents of unvaccinated children (38.58%). Knowledge of HIV's association with HPV (62.95%), HPV causing HNC (55.57%), and the vaccine's efficacy against HNC (55.57%) was also moderate. Identifying female (P = .042), a self-perceived high-risk (P < .001), and having vaccinated children (P < .001) increased vaccination likelihood; transgender (P = .021), or lesbian or gay sexual identity (P < .001) decreased likelihood. Personal HNC diagnosis (P < .001), self-vaccination (P < .001), having vaccinated children (P < .001), having anal sex (P = .001) or no knowledge of past HPV status (P < .001) increased likelihood of high self-perceived risk.

CONCLUSION

Efforts to improve public education regarding the association between HPV and HNC and vaccination efficacy are required to better inform vaccine decision-making among individuals at risk for HPV infection.

Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States

OBJECTIVE

The human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9-26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27-45 years. This study also assessed factors associated with HPV vaccine initiation after age 26.

METHODS

Data were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27-45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27-45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models.

RESULTS

Overall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males.

CONCLUSIONS

The ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

Pursuance of a Yoruba name for cervical cancer in Southwest Nigeria: a case study

OBJECTIVES

Participants' comprehension of research process affects the quality of research output, which is the reason why translation of research instruments into local languages is standard practice. Literature has consistently reported that in Africa, knowledge about cervical cancer is low but paradoxically, expressed, and actual uptake of human papillomavirus vaccine for its prevention is high. This study explored the Yoruba names of cervical cancer among Yoruba people in Ibadan, Nigeria to guide the translation of cervical cancer research instruments to Yoruba language.

DESIGN

Exploratory case study design was used and data were obtained with 10 in-depth interviews and four focused group discussions. Data were analysed using content analysis.

SETTINGS

The study took place in Ibadan North local government area, Southwest Nigeria.

PARTICIPANTS

These were 4 traditional healers, 3 Yoruba linguists, 3 public health educators and 38 parents of adolescents.

MEASURES

These were Yoruba names for cervical cancer and their meanings.

RESULTS

Participants were aware of cervical cancer but only the traditional healers and public health educators had names for it. These names were highly varied. The public health educators gave names that were linked with different parts of the female reproductive system and external genital which were actually different medical conditions. Each traditional healer also had different names for cervical cancer, which either described the female body parts, or symptoms of female genital infections. These various names can lead to unnecessary misconceptions and misinformation about cervical cancer, its prevention, management, and research.

CONCLUSIONS

There was no consensus Yoruba name for cervical cancer among the study participants. Efforts to educate the Yoruba speaking populace about cervical cancer, its prevention, management and participation in its research can be frustrated if a generally accepted Yoruba name is not provided for this cancer. Stakeholders' collaboration is required to get an appropriate Yoruba name for cervical cancer.

Awareness of the causal association between human papillomavirus and anal cancer among US adults

PURPOSE

The incidence of anal cancer is on the rise in the US, especially among high-risk groups. This study examined the prevalence and determinants of awareness of the causal relationship between HPV and anal cancer among US adults.

METHODS

Study data was obtained from the 2017 to 2020 iterations of the Health Information National Trends Survey. The prevalence of awareness that HPV causes anal cancer was estimated among HINTS respondents who were aware of HPV in general. Survey weights were used to provide estimates representative of the adult US population. Multivariable logistic regressions were used to examine the associations between awareness that HPV causes anal cancer and cancer-related behaviors/perceptions and sociodemographic characteristics of respondents.

RESULTS

Two thousand six hundred and eighty four (27.2%) of the study population were aware that HPV caused anal cancer. Those of gay sexual orientation were more aware than heterosexuals [OR 2.27; 95% CI (1.24, 4.14)]. Compared to respondents with a high school diploma or less, individuals with some college education [OR 1.38; 95% CI (1.03, 1.85)] and those with at least a college degree [OR 1.52; 95% CI (1.17, 1.98)] were more likely to be aware. Participants who had positive cancer information seeking behavior were more aware of the HPV-anal cancer link compared to those who did not [OR 1.57; 95% CI (1.30, 1.89)].

CONCLUSION

Population-level awareness that HPV causes anal cancer remains critically low in the US. Sexual orientation, level of education and cancer information seeking behavior are associated with increased awareness of the causal relationship between HPV and anal cancer. Efforts should be directed toward addressing the awareness gap among individuals with lower education levels and promoting curiosity-driven information seeking behaviors.

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

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

Age, gender and socioeconomic disparities in human papillomavirus (HPV) awareness and knowledge among Japanese adults after a 7-year suspension of proactive recommendation for the HPV vaccine: A nationally representative cross-sectional survey

The Japanese government's 2013 suspension of its proactive recommendation for Human papillomavirus (HPV) vaccination resulted in low HPV vaccination coverage and was unique. However, data on awareness and knowledge of HPV vaccines in the general population was limited. Here, to investigate more recent awareness and knowledge of HPV vaccines by age, gender, and socioeconomic status, we used data from the INFORM Study 2020, a nationally representative cross-sectional survey of self-administered questionnaires with 1,998 Japanese individuals aged 20 to 59 years. We found that 47.5% of females and 21.0% of males had heard of HPV, and 33.6% of females and 16.8% of males had knowledge of HPV vaccine efficacy. After adjusting for potential confounders, females aged 50-54 years were more likely to be aware of HPV than females aged 20-24 (AOR, 2.02, 95%CI: 1.12-3.65). Females (AOR, 2.13, 95%CI: 1.48-3.07) and males (AOR, 1.64, 95%CI: 1.03-2.59) with higher education had more awareness than those with less education. Females with higher education had more knowledge about HPV vaccine efficacy than those with less education (AOR, 1.70; 95%CI: 1.16-2.50). We found a generally low level of awareness and knowledge about HPV vaccines in Japan, which might be attributable to the suspension of proactive recommendations. Additionally, we identified disparities in awareness and knowledge by age, gender, socioeconomic status, and health literacy. Enhancing HPV awareness and understanding of HPV vaccines and implementing targeted efforts for specific subpopulations within Japan after the resumption of proactive recommendation for HPV vaccines, are imperative.

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.

Cancer Prevention Begins in Middle School: The Personal Advantages of HPV Immunization in Males

The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States despite most cases being preventable by vaccination. HPV vaccine efficacy varies in relationship to when the vaccine is administered, with greater efficacy obtained if administered prior to sexual debut. Historically, this vaccine was created to protect women from cervical cancer. As scientific knowledge of HPV-related cancers has advanced, it has become evident that HPV vaccination is a priority for both genders. HPV is known to contribute to male cancers of the mouth, throat, anus, and penis, as well as causing genital warts. This article aims to explain the benefits of HPV immunization for the gender the farthest from meeting vaccination goals, boys, and young men. This article expounds on the school nurses' role in promoting vaccination to prevent HPV infection and the sequela of related cancers.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSION

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

College Students' Awareness of the Link Between Human Papillomavirus (HPV) and HPV-Associated Cancers

We describe the level of awareness of the link between HPV and HPV-associated cancers and identify demographic and lifestyle factors associated with awareness. This was a cross-sectional study of college students (n = 862) at a public Midwestern university conducted between February and May 2021. The outcomes were student's awareness-accessed by asking students if they knew whether HPV was causally link with anal, cervical, vaginal, oropharyngeal, vulvar, and penile cancers. Logistic regression models estimated the association between sociodemographic and sexual behavior and awareness of the link between HPV and HPV-associated cancers. Approximately 70% were aware that HPV causes cervical, 53% were aware HPV causes vaginal, 40% were aware HPV causes vulvar cancers, 39% were aware HPV causes oropharyngeal, 38% were aware HPV causes penile, and 34% were aware HPV causes anal cancers. In multivariable analyses, men were less likely to be aware that HPV causes vaginal (aOR = 0.42, 95% CI 0.30-0.59) or vulvar cancers (aOR = 0.54, 95% CI 0.38-0.77) compared to women. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV causes anal (aOR = 1.98, 95% CI 1.17-3.34), penile (aOR = 1.82, 95% CI 1.11-2.97), vaginal (aOR = 1.81, 95% CI 1.14-2.88), or vulvar (aOR = 2.05, 95% CI 1.24-3.40) cancers. Awareness of the link between HPV and HPV-associated cancers was low, except cervical. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake.

Factors Affecting Completion of Human Papillomavirus Vaccination Series by Gender in a Predominantly Hispanic Border Town Community

OBJECTIVES

The human papillomavirus (HPV) vaccine is recommended for females and males aged 9 to 45. Nationally, the HPV vaccination rates are lower for males than females; however, this has not been studied in a US-Mexico border community. Our study aims to report the HPV vaccination completion by gender and determine which sociodemographic factors influence vaccination.

METHODS

This cross-sectional study was conducted among uninsured and underinsured individuals aged between 9 and 26 years served through a community-based HPV vaccine program in El Paso, TX. Data collected included demographic information, psychosocial variables, and vaccine administration data. Descriptive statistics were used to summarize demographic data. Unadjusted t test/Fisher exact test and multivariable relative risk regression were run on significant variables to determine the association with vaccine completion by gender.

RESULTS

Most participants were female (63.4%), and an overall vaccine series completion was 30.67%. We found no significant difference in HPV vaccine completion rates by gender. Males who resided in the United States for more than a decade were 31% more likely to complete the vaccine series, and females who had 9 to 13 years of education had lower odds of vaccine completion. Knowledge significantly increased after the intervention for both genders (p = .002). There was no significant change in psychosocial variables from the preintervention to the immediate postintervention survey.

CONCLUSIONS

Our multicomponent, culturally tailored intervention may equally impact male and female participants and encourages all genders to complete their HPV vaccine series. Additional studies with a larger male sample are needed.

HPV Vaccination Adherence in Working-Age Men: A Systematic Review and Meta-Analysis

BACKGROUND

Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. HPV vaccination adherence rates in men are generally lower than in women. The aim of this systematic review and meta-analysis was to assess adherence to HPV vaccination in young working-age males (18-30 years old).

METHODS

A systematic review was performed using three databases: PubMed, Scopus, and Web of Science, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

After duplicate removal, the initial search resulted in 478 eligible papers. With the exclusion of 425 papers after screening the abstracts, full texts of 53 articles were reviewed. Subsequently, 45 were excluded. Among the eight studies included, four (50%) examined the vaccination adherence in young adults through data registered in nationwide insurance or private companies' databases, three (37.5%) in young adults in different settings through data collected from surveys and questionnaires, and one (12.5%) an HPV vaccination campaign in a family medicine residency practice.

CONCLUSION

Adherence to HPV vaccination in men of working age (18-30 years) does not appear to be adequate (pooled prevalence 11%). In order to achieve a higher level of compliance, it is important to place an emphasis on vaccination campaigns in schools as well as in the workplace, after consultation with and approval from local, regional, and federal public health agencies.

"If People Were Told About the Cancer, They'd Want to Get Vaccinated": Knowledge, Attitudes, and Beliefs About HPV Vaccination Among Mid-Adult Men

In 2018, nine-valent human papillomavirus (HPV) vaccine eligibility expanded to include adults aged 27 to 45. This study aimed to identify knowledge, attitudes, and beliefs (KABs) about HPV and HPV vaccination among newly eligible mid-adult men, for whom uptake in adolescence and younger adulthood remains suboptimal. We conducted six virtual focus groups (N = 34 participants) with unvaccinated men aged 27 to 45 living in Southern California's Inland Empire. Data were systematically analyzed to identify emergent themes using the rigorous and accelerated data reduction technique. The sample of men was diverse (79% Hispanic, non-Hispanic Black, Asian, or mixed race/ethnicity; 26% gay or bisexual) and captured participants from across the socioeconomic spectrum. Eighty-eight percent of participants had never received a provider recommendation to be vaccinated against HPV. Many had unanswered questions about HPV and HPV vaccination, could not recall any HPV-related cancers that affect men, and were unaware of their current eligibility for vaccination. Embarrassment and stigma surrounding vaccination against a sexually transmitted infection, concerns about vaccine side effects and safety, and preferences for preventing HPV via "safer sex" and monogamy were salient barriers to vaccination. Nevertheless, many men were eager to learn more about HPV vaccination and engage with health care providers around that topic. Interventions aimed at improving men's knowledge, changing social norms, and supporting health providers to identify HPV vaccine-eligible patients may be especially fruitful for facilitating shared clinical decision-making between mid-adult men and their health care providers.

Maternal perceptions of vaccinating boys against human papillomavirus (HPV) in Seoul, South Korea: A descriptive exploratory qualitative study

Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone interviews with ten mothers using a semi-structured interview guide. Questions probed mothers' views on vaccinating boys against HPV and the reasons for not vaccinating their sons. We found that mothers were hesitant to vaccinate their sons against HPV due to high out-of-pocket costs, fear of side effects concerning the young age of their sons, and low awareness of HPV and HPV vaccine, all of which stemmed from the exclusion of male HPV vaccination in the national immunization program. Sociocultural factors, including vaccination norms, lack of HPV education, and values associated with sexually transmitted infections were also likely to negatively impact mothers' vaccination decision-making. Despite the barriers, mothers were willing to accept HPV vaccination when it was framed as cancer prevention for not only the sons but also their future spouses. In conclusion, reasons for Korean mothers' hesitancy for their sons' HPV vaccine uptake were multifaceted. Healthcare providers' role in emphasizing and conveying the importance of gender-neutral HPV vaccination will be essential to alleviate negative sentiments around the vaccine for boys and reduce their risk of compromised sexual health. As an effective public health strategy, tailored cancer prevention messages should be delivered heightening significant benefits of the HPV vaccine beyond the prevention of cervical cancer.

Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

Human papillomavirus vaccine uptake among teens before and during the COVID-19 pandemic in the United States

It is unclear how the COVID-19 pandemic impacted human papillomavirus (HPV) vaccine uptake and which sociodemographic groups may have been most impacted. We aimed to assess differences in HPV vaccine uptake (initiation and completion) before and during the pandemic in the United States. We conducted a cross-sectional study using data from the 2019 to 2020 National Immunization Surveys - Teen (NIS-Teen), comparing vaccine initiation and completion rates in 2019 vs. 2020, based on confirmed reports by a healthcare provider. Weighted logistic regression analysis estimated odds of vaccine initiation and completion for both adolescent and parental characteristics. There were 18,788 adolescents in 2019 and 20,162 in 2020. There was 3.6% increase in HPV vaccine initiation (71.5% vs. 75.1%) and a 4.4% in completion (54.2% vs. 58.6%) rates from 2019 to 2020. In 2020, Non-Hispanic White teens were significantly less likely to initiate (aOR = 0.62, 95% CI: 0.49, 0.79) and complete (aOR = 0.71, 95% CI: 0.58, 0.86) vaccine uptake compared with non-Hispanic Black teens. Additionally, teens who lived above the poverty line were also less likely to initiate HPV vaccination (aOR = 0.63, 95% CI: 0.49, 0.80) or complete them (aOR = 0.73, 95% CI: 0.60, 0.90), compared to those who lived below the poverty line. During the COVID-19 pandemic in 2020, some historically advantaged socioeconomic groups such as those living above the poverty line were less likely to receive HPV vaccine. The impact of the pandemic on HPV vaccine uptake may transcend traditional access to care factors.

Medical students' knowledge of HPV, HPV vaccine, and HPV-associated head and neck cancer

On the basis of their training, medical students are considered "the best case scenario" among university students in knowledge of the human papillomavirus (HPV). We evaluated differences in knowledge of HPV, HPV vaccine, and head and neck cancer (HNC) among medical students. A previously validated questionnaire was completed by 247 medical students at a Midwestern university. Outcomes of interest were knowledge score for HPV and HPV vaccine, and HNC, derived from combining questionnaire items to form HPV knowledge and HNC scores, and analyzed using multivariate linear regression. Mean scores for HPV knowledge were 19.4 out of 26, and 7.2 out of 12 for HNC knowledge. In the final multivariate linear regression model, sex, race, and year of study were independently associated with HPV and HPV vaccine knowledge. Males had significantly lower HPV vaccine knowledge than females (β = -1.53; 95% CI: -2.53, -0.52), as did nonwhite students (β = -1.05; 95% CI: -2.07, -0.03). There was a gradient in HPV vaccine knowledge based on the year of study, highest among fourth year students (β = 6.75; 95% CI: 5.17, 8.33). Results were similar for factors associated with HNC knowledge, except for sex. HNC knowledge similarly increased based on year of study, highest for fourth year students (β = 2.50; 95% CI: 1.72, 3.29). Among medical students, gaps remain in knowledge of HPV, HPV vaccine, and HPV-linked HNC. Male medical students have significantly lower knowledge of HPV. This highlights the need to increase medical student knowledge of HPV and HPV-linked HNC.

Papillomavirus Infection and Prevention: How Much Does the Sicilian Population Know? An Observational Study

Human papillomavirus is a sexually transmitted virus that is responsible not only for uterine cervical cancer, but also for the oral and oropharyngeal cancers. In this latter case, the virus indiscriminately affects both sexes at any age. Vaccination plays a key role in preventing infection and its possible consequences. Therefore, this study aimed to assess the degree of awareness of papillomavirus infection and its possible prevention in the Sicilian population. A prospective observational study was carried out on the Sicilian population through a self-administered questionnaire, consisting of 10 multiple-choice questions. The survey lasted from June 2021 to December 2021. A total of 844 respondents were included: 60.90% were female and 53.55% were aged between 21 and 30 years. Most of the surveyed population knew about the virus and the existence of the vaccine, however, many of them did not know about virus's effects on the oral and oropharyngeal sites (49.17%), or about the indication for vaccination for males (39.69%). Oral and oropharyngeal papillomavirus-related cancers are an increasingly frequent finding, especially in young adults. Therefore, it is necessary and quite mandatory to educate the population about the risks that certain voluptuous habits may cause, with the help of general practitioners, schools, social media, and social networks.

Is HPV vaccine awareness associated with HPV knowledge level? Findings from HINTS data across racial/ethnic groups in the US

BACKGROUND AND PURPOSE

Human papillomavirus (HPV) is recognized as a leading cause of multiple types of cancer. The current study examined HPV knowledge level and its associated factors, especially its relationship with HPV vaccine awareness, across race/ethnicity, including non-Hispanic White, non-Hispanic African American, and Hispanic.

METHODS

Cross-sectional data were merged from Cycles 1 (2017) and Cycle 2 (2018) of the National Cancer Institute (NCI) Health Information National Trends Survey 5 (HINTS5, total N = 3648), which was collected in the United States. A multiple linear regression was performed across the three race/ethnicity groups to determine potential associated factors with level of HPV knowledge.

FINDINGS

Overall HPV knowledge level among participants was low (Mean = 1.68; SD = 1.44; range 0-4). Among three racial/ethnic groups, non-Hispanic African American had the lowest level of HPV knowledge (Mean = 1.51). Less than 30% answered correctly to each of the three items assessing knowledge of HPV-associated (HPVa) cancers other than cervical (e.g. if HPV can cause penile, anal, and/or oral cancer). The HPV vaccine awareness was significantly associated with HPV knowledge across all three racial/ethnic groups.

CONCLUSIONS AND IMPLICATIONS

The lowest level of HPV knowledge among non-Hispanic African American suggests that HPV education is urgently needed for this population. Specific interventions should emphasize information regarding HPVa cancers other than cervical cancer. Additionally, promoting awareness of the HPV vaccine will help to improve HPV knowledge among general population. Lastly, various factors associated with HPV knowledge across different racial/ethnic groups need to be addressed when implementing HPV education programs.

Facilitators and barriers of healthcare workers' recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework

BACKGROUND

The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF).

METHODS

Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified.

RESULTS

Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism.

CONCLUSION

All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.

Acceptability of HPV Vaccination in Young Students by Exploring Health Belief Model and Health Literacy

Evidence on the human papillomavirus (HPV) vaccine shows that it is effective in reducing the burden of HPV-related diseases. For more than 15 years the HPV vaccine has been offered free of charge in Italy to girls from the age of 12. Over time, the free offer of the HPV vaccine has also been extended to boys and to young adults at risk of developing HPV lesions. Despite the HPV vaccine’s effectiveness and availability, vaccination coverage is low in Italy, with a reported value of 46.5% in 2020. Furthermore, in the southern administrative regions, vaccination coverage is even lower than national values, with 25.9% coverage in Sicily. A cross-sectional study was conducted among university and high school students in the Palermo area (Sicily, Italy) in order to identify the determinants of HPV vaccination adherence by using a questionnaire that investigated factors of HPV vaccine practice. The study explored the behavioral attitude by using the Health Belief Model (HBM), and also used the SILS test and the METER test to investigate the level of health literacy (HL). Overall, 3,073 students were enrolled, and less than a third reported they had completed the vaccination schedule (n = 925, 30.1%). Multivariable analysis showed that the factors directly associated with the adherence to HPV vaccination were female sex (OR = 4.43, p < 0.001), high HBM total score (OR = 4.23, p < 0.001), good HL level (OR = 1.26, p = 0.047), parents (OR = 1.78, p = 0.004), general practitioner (OR = 1.88, p = 0.001), and educational material provided by public vaccination services (OR = 1.97, p = 0.001) as HPV vaccine information sources. Further health-promotion programs focused on improving HL and perception of the HPV vaccine’s benefits should be implemented in order to achieve the desirable 95% vaccination coverage.

The Development and Psychometric Evaluation of the Mid-adult Human Papillomavirus Vaccine Knowledge Scale in the United States

BACKGROUND

Previous human papillomavirus (HPV) and HPV vaccine knowledge scales have focused on young adults in the vaccination catch-up age range or parents of vaccine eligible adolescents. Previous scales are not specific to the new guidelines for HPV vaccination in mid-adults. The study aimed to develop and validate a mid-adult HPV vaccine knowledge scale informed by the latest vaccine recommendations.

METHODS

Self-reported data were collected using a cross-sectional survey of adults aged 27 to 45 years with no history of HPV vaccination (n = 706). Exploratory and confirmatory factor analyses identified latent constructs in a 13-item mid-adult HPV vaccine knowledge scale. Sociodemographic differences in the HPV vaccine knowledge were also assessed.

RESULTS

The mean of correct responses across all items was 5.9 (SD, 2.8; range, 0-13). Exploratory and confirmatory factor analyses revealed a 3-factor structure best explained the data with a good construct validity and reliability. The first factor contained 6 items about HPV infection, the second factor contained 3 items about HPV prevention through vaccination, and the third factor contained items about HPV vaccination misinformation. Analysis of variance and t test found significant group level differences in knowledge among sex, race, educational level, annual income, health insurance, and marital status.

CONCLUSIONS

Our study supports the use of a knowledge scale for US mid-adults to assess HPV and HPV vaccination knowledge because the patient requires some baseline knowledge of this recommendation to discuss the vaccine with their health care provider. The mid-adult HPV vaccine knowledge scale can measure basic HPV knowledge important to informed decision making.

Barriers and Factors Associated with HPV Vaccination Among American Indians and Alaska Natives: A Systematic Review

American Indian and Alaska Native (AI/AN) persons bear a disproportionate burden of human papillomavirus (HPV)-associated cancers and face unique challenges to HPV vaccination. We undertook a systematic review to synthesize the available evidence on HPV vaccination barriers and factors among AI/AN persons in the United States. We searched fourteen bibliographic databases, four citation indexes, and six gray literature sources from July 2006 to January 2021. We did not restrict our search by study design, setting, or publication type. Two reviewers independently screened the titles and abstracts (stage 1) and full-text (stage 2) of studies for selection. Both reviewers then independently extracted data using a data extraction form and undertook quality appraisal and bias assessment using the modified Mixed Methods Appraisal Tool. We conducted thematic synthesis to generate descriptive themes. We included a total of 15 records after identifying 3017, screening 1415, retrieving 203, and assessing 41 records. A total of 21 unique barriers to HPV vaccination were reported across 15 themes at the individual (n = 12) and clinic or provider (n = 3) levels. At the individual level, the most common barriers to vaccination-safety and lack of knowledge about the HPV vaccine-were each reported in the highest number of studies (n = 9; 60%). The findings from this review signal the need to develop interventions that target AI/AN populations to increase the adoption and coverage of HPV vaccination. Failure to do so may widen disparities.

Social media-assisted interventions on human papillomavirus and vaccination-related knowledge, intention and behavior: a scoping review

Social media holds the potential to engage adolescents and young adults and to facilitate interventions improving Human Papillomavirus Vaccine (HPVV). This article systematically reviewed the literature on Cochrane Library, PubMed, Web of Science, EMBASE, Scopus and CINAHL. Interventions delivered or facilitated by social media with outcomes of HPV-related knowledge, awareness, attitude, vaccination intention and behavior were included. Standardized forms were used to abstract the basic characteristics, settings, guiding theories and key findings of the interventions. Twenty-four studies met the eligibility criteria. Sixteen were educational interventions, and the other eight investigated the effect of social media message contents on improving Human Papillomavirus (HPV)-related outcomes. The studies were published between 2015 and 2021. The most frequently used social media platforms were Facebook, and the most commonly adopted theory was the health belief model (HBM). Existing interventions have shown preliminary but promising effects in improving HPV awareness and knowledge. Still, such improvements have not always been translated to improved behavioral intentions and vaccination rates. The contents and phrasing of social media messages and pre-existing individual characteristics of social media users moderated intervention effectiveness. Social media could be a valuable tool for engaging participants and delivering HPV interventions. Future interventions should apply stronger theory bases.

Factors associated with intention of human papillomavirus vaccination among Chinese college students: implications for health promotion

Human papilloma virus (HPV) is the most common reproductive tract virus. Most HPV infections occur during adolescence or young adulthood, and thus college students are one of the main target populations of HPV vaccination. However, data on knowledge of HPV and HPV vaccine as well as the intention to be vaccinated among Chinese college students were limited. The purpose of this study was to address this gap by investigating a sample of college students from four universities and analyzing the factors influencing their intention. College students (N = 343) filled in a survey comprised of demographic information, HPV and vaccine knowledge, and vaccination intention between September 2018 and January 2019. A descriptive statistical analysis was conducted to describe students' HPV-related knowledge and vaccination intention. Logistic regression analysis was used to determine the predictors of HPV vaccination intention. The participants had low levels of HPV and HPV vaccine-related knowledge, as well as modest intention to be vaccinated. Significant differences were identified in gender, years of study, and perceived susceptibility of HPV infection. Students who perceived higher risk of HPV infection (OR = 6.659, p = .001), had higher level knowledge of HPV vaccine (OR = 2.697, p < .001), in junior (OR = 0.186, p = .006) and senior year (OR = 0.276, p = .015) had greater intention to get HPV vaccinated. The findings suggest that multiple-level efforts are continuously needed to target Chinese college students to increase their HPV vaccine knowledge and vaccination awareness to reduce HPV-related disease burden among this population.

Beliefs about HPV vaccination and awareness of vaccination status: Gender differences among Northern Italy adolescents

Human papillomavirus (HPV) is one of the most frequent sexually transmitted infectious agents worldwide, and it is responsible for a significant burden of cancers. The aim of this study was to evaluate HPV knowledge and awareness in a sample of Northeastern Italian adolescents and parental support available to them, in order to highlight potential room for improvement towards optimal HPV vaccination adherence. Between April and May 2018 an observational questionnaire-based study was conducted in 1st year students of secondary upper schools in Udine (Italy). We quantitatively evaluated HPV knowledge, awareness and parental support level of male and female adolescents. The contribution of sociodemographic characteristics to HPV vaccination knowledge and uptake were explored using Chi-Square or Fisher test and multivariate logistic. Knowledge about HPV vaccine resulted to be mostly insufficient among enrolled adolescents, with a worrying proportion of them believing that HPV vaccine was expected to prevent HIV/AIDS. Awareness about their vaccination status was poor, and more than half of them were not involved in HPV vaccine uptake deliberation. Girls performed better than boys in relation to knowledge, awareness and engagement. Our results support the hypothesis that HPV vaccine knowledge and uptake can be affected by some gender bias. Improvements in adolescent health education and vaccination strategies are needed to engage and finally protect both genders from HPV.

The Awareness of the Human Papillomavirus Infection and Oropharyngeal Cancer in People to Improve the Health Care System at Al Qunfudhah Region, Kingdom of Saudi Arabia

With 14 million new infections each year, the human papillomavirus (HPV) is the most common sexually transmitted infection (STI) among both men and women in the United States (US). Infections with the human papillomavirus (HPV) are responsible for a considerable portion of the global cancer burden. HPV-related oral malignancies are on the rise around the world, according to epidemiological studies. To provide accurate advice to their patients, dental practitioners require thorough, up-to-date HPV-related knowledge. Methods. In this cross-sectional study, data were collected by the purposely constructed questionnaire. A questionnaire composed of the demographic items and items related to the awareness and knowledge about Human papillomavirus. The questionnaire was constructed after a series of discussions between the panel of experts. This panel was composed of a subject specialist, researcher, and language expert. The Cronbach alpha of the questionnaire was calculated. The study will be conducted in the Al Qunfudhah. Results. The Cronbach alpha of the questionnaire was 0.72. Out of a total of 550 respondents, with a mean (SD) age of 47.5 (11.5), the female respondents were 167 (30.4%) while male were 383 (69.6%). 20.5% of the respondents (out of 550) were having awareness of HPV. Implications. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training. This problem can be solved by better educational training programs. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training.

Factors affecting human papillomavirus (HPV) vaccination in men: A systematic literature review (Preprint)

Background

Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender.

Objective

The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach.

Methods

A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study.

Results

In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors.

Conclusions

To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination.

Human Papillomavirus-Associated Sexual Risks Among High School Students in the U.S.: Does Sexual Orientation Play a Role?

We examined the association between sexual orientation and human papillomavirus (HPV)-related risky sexual behaviors among high school students in the U.S. We used the 2015 Youth Risk Behavior Survey, a three-stage cluster sample, nationally representative, cross-sectional study. Participants were sexually active students (Grades 9-12) in public, private, and Catholic schools in 50 states and the District of Columbia (n = 5,958). Sexual orientation dimensions were: sexual self-identity (heterosexual, gay, lesbian, bisexual, and not sure) and sex of sexual contacts. HPV-associated risky sexual risk behaviors selected a priori were early sexual debut (≤ 12 or  ≥ 13 years old) and number of lifetime partners (≥ 2 or  ≥ 4). Separate multiple logistic regression analyses estimated association between sexual orientation and sex of sexual contacts, and HPV-associated risky sexual behaviors. Among the 5,958 high school students, a quarter had ≥ 4, and two-thirds had ≥ 2 sexual partners. Students who self-identified as bisexual (aOR = 2.43, 99% CI 1.19-4.98) or "not sure" (aOR = 4.56, 99% CI 2.54-8.17) were more likely to have sexual debut before 13 years. Similarly, students whose sexual contacts were adolescent females who had sex with females and males were more likely to have sexual debut before they turned 13 years of age (aOR = 3.46, 99% CI 1.83-6.48), or had ≥ 4 sexual partners (aOR = 2.66, 99% CI 1.74-4.08), or had ≥ 2 sexual partners (aOR = 3.09, 99% CI 1.91-5.00). In conclusion, HPV-associated risky sexual behavior is prevalent among high school students, especially sexual minorities. Interventions tailored to this population could increase HPV vaccine uptake and prevent future HPV-associated cancers and other negative outcomes.

Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ)

Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the second factor captured perceptions of gender differences in HPV infection and vaccine recommendations. The 13-item scale and 2-factor solution displayed strong internal consistency and good model fit. Parents of vaccinated adolescents scored higher on the 13-item HPV-KQ (Mean = 8.56) than parents of unvaccinated adolescents (Mean = 6.43) (p < .001). In regression models, controlling for key covariates, parents' performance on the HPV-KQ predicted adolescent HPV vaccination (p < .001). Conclusions: Evaluation indicates the HPV-KQ is a reliable and valid tool for measuring knowledge of HPV and the HPV vaccine among parents residing in the southern US. We recommend further efforts to validate the scale with other populations.

Joint effects of HPV-related knowledge and socio-demographic factors on HPV testing behaviour among females in Shenzhen

BACKGROUND

Limited population-based studies explore the utilization and associated barriers or facilitators to cervical cancer screening in China. We attempted to investigate the associations of socio-demographic factors, HPV specific knowledge with HPV testing behaviour in Shenzhen, China.

METHODS

A citywide cross-sectional survey was conducted from January to June 2015 in Shenzhen city by using a multistage stratified cluster sampling method. Socio-demographic information, awareness and specific knowledge of HPV, practice of HPV testing, and HPV vaccination-related attitude were collected. Multivariate logistic regression model was used to analyse possible associations.

RESULTS

Approximately one third of total 8639 women aged from 30 to 60 years old had ever received HPV testing. Overall, 67.6% of all participants demonstrated low knowledge level of HPV. High HPV knowledge level was significantly associated with HPV testing behaviour (odds ratio: 3.792, 95% confidence interval: 3.400-4.230). The impact of residence and education on testing behaviour only turned to be significant if women had low level of HPV knowledge (P for multiplicative interactions: 0.001 and <0.001, respectively), whereas monthly income exerted promotion effects apparently among those with high knowledge level (P for multiplicative interaction: 0.037).

CONCLUSIONS

Our study revealed gaps in HPV knowledge and screening participation among Chinese women, and provided novel clues that women with high HPV knowledge level would be more appeal to involve in HPV testing behaviour. The influence of HPV-related knowledge on HPV testing also lies in the joint effects with socio-demographic factors, including residence, education and monthly income.

Information seeking behaviour differences indicate which US population groups lack information about human papilloma virus and associated cancer risks

BACKGROUND

The majority of the US population have poor knowledge of cancers related to human papillomavirus (HPV). Identifying best sources for communicating this information can guide strategies to promote HPV vaccination.

OBJECTIVES

To assess the relationship between sources of health information and individuals' knowledge of HPV-related cervical and oropharyngeal cancer.

METHODS

This study conducts logistic regression on the most recent wave (2019) of the Health Information National Trends Survey. Dependent variables are indicators for self-reported awareness that HPV causes (a) cervical cancer and (b) oropharyngeal cancer. The primary indicator is a variable for different sources of health information: The Internet, professional sources, print materials, friends/family and never looked for health information.

RESULTS

Being female, young, non-Hispanic White and having college education is associated with higher odds of knowing about HPV-related cervical cancer. Controlling for demographic factors, individuals using professionals and the Internet are more likely to know that HPV causes cervical cancer (aOR: 2.65, 95% CI: 1.66, 4.25; aOR: 2.47, 95% CI: 1.75, 3.50, respectively) compared to those who have never looked for health information. Similar results were found for HPV-related oropharyngeal cancer.

CONCLUSION

Findings provide implications for targeted messaging through effective channels to improve HPV vaccination uptake.

Disparities in HPV knowledge by race/ethnicity and socioeconomic position: Trusted sources for the dissemination of HPV information

PURPOSE

To examine the differences in HPV and HPV vaccine awareness, knowledge, and beliefs by race/ethnicity and socioeconomic position (SEP) among a national sample of non-Hispanic whites (NH-Whites), non-Hispanic Blacks (NH-Blacks), and Hispanics in the United States. We also examine differences in trusted health information sources by race/ethnicity and SEP.

METHODS

Data were obtained from the Health Information National Trends Survey, Cycle 1, conducted from January to April 2017. Descriptive statistics, bivariate analyses, multivariate logistic regression, and listwise deletion were used to examine HPV and HPV vaccine awareness and knowledge-related items, and trust in health information sources among NH-Whites, NH-Blacks, and Hispanics 18-49 years old.

RESULTS

HPV vaccine awareness was moderate with no significant differences across racial/ethnic groups. NH-Whites had significantly higher knowledge that HPV causes cervical cancer than NH-Blacks and Hispanics (p < 0.001). High SEP NH-Blacks (OR = 0.42, 95% CI = [0.24-0.73], p = 0.002]) and Hispanics (OR = 0.49, 95% CI = [0.31-0.79, p = 0.003]) had lower odds of knowing HPV causes a sexually transmitted disease than their white counterparts. Low SEP NH-Blacks (OR = 11.03, 95% CI = [3.05-39.86, p < 0.001]) had 11 times the odds of ever hearing about the HPV vaccine than low SEP NH-Whites. NH-Blacks had twice the odds of trusting health information from television (OR = 2.39, 95% CI = [1.52-3.78]. p < 0.001), and almost six times the odds of trusting health information from religious organizations than low SEP NH-Whites (OR = 5.76, 95% CI = [2.02-16.44, p < 0.001]).

CONCLUSION

Tailored communication strategies may address the low HPV knowledge among NH-Blacks and Hispanics from high and low SEP.

Factors associated with HPV vaccination initiation among United States college students

Human papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.

FACTORS ASSOCIATED WITH ADOLESCENT COMPLIANCE WITH HUMAN PAPILLOMAVIRUS VACCINE: A CROSS-SECTIONAL STUDY

ABSTRACT Objective: to identify the factors associated with adolescent compliance with the human papillomavirus vaccine. Method: this is a cross-sectional study, developed through a school survey, in Teresina, Piauí, Brazil, whose data collection occurred in 2018. A scale was used to assess decision-making, attitudes, feelings and knowledge about the human papillomavirus, in addition to a questionnaire to collect sociodemographic, economic and vaccination status data. The variables were submitted to the multivariate model of logistic regression to explain factors associated with vaccination adeforemen. Results: the study sample consisted of 624 adolescents, 15 years old, attending the first year of high school, of which 22.8% received the human papillomavirus vaccine. Being male decreases the chance of complying with the vaccine by 50% (aOR=0.05). Moreover, disagreeing or disagreeing with or disagreeing with parents to make the decision to vaccinate their children also reduced the chances of vaccination by 66% (aOR=0.34), respectively, as well as disagreeing with or disagreeing that men do not take human papillomavirus, minimized the chances of vaccination complying with vaccination by 66% (aOR=0.34), when compared to those who disagreed with this statement. Conclusion: low adolescent compliance with human papillomavirus vaccine was identified. Adolescents remain susceptible to diseases related to the human papillomavirus. Therefore, vaccination strategies need to be rethought, with the offer of vaccination in schools, mediated by educational campaigns.

Change in Age at Diagnosis of Oropharyngeal Cancer in the United States, 1975-2016

Simple Summary

While previous studies have suggested that HPV-associated head and neck cancer (HNC) is mostly in the younger population, we found that in the last 40 years, the mean age at diagnosis of oropharyngeal cancer has been 60.3 years. We found that after an initially decrease leading up to the early 2000s, there has been a steady increase in age at diagnosis of oropharyngeal cancer since 2002. For non-oropharyngeal HNC, mean age at diagnosis has steadily increased throughout the last four decades. Finally, we found that age at diagnosis of HNC is higher among females in general, and lowest among blacks.

Abstract

The emergence of the human papillomavirus (HPV) as the primary etiology of oropharyngeal cancer has changed head and neck cancer (HNC) epidemiology. This study described change in the age at diagnosis of oropharyngeal and non-oropharyngeal HNC in the United States in the last four decades. Using a retrospective cohort analysis, the Surveillance, Epidemiology, and End Results dataset from 1975 to 2016 was queried for eligible adult cases of HNC, grouped as oropharyngeal (n = 31,702) versus non-oropharyngeal (n = 87,108). Age at diagnosis was compared by gender (female, male) using independent t-test, and by race/ethnicity (Hispanic, non-Hispanic black, non-Hispanic white, non-Hispanic other) using analysis of variance. Joinpoint regression estimated yearly increases/decreases in age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Mean age at diagnosis for oropharyngeal cancer was 60.3 years. While there was initially a decrease in age at diagnosis, a 0.37% annual increase occurred from 2002 to 2016 (APC = 0.37, 95% confidence interval (CI) 0.28, 0.45). For non-oropharyngeal cancer, mean age at diagnosis was 63.2 years, with a continuous increase in age at diagnosis throughout the study period (1975–2016 AAPC = 0.08, 95% CI 0.04, 0.12). Females had higher average age at diagnosis than males for both sites, while blacks (57.4 years for oropharyngeal cancer; 59.0 years for non-oropharyngeal) had the lowest age at diagnosis of all races/ethnicity. Age at diagnosis of oropharyngeal cancer has increased significantly since 2002, while non-oropharyngeal HNC has increased significantly in the last four decades.

HPV vaccination and Native Americans: protocol for a systematic review of factors associated with HPV vaccine uptake among American Indians and Alaska Natives in the USA

INTRODUCTION

The nine-valent human papillomavirus (HPV) vaccine could prevent an estimated 92% of the cancers attributable to HPV types targeted by the vaccine. However, uptake of the HPV vaccine among American Indian and Alaska Native (AI/AN) adolescents has been low. AI/ANs also bear a disproportionate burden of cervical and other HPV-associated cancers. Increasing HPV vaccination rates is a national priority, but reviews and national surveys on HPV vaccination factors are lacking for the AI/AN population. The objective of this systematic review is to assess factors associated with HPV vaccination among AI/ANs in the USA.

METHODS AND ANALYSIS

A systematic review is proposed to synthesise the current literature on HPV vaccination factors in AI/ANs from 1 July 2006 until 30 September 2019. As applicable, controlled vocabulary terms, keywords and special features (eg, limits, explode and focus) will be incorporated into database searches. To maximise the identification of relevant studies, citation indexes and databases that index dissertations, preprints and grey literature are included. Studies will be screened and selected independently in two stages. In stage 1, titles and abstracts will be screened. In stage 2, full-text articles will be screened and selected. A data extraction form and quality assessment tool will be piloted, revised and implemented. If available, measures of frequency and association will be presented. A narrative synthesis of the included studies will also be undertaken and reported.

ETHICS AND DISSEMINATION

As our review will use publicly available data and publications, an Institutional Review Board review will not be required. We will disseminate the findings from this review through peer-reviewed publication(s) and conference presentation(s).

POTENTIAL AMENDMENTS

In the event of amendments to the protocol, we will provide the date, rationale, and description of the change for each amendment.

PROSPERO REGISTRATION NUMBER

CRD42020156865.

Knowledge of the Human Papillomavirus by Social Stratification Factors

BACKGROUND

Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection.

OBJECTIVES

The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women.

METHODS

A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015-2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose-response associations were estimated based on p-trend.

RESULTS

Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose-response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine.

DISCUSSION

In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

Knowledge Gaps among Patients and Providers in HPV-Related Oropharyngeal Cancer: A Systematic Review

Objective

To describe the level of knowledge of human papillomavirus (HPV) and HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) among the general population and health care providers.

Data Sources

Systematic search was performed on December 20, 2018, using MEDLINE (1966 to December 2018), EMBASE (1975 to December 2018), Web of Science (1900 to December 2018), and CENTRAL (1996 to December 2018) databases. English-language literature involving human subjects was used, and studies were limited to case series, case-control, cohort, and randomized controlled trial designs.

Review Methods

Studies were included if they assessed knowledge of HPV and HPV-associated OPSCC. The primary outcome measure was the knowledge of HPV-associated OPSCC among the general population and with health care providers. Meta-analysis of proportions was attempted using random-effects model. The PRISMA guidelines were used for accuracy of reporting.

Results

Thirty-two studies were included with 17,288 participants. There was a high degree of heterogeneity preventing completion of a meta-analysis. Knowledge of HPV and HPV-associated OPSCC varied between the general population and health care providers. The proportion of the general population and health care providers with knowledge of HPV ranged from 16% to 75% and 21% to 84%, respectively. Knowledge of HPV-associated OPSCC was greater in health care providers and ranged from 22% to 100% compared with the general population, which ranged from 7% to 57%.

Conclusion

There is a knowledge gap of HPV-associated OPSCC for both the general population and health care providers. Additional education may not only increase awareness but may also result in prevention and earlier detection.

Are Men Being Left Behind (Or Catching Up)? Differences in HPV Awareness, Knowledge, and Attitudes Between Diverse College Men and Women

The aim of this cross-sectional survey was to assess awareness, knowledge, and attitudes in regard to human papillomavirus (HPV) and vaccination against HPV among college students. From 2015 to 2017, 386 diverse undergraduates were recruited from a south Florida university. A survey, part of which was researcher developed, of HPV awareness, knowledge, and attitudes was conducted. The majority (84%) of participants had heard of HPV, and 70% had favorable attitudes toward vaccination. Only 28% of men and 55% of women had received ≥1 dose vaccine (p = .01), and 4% of all participants reported that they had received 3 doses. Those with ≥1 dose (n = 123, 40.1%) were more knowledgeable about HPV (p = .01). High knowledge scores were recorded for 30% of respondents and were strongly associated with HPV vaccine initiation among both men and women (p < .001) and perceived knowledge among women only (p < .001). Negative attitudes toward HPV vaccine acceptance were associated with low knowledge scores (p = .01) and undervaccination (p < .001). Vaccinated women (n = 95) were over seven times more likely than were unvaccinated women (n = 115) to report positive vaccine attitudes (relative risk = 7.1). HPV vaccination status was not associated with vaccine attitudes among men. HPV knowledge and vaccine uptake remain problematic among college students, and deficits in both are associated with negative HPV vaccine attitudes. Although the knowledge gap is narrowing, HPV vaccination efforts should target young men, as HPV-related cancer morbidity continues to rise in men.

Differences in human papillomavirus (HPV) vaccine uptake by nativity status among men aged 18-34 years

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Only 1 in 11 men had initiated and 1 in 30 men had completed the HPV vaccine series.

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Immigrants from Indian subcontinent had the lowest HPV vaccination rates.

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Foreign-born men who reported US citizenship had higher rates of HPV vaccination rates.

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Foreign-born men had lower odds of having initiated the HPV vaccination compared with US-born men.

Annually, about 16,500 HPV-associated cancers occur in the US among men. Data regarding HPV vaccine uptake among men based on nativity status (i.e., US-versus foreign-born) is limited, yet potentially important for informing interventions. We assessed differences in HPV vaccine uptake by nativity status among men aged 18–34 years in the US. The 2014–2017 National Health Interview Survey was examined for men, aged 18–34 years (n = 14,056). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of three doses. Weighted, multivariable binary logistic regression models were used to assess the association between nativity status and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare factors. Analyses were performed in July 2018. Overall, 17% of men self-identified as foreign-born, 9.9% of men had initiated the HPV vaccine, and 3.3% had completed the HPV vaccine. Among foreign-born men, Asians had the highest HPV vaccination rates whereas those from Indian subcontinental region had the lowest rates. After accounting for demographic, socioeconomic, and healthcare factors, compared to US-born men, foreign-born men were 46% (adjusted odds ratio = 0.54; 95% CI = 0.39–0.72) less likely to initiate the HPV vaccine but there was no difference between the two groups in terms of vaccine completion. We found that HPV vaccine uptake among men was very low overall, and foreign-born men had lower initiation compared to US-born men. Public health interventions which improve HPV vaccination need to be developed for all men, irrespective of nativity status.

Natural history of human papillomavirus and vaccinations in men: A literature review

BACKGROUND AND AIMS

Infection with high-risk (HR) genotypes of the human papillomavirus (HPV) is necessary for and causative of almost all cervical cancers and their precursor condition, cervical intraepithelial neoplasia. These conditions have been sharply reduced by cervical cytology screening, and a further decrease is expected because of the recent introduction of prophylactic HPV vaccinations. While significant attention has been given to gynecologic HPV disease, men can be affected by HPV-related cancers of the anus, penis, and oropharynx. This literature review aims to address disparities in HPV-related disease in men, and certain HR male subpopulations, compared with women.

DISCUSSION

Overall, immunocompetent men are far less likely than women to develop anogenital HPV-related cancers, despite harboring HR HPV infections at anogenital sites. On the other hand, men who have sex with men and men living with human immunodeficiency virus infection are at considerably higher risk of HPV-related disease. Historic rates of prophylactic HPV vaccination in males have trailed those of females due to numerous multilevel factors, although, in recent years, this sex gap in vaccination coverage has been closing. In the absence of routine HPV screening in males, therapeutic vaccinations have emerged as a potential treatment modality for preinvasive neoplasia and are in various phases of clinical testing.

CONCLUSION

Successful reductions in HPV disease morbidity at the population level must acknowledge and target HPV infections in men.

Cervical Cancer, Human Papillomavirus Infection, and Vaccine-Related Knowledge: Awareness in Chinese Women

Cervical cancer (CC) has a high incidence and mortality and is accompanied by lack of organized CC screening programs, lack of health-care facilities, and a lack of human papillomavirus (HPV) vaccination among female population in the world, particularly China. We recruited 487 females who visited the outpatient department of the First People’s Hospital of Yunnan Province from November 2015 to January 2016 to complete a standardized-designed questionnaire. We found that only 39.6% of the females knew about the role of HPVs in the development of cervical cancer. Moreover, none of the females knew that HPV could cause penile carcinomas, perianal carcinomas, and head and neck carcinomas. The majority of the participants acquired information about cervical cancer, HPV, and the HPV vaccine from medical workers. Only 15.6% of the recruited females had heard about the HPV vaccine. The overall HPV vaccine acceptance rate was higher (91.2%) if the vaccine was available free of cost. In this study, we found high acceptability of the HPV vaccine in Chinese women and high awareness about cervical cancer. However, very low levels of knowledge about HPVs and their role in cancer development among the recruited women is alarming. Therefore, it is very important to initiate educational programs to raise awareness and knowledge about cervical cancer, HPV, and the HPV vaccine in this region.