Influences on Human Papillomavirus Vaccination Status Among Female College Students

Creation of a sexual risk index from the American College Health Association-National College Health Assessment (ACHA-NCHA) III to compare nontraditional and traditional student sexual risk

OBJECTIVE

To examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions.

METHODS

The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach's alpha of .714.

RESULTS

All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = -1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges.

CONCLUSIONS

Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items.

Public Awareness of the Traditional and Complementary Medicine Act Governing Chiropractic in Malaysia: A Survey of Adults in Klang Valley

Objective

This study aimed to assess the level of awareness of the traditional and complementary medicine law governing chiropractic among adults in Klang Valley, Malaysia.

Methods

A cross-sectional study was conducted of patients attending the following 4 health care services: medicine, dentistry, pharmacy, and chiropractic. The study ran from July to November 2018. Data were collected through self-administered questionnaires and reported using descriptive statistics. Variables included demographic characteristics and awareness of the Traditional and Complementary Medicine Act 2016 (Act 775).

Results

We obtained 440 responses, 186 (42.3%) from men and 254 (57.7%) from women, with ages ranging from 18 to 81 years. The majority of respondents (97.3%) were Malaysian from the non-Malay ethnic group. Almost half (47.5%) of the respondents had a bachelor's degree. The awareness of the traditional and complementary medicine law governing chiropractic was low (4.8%). Binary logistic regression revealed marital status as the only significant predictor of awareness of the Traditional and Complementary Medicine Act, with married individuals showing higher awareness (adjusted odds ratio: 2.77; 95% CI, 1.38-5.58).

Conclusion

For this sample of adults, the awareness of the Traditional and Complementary Medicine Act 2016 governing chiropractic was found to be low. As the regulation of chiropractic is still new in Malaysia and other Asian countries, efforts are needed to increase public awareness to ensure the safety and quality of chiropractic services.

Knowledge, beliefs, and practice regarding human papillomavirus (HPV) vaccination among American college students: Application of the health belief model

Objective: To identify facilitators and barriers to human papillomavirus (HPV) vaccination among college students.Methods: A cross-sectional survey with college students (N = 306) between the ages of 18 and 26 was conducted using a computer-delivered survey via iPad. A survey was designed to assess HPV/HPV vaccine-related knowledge, beliefs, and vaccination practices.Results: Low completion rates for the HPV vaccination series (females: 28.9%; males: 11.5%) were observed among college students. The compliance was lower among students who were black American and did not speak English at home. In contrast, the compliance was higher among those who had received any recommendation for HPV vaccination, those with higher knowledge about HPV and HPV vaccine, and higher perceived benefits of vaccination.Conclusions: Increasing knowledge of HPV infection, including the benefits of HPV vaccination and health care providers recommending the HPV vaccine, may increase HPV vaccination among college students and reduce the incidence of the disease.

HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

HPV Knowledge, Vaccine Status, and Health Literacy Among University Students

The aim of this study was to assess university students' knowledge and understanding about HPV and its association with their vaccination status and health literacy. A sample of 383 undergraduate university students between the ages of 18 and 26 were recruited between February 14 and March 22, 2018. An electronic survey was administered to assess knowledge and HPV awareness, vaccination status, and health literacy. Participants had moderate mean knowledge scores of 6.02 of a possible 11 (SD = 3.06). There was a positive association between health literacy and HPV knowledge and a statistically significant difference in knowledge scores between those who are vaccinated and unvaccinated p < 0.001. This study expanded available research on HPV vaccine and its uptake among university students and can be used to develop educational interventions. Continuous examination of HPV knowledge gaps and identifying factors that affect vaccine uptake is pivotal to increasing vaccination rates.

The impact of HPV vaccine narratives on social media: Testing narrative engagement theory with a diverse sample of young adults

Rates of human papillomavirus (HPV) infection are highest in young adults, who can be vaccinated against HPV if they were not vaccinated as adolescents. Since young adults increasingly access health information on social media, we tested the impact of a social media campaign with narrative-based health information on intentions related to HPV vaccination. We also aimed to understand which ads resonated most with young adults and led to higher survey completion rates. We created social media posts featuring videos promoting HPV vaccination. We launched a sponsored ad campaign on Facebook to reach young women, ages 18-26, across the country. Participants were randomly assigned one of 6 videos and then completed a brief survey about video engagement and intentions to: talk with a health care professional, talk with friends or family, and vaccinate against HPV. A descriptive correlational design and a test for moderation were used to explore hypothesized relationships. Across all ads, 1332 link clicks led to 991 completed surveys that were reduced to 607 surveys (95 % ages 18-26, 63 % non-Caucasian; 58 % sexually active). Higher video engagement was associated with stronger intentions to talk with a health care professional (r = 0.44, p =.01), talk with friends/family (r = 0.52, p =.01), and vaccinate against HPV (r = 0.43, p =.01). Young adults were receptive to watching narrative-based health information videos on social media. When promoting HPV vaccination, more engaging information leads to greater intentions to talk about the vaccine and get vaccinated.

Stakeholders' perspectives on system-level barriers to and facilitators of HPV vaccination among Hispanic migrant farmworkers

OBJECTIVES

Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities.

DESIGN

Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders (n = 13) representative of health, social services, and political sectors. Stakeholders were asked about their perceptions of barriers to and facilitators of HPV vaccination among migrant farmworkers. Interviews were audio-recorded, transcribed, and thematically analyzed. Responses were coded according to components of the SEM.

RESULTS

Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy.

CONCLUSIONS

Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.

Factors Associated with Human Papillomavirus Vaccination and the Intention among Undergraduate Nursing Students: A Cross-Sectional, Correlational Study

PURPOSE

To examine factors associated with overall human papillomavirus (HPV) vaccination status, completion of HPV vaccination, and intention to receive vaccination among nursing students.

DESIGN

A Cross-sectional, correlational study.

METHODS

Data from 86 students were analyzed using logistic and multiple regression.

FINDINGS

Among knowledge, attitudes and beliefs, and recommendation, more positive attitudes and beliefs were the only factors associated with initiation and/or completion of HPV vaccination and the intention to receive HPV vaccination.

CONCLUSIONS

More positive attitudes and beliefs need to be enhanced for HPV vaccination.

CLINICAL EVIDENCE

Changes in attitudes and beliefs can be important targets of interventions to increase HPV vaccination.

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

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

Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood

PURPOSE

Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university.

METHODS

We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination.

RESULTS

Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.

CONCLUSIONS

Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.

Monogamy as a Barrier to Human Papillomavirus Catch-Up Vaccination

Background: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) in the United States. Although a vaccine to prevent HPV infection exists, only 53.7% of females 13-17 years of age were up-to-date on the HPV vaccination series in 2018. There is a catch-up period of vaccination for females 18-26 years of age that shows consistent underparticipation. A potential barrier to vaccination is relationship status, as long-term relationships may negatively impact HPV risk perception. This study examined monogamy as a risk factor for nonvaccination and explored how risk perception may influence this association. Materials and Methods: An electronic survey was distributed to females 18-26 years of age who attended a large public university in the mid-Atlantic region (n = 629). Multivariable and descriptive statistics were estimated using SAS 9.4 to explore the likelihood of vaccination during the catch-up period by relationship status. Results: Most participants had received the HPV vaccine, a small proportion of whom received it during the catch-up period. After adjusting for confounders, women who were in monogamous relationships were significantly less likely to have participated in HPV catch-up vaccination compared to women who were single and dating (adjusted odds ratio: 0.36, 95% confidence interval: 0.15, 0.87). Women in monogamous relationships had a lower average sexually transmitted disease (STD) risk perception compared to women who were single and dating (p < 0.0001). Conclusions: A decreased risk perception may present a barrier to participating in catch-up vaccination for monogamous women. Practitioners and the public health community should focus on communicating HPV risk to women in monogamous relationships, especially given the recently expanded age range for HPV vaccination.

Knowledge of Human Papillomavirus (HPV) and Oropharyngeal Cancer and Acceptability of the HPV Vaccine among Dental Students

Objectives:

To assess knowledge about human papillomavirus (HPV), vaccination, and HPV-related oropharyngeal cancer (OPC) and to evaluate HPV vaccine acceptability among a sample of undergraduate dental students.

Methods:

All third- and fourth-year dental students enrolled in any of the dental schools in Jeddah, Saudi Arabia, were invited to participate in this cross-sectional study. In total, 500 students completed a self-administered questionnaire on HPV, HPV vaccines, and HPV-related OPC knowledge. HPV, HPV vaccine and HPV-related OPC knowledge scores were calculated. Associations of participants characteristics with the knowledge scores and with willingness to take the HPV vaccine were assessed.

Results:

Of the participants, 62% had heard of HPV infections, and 57% of HPV vaccines. Average knowledge scores were low: HPV knowledge score 3.8±4.5 out of 16, HPV vaccination knowledge score 0.9±1.6 out of 7, OPC knowledge score 0.9±1.2 out of 5. Clinical-year students had better knowledge and were more willing to take the HPV vaccine than were preclinical-year students, as were those vaccinated for hepatitis B versus those not vaccinated for hepatitis B. Students with higher HPV knowledge scores were more willing to take the HPV vaccine (66%) than were those with lower scores (43%) (p=0.018). Only 4% of males and 12% of females reported taking the HPV vaccine. Of those who refused it, 51% cited lack of knowledge as the primary reason.

Conclusions:

Knowledge about HPV, its vaccine, and HPV-related OPC is low among this sample of Saudi undergraduate dental students. Improving knowledge among them may increase their awareness, which could affect the care provided to patients.

HPVs Vaccination among Racial/Ethnic Minority College Students: Current Status and Future Direction

OBJECTIVES

College is an important period for catch-up vaccination for Human Papillomaviruses (HPVs), but HPVs vaccination rates are low among college students. Given that racial/ethnic minorities are disproportionately affected by HPVs-related cancers, the aim of the present study is to conduct a scoping review about HPVs and HPVs vaccination conducted among racial/ethnic minority college students. Specifically, we examined: 1) the prevalence of HPVs vaccination among racial/ethnic minority college students in the US and 2) the correlates of HPVs vaccination or vaccination intention/interest.

METHODS

We searched three database (PubMed, PsycINFO, and CINAHL) for relevant articles. Of 58 articles initially identified, 23 articles met all inclusion/exclusion criteria.

RESULTS

Racial/ethnic minority college women (especially Black and Asian/Pacific Islander) were less likely to be vaccinated compared to their non-Hispanic white counterparts. Racial/ethnic minority college men reported lower knowledge of HPVs and HPVs vaccination compared with their women counterparts. However, overall, a majority of racial/ethnic minority college students appeared to have high knowledge about HPVs and intention to vaccinate. Age, doctor recommendation, and psychosocial and cultural factors (e.g., HPVs/HPVs vaccine knowledge, perceived benefits of vaccination, social norms and values, mistrust of health care providers, and cultural norms) were associated with vaccination and individuals' intention to be vaccinated.

DISCUSSION

Significant racial/ethnic disparities in HPVs vaccination exist among both college men and women. Interventions to increase vaccine awareness, access, and uptake among racial/ethnic minority college students are lacking and warranted. Interventions targeting only knowledge and/or intention might not be sufficient. Theory-based studies that examine unique factors involved in vaccine uptake during college across multiple levels of influence including psychosocial, provider, health care, and culture are needed.

Knowledge, Beliefs, and Practices Among U. S. College Students Concerning Papillomavirus Vaccination

Human papillomavirus (HPV) is the most common sexually transmitted disease in the U.S. Data on knowledge, attitudes, and beliefs related to HPV vaccination among college students are limited. The purpose of this study was to provide a comprehensive description of the variables influencing HPV vaccination uptake and intention among college students. This study employed a cross sectional descriptive quantitative design. Survey data were collected online from the 181 college students, aged 18-25 years. The data were analyzed to identify the students' attitudes toward HPV vaccine (perceived potential harm, effectiveness, barriers, and uncertainty), knowledge of HPV and HPV vaccine, and their intention of receiving the vaccine in the next 6 months. Descriptive statistics, Chi-square tests, ANOVA, and logistic regressions were conducted to examine the correlates of vaccination intention and uptake. Among 181 participants, 101 (55.8%) were had received at least one dose of HPV vaccine, 52 (28.7%) intended to receive HPV vaccine, and 28 (15.5%) did not intend to receive HPV vaccine. On average, participants responded correctly to less than half of the questions on the HPV knowledge and HPV vaccine knowledge scales, and those who were vaccinated were significantly more knowledgeable than their counterparts. Multivariate logistic regression showed HPV vaccine knowledge and uncertainty were significant factors associated with HPV vaccine uptake. Providing education designed to improve HPV and HPV vaccination knowledge and decrease feelings of uncertainty could improve college students' HPV vaccination uptake.

Post-hoc analysis of injection-site reactions following vaccination with quadrivalent human papillomavirus vaccine in Japanese female clinical trial participants

AIM

The quadrivalent human papillomavirus (4vHPV) vaccine has demonstrated efficacy and immunogenicity and was generally well tolerated in clinical trials conducted in Japan. We report a detailed safety analysis of injection-site reactions in female Japanese 4vHPV clinical trial participants.

METHODS

This post-hoc analysis included data from 2 double-blind, placebo-controlled phase II clinical trials of a 3-dose (Day 1, Month 2, Month 6) regimen of 4vHPV vaccine in Japanese young women aged 18-26 years (N = 1021; NCT00378560) and girls aged 9-17 years (N = 107; NCT00411749). Injection-site and systemic adverse events (AEs) were monitored using vaccination report cards for 15 days after each vaccine dose; serious AEs were reported throughout the trials. Post-hoc analyses of data from these trials were performed to examine details of injection-site AEs, including day of onset, time from onset to resolution, and maximum intensity.

RESULTS

Injection-site AEs were reported by 85.6% of 4vHPV vaccine recipients and 72.4% of placebo recipients, most commonly erythema, pain, pruritus, and swelling (each >5% of 4vHPV vaccine recipients). The majority of injection-site AEs had an onset within 3 days of vaccination and were mild to moderate in intensity; few 4vHPV vaccine recipients reported severe injection-site AEs (2.0% overall). All injection-site AEs resolved, and most (4vHPV: 87.5%; placebo: 92.7%) resolved within 5 days of onset.

CONCLUSIONS

Most injection-site reactions are mild or moderate in intensity and of short duration. The 3-dose regimen of 4vHPV vaccine is well tolerated in Japanese female clinical trial participants based on this post-hoc analysis. These results will further support safety communication between healthcare providers and vaccine recipients regarding the HPV vaccine.

TRIAL REGISTRATION

Clinicaltrials. gov: NCT00378560 and NCT00411749.

Uptake of HPV vaccine in traditional-age undergraduate students: Knowledge, behaviors, and barriers

Objective: This study investigated potential factors associated with HPV vaccine uptake in a diverse population of traditional-age undergraduate students. Participants: One hundred and twenty-nine undergraduate students aged 18-24 attending a small southeastern university completed surveys in January to March of 2013. Methods: Questionnaires included demographic information, basic HPV knowledge, HPV vaccine uptake, and factors influencing uptake decision. Survey results were analyzed with chi-square and t-test analyses. Results: Vaccine uptake was significantly higher in students who reported that health care provider, public health information, parents, and access to vaccine were important factors in their decision to get vaccinated. Female students had a significantly higher vaccine uptake in comparison to males and the HPV knowledge scores differed significantly by race but not gender. Conclusions: It is especially important to consider how public health campaigns and communication with parents and health care providers help promote HPV vaccine uptake in this high-risk group.

Human papillomavirus vaccination among diverse college students in the state of Georgia: who receives recommendation, who initiates and what are the reasons?

Young adulthood is a critical time for catch-up HPV vaccination. We assessed predictors of vaccine recommendation and initiation among college students. We analysed cross-sectional surveys from 2397 students using multivariable logistic regressions. Guided by the Socio-ecological and Health Belief Models, measures included socio-demographic characteristics, intrapersonal measures (e.g. vaccine beliefs), interpersonal measures (e.g. doctor's recommendation) and institutional-level measures (e.g. college settings). The sample included students from private, public, technical and historically black colleges/universities. Of the sample, 64.5% were White; additionally, 48.3% of women (n = 750/1552) and 18.8% of men (n = 159/845) received a doctor's recommendation. Among women, predictors included older age, US-born, higher parental education and attending private schools. Among men, predictors included younger age, being homosexual and attending private schools. HPV vaccine series initiation was low-43.3% of women (n = 672) and 16.7% of men (n = 141). Doctor's recommendation predicted initiation for both sexes. Younger women, women attending technical colleges and men of 'multiple/other' race had lower odds of initiation. Common initiation barriers for both sexes included a lack of doctor recommendation and sexual inactivity. These barriers and the associations between nativity, race and socio-economic status with vaccine recommendation and initiation should be further investigated. Interventions should improve patient-provider communication around HPV vaccine.

HPV Vaccine recommendations: does a health care provider's gender and ethnicity matter to Unvaccinated Latina college women?

Objectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences. Design: Unvaccinated Latina college students (n = 187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP. Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider. Conclusions: Latinas' preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.

A significant portion of college students are not aware of HPV disease and HPV vaccine recommendations

There is limited data on the HPV immunization status of Latino/Hispanic youth in the USA. In Los Angeles County in 2015, 54,973 (34.3%) college students were of Latino/Hispanic background. We examined Los Angeles County college students’ awareness of HPV and HPV-related disease, HPV vaccine recommendations, and their vaccination status. This study surveyed 212 Los Angeles college students from January to April 2018. In a convenience sampling study, a 31-question, IRB-approved survey was administered face-to-face to college students 18 years and older at California State University settings in Los Angeles County. Almost two-thirds of the male (65%) and half of the female (51.6%) respondents did not know that the HPV vaccine is recommended through 26 years of age, and 47.6% did not know they can get the HPV vaccine at the college student health center or youth-friendly clinics. Ethnicity, family income, and the highest level of education in the family had a significant impact on immunization rates. Self-reported and actual HPV knowledge levels were significantly associated with vaccination status. Educational strategies focusing on the logistics of receiving the HPV vaccine and HPV vaccine catch-up eligibility for college students may be effective in decreasing racial disparities in vaccine receipt.

Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel

BACKGROUND

Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use.

OBJECTIVE

The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials.

METHODS

The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO).

RESULTS

The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep).

CONCLUSIONS

The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.

Examining HPV Awareness, Sexual Behavior, and Intent to Receive the HPV Vaccine Among Racial/Ethnic Male College Students 18-27 years

Human papillomavirus (HPV) awareness and vaccination among males in the general population is low. Men in general, but particularly racial/ethnic men, are disproportionately affected by HPV. The purpose of this article is to examine college males' (a) HPV awareness, (b) sexual behaviors, and (c) intention to receive the HPV vaccination. A non-probability sample of all students who self-reported their race/ethnicity and were attending a university in Southeastern United States were contacted by the university registrar's office and recruited to participate in the 15-minute survey. Males, ages 18-27 years ( N = 190), were identified for this study. χ2, t-tests, and binomial logistic regression analyses assessed the relationship between knowing about HPV and HPV vaccine and the intent to receive the HPV vaccination. Findings indicated that 67.4% of the sample identified as Hispanic or Black. Among all men, 73.2% reported previous sexual experience and 49.5% were currently sexually active. There were 79.5% who had previous knowledge about HPV and 55.8% had knowledge about the HPV vaccine; 71.1% of the sample did not intend to receive the vaccine. Hispanic and Black men were less likely to identify as virgins, more likely to be sexually active, and more likely to have sexual experiences at an earlier age compared to White, Asian, and other men. Men with previous HPV vaccine knowledge (28.4%) were more likely to intend to receive the vaccine compared to men who did not have previous knowledge about the vaccine (14.9%). Providing males with information about HPV, its transmission, and possible HPV-related outcomes may increase HPV vaccine uptake.

HPV-Related Knowledge Among Dentists and Dental Hygienists

Dental providers, such as dentists and dental hygienists, play an important role in HPV-related oropharyngeal cancer prevention. Dental professional organizations recommend dental providers educate patients about HPV and oral cancers. The objective of this study was to assess HPV knowledge among dental providers. Dentists (n = 36) and dental hygienists (n = 146) attending a professional conference completed a continuing education post-test survey, which included socio-demographics, an HPV knowledge scale, and measure of HPV discussion with patients ("no," "yes," and "yes, but only with some patients"). Chi-square tests, t tests, and ANOVA tests were used for this analysis. Although dental hygienists (35.4%) reported less discussion with patients about HPV than dentists (52.8%), these differences were not significant. The mean knowledge score was 24.7 (SD = 3.8) with no significant differences by profession. Among dentists, knowledge did not significantly differ by discussion category (p = 0.28). In contrast, dental hygienists who did not discuss HPV with patients had significantly lower mean knowledge scores (mean = 23.4) than those who discussed with patients (mean = 26.5, p < 0.01) or discussed only with some patients (mean = 26.0, p = 0.01). Knowledge deficits included outcomes associated with HPV, HPV in men, and curability. Specifically, participants incorrectly answered that HPV can affect a women's ability to get pregnant (81.9%), that one can never get rid of HPV once they have it (69.2%), and that HPV can cause herpes (43.4%). This study identified HPV knowledge deficits among dental providers. Given the recommendation for dental providers to discuss HPV prevention with their patients, additional education and training on this emerging topic may benefit these professionals.

Factors Associated with College Women's Personal and Parental Decisions to be Vaccinated Against HPV

The human papillomavirus (HPV) is a public health concern because of its association with cancer. HPV vaccine rates among college students remains low. This is a critical catch-up age for individuals to receive the HPV vaccine and research shows parents still play a role in college students' medical decision-making. Therefore, the purpose of this study was to examine factors related to college women making a solo decision to initiate the HPV vaccination in comparison to making a joint parent-daughter decision. Data collected using an internet-delivered questionnaire were analyzed from 799 college women who had initiated or completed the HPV vaccination. Multinomial logistic regression was performed to compare study variables on who decided the participant should be vaccinated (self-decision, parent-only decision, joint parent-daughter decision). Participants who were older (OR 1.68, p < 0.001) and sexually active (OR 4.97, p < 0.001) were significantly more likely to have made a solo decision to be vaccinated. Participants who completed the HPV vaccination (OR 0.33, p < 0.001) and those who talked with a parent about the HPV vaccine (OR 0.12, p < 0.001) were significantly less likely to have made a solo decision to be vaccinated. Findings indicate joint parent-daughter decisions may improve HPV vaccination cycle completion.

Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18-26 year olds in the United States

PURPOSE

To examine correlates of HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults.

METHODS

Young adults aged 18-26 years were identified from the 2014 and 2015 National Health Interview Survey (n = 7588). Survey-weighted multivariable logistic regression models estimated sociodemographic factors associated with HPV vaccine initiation (≥1 dose) and completion (≥3 doses).

RESULTS

Approximately 27% of study participants had initiated the HPV vaccine and 16% had completed the HPV vaccine. Participants were less likely to initiate the vaccine if they were men [(adjusted odds ratio) 0.19; (95% confidence interval) 0.16-0.23], had a high school diploma (0.40; 0.31-0.52) or less (0.46; 0.32-0.64) vs. college graduates, and were born outside the United States (0.52; 0.40-0.69). But, participants were more likely to initiate the HPV vaccine if they visited the doctor's office 1-5 times (2.09; 1.56-2.81), or ≥ 6 times (1.86; 1.48-2.34) within the last 12 months vs. no visits. Odds of completing HPV vaccine uptake followed the same pattern as initiation. And after stratifying the study population by gender and foreign-born status, these variables remained statistically significant.

CONCLUSIONS

In our nationally representative study, only one out of six 18-26 year olds completed the required vaccine doses. Men, individuals with high school or less education, and those born outside the United States were less likely to initiate and complete the HPV vaccination. Our findings suggest that it may be useful to develop targeted interventions to promote HPV vaccination among those in the catch-up age range.

Changes in HPV Knowledge Among College Women from 2008 to 2015

The human papillomavirus (HPV) can cause anogenital cancers and genital warts; however, it can be prevented through the HPV vaccine, which has been available since 2006. While this vaccine is targeted toward 11-to-12-year-olds, 18-to-26-year-old young adult women are eligible for "catch-up" vaccination. Knowledge of HPV may impact HPV vaccine uptake among this population. The purpose of this study was to assess changes in HPV knowledge and HPV vaccine information sources among young adult college women over a 7-year period. Two independent samples (N = 223 for 2008; N = 323 for 2015) completed a 23-item knowledge scale and survey regarding HPV. Adjusted logistic regression models compared the odds of correctly answering each knowledge item between each time period. The study found that HPV knowledge increased significantly over time (p < 0.01). The participants in 2015 were more likely than the 2008 participants to accurately report that a condom can decrease the chance of HPV transmission; there is a vaccine for women that prevents certain types of HPV; HPV can cause genital warts; HPV can be passed to a newborn at birth; and even if you do not see a wart, you can transmit HPV. Recent participants were also more likely to correctly report only women can get HPV as false. While improvements in HPV knowledge were found over time, misperceptions regarding outcomes associated with HPV persist. In order to promote HPV vaccination among this population, health literacy skills, in addition to knowledge, should be improved.

"We've Been Together. We Don't Have It. We're Fine." How Relationship Status Impacts Human Papillomavirus Vaccine Behavior among Young Adult Women

BACKGROUND

Vaccination against the human papillomavirus (HPV) has the potential to significantly reduce morbidity and mortality associated with genital warts and HPV-related cancers. However, HPV vaccination rates continue to be suboptimal among the "catch-up" population of 18- to 26-year-old women. One consistent risk factor for nonvaccination is being in a relationship. This study aimed to understand how relationship status and vaccination status impact risk perceptions and perceived need for the HPV vaccine among young adult women.

METHODS

In-depth interviews were conducted with a sample (n = 50) of recently HPV vaccinated and unvaccinated college women, and stratified by four relationship categories. Comparative thematic analysis was used to assess relationship status and HPV risk perceptions.

RESULTS

Women in relationships perceived their risk of HPV to be low, which they attributed to monogamy and few sexual partners. Women in dating relationships reported higher HPV risk, which was linked to unprotected sex and sexual activity. In contrast, single women stated that their low risk for HPV was due to sexual inactivity.

CONCLUSIONS

This study builds on the epidemiological literature, by understanding how relationship status impacts HPV vaccination among young adult women. Relationship status contributed to HPV risk perceptions and vaccination decisions among these women. Perceptions were framed based on sexual behavior, such as monogamy or number of sexual partners. Future efforts should tailor health messages to young adult women's specific risk misperceptions about HPV.

Understanding women's hesitancy to undergo less frequent cervical cancer screening

Inappropriate cervical cancer screening (e.g., screening too often) can result in unnecessary medical procedures, treatment, and psychological distress. To balance the benefits and harms, cervical cancer screening guidelines were recently modified in favor of less frequent screening (i.e., every 3 to 5 years). This study investigated women's acceptance of less frequent cervical cancer screening and their primary concerns about extending the screening interval beyond one year. A national sample of 376 U.S. women ages 21-65 completed an online survey in 2014. Predictors of willingness to get a Pap test every 3 to 5 years were identified using logistic regression. We also examined perceived consequences of less frequent screening. Over two thirds were willing to undergo less frequent screening if it was recommended by their healthcare provider. Nevertheless, nearly 20% expressed discomfort with less frequent screening and 45% were either in opposition or unsure whether they would be comfortable replacing Pap testing with primary HPV testing. Women whose most recent Pap test was (vs. was not) within the past year and women who ever (vs. never) had an abnormal Pap test were less willing to extend the screening interval. Additionally, women who typically saw an obstetrician/gynecologist or nurse practitioner for their Pap test (vs. a family physician) were less accepting of the guidelines. Hesitancy about the longer screening interval appears to stem from concern about developing cancer between screenings. Findings contribute to the growing body of research on cancer overscreening and may inform interventions for improving adherence to cancer screening guidelines.

Factors Associated with Human Papillomavirus Vaccination Status at U.S. Colleges and Universities

Human papillomavirus (HPV) vaccination rates remain low, but college student vaccination could offset this trend. This study identifies characteristics that could enhance HPV vaccination among U.S. college students. Data were from the National College Health Assessment II survey (fall 2012, N = 18,919). Univariate and logistic regression analyses were used to examine associations among demographic characteristics, college region and size, health status, receipt of health services, sexual health information, and HPV vaccination status. Among women, ethnic minorities, students attending schools in the South, those not receiving routine gynecological care in the past 12 months, and those unsure of when they last received gynecological care were less likely to report HPV vaccination. Among men, African Americans, students attending schools in the South and West, and those receiving sexually transmitted infection information were more likely to report vaccination. Data suggest that college health education can help to improve U.S. HPV vaccination rates. Campus health practitioners providing sexual health information and referrals are positioned to assist in this effort.

Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists

STUDY OBJECTIVE

Many adolescents with chronic medical conditions (CMCs) are at risk of human papillomavirus (HPV) infection, associated complications, and underimmunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown.

DESIGN AND SETTING

National cross-sectional study.

PARTICIPANTS

Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418).

INTERVENTIONS

Subspecialists who care for adolescents with CMCs in the outpatient setting were recruited to complete a Web-based survey on their HPV-related knowledge, attitudes, comfort, and practices.

MAIN OUTCOME MEASURES

HPV vaccination recommendation.

RESULTS

Over half of respondents (50.4%; n = 196/389) reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (adjusted odds ratio [AOR], 4.69; 95% confidence interval [CI], 1.86-11.81) or rheumatology (AOR, 6.55; 95% CI, 1.67-25.74) specialization, seeing more adolescent patients with CMCs (AOR, 1.01; 95% CI, 1.00-1.02), and sometimes or always discussing sexual health (AOR, 2.53; 95% CI, 1.05-6.08) or checking vaccine status (AOR, 3.83; 95% CI, 1.59-9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR, 0.28; 95% CI, 0.12-0.70) or who reported insufficient HPV vaccine information (AOR, 0.45; 95% CI, 0.23-0.88) or lack of primary-subspecialty care provider communication (AOR, 0.38; 95% CI, 0.16-0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination.

CONCLUSION

This study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.

Zika virus knowledge, attitudes, and vaccine interest among university students

BACKGROUND

Zika virus vaccine development is underway. We examined interest in receiving a Zika virus vaccine (after one becomes commercially available) among students at a large public university in Northern Virginia.

METHODS

An online survey of Zika virus-related knowledge, attitudes, and interest in receiving a Zika vaccine was completed by 619 undergraduate students in April, 2016. Stepwise logistic regression with backward elimination was used to identify the variables most strongly associated with interest in being vaccinated against Zika virus.

RESULTS

More than half of participants (52.8%) reported that they would be likely or very likely to be vaccinated against Zika virus. Vaccination interest was significantly higher among participants who received an influenza vaccine in the past year (p=0.002), had higher levels of knowledge about Zika virus (p=0.046), reported knowing where to access information about Zika virus (p=0.041), had higher perceived susceptibility to Zika virus (p<0.001), and believed that the U.S. Government should prioritize actions to control Zika virus (p=0.001).

CONCLUSIONS

Communication and intervention strategies encouraging vaccine uptake may benefit from increasing knowledge of Zika virus, addressing perceived susceptibility, and reaching students, travelers, and others who may be seeking information about prevention of Zika virus and other emerging infectious diseases.

Human papillomavirus vaccine and Pap tests on college campuses: How do historically black colleges and universities (HBCUs) measure up?

OBJECTIVE

The availability of cervical cancer prevention services at college health centers was compared between historically black colleges and universities (HBCUs) and non-HBCUs.

METHODS

Four-year, non-primarily distant learning colleges, matching HBCUs with randomly selected non-HBCUs within the same states (N = 136) were examined. Data were collected (2014-2015 academic year) on the availability of human papillomavirus (HPV) vaccine and Pap tests at college health centers. HBCUs were compared with non-HBCUs using conditional logistic regression, and correlates of offering these services were identified.

RESULTS

Many institutions did not offer HPV vaccine or Pap tests. Fewer HBCUs offered HPV vaccine (18% vs 53%) and Pap tests (50% vs 76%) compared with non-HBCUs. In multivariable analyses, HBCUs remained less likely than non-HBCUs to offer HPV vaccine (odds ratio [OR] = 0.07, 95% confidence interval [CI]: 0.02-0.26) and Pap tests (OR = 0.19, 95% CI: 0.06-0.61).

CONCLUSIONS

Greater effort is needed to make cervical cancer prevention services available at colleges, especially at HBCUs.

Human papillomavirus vaccine information, motivation, and behavioral skills among young adult US women

This study elicited the information needs, motivations, and behavioral skills related to human papillomavirus vaccine decision-making among young adult women. Interviews were conducted with college women, aged 18-26 years, and stratified by recently vaccinated ( N = 25) and unvaccinated ( N = 25). Comparative thematic analysis using the Information, Motivation, and Behavioral Skills Model was conducted. Healthcare providers were identified as the most trusted sources for information. While unvaccinated women did not have experience receiving the vaccine, they reported the same procedural knowledge for vaccination. These findings suggest that young adult women have the information and procedural knowledge for human papillomavirus vaccination, but motivations may influence their decision-making.

A brief information-motivation-behavioral skills intervention to promote human papillomavirus vaccination among college-aged women

Background

Human papillomavirus (HPV) is prevalent among college-aged women. Although HPV vaccines decrease women’s risk for cervical cancer, the vaccination rates remain inadequate.

Objective

This study explored the utility of an information–motivation–behavioral skills (IMB) intervention in promoting HPV vaccination knowledge, motivation, and intentions among college-aged women.

Methods

In Spring/Fall 2012, 62 participants were randomly assigned to a single-session intervention or attention control and were assessed baseline, post-intervention, and at 1 month.

Results

The participants demonstrated adequate baseline vaccine knowledge, low HPV/cancer knowledge, and ambivalence about the vaccination. Post-intervention, the IMB arm demonstrated increased HPV/cancer and vaccination knowledge, motivation, and intentions. There were no group differences in vaccination at 1 month; however, the odds of wanting to get vaccinated increased sevenfold in the IMB arm.

Conclusion

These results provide preliminary support for an IMB-based intervention in increasing vaccination knowledge, motivation, and intentions among at-risk women. Future research examining the efficacy of longer trials with larger, diverse populations is warranted.

Knowledge, Attitude and Practices Regarding HPV Vaccination Among Medical and Para Medical in Students, India a Cross Sectional Study

BACKGROUND

High risk human papilloma virus (HPV) types 16 and 18 have been proven as central causes of cervical cancer and safety and immunogenicity of HPV vaccines are sufficiently established. Knowledge and practices of HPV vaccination among medical and paramedical students is vital as these may strongly determine intention to recommend vaccination to others in the future. The present study was therefore undertaken to assess the knowledge, attitude and practices regarding cervical cancer screening and HPV vaccination among medical and paramedical students and to analyze factors influencing them.

MATERIALS AND METHODS

The present cross sectional study, conducted in a tertiary care teaching hospital in south India, included undergraduate students aged 18 years and above, belonging to medical, dental and nursing streams, after informed written consent.

RESULTS

Out of 957 participants, only 430 (44.9%) displayed good knowledge and only 65 (6.8%) had received HPV vaccination. Among the unvaccinated, 433 (48.54%), were not willing to take the vaccine. Concerns regarding the efficacy (30.5%), safety (26.1%) and cost of the vaccine (21.7%) were responsible for this. Age, gender, family history of malignancy and mother's education had no influence on knowledge. Compared to medical students, nursing students had better knowledge (OR-1.49, 95% CI 0.96 to 2.3, p = 0.072) and students of dentistry had poor knowledge (OR-0.50 95% CI 0.36 to 0.70, p <0.001).

CONCLUSIONS

The knowledge and uptake of HPV vaccination among medical and paramedical students in India is poor. Targeted health education interventions may have huge positive impact not only on the acceptance of vaccination among them, but also on their intention to recommend the vaccine in future.

Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys

As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions.

The role of human papillomavirus (HPV)-related stigma on HPV vaccine decision-making among college males

OBJECTIVE

The goals of the present study are (1) to identify sociodemographic and psychosocial predictors of human papillomavirus (HPV)-related stigma and (2) to examine the relationship between HPV-related stigma in predicting HPV vaccine decision-making among college males.

PARTICIPANTS

Six hundred and eighty college males aged 18-26 from 3 Canadian universities were recruited from September 2013 to April 2014.

METHODS

Participants completed a self-report survey assessing HPV-related stigma, psychosocial predictors of HPV-related stigma, and HPV vaccine decision-making. The results were analyzed using variance analyses and linear regressions.

RESULTS

Ethnicity, province of residence, and perceived severity of HPV were found to significantly influence HPV-related stigma. In addition, HPV-related stigma was higher in those unaware of the availability of the HPV vaccine for males.

CONCLUSIONS

Promotion efforts should concentrate on Asian minorities and should avoid HPV severity messaging, as these may lead to higher HPV-related stigma, which in turn may act as a barrier to vaccination.

HPV Vaccination Status and Mandate Support for School-Aged Adolescents Among College Females

The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire during February to March 2011. This descriptive study utilizes χ² tests and t-tests to compare participant responses. HPV-related knowledge scores were 8.08 out of 11 points. Those who initiated HPV vaccination were significantly younger, single, engaged in sex, were sexually active, and had a Pap test. Participants who had more friends receiving the vaccine were significantly more likely to support mandates for 9-11 and 12-17 years and were more likely to complete the HPV vaccination cycle. Findings suggest the importance of educational programs adopted and delivered by school nurses, which aim to improve student knowledge and reduce misconceptions related to the HPV vaccine and vaccination mandates.

Does parents' socio-economic status matter in intentions of vaccinating against human papillomavirus for adolescent daughters?

BACKGROUND

The Human Papilloma Virus (HPV) vaccination provides substantial protection, and it is best to be taken before the age of twelve. Taiwan approved HPV vaccines since 2006. However, very few female adolescent have been vaccinated until now.

OBJECTIVES

To examine whether the parents' socio-economic status matters in deciding to purchase HPV vaccination for their daughters based on the theory of planned behavior.

METHOD

A structured questionnaire to collect 394 responses from parents of adolescent girls in Taiwan. Data was coded to categorize relevant socio-economic classes, and was analyzed with SPSS.

RESULTS

The behavior intentions of parents with low (mean= 5.28) and high (5.01) socio-economic status are significantly stronger than the moderate (4.56) in deciding to purchase the HPV vaccination. Socio-economic factor has a slightly negative impact (B= -0.08), and attitude (0.68), subjective norms (0.16), and behavior control (0.32) have positive impacts on the parents' intention.

CONCLUSION

Major impacts on the decision to purchase an HPV vaccination for their adolescent was not due to the parents' socio-economic status but the parent's attitude. As the major predictor of a less complicated decision, attitudes toward the HPV vaccination should be reinforced through continuous communications between service providers and patient-advocate groups.

Does intention to recommend HPV vaccines impact HPV vaccination rates?

Despite recommendations for routine vaccination, HPV vaccination rates among adolescent females have remained low. The objective of this prospective cohort study was to determine whether clinician intention to recommend HPV vaccines predicts HPV vaccine series initiation among previously unvaccinated 11 to 18 year-old girls (N=18,083) who were seen by a pediatric clinician (N=105) from a large primary care network within 3 years of vaccine introduction. We used multivariable logistic regression with generalized estimating equations, Cox Regression and standardized survival curves to measure the association between clinician intention and time to and rate of first HPV vaccine receipt among eligible females. All models adjusted for patient age, race/ethnicity, payor category, visit type, and practice location. Eighty-5 percent of eligible 11 to 12 year-old and 95% of 13 to 18 year-old girls were seen by a provider reporting high intention to recommend HPV vaccines. However, only 30% of the cohort initiated the HPV vaccine series and the mean number of days from first eligible visit to series initiation was 190 (95% C.I. 184.2, 195.4). After adjusting for covariates, high clinician intention was modestly associated with girls' likelihood of HPV vaccine series initiation (OR 1.36; 95 % C.I. 1.07, 1.71) and time to first HPV vaccination (HR 1.22; 95% 1.06, 1.40). Despite high intention to vaccinate among this cohort of pediatric clinicians, overall vaccination rates for adolescent girls remained low. These findings support ongoing efforts to develop effective strategies to translate clinician intention into timely HPV vaccine receipt.

Correlates of human papillomavirus vaccination among female university students

Human papillomavirus (HPV) is the most frequently occurring sexually transmitted infection in the United States, but only one third of adolescent girls have received the HPV vaccine (Centers for Disease Control and Prevention [CDC], 2012; Committee on Infectious Diseases, 2012). Understanding correlates of vaccination behavior among young women has important implications for health care delivery and public service messages targeting HPV vaccination. Female college students (N = 313) completed web-based surveys during their sophomore (second) year of college, fall 2008. Surveys included questions about HPV vaccination, demographic factors (ethnicity/race, socioeconomic status [SES]), individual characteristics (romantic relationship status, grade point average, religiosity), and sexual behavior. Lifetime HPV vaccination was reported by 46.5% of participants. Being African American/Black was associated with a lower likelihood of vaccination. Having a mother with more education, adhering to religious teachings about sex-related principles, and having engaged in recent penetrative sex were associated with a higher likelihood of vaccination. Health care providers should consider young women to be an important group for HPV vaccine education and catch-up, particularly for African American/Black young women and young women from lower SES backgrounds. Providing vaccine education and access to young women before they become sexually active is critical.

The multidimensional nature of perceived barriers: global versus practical barriers to HPV vaccination

OBJECTIVE

Perceived barriers are one of the strongest determinants of health behavior. The current study presents a novel conceptualization of perceived barriers by testing the following hypotheses: (a) perceived barriers are multidimensional and thus should cluster into distinct factors; (b) practical barriers should be salient for individuals intending to engage in a particular health behavior, whereas global barriers should be salient for individuals not intending to enact the behavior; and (c) whereas global barriers should be negatively associated with behavioral intentions, practical barriers should be positively related to intentions.

METHODS

The context for this investigation was young adult women's perceived barriers to human papillomavirus (HPV) vaccination. Two months after viewing an educational video about HPV vaccination, women (aged 18-26) who had not received any doses of the HPV vaccine (n = 703) reported their perceived barriers to HPV vaccination and intentions to receive the vaccine.

RESULTS

Relative to the conventional single-factor approach, a five-factor model provided a better fit to the data and accounted for a larger proportion of variance in vaccination intentions. The relative salience of different perceived barriers varied as a function of women's intentions. Participants who were not intending to get vaccinated cited global concerns about vaccine safety and low perceived need for the vaccine. In contrast, participants intending to get vaccinated cited practical concerns (cost, logistical barriers) related to carrying out their intentions. Moreover, whereas global perceived barriers were associated with lower intentions, practical barriers were associated with higher intentions.

CONCLUSIONS

Perceived barriers are multidimensional and vary systematically as a function of people's behavioral intentions.

Ohio Appalachia public health department personnel: human papillomavirus (HPV) vaccine availability, and acceptance and concerns among parents of male and female adolescents

Public health departments (n = 48) serving the 32 counties of Ohio Appalachia were contacted to determine human papillomavirus (HPV) vaccine availability and to assess patient and parental attitudes, perceived barriers, and decisional differences about vaccination for male and female adolescents. Nurses or nursing supervisors in 46 of 48 health departments agreed to participate with 45 (97.8 %) reporting that HPV vaccines were available for males and females. HPV vaccination barriers reported most frequently were lack of knowledge about the vaccines, concerns about potential side effects, the newness of the HPV vaccines, and parents believing their children were not sexually active or were too young to receive an HPV vaccine. Provider reports of the primary differences in the acceptability of an HPV vaccine among parents of males compared to the parents of females were lack of awareness that an HPV vaccine was available for males, not understanding why the vaccine should be given to males, and fear of vaccination increasing sexual promiscuity among female adolescents. Half of the health departments (n = 24) reported that parents of females were more receptive toward HPV vaccination, 16 health departments reported no difference in acceptability based on gender of the child, and 5 health departments reported that parents of males were more receptive. This study suggests that there are different informational needs of males and females and parents of male and female children when making an informed decision about HPV vaccination. Findings highlight content to include in strategies to increase HPV vaccination rates among Appalachia Ohio residents.

Correlates of human papillomavirus vaccination rates in low-income, minority adolescents: a multicenter study

BACKGROUND

Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence.

METHODS

Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11-21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care.

RESULTS

Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11-<13 (46%) and 13-<18 (47%) initiated vaccination than those aged 18-21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases.

CONCLUSIONS

Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.

Confusion about Pap smears: lack of knowledge among high-risk women

BACKGROUND

The impact of the Papanicolaou (Pap) smear on the prevention of cervical cancer is one of the greatest public health success stories. However, it is not clear if women understand the purpose of the Pap smear despite recent advancements and national attention over cervical cancer prevention. The purpose of this study was to examine Pap smear knowledge among three high-risk populations at different points in time.

METHODS

Women from three separate human papillomavirus (HPV) psychosocial studies completed surveys assessing Pap smear knowledge: (1) HPV-positive women (prevaccine population in 2005-2006, n=154, mean age 23.5), (2) college women (postvaccine population in 2008, n=276, mean age 18.9), and (3) minority college women (postvaccine population in 2011, n=711, mean age 23.3). Frequencies and logistic regression were employed to examine associations between demographic factors and accurate knowledge of Pap smear testing within each study.

RESULTS

Approximately one quarter of participants across all three samples did not know that the Pap smear is a test for cervical cancer. Participants also incorrectly believed that the Pap smear tests for HPV (82%-91%), vaginal infections (76%-92%), yeast infections (65%-86%), gonorrhea (55%-81%), herpes (53%-80%), HIV/AIDS (22%-59%), and pregnancy (17%-38%). Among all three studies, older age was the only factor significant with higher Pap knowledge. Higher HPV knowledge scores were significantly associated with higher Pap knowledge in studies 2 and 3 only.

CONCLUSIONS

Knowledge about the purpose of the Pap smear remains low. Findings underscore the significant need for clear and consistent messages among high-risk women regarding the prevention of cervical cancer and other reproductive health conditions.

Knowledge of the HPV vaccine and its association with vaccine uptake among female higher-education students in Greece

The aims of the study were to assess the awareness and knowledge of HPV vaccination among female university and technological institutes students, and their association with vaccine uptake, and to identify the variables associated with higher levels of knowledge.