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Enskär I, Fransson E, Enskär K, Nevéus T, Grandahl M. School children's perceptions about being offered the HPV vaccination - A focus group study. Acta Paediatr 2024; 113:1672-1678. [PMID: 38551330 DOI: 10.1111/apa.17225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/12/2024]
Abstract
AIM There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views. METHODS We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis. RESULTS This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents. CONCLUSION We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.
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Affiliation(s)
- Ida Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mattebo M, Gottvall M, Grandahl M. School Nurses' Perceptions and Experiences of Delivering a School-Based Intervention to Improve Primary Prevention of Human Papillomavirus Among Adolescents-A Focus Group Study Following a Randomized Controlled Trial. J Sch Nurs 2024; 40:166-173. [PMID: 34632854 PMCID: PMC10924545 DOI: 10.1177/10598405211046174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present qualitative study is a part of the process evaluation of a complex intervention, the randomized controlled trial, "Prevention of human papillomavirus (HPV) in a school-based setting." We aimed to explore participating school nurses' perceptions and experiences of delivering the educational HPV intervention to adolescents aged 16. Focus group interviews were conducted with school nurses (n = 20) and analyzed with inductive qualitative content analysis. The overall theme Easily adapted into the existing role as a school nurse permeated the participants' views. The nurses were in favor of delivering an intervention that increased the HPV vaccination rates and improved beliefs and awareness about HPV prevention. It suits their work and health-promoting aspect of their role well and can easily be adapted into the current school health consultant curriculum. Having material in different languages to share with adolescents and their parents to promote equal health was deemed important.
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Affiliation(s)
- Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Gottvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, The Red Cross University College, Huddinge, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Urrutia MT, Araya AX, Gajardo M, Chepo M, Torres R, Schilling A. Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary. Vaccines (Basel) 2023; 11:1486. [PMID: 37766161 PMCID: PMC10536942 DOI: 10.3390/vaccines11091486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.
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Affiliation(s)
- María-Teresa Urrutia
- School of Nursing, Universidad Andrés Bello, Santiago 8370134, Chile; (A.-X.A.); (M.C.)
| | | | - Macarena Gajardo
- School of Medicine, Universidad de Chile, Santiago 9170022, Chile;
| | - Macarena Chepo
- School of Nursing, Universidad Andrés Bello, Santiago 8370134, Chile; (A.-X.A.); (M.C.)
| | - Romina Torres
- Sistema de Bibliotecas UC, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
| | - Andrea Schilling
- Clinical Research Center, Institute of Science and Innovation in Medicine, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago 7610315, Chile;
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Choi S, Ismail A, Pappas-Gogos G, Boussios S. HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens 2023; 12:pathogens12020298. [PMID: 36839570 PMCID: PMC9960303 DOI: 10.3390/pathogens12020298] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.
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Affiliation(s)
- Sunyoung Choi
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - Ayden Ismail
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, 6th Kilometer, 68100 Alexandroupolis, Greece
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or or
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Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers' Perspective. Vaccines (Basel) 2023; 11:vaccines11020310. [PMID: 36851188 PMCID: PMC9962905 DOI: 10.3390/vaccines11020310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges. METHODS Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. RESULTS Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. CONCLUSIONS Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.
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Ferreira GRON, Formigosa JADS, Lira ALBDC, Reis RK, Gir E, Freitas WLS, Carvalho JN, Gonçalves LHT, Botelho EP, Ramos AMPC. The Family Health Strategy Influence on the Human Papillomavirus Vaccine Acceptance in a Peripheral Community of the Brazilian Amazon Region. Health Equity 2022; 6:852-861. [DOI: 10.1089/heq.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Renata Karina Reis
- Graduate Program in Fundamental Nursing, Ribeirão Preto, Sao Paulo, Brazil
| | - Elucir Gir
- Graduate Program in Fundamental Nursing, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Jacira Nunes Carvalho
- Graduate Nursing Program at the Federal University of Pará (UFPA), Belém, Pará, Brazil
| | | | - Eliã Pinheiro Botelho
- Graduate Nursing Program at the Federal University of Pará (UFPA), Belém, Pará, Brazil
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Herbert C, Curtin C, Epstein M, Wang B, Lapane K. Uptake of HPV Vaccine among young adults with disabilities, 2011 to 2018. Disabil Health J 2022; 15:101341. [PMID: 35659860 PMCID: PMC9653512 DOI: 10.1016/j.dhjo.2022.101341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about human papillomavirus (HPV) vaccine uptake among young adults with disabilities (YAWD), despite this population having a higher risk of HPV infection and related cancers compared to the general population. OBJECTIVE To compare the prevalence of HPV vaccination among young adults with disabilities to young adults without disabilities. We hypothesized that YAWD would have a lower prevalence of HPV vaccination than the general population. METHODS This cross-sectional study used data for the years 2011 to 2018 of the National Health Interview Survey. Our analysis included 14,577 people (weighted n = 34,420,024) aged 18 to 26 years. Univariate and multivariable logistic models were used to estimate the role of disability on HPV vaccination uptake among young adults and to identify potential factors associated with HPV vaccination among YAWD. RESULTS The proportion of female and male YAWD with HPV vaccination was similar to those without disabilities, regardless of sex (Female Adjusted Odds Ratio (OR): 1.16; 95% Confidence Interval (CI): 0.91 to 1.48; Male Adjusted OR: 1.05; 95% CI: 0.69 to 1.60). Among female and male YAWD, the proportion with HPV vaccination was 56.1% and 28.5%, respectively. Other factors significantly associated with HPV vaccination among YAWD included age, country of birth, healthcare utilization, and insurance status. CONCLUSIONS HPV vaccination among YAWD did not differ significantly from those without disabilities; however, the prevalence of HPV vaccination among young adult males and females remains significantly below national goals. Connecting young adults, specifically male YAWD, to the healthcare system is of utmost importance to improve HPV vaccination uptake.
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Affiliation(s)
- Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Carol Curtin
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mara Epstein
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kate Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Venderbos JR, Eilers R, de Vries H, van Zoonen K. A qualitative study of parental associations and beliefs regarding the HPV vaccination for Dutch boys. BMC Public Health 2022; 22:1188. [PMID: 35701791 PMCID: PMC9196852 DOI: 10.1186/s12889-022-13605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Human Papillomavirus (HPV) occurs in 80% of the sexually active population and may cause certain types of cancers among men and women. Vaccination against HPV could prevent cancers associated with HPV. The Dutch National Immunization Program (NIP) only includes HPV vaccination for girls, but the HPV vaccination for boys will be implemented in 2022. Little is known about the awareness of parents and their attitudes regarding the vaccination for boys. However, these concepts might influence the intention to vaccinate one’s child. Gaining insight in these factors could lead to more effective communication strategies. Methods This qualitative research aimed to explore parental associations and beliefs regarding the HPV vaccination for boys. In total, 16 interviews were conducted with parents. Topics discussed were primary associations with vaccinations, associations with HPV-vaccination and information needs regarding the HPV vaccination for boys. Results Most parents were unaware about HPV infections in boys as well as the possibility to vaccinate their sons. Furthermore, after hearing about the vaccine parents reported uncertainties about anticipated adverse effects of the vaccine. Other themes that emerged were difficulties with the proposed age at which boys would be offered the vaccination and low risk perception of the virus. Conclusion Public campaigns regarding (the HPV) vaccination should improve (parental) awareness about the virus and the vaccination, and increase knowledge. Moreover, it should address concerns regarding vaccination and be transparent about decision making. For example, a rationale why HPV vaccination is needed for boys who turn 10 years and its advantage to reducing risks for boys to contract HPV related cancers should be provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13605-y.
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Affiliation(s)
- Judith R Venderbos
- Faculty of Health, Medicine and life Sciences, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Renske Eilers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, 3720 MA, Bilthoven, The Netherlands
| | - Hein de Vries
- Faculty of Health, Medicine and life Sciences, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Kim van Zoonen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, 3720 MA, Bilthoven, The Netherlands.
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HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 2022; 19:306-327. [PMID: 35105976 PMCID: PMC8805140 DOI: 10.1038/s41571-022-00603-7] [Citation(s) in RCA: 272] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
Abstract
Human papillomavirus (HPV)-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the UICC/AJCC staging system separates HPV+ OPSCC from its HPV-negative (HPV−) counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment de-intensification as a means to improve quality of life while maintaining acceptable survival outcomes. In addition, owing to the distinct biology of HPV+ OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage owing to a lack of symptoms in the early stages; therefore, a need exists to identify and validate possible diagnostic biomarkers to aid in earlier detection. In this Review, we provide a summary of the epidemiology, molecular biology and clinical management of HPV+ OPSCC in an effort to highlight important advances in the field. Ultimately, a need exists for improved understanding of the molecular basis and clinical course of this disease to guide efforts towards early detection and precision care, and to improve patient outcomes. The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in most developed countries. In this Review, the authors provide an overview of the epidemiology, molecular biology and treatment of HPV-positive OPSCC, including discussions of the role of treatment de-escalation and emerging novel therapies. The incidence of human papillomavirus-associated oropharyngeal cancer (HPV+ OPSCC) is expected to continue to rise over the coming decades until the benefits of gender-neutral prophylactic HPV vaccination begin to become manifest. The incidence of HPV+ OPSCC appears to be highest in high-income countries, although more epidemiological data are needed from low- and middle-income countries, in which HPV vaccination coverage remains low. The substantially better prognosis of patients with HPV+ OPSCC compared to those with HPV– OPSCC has been recognized in the American Joint Committee on Cancer TNM8 staging guidelines, which recommend stratification by HPV status to improve staging. The molecular biology and genomic features of HPV+ OPSCC are similar to those of other HPV-associated malignancies, with HPV oncogenes (E6 and E7) acting as key drivers of pathogenesis. Treatment de-intensification is being pursued in clinical trials, although identifying the ~15% of patients with HPV+ OPSCC who have recurrent disease, and who therefore require more intensive treatment, remains a key challenge.
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Nahum AS, Vongsachang H, Friedman DS, Collins ME. Parental Trust in School-Based Health Care: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:79-91. [PMID: 34773404 DOI: 10.1111/josh.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health care delivery in schools is a frequently adopted approach to reduce health care inequalities. Lack of parental trust has been identified as impacting participation in school-based health care programs (SBHPs). The aim of our systematic review is to outline themes related to parental trust in SBHPs. METHODS We searched MEDLINE, Embase, CINHAL, ERIC, PsycInfo, and Web of Science for articles published between 1969 and 2019. Eligible studies (1) were peer-reviewed primary research articles; (2) were school-based health interventions or screening programs; (3) included parental trust data; and (4) were carried out on schoolchildren from pre-K to grade 12. Study location, data collection date, number of participants, demographics, intervention type, study aim and methodology, and all trust themes mentioned, were extracted. Studies were critically appraised using the CASP checklist for qualitative research. RESULTS We identified 9 themes related to parental trust in SBHPs: (1) safety; (2) effectiveness; (3) health professionals' training and credentials; (4) communication; (5) confidentiality; (6) providers; (7) government, authorities, and health service; (8) the pharmaceutical industry; and (9) research and data sharing. CONCLUSIONS The themes identified provide a framework for examining trust in SBHPs, and may guide the development of interventions to increase trust and engagement in SBHPs.
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Affiliation(s)
- Andrea S Nahum
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287
- UCL Medical School, University College London, 74 Huntley Street, Bloomsbury, London, WC1E 6DE, UK
| | - Hursuong Vongsachang
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Megan E Collins
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
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Grandahl M, Nevéus T. Barriers towards HPV Vaccinations for Boys and Young Men: A Narrative Review. Viruses 2021; 13:v13081644. [PMID: 34452508 PMCID: PMC8402923 DOI: 10.3390/v13081644] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. Results: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. Conclusions: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.
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Abstract
AIMS This article examines the reasons for partial and complete refusal of childhood vaccination as reported by parents in Finland. It analyzes perceptions and experiences central in vaccination decisions. METHODS The analysis is based on 38 in-depth interviews with Finnish parents who have refused all or several vaccines for their children. The interviews were analyzed using qualitative content analysis. RESULTS Three categories of reasons were identified in the analysis: 1) risks and effects of vaccination - concern about and/or experiences of possible side-effects was the most important reason for avoiding vaccines; 2) distrust - participants did not trust vaccination recommendations made by health officials and medical professionals due to perceived bias in medical research, ties between health officials and the pharmaceutical industry, and personal experiences of (suspected) adverse effects and the way these concerns were received in healthcare institutions; 3) health perceptions and practices - parents supported their vaccination choices with complementary and alternative medicine treatments and alternative health understandings. Many stated that contracting vaccine-preventable illnesses would provide longer lasting and more 'natural' immunity than vaccination, and possibly other health benefits. CONCLUSIONS A loss of trust in medical and public health actors was central to the process in which parents came to question, contest, and eventually refuse childhood vaccination. The adverse effects of the Pandemrix vaccine in 2009-2010 have been important in leading to distrust and contestation. Distrust may relate to personal experiences of (suspected) adverse effects or to broader concerns over the neutrality of health authorities and the trustworthiness of medical research.
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Brenner N, Mentzer AJ, Hill M, Almond R, Allen N, Pawlita M, Waterboer T. Characterization of human papillomavirus (HPV) 16 E6 seropositive individuals without HPV-associated malignancies after 10 years of follow-up in the UK Biobank. EBioMedicine 2020; 62:103123. [PMID: 33248371 PMCID: PMC7704422 DOI: 10.1016/j.ebiom.2020.103123] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antibodies against the HPV16 oncoprotein E6 are promising biomarkers for HPV16-driven oropharyngeal cancer (HPV16-OPC) due to their high sensitivity and specificity, and prospective manifestation. In previous studies, 0•7% of controls without HPV-associated malignancies were HPV16 E6 seropositive of which only a minority is expected to develop HPV16-driven cancer. We aimed to characterise HPV16 E6 antibodies in individuals without HPV-associated malignancies. METHODS We analysed serum antibodies against HPV16 E6, E7, L1 and HPV18 L1 in a random sample (n = 9,695) of the prospective UK Biobank cohort (UKB). Excluding individuals with potentially HPV-associated malignancies (n = 192), we assessed risk factors for seropositivity by logistic regression. FINDINGS In individuals without potentially HPV-associated malignancies (n = 9,503), the HPV16 E6 seroprevalence was 0•8%. Seropositivity against HPV16 E6 and all other HPV antigens was strongly associated with sexual behaviour. The seroprevalence of HPV16 E6, L1 and HPV18 L1 increased with the number of lifetime sex partners (ptrend<0•005), and all HPV antibodies were associated with same-sex intercourse (ORE6 3•1, 95%CI 1•4-6•9; reference category: no same-sex intercourse). HPV16 E6 and L1 seropositivity were associated with young age (≤17 years) at sexual debut (ORE6 2•0, 95%CI 1•1-3•7) compared with individuals reporting sexual debut at age ≥20 years. INTERPRETATION This is the first study characterising HPV16 E6 antibodies in the general UK population. Their strong association with sexual behaviour, and overlapping risk factor profiles with other HPV antibodies support their relevance for HPV16-OPC disease prediction. However, additional risk stratification will be required to identify individuals at highest risk to develop HPV16-OPC.
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Affiliation(s)
- Nicole Brenner
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Research Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Alexander J Mentzer
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Michael Hill
- MRC-Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Naomi Allen
- UK Biobank, Stockport, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Pawlita
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Research Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Research Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Jeanne M, Eve S, Pasquier J, Blaizot X, Turck M, Raginel T. [Human papillomaviruses vaccination: Vaccine intentions of parents of children aged 10 to 11s in Normandy schools after an information campaign during the 2015-2016 school year]. Presse Med 2019; 48:e369-e381. [PMID: 31785940 DOI: 10.1016/j.lpm.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2015, the vaccine against human Papillomavirus (hPV) was recommended in France for children from 11 to 14 years-old. This study assessed the knowledge of parents from Normandy about this vaccine and measured the impact of an information campaign on their intent to have their children vaccinated. METHODS Parents from Normandy with children in sixth-grade class, aged 10 to 11, during the 2015-2016 school year were included. The secondary schools were selected in collaboration with academic institutions. The intent to have their child vaccinated was measured with a questionnaire distributed to children in April 2016 and collected from May to June 2016 by school nurses. RESULTS Among the 16 selected secondary schools, 1428 questionnaires were distributed and 864 (60.5 %) were collected regardless of the gender of the child. Among the 439 girls, 85.9 % were not vaccinated against hPV. The intent to vaccinate was higher when the parent who responded was the mother (P<0.001). Among the parents who took note of the information booklet, 73.7 % found this information useful. There was a significant association between the knowledge about the vaccine against hPV and the intent to vaccinate (P<0.001). The percentage of vaccinated girls was significantly higher when their parents were informed (10.9 % versus 3.2 %). We noticed a significant rise of the intent to vaccinate children when information booklets were distributed (P<0.001). CONCLUSION The vaccination rate after specific information about vaccination against hPV was significantly higher. The information campaign has thus a significant positive impact.
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Affiliation(s)
- Mathilde Jeanne
- Normandie Université, Unicaen, faculté de médecine, département de médecine générale, 14000 Caen, France
| | - Ségolène Eve
- Normandie Université, Unicaen, faculté de médecine, département de médecine générale, 14000 Caen, France
| | - Julie Pasquier
- Réseau OncoNormandie, 14000 Caen, France; Observatoire régionale de Santé de Basse-Normandie, 14200 Hérouville Saint-Clair, France
| | | | - Mélusine Turck
- CHU de Caen, départment de gynécologie-obstétrique, 14000 Caen, France
| | - Thibaut Raginel
- Normandie Université, Unicaen, faculté de médecine, département de médecine générale, 14000 Caen, France; Normandie université, Unicaen, ANTICIPE, Inserm, 14000 Caen, France.
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15
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Mammas IN, Dalianis T, Doukas SG, Zaravinos A, Achtsidis V, Thiagarajan P, Theodoridou M, Spandidos DA. Paediatric virology and human papillomaviruses: An update. Exp Ther Med 2019; 17:4337-4343. [PMID: 31186676 PMCID: PMC6507507 DOI: 10.3892/etm.2019.7516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Tina Dalianis
- Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden
| | - Sotiros G. Doukas
- Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, CT 06519, USA
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, 1516 Nicosia, Cyprus
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals NHS Trust, TR1 3LQ Cornwall, UK
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women and Children's Health, Noble's Hospital, IM4 4RJ Douglas, Isle of Man, British Isles
| | - Maria Theodoridou
- First Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, 115 27 Athens, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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16
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Sherman SM, Nailer E. Attitudes towards and knowledge about Human Papillomavirus (HPV) and the HPV vaccination in parents of teenage boys in the UK. PLoS One 2018; 13:e0195801. [PMID: 29641563 PMCID: PMC5895045 DOI: 10.1371/journal.pone.0195801] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/29/2018] [Indexed: 01/27/2023] Open
Abstract
The incidence of cancers attributable to Human Papillomavirus (HPV) that affect males is on the rise. Currently in the UK teenage boys are not vaccinated against HPV while teenage girls are. The rationale for not vaccinating boys is that vaccinating girls should provide herd immunity to boys, however this does not protect men who have sex with men or men who have sex with unvaccinated women. The issue of whether to vaccinate boys or not is a controversial one with considerable lobbying taking place to change the existing policy. On one side of the debate are financial considerations while on the other side health equality is important. One avenue that has not been presented is the parental perspective. The current study uses a self-report questionnaire to explore what parents of teenage boys know about HPV and the vaccine and whether they want the vaccine for their sons. Only half of the parents had heard of HPV prior to completing the survey. Of those who had heard of HPV, knowledge about the health sequelae of HPV for men was poor relative to their knowledge about its impact on female health. Parents who would be willing to vaccinate their sons had higher levels of knowledge about HPV than those parents who would be unwilling or unsure. Irrespective of whether they had previously heard of HPV or not, once provided with a brief description of HPV, the majority of parents thought that boys should be offered the vaccination. There is a pressing need for public education about the potential impact of HPV on male health in order to facilitate uptake of the vaccine in the event of the vaccination programme being extended to men or to facilitate informed decision making about seeking the vaccine privately in the event that it isn't.
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Affiliation(s)
| | - Emma Nailer
- School of Psychology, Keele University, Keele, Staffs, United Kingdom
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17
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Grandahl M, Chun Paek S, Grisurapong S, Sherer P, Tydén T, Lundberg P. Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand. PLoS One 2018; 13:e0193054. [PMID: 29447271 PMCID: PMC5814087 DOI: 10.1371/journal.pone.0193054] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/ related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.
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Affiliation(s)
- Maria Grandahl
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Seung Chun Paek
- Department of Society and Health, Mahidol University, Salaya Campus, Bangkok, Thailand
| | - Siriwan Grisurapong
- Department of Society and Health, Mahidol University, Salaya Campus, Bangkok, Thailand
| | - Penchan Sherer
- Department of Society and Health, Mahidol University, Salaya Campus, Bangkok, Thailand
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Pranee Lundberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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18
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Perceived cervical cancer risk among women treated for high-grade cervical intraepithelial neoplasia: The importance of specific knowledge. PLoS One 2017; 12:e0190156. [PMID: 29272293 PMCID: PMC5741232 DOI: 10.1371/journal.pone.0190156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Women with high-grade cervical intraepithelial neoplasia (CIN) are at increased risk for developing cervical cancer. We examine how women with high-grade CIN perceive their own risk, and about pertinent knowledge concerning human high-risk papillomavirus (HPV), CIN and cervical cancer. Methods All patients who underwent first-time treatment of high-grade CIN (grade 2+) were followed-up at 6-months at the Karolinska University Hospital, Stockholm, Sweden and were invited to participate in the present study. This included completion of a questionnaire examining sociodemographic characteristics, self-perceived risk of cervical cancer without regular gynecologic follow-up, and 14 queries about HPV, CIN and cervical cancer knowledge, inter alia. Results The participation rate was 96.6%, with 479 women enrolled in this study. Over 75% were age 40 or younger, over half had completed university education. Most were married or co-living with their partner and were gainfully employed. On a scale scored from 10 (highest self-perceived risk of cervical cancer without regular gynecologic follow-up) to 1 (lowest self-perceived risk), 64% rated their risk ≥ 7; almost 30% viewed their risk ≤ 6 and 7.5% did not rate their risk. A Specific Knowledge Scale with six of the queries explained 58.3% of the total variance. Nearly 30% of the women answered four or fewer of the six queries correctly. The Specific Knowledge Scale predicted self-perceived cervical cancer risk (Odds ratio = 11.3, 95% Confidence Interval 5.6 − 22.6) after adjusting for age, income and education. Most of the women with low self-perceived cervical cancer risk did not rate their HPV-related knowledge as good. However, 32 predominantly university-educated women, with low self-perceived cervical cancer risk, considered their HPV-related knowledge good. Conclusion It is vital to effectively convey accurate information about these patients’ cervical cancer risk, needed preventive and follow-up measures, together with the relevant specific knowledge, for these women at increased risk for developing cervical cancer. Tailored programming to address these knowledge gaps is needed.
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Grandahl M, Larsson M, Tydén T, Stenhammar C. School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study. PLoS One 2017; 12:e0175883. [PMID: 28419156 PMCID: PMC5395208 DOI: 10.1371/journal.pone.0175883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.
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Affiliation(s)
- Maria Grandahl
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Christina Stenhammar
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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