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Hittson H, McAleer L, Saucedo L, Mahler L, Andino G, Zorba A, Walden S, Pickett BE, Poole BD, Abel EL. Association between Religious Beliefs and HPV Vaccination Attitudes among College Students. Vaccines (Basel) 2023; 11:1623. [PMID: 37897025 PMCID: PMC10611068 DOI: 10.3390/vaccines11101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE AND PARTICIPANTS The authors sought an updated examination of attitudes toward Human Papillomavirus (HPV) catch-up vaccination among college students at a private religious university. METHODS A total of 1557 college students completed a 62-question survey of religious and HPV vaccination attitudes during the fall of 2021. Students' willingness to receive catch-up HPV vaccination and willingness to vaccinate a future child against HPV were recorded. RESULTS Of the 46.8% of students who reported being unvaccinated or unaware of vaccination status, ~26% reported being uninterested in receiving catch-up HPV vaccination; ~22% of all students surveyed reported being unwilling to vaccinate a future child against HPV. The strongest predictors of vaccine hesitancy included religious concerns about sexual abstinence and safety concerns. CONCLUSIONS College health professionals can increase the rate of HPV vaccination among college students and subsequent future generations by addressing the safety and utility of the vaccine regardless of intentions for sexual abstinence prior to marriage. Additionally, rather than a uniform approach to all students who self-identify as Christian, an effort to identify and discuss the unique religiously influenced beliefs of individual students is recommended when discussing HPV vaccination.
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Affiliation(s)
- Hannah Hittson
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Leah McAleer
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Lydia Saucedo
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Lindsay Mahler
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Gabriel Andino
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Andie Zorba
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Sarah Walden
- Baylor Interdisciplinary Core, Honors College, Baylor University, Waco, TX 76798, USA;
| | - Brett E. Pickett
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA; (B.E.P.); (B.D.P.)
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA; (B.E.P.); (B.D.P.)
| | - Erika L. Abel
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
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Rodriguez AM, Do TQN, Goodman M, Schmeler KM, Kaul S, Kuo YF. Human Papillomavirus Vaccine Interventions in the U.S.: A Systematic Review and Meta-analysis. Am J Prev Med 2019; 56:591-602. [PMID: 30773231 DOI: 10.1016/j.amepre.2018.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite current recommendations, human papillomavirus vaccine uptake remains low. A systematic review and meta-analysis assessed the effectiveness of interventions targeting human papillomavirus vaccine initiation and completion among children, adolescents, and young adults aged 9-26 years. EVIDENCE ACQUISITION Three electronic databases (CINAHL, OVID, and Web of Science) were searched for articles published in English peer-reviewed journals between January 2006 and January 2017 of U.S. studies that evaluated intervention strategies and reported post-intervention human papillomavirus vaccine initiation or completion rates among individuals aged 9-26 years. Study characteristics and outcomes were extracted. Data were collected in 2016 and analyzed in 2017. EVIDENCE SYNTHESIS Reviewers screened 983 unique titles and abstracts, read 241 full-text articles, and extracted data from 30 articles meeting the inclusion criteria (12 behavioral, ten environmental, four informational, and four combination strategies). Published EQUATOR (Enhancing the Quality and Transparency of Health Research) guidelines were used to assess study quality. Random effects meta-analyses were conducted. The meta-analyses included 17 RCTs and quasi-experiments involving 68,623 children, adolescents, and young adults. The pooled relative incidence estimates were 1.84 (95% CI=1.36, 2.48) for human papillomavirus vaccine initiation and 1.50 (95% CI=1.23, 1.83) for completion. Behavioral and informational interventions doubled human papillomavirus vaccine initiation (relative incidence estimate=2.04, 95% CI=1.36, 3.06 and relative incidence estimate=1.92, 95% CI=1.27, 2.91, respectively). Behavioral interventions increased completion by 68% (relative incidence estimate=1.68, 95% CI=1.25, 2.27). CONCLUSIONS Evidence supports behavioral interventions for increasing human papillomavirus vaccine initiation and completion. Future studies are needed to assess the effectiveness of interventions in reaching diverse populations and reducing missed opportunities for human papillomavirus vaccination.
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Affiliation(s)
- Ana M Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; Sealy Institute for Vaccine Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas.
| | - Thuy Quynh N Do
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Michael Goodman
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
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Walling EB, Benzoni N, Dornfeld J, Bhandari R, Sisk BA, Garbutt J, Colditz G. Interventions to Improve HPV Vaccine Uptake: A Systematic Review. Pediatrics 2016; 138:peds.2015-3863. [PMID: 27296865 DOI: 10.1542/peds.2015-3863] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The human papillomavirus (HPV) vaccine is a safe, effective cancer prevention method that is underutilized in the United States. Despite increased understanding of barriers to vaccination, rates remain low. Globally, developed and developing nations have achieved high rates of vaccination. OBJECTIVE Identification of effective strategies is necessary to optimize uptake of the HPV vaccine. We systematically reviewed the literature for national and international interventions that have successfully increased HPV vaccine uptake. DATA SOURCES We used a standardized protocol to search for articles published between January 1, 2006, and April 30, 2015, in 3 electronic databases: PubMed, Scopus, and Embase. STUDY SELECTION We identified interventions designed to increase HPV vaccine uptake among adolescents and young adults aged 11 to 26 years. All study designs were acceptable. Only articles that included postintervention vaccination rates were included. DATA EXTRACTION Two authors independently reviewed each article for data extraction and quality assessment. Interventions were classified according to the Community Preventive Service Task Force guide. RESULTS Results were reported according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Fifty-one articles met eligibility criteria: 2 informational interventions, 18 behavioral interventions, and 31 environmental interventions. Factors associated with HPV vaccine uptake were increased vaccine availability, decreased financial barriers, and interventions targeting both providers and patients. LIMITATIONS Lack of consistent RE-AIM metric reporting, limiting our ability to assess intervention validity and quality. CONCLUSIONS Population-based vaccination strategies that increased vaccine availability reached the greatest number of adolescents and were most successful in achieving high rates of vaccination.
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Affiliation(s)
- Emily B Walling
- Division of Hematology & Oncology, Department of Pediatrics, School of Medicine,
| | | | | | | | | | - Jane Garbutt
- Department of Pediatrics, School of Medicine, Division of General Medical Sciences, Department of Medicine, School of Medicine, and
| | - Graham Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, Missouri
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Rambout L, Tashkandi M, Hopkins L, Tricco AC. Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review. Prev Med 2014; 58:22-32. [PMID: 24176938 DOI: 10.1016/j.ypmed.2013.10.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/27/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Widespread uptake of preventive human papillomavirus vaccination among target groups is an important public health goal. To evaluate barriers and facilitators to human papillomavirus vaccination, we conducted a systematic review of self-reported views of adolescent girls and young women. METHODS Twenty-two studies including 8079 females aged 9-26 years in North America, published between 2008 and 2011 (representing studies conducted post-vaccine availability), were included. Two reviewers performed all levels of screening and data abstraction in duplicate. We collated findings pertaining to vaccination barriers and facilitators, study characteristics, and study quality. RESULTS Participants were mainly unvaccinated (70%) and sexually active. Twenty-one barriers to vaccination were identified. Cost was the most frequently reported barrier, followed by feelings that vaccination was unnecessary, and concerns regarding vaccine safety and side effects. Facilitators included perceived benefit of vaccination, health care provider recommendations, and social norms. Few studies specifically sought to isolate the views of adolescents, though not being sexually active was the most commonly reported barrier among this group. CONCLUSION Understanding factors which arbitrate in vaccination decisions among key target groups can improve the success of health promotion interventions. Additional studies of superior methodological quality are needed to produce reliable data to inform health promotion strategies.
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Affiliation(s)
- Lisa Rambout
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.
| | - Mariam Tashkandi
- Applied Health Research Centre of St. Michael's Hospital, Toronto, Ontario M5B 1M8, Canada.
| | - Laura Hopkins
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario M5B 1T8, Canada.
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Abstract
Despite strong national recommendations to vaccinate adolescents against the human papillomavirus (HPV), only 14% of teenage girls completed all 3 doses in 2010. Parental hesitancy may be one of the strongest reasons behind this low uptake rate. This review investigates sources of parental hesitancy including parental concerns associated with vaccinations in general, parental knowledge as a basis of HPV vaccine hesitancy, social qualms parents may have with regards to the HPV vaccine, and parental attitudes toward allowing their sons to be vaccinated against HPV. By better understanding these sources of hesitancy, we can focus research efforts towards addressing them in an attempt to improve HPV vaccine uptake.
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Affiliation(s)
- Pooja R Patel
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health; The University of Texas Medical Branch; Galveston, TX USA
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health; The University of Texas Medical Branch; Galveston, TX USA
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Casey BR, Crosby RA, Vanderpool RC, Dignan M, Bates W. Predictors of initial uptake of human papillomavirus vaccine uptake among rural Appalachian young women. J Prim Prev 2013; 34:71-80. [PMID: 23325057 PMCID: PMC4758115 DOI: 10.1007/s10935-013-0295-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Women in Appalachian Kentucky experience a high burden of cervical cancer and have low rates of human papillomavirus (HPV) vaccination. The purpose of this study was to identify normative influences predicting initial HPV vaccine uptake among a sample of young women in southeastern Kentucky. Women (N = 495), ages 18 through 26 years, were recruited from clinics and community colleges. After completing a questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for Dose 1 served as the primary outcome variable. Hierarchical logistic regression was used to estimate the influence of healthcare providers, friends, mothers, and fathers on vaccine uptake. One-quarter of the total sample (25.9%) received Dose 1. Uptake was higher in the clinic sample (45.1%) than in the college sample (6.9%). On multivariate analysis, women indicating that their healthcare provider suggested the vaccine, that their friends would "definitely" want them to be vaccinated, and that their fathers would "definitely" want them to receive the vaccine all were 1.6 times more likely to receive Dose 1. Interaction effects occurred between recruitment site (clinic vs. community college) and all three of the normative influences retaining multivariate significance, indicating that the associations only applied to the clinic sample. HPV vaccine interventions may benefit from highlighting paternal endorsement, healthcare provider recommendation, and peer support.
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Affiliation(s)
- Baretta R Casey
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, 151 Washington Avenue, 346 Bowman Hall, Lexington, KY 40506-0059, USA.
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Cohen EL, Head KJ. Identifying knowledge-attitude-practice gaps to enhance HPV vaccine diffusion. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1221-34. [PMID: 23767775 DOI: 10.1080/10810730.2013.778357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
To examine differences in knowledge, attitudes, and related practices among adopters and nonadopters of the human papillomavirus (HPV) vaccine, the researchers conducted 83 in-depth interviews with 18- to 26-year-old women. The study identified knowledge-attitude-practice gaps in the context of the HPV vaccine to explain why diffusion of a preventive innovation (such as the HPV vaccine) requires targeted risk communication strategies in order to increase demand. Salient findings included similarities between vaccinated and unvaccinated women's lack of knowledge and uncertainties about HPV and cervical cancer. Vaccinated women who had no knowledge of HPV or no-risk/low-risk perceptions of HPV reported receiving vaccination, indicating HPV risk protection behavior could precede knowledge acquisition for vaccinated women. These vaccinated women identified an interpersonal network supportive of vaccination and reported supportive social influences. Among unvaccinated women, unsupportive vaccination attitudes included low perceived personal risk of HPV. In contrast, unvaccinated women often cited erroneous beliefs that HPV could be avoided by abstinence, monogamy, and knowledge of their partners' sexual history as reasons that the vaccine was not personally relevant. Unvaccinated women cited interpersonal influences that activated short- and long-term vaccination safety and efficacy concerns. Different levels of fear regarding the HPV vaccine may underlie (a) attitudinal differences between vaccinated and unvaccinated women in perceived vaccination value and (b) attitude-practice gaps.
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Affiliation(s)
- Elisia L Cohen
- a Department of Communication , College of Communication and Information, University of Kentucky , Lexington , Kentucky , USA
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Head KJ, Cohen EL. Young women's perspectives on cervical cancer prevention in Appalachian Kentucky. QUALITATIVE HEALTH RESEARCH 2012; 22:476-87. [PMID: 22068039 DOI: 10.1177/1049732311425053] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Human papillomavirus (HPV) vaccination coupled with routine Papanicolaou (Pap) tests can prevent pervasive HPV infections causing cervical cancer. However, both HPV vaccination rates and Pap testing rates in Appalachian Kentucky are lower among all age groups than the rest of the United States. We recruited 19 young women residing in Appalachian Kentucky from university-based and rural clinical settings for group and individual interviews. After considering an integrated behavioral framework, we illustrate these women's perspectives by detailing five themes, including (a) experiential beliefs pose barriers to performing behaviors, (b) three vaccine doses complicate vaccination intention, (c) women have misunderstandings about HPV and the HPV vaccination function, (d) normative influences cue action (and inaction), and (e) specific environmental and contextual barriers exist to performing cervical cancer prevention behaviors in Appalachian Kentucky. These findings related to cervical cancer prevention in Appalachian Kentucky have implications for health-message design and clinical practice.
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Crosby RA, Casey BR, Vanderpool R, Collins T, Moore GR. Uptake of free HPV vaccination among young women: a comparison of rural versus urban rates. J Rural Health 2011; 27:380-4. [PMID: 21967381 DOI: 10.1111/j.1748-0361.2010.00354.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To contrast rates of initial HPV vaccine uptake, offered at no cost, between a rural clinic, a rural community college, and an urban college clinic and to identify rural versus urban differences in uptake of free booster doses. METHODS Young rural women attending rural clinics (n = 246), young women attending a rural community college (n = 251) and young women attending an urban university health clinic (n = 209) were recruited in Kentucky. After completing a brief questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for the initial dose of vaccine served as the study outcome variable. FINDINGS In controlled analyses, the contrast in initial uptake between urban clinic women (reference category) and rural college women was significant (P < .0001). However, the contrast in initial uptake between urban clinic women (reference category) and rural clinic women was not significant (P = .42). The model predicting uptake of subsequent doses among those with initial uptake (n = 235) also indicated significant differences as a function of recruitment location, with rural clinic women being about 7 times more likely than urban clinic women (P < .0001) to not return for at least 1 follow-up dose. The contrast between urban clinic women and rural college women was also significant (P = .014). CONCLUSION Initial uptake of free HPV vaccination among young rural college women may be problematic. Moreover, uptake of subsequent free doses among rural women may be problematic regardless of whether contact is made in a clinic or through college recruitment.
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Affiliation(s)
- Richard A Crosby
- College of Public Health at the University of Kentucky, Lexington, Kentucky 40506, USA.
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