Will they lead by example? Assessment of vaccination rates and attitudes to human papilloma virus in millennial medical students

Medical and dental student knowledge about COVID-19 and influenza vaccines impact opinions about vaccine advocacy and future practice

Introduction

The World Health Organization has identified vaccine hesitancy as a global public health challenge. Healthcare providers are among the most influential and trusted figures for vaccine counseling. This article focuses on COVID-19 and influenza personal immunization behaviors, vaccine knowledge and opinions, and vaccine counseling confidence among future healthcare providers - dental and medical students.

Methods

A cross-sectional anonymous online survey was conducted at four dental schools and one allopathic medical school in the United States. Items included personal vaccination status for the COVID-19 and influenza vaccines and vaccine-specific items developed based on past research to assess knowledge, opinions, and behaviors.

Results

Two hundred and thirty-two medical and 221 dental students completed the survey. 68 and 55% scored average/above-average knowledge on COVID-19 and influenza vaccine items, respectively. There were significant differences between those with average/above-average and below-average knowledge scores regarding learning about, recommending, and advocating for vaccines and counseling vaccine-hesitant patients for both vaccines (p < 0.0001). Although higher-knowledge students had higher vaccination rates (p < 0.0001), many had insufficient knowledge about vaccines.

Discussion

Healthcare providers play a crucial role in vaccine advocacy. The identified knowledge gaps are significant as they impact quality of patient care. And opinions about future vaccination practice such as recommending, providing, and counseling about vaccines. Equipping students with knowledge and communication skills will enable them to be strong vaccine advocates to improve overall public health.

Graduate and Health Professional Student Knowledge, Attitudes, Beliefs, and Behavior Related to Human Papillomavirus and Human Papillomavirus Vaccination: A Scoping Review of the Literature

Human papillomavirus (HPV) is a common sexually transmitted infection. Despite a safe and effective vaccine, uptake continues to be suboptimal. Recently, focus has moved to college campuses in an effort to increase vaccination rates. Little is known about the extent of efforts to reach graduate students on college campuses in the United States and the vaccination rates within this subpopulation. This scoping review assessed the literature on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination among graduate and post-baccalaureate professional students in the United States. This review also aims to identify areas for further research to improve institutions' abilities to create health programming to increase HPV awareness and HPV vaccination coverage on their campuses. Publications focusing on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination in post-baccalaureate students were included. The systematic review of PubMed, CINAHL, and Embase identified 2562 articles, and 56 articles met all inclusion criteria and were included in this scoping review. A majority of the reviewed studies investigated some combination of knowledge, attitudes, behaviors, and beliefs about HPV and the HPV vaccine in students in professional programs such as medicine. Study design approaches were primarily cross-sectional, utilizing web-based survey distribution methods. HPV vaccination status and HPV screening behaviors were primarily measured through participant self-report. There is limited research investigating post-baccalaureate student knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination. There is a need for researchers to further investigate the needs of graduate students to create informative and effective HPV programming.

Do Not Throw Away Your Shot: Pilot Study in Improving Medical School Curricula Through Focused Vaccine Education

Introduction

With widely prevalent vaccine hesitancy and medical mistrust, future healthcare providers require knowledge of vaccines and comfort in discussing vaccines with patients. However, many U.S. medical schools do not offer formal or elective curricula focused on vaccine education.

Methods

We sought to identify the need for such a curriculum and student gaps in knowledge through a pilot study surveying first- and second-year medical students at a large Pennsylvania medical school to assess knowledge about vaccine initiatives/policies, comfort in discussing vaccines, attitudes toward curricular changes, and effects of COVID-19 on willingness for vaccine education.

Results

Many participants (>40%) reported insufficient knowledge of vaccine policy, vaccine development and testing, and community vaccine initiatives. The majority (>50%) indicated discomfort in discussing vaccines in a clinical setting. Importantly, 79% of participants reported insufficient coverage of vaccine topics in the current curriculum. A total of 54% decisively wanted formal/mandatory education versus 72% who decisively wanted elective education. Desiring formal education was associated with less comfort in discussing vaccines overall and with vaccine-hesitant people in clinical settings. Reassuringly, 74% of participants noted that the COVID-19 pandemic made them want to learn more about vaccines. Guided by these findings, we conducted a pilot elective teaching about vaccines through case studies, interactive discussions, and role-playing scenarios. Pre- and postcourse surveys showed improvement in student knowledge in all vaccine-related topics assessed.

Conclusions

These data can inform the development of formal and elective curricula that effectively prepare medical students for patients' vaccine questions.

The intentions of French health university students to recommend and to receive the HPV vaccine are mainly influenced by vaccine knowledge, confidence in vaccines and personal HPV vaccination

INTRODUCTION

Despite documented effectiveness in preventing several cancers, genital warts and safety of Human Papillomavirus (HPV) vaccine, immunization coverage among French adolescents remains far from the 80 % target. University health students (HS) in France may promote HPV vaccine through a national service (Service Sanitaire des Etudiants en Santé). We aimed to evaluate intentions to recommend the HPV vaccine to friends and relatives, to receive HPV vaccine, and to identify factors associated with these attitudes.

METHODS

We conducted a cross-sectional survey in five French Universities from October 2019 to February 2020, using a self-administered online questionnaire. We used bivariable and multivariable logistic regression models to identify determinants of behavior around HPV vaccine: (i) individual intention for vaccination, and (ii) vaccine recommendation to friends and relatives.

RESULTS

Among the 732 respondents (180 men, 552 women), 305 (41.7%) reported previous HPV vaccination (54.5 % among women), 504 (68.9%) would recommend the HPV vaccine to friends and relatives, 532 (72.7%) respondents would be vaccinated today if it was recommended for them. Intentions to recommend or to receive the HPV vaccine were less frequent in nursing students compared to medical and pharmacy students. After adjustment for demographical factors, HPV vaccine knowledge was associated with intention [aOR 1.30 (95%-confidence interval, 1.15-1.47)] and recommendation [1.26 (1.10-1.45)], respectively. Additionally, adjusting for knowledge about HPV infections, and confidence in vaccines in general was associated with vaccine intention [1.55, (1.30-1.84)] and recommendation [1.52 (1.24-1.86)]. HPV-vaccinated HS were more prone to recommend the HPV vaccine to friends and relatives [10.9 (6.6-17.9)].

CONCLUSION

A majority of HS would accept and/or recommend HPV vaccines. HS with greater knowledge about the HPV vaccine were more prone to recommend it. Strengthening knowledge about HPV and its vaccination is probably necessary before their Involvement in a HPV immunization program.

Surgical Treatment for Early Cervical Cancer in the HPV Era: State of the Art

Cervical cancer (CC) is the fourth most common cancer among women worldwide. The aim of this study is to focus on the state of the art of CC prevention, early diagnosis, and treatment and, within the latter, the role of surgery in the various stages of the disease with a focus on the impact of the LACC study (Laparoscopic Approach to Cervical Cancer trial) on the scientific debate and clinical practice. We have discussed the controversial application of minimally invasive surgery (MIS) for tumors < 2 cm and the possibility of fertility-sparing surgery on young women desirous of pregnancy. This analysis provides support for surgeons in the choice of better management, including patients with a desire for offspring and the need for sentinel node biopsy (SNB) rather than pelvic lymphadenectomy for tumors < 4 cm, and without suspicious lymph nodes' involvement on imaging. Vaccines and early diagnosis of pre-cancerous lesions are the most effective public health tool to tackle cervical cancer worldwide.

HPV Knowledge Retention and Concurrent Increase in Vaccination Rates 1.5 Years After a Novel HPV Workshop in Medical School

Comprehensive education regarding human papillomavirus (HPV) pathogenesis, vaccination, and patient counseling are not routinely included in the medical school curriculum; consequently, student and provider knowledge, especially concerning head and neck pathology, remains low. The objective of this study was to demonstrate long-term retention of HPV knowledge and positive attitudes towards HPV vaccination after attending our novel HPV workshop, with a focus on knowledge of oropharyngeal cancer. A follow-up survey was administered to medical students 1.5 years after the initial completion of the workshop. HPV vaccination records from the student-led clinic were collected from the immunization information system. Awareness that HPV causes oropharyngeal cancer was present in 33% of medical students pre-curriculum; immediate and long-term post-curricular awareness of this association remained at 90% or higher (p < 0.0001). Comfort with HPV counseling, having enough information to recommend the vaccine, and knowledge of HPV malignancies, symptoms, transmission, and vaccination schedule remained persistently elevated over pre-curriculum scores (p < 0.05). Long-term knowledge scores were also higher than a control group of medical students at the same stage of training who had never participated in the workshop (p < 0.05). HPV vaccination rates at the medical school's student-run clinic also increased after the curriculum, from an average of 1.89 HPV vaccines given per clinic to 3.55 (p = 0.001). This study demonstrates that knowledge and positive attitudes were maintained 1.5 years after participating in this HPV curriculum during students' preclinical years of medical school. Additionally, an increase in HPV vaccination rates occurred at a student-led clinic, indicating a positive clinical impact on the curriculum.

The Evaluation of a Digital Health Intervention to Improve Human Papillomavirus Vaccine Recommendation Practices of Medical Students

We investigated what is being taught about HPV in US medical schools and evaluated a digital health intervention for medical students to increase their intention to provide a high-quality HPV vaccine recommendation. An online survey was emailed to Academic Deans at the 124 accredited US Schools of Medicine and Osteopathic Medicine between February and April 2018. A digital educational module was emailed to medical students in June 2020. A single-subject longitudinal study design was employed. Pre- post-survey administration measured change in knowledge, attitudes, subjective norms, perceived behavioral control, and intention to recommend HPV vaccine. Gaps in medical school curricula were found. Very few schools (~ 9%) reported teaching content on HPV prevention strategies or patient education. For the digital intervention, independent and dependent variables increased positively. Perceived behavioral control improved at significant levels as participants felt more confident addressing parents' concerns about the vaccine (p < 0.001) and more confident recommending the vaccine for patients (p < 0.05) post module. On the pre-survey, only 6% of the sample knew the most effective HPV vaccine communication style and on the post-survey 81% correctly identified it (p < 0.001). The intervention increased HPV and HPV vaccine knowledge, self-efficacy, and intention to provide a high-quality HPV vaccine recommendation to patients.

Inactivated COVID-19 vaccine hesitancy among midwifery students: a prospective online survey

Limited information on vaccines' reliability and lack of sufficient scientific data may cause suspicion among individuals concerning the Coronavirus Disease-2019 (COVID-19) vaccines. This study aimed to investigate the attitudes of midwifery students to an inactivated COVID-19 vaccine. This prospective online survey was conducted between 01 March and 01 May 2021 with 172 midwifery students. An anonymous online survey was developed by the researchers, taking into account the studies in the literature examining the attitudes of individuals towards the vaccine. The online survey included a total of 19 questions, covering five main topics. The study revealed that 118 (68%) of 172 midwifery students were hesitant to get vaccinated. There was a significant difference between the vaccine-hesitant and -accepting groups regarding the general attitude towards the vaccine (respectively; <0.001, 0.001). It was determined that 48.1% of the vaccine-accepting participants strongly agreed that this vaccination should be mandatory for all midwifery students working in a clinical practice internship. Higher vaccination willingness levels are expected in students who attend health curricula due to the high literacy level in health-related issues. In conclusion, healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.IMPACT STATEMENTWhat is already known on this subject? Limited information on vaccines' reliability and lack of sufficient scientific data caused suspicion about the COVID-19 vaccines among many people .What do the results of this study add? Almost half of the participants in both groups agreed that the vaccine could be ineffective if the virus is mutated. Nearly half of the hesitant group thought that the COVID-19 vaccine might not be effective and were concerned about serious side effects.What are the implications of these findings for clinical practice and/or further research? This study reveals that healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.

Knowledge of cervical cancer prevention and treatment, and willingness to receive HPV vaccination among college students in China

BACKGROUND

Cervical cancer is the fourth most common cancer in women. Up to 99% of cervical cancer cases are associated with high-risk human papillomavirus (HPV). Sexual behavior is a direct risk factor for HPV infection, and sexually active college students, therefore, receive attention for HPV vaccination. At present, most Chinese studies lack of in-depth research on influencing factors, and are limited to cervical cancer, HPV, or HPV vaccine, without comprehensive consideration. This study investigated Chinese college students' cervical cancer prevention and treatment knowledge level, and explored the influencing factors, and understood their willingness to receive HPV vaccination. The findings of this study will lay a foundation for promoting the early screening of cervical cancer and vaccination process.

METHODS

A total of 800 college students from four universities in Zhengzhou, China were selected by multistage random sampling method. A self-administered questionnaire on the knowledge of cervical cancer prevention and treatment, and willingness to receive HPV vaccination was carried out. A logistic regression model was conducted to analyze factors influencing knowledge of cervical cancer prevention and treatment among college students.

RESULTS

Up to 87.9% of college students said they had heard of cervical cancer. The proportion of college students with good knowledge of cervical cancer prevention and treatment was 46.7%. Logistic regression showed that gender, major, grade, level of education, the father's level of education, premarital sex attitude, and mother cervical cancer screening participation had a significant influence on cervical cancer prevention and treatment knowledge level (P < 0.05). In addition, 589 (74.0%) of college students had heard of HPV vaccine, and 92.8% of college students said they were willing to get vaccinated or recommended that their relatives and friends get vaccinated.

CONCLUSIONS

The knowledge level of cervical cancer prevention and treatment knowledge among college students in Zhengzhou is low. Many of them had poor knowledge about HPV vaccine, but their willingness to vaccination is high. Various health education modes should be carried out for people with different characteristics, to improve their knowledge of cervical cancer prevention and promote the vaccination process.

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

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

Leveraging teachable moments in cancer prevention by improving HPV vaccination in health professional students (HPS): A systematic review

Introduction

Vaccination against HPV is safe and effective in cancer prevention, yet vaccination uptake remains low. Strong recommendation of HPV vaccination by healthcare providers increases immunization rates, but gaps in knowledge persist surrounding HPV and HPV vaccination amongst health professional students (HPS). It is critical to educate HPS in all professions to maximize vaccination opportunities and increase vaccine uptake. The objective of this study is to evaluate evidence on HPV knowledge, vaccine uptake, and educational interventions in HPS to identify specific deficits to improve education.

Methods

A systematic literature search for articles on HPV vaccine uptake, knowledge, and educational interventions in HPS was performed in PubMed, Embase, Web of Science, CINAHL, and Scopus from January 1, 2006 – July 21, 2021. Included studies assessed HPS for HPV vaccine uptake, knowledge, counseling comfort, or educational interventions to increase HPV vaccine knowledge. Studies were screened for inclusion by 2 independent reviewers and evaluated for risk of bias. PRISMA guidelines for reporting were followed.

Results

Twenty-one unique articles met inclusion criteria and were included in the analysis. Of the studies included, 20 included knowledge, 11 included vaccine uptake, 8 included interventions, and 12 included counseling comfort. The students in the studies included medical (n=14), dental (n=7), dental hygiene (n=6), nursing (n=3), physician assistant (n=2), public health (n=1), and pharmacy (n=1). Across studies, HPV vaccine series initiation ranged from 34.6-70.3%, with 28.3-58.3% up to date on vaccination. Most students knew that HPV causes cervical cancer (99%), but fewer knew that HPV causes head and neck cancer (40-47%) and oropharyngeal cancer (45%). Educational interventions included team-based approaches and lectures, and improved outcomes including vaccine knowledge, vaccination schedule, and cancer knowledge. Medical students with lower knowledge of HPV were more hesitant to recommend vaccination at baseline but were more likely to recommend vaccination after an education session.

Discussion

Across HPS, inadequacies persist in HPV vaccine uptake, knowledge, and counseling comfort. It is critical to target vaccine uptake in this population and improve existing educational efforts to reduce preventable cancers. Institutions must prioritize HPV vaccine education to impact HPV related death.

HPV vaccine recommendation practices of current and future physicians in North Carolina: an exploratory study

We assessed human papillomavirus (HPV) prevention practices and HPV literacy of pediatricians, family physicians and medical students in North Carolina. An online survey was distributed to physicians in 2018, and paper surveys were collected among medical students in 2019. Surveys measured HPV literacy, HPV prevention practices and HPV prevention self-efficacy. In terms of comfort, 27% of medical students and 24% of physicians anticipated having an uncomfortable conversion when recommending the vaccine to patients. Most physicians (76%, n = 230) followed the HPV vaccine age recommendation guidelines; however, those with higher HPV vaccine knowledge were more compliant with the guidelines (P < 0.01). Female physicians were more likely to start routinely recommending the HPV vaccine to women (84%, n = 134 versus 72%, n = 92) and men (81%, n = 127 versus 71%, n = 84) between the ages of 9 and 12 years (P < 0.05). Only 27%, n = 73 of physicians and 18%, n = 19 of medical students followed/knew the 'provider-driven' HPV-recommended style. Female physicians were more likely to use this communication style (32%, n = 48 versus 20%, n = 23, P = 0.03). HPV prevention curriculum should be incorporated into medical programs. The gender-related practice patterns found indicate a need for training of male providers specifically. Quality improvement efforts are needed for all physicians to strengthen vaccine communication, recommendation practices and guideline adherence.

Human papillomavirus (HPV) and HPV vaccine knowledge, the intention to vaccinate, and HPV vaccination uptake among male college students

ObjectiveThis systematic mixed studies review aims to summarize the results of available research on knowledge of the human papillomavirus (HPV) and HPV vaccine, the intention to vaccinate, and HPV vaccination uptake among male college students. Methods: PubMed, ProQuest, EBSCO, PsycINFO, JSTOR, MEDLINE, and Google Scholar searches were performed to identify studies. A total of 39 studies were included in this review. Results: Most studies were cross-sectional (n = 27) and used convenience samples (n = 18). Although many students were aware of HPV and the HPV vaccine, gaps in their knowledge about the mode of transmission, symptoms, risk factors, and HPV vaccine mechanism were evident. The cost of HPV vaccination and concerns about safety and side effects were the most frequently reported barriers to obtaining the vaccination. Conclusion: More effort to increase knowledge about HPV and the uptake of the HPV vaccination among college men in the United States is necessary.

Vaccine Hesitancy Counseling-an Educational Intervention to Teach a Critical Skill to Preclinical Medical Students

INTRODUCTION

There has been a recent rise in public perception that vaccines are unsafe, fostering vaccine hesitancy (VH). Few interventions have focused on teaching medical students' communication skills for counseling vaccine-hesitant patients.

METHODS

Our educational intervention, designed for medical students, involved a self-study module followed by an interactive session on VH. Students practiced counseling vaccine-hesitant standardized patients (SPs). Faculty and SPs assessed student counseling skills. Students completed pre- and post-intervention surveys to assess attitudes and preparedness to counsel VH patients.

RESULTS

Students showed a better ability to talk to parents about Human Papillomavirus (HPV) vaccine concerns and Measles Mumps Rubella (MMR)/autism-related issues than to address patients' concerns related to the Varicella Zoster Virus (VZV) vaccine.Students' surveys pre- and post-intervention revealed significant improvement in their vaccination knowledge and comfort with counseling vaccine-hesitant patients. Student counseling skills as part of an Objective Structured Clinical Exam (OSCE) showed 73% of students asked about immunization and elicited SP concerns, but only 36% counseled appropriately.

CONCLUSIONS

In the face of emerging VH, physicians play a critical role in advising and influencing vaccination decisions. Therefore, it is a core responsibility of medical educators to train medical students on recommending vaccinations and responding effectively to vaccine-hesitant parents and patients. Our multifaceted interactive session provided preclinical students with knowledge and skills to improve communication skills with VH patients and parents and the need for ongoing practice of these VH counseling skills.

COVID-19 Vaccination Compliance and Associated Factors among Medical Students during an Early Phase of Vaccination Rollout-A Survey from Israel

COVID-19 is "a once-in-a-century" pandemic, bringing with it unparalleled health, social, and economic ramifications. As part of the world's efforts to restrain the pandemic, vaccine development has been expedited. This population-representative survey in Israel aimed to investigate whether the knowledge, attitudes, and vaccination status of medical students affect their intention to recommend COVID-19 vaccination (as well as reasons for refusal and acceptance of the vaccine). The questionnaire was anonymous, via Google Forms app in December 2021. One-hundred and four medical students completed the survey. Overwhelmingly, (91.3%) COVID-19 vaccination status and intention to receive the vaccine were positively associated with intention to recommend. Twenty-five percent of the students replied that they lacked knowledge regarding the vaccine. A statistically significant association was found between experiencing quarantine and the intention to be vaccinated (p = 0.034). There was a significant positive relationship between the number of symptoms from previous vaccines and the fear of COVID-19 (rs = 0.272, p < 0.01). Prior vaccination did not have an effect on COVID-19 vaccine hesitancy. This first study evaluating COVID-19 vaccine hesitancy among Israeli medical students highlighted the need for medical programs to emphasize the benefits of COVID-19 vaccination in the protection of healthcare workers and patient safety. Education, awareness campaigns, and regulation of vaccine trials could further decrease COVID-19 vaccine hesitancy and increase vaccine rates among medical students.

COVID-19 Vaccine Hesitancy and Acceptance among Medical Students: An Online Cross-sectional Study in Iraq

BACKGROUND: Vaccine hesitancy and reluctant had an important obstacle in achieving protection and population immunity against coronavirus disease 19 (COVID-19). It is essential to achieve high COVID-19 vaccination acceptance rates among medical students and health care workers to provide recommendations and counseling vaccine hesitant population. AIM: This study aims to identify level of COVID-19 hesitancy, attitude, knowledge, and factors that affect vaccination decision. MATERIALS AND METHODS: A cross-sectional study was done among medical students in Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq. Data collection was done through an online Google Forms questionnaire during 2021 from 810 medical students. RESULTS: A total of 810 adults’ medical students participated in this study. The majority of the study participants were female (488, 60.2%) while males were 322, 39.8%. Vaccine concept hesitancy among males was 65.21% and rest were vaccinated (34.78%) (OR = 0.13) (95% CI = 0.096–0.177) (p = 0.0001). Same hesitancy from COVID-19 vaccine was same with females (66.80%). CONCLUSIONS: This study evaluated and shed light on vaccine hesitancy among sample of Iraqi medical students toward COVID-19 vaccination program and considered medical students as leaders and guides in the health system for increased planning and education of the population for COVID-19 vaccine acceptability.

Health worker recommended vaccination rates among medical students in Brazil

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Medical students are a risk population for many infectious diseases, which leads to their being included in health-staff vaccination recommendations.

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There is an increasing noncompliance with vaccination programs, especially in the last decade, which can have also affected medical students’ immunization status and personal beliefs about this theme. Few studies have gauged student awareness of these programs and their effect in vaccination status along the medical course.

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After being submitted to an electronic questionnaire, 74,7% Brazilian students were found to have incomplete vaccination in some way, with Pertussis, Varicella, and Influenza as the highest noncompliance rates. There was an increase in vaccination status toward the end of the course, though still far from optimal.

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Main reasons given not to vaccinate were vaccination hesitancy (for influenza and varicella), and lack of awareness of the need to vaccinate (for pertussis).

Health workers are a risk population for many infectious diseases, which leads to a number of vaccines being routinely recommended for health care staff. Medical students are also prone to such hazards. This study accesses undergraduate medicine students’ compliance to recommended health-staff vaccination, and their reasons for noncompliance.

Method

An online questionnaire was sent to all undergraduates in a major public medical school in Brazil, asking about vaccination status to Hepatitis B, Measle-mumps-rubella, Varicella, Pertussis and Influenza, and reasons in case of noncompliance

Results

146 students answered the questionnaire, (response rate 14,6%). Overall vaccination status showed 74,7% of students with incomplete vaccination in some way, with an increase in vaccination status toward the end of the course. The highest noncompliance rates were Pertussis (49,3%), Varicella (47,3%) and Influenza (30,1%) vaccines. The vaccine with the lowest noncompliance rate was measles (9,6%). During the course, the greatest increases in adequate vaccination status were Hepatitis B, from 53,2% in first-years to 93,2% by the end sixth year (chi-sq 21, p < 0,0001), and Influenza, from 48,9% to 91,5% (chi-sq 22,5, p < 0,00009). Main reasons given not to vaccinate were vaccination hesitancy for influenza and varicella (respectively 61% and 46%), and lack of awareness of the need to vaccinate for pertussis (53%).

Conclusions

Overall vaccine coverage in medical students in Brazil is still far from optimal. There is a markedly high level of vaccine hesitancy and unawareness of need to vaccinate for some diseases, particularly pertussis and influenza.

Clinical trial registry (Brazilian regulation boards): 24159119.3.0000.0065.

Are Medical Students from Across the World Aware of Cervical Cancer, HPV Infection and Vaccination? A Cross-Sectional Comparative Study

This study aims to understand and compare the level of knowledge, the attitude and the awareness of cervical cancer, HPV infection and vaccination among medical students from across the globe. It was conducted by sharing a questionnaire on medical students' Facebook groups. We successfully analysed 736 responses, of which 74.3% were females and 25.7% males. Their mean age was 23.14. As regards to the respondents' knowledge of the risk factors for cervical cancer, 28.8% of the participants identified HPV, 23.5% chose "Having many sexual partners", 15.4% identified "Starting the sexual life at a young age", 14.7% chose HIV and 13.3% answered smoking. Regarding the knowledge of the Pap test, 92.4% of the students stated that they knew what it is, although 98.5% of these respondents chose the correct answer. Concerning the knowledge of early warning signs of cervical cancer, 34.4% recognised vaginal bleeding. According to our research, American, Eastern and Western European students had more knowledge regarding the risk factors, early signs of cervical cancer and Pap test than African and Asian students. A total of 50% of the sexually active females had gone at least once to be screened by the means of a Pap test. A total of 39.8% of the participants stated that they had received the HPV vaccine. The findings of our research highlight the need for additional education measures to improve knowledge and awareness regarding HPV infection, especially among medical students, since they will be future healthcare providers.

Polish Medical Students' Knowledge Regarding Human Papillomavirus's Ways of Transmission, Risk of Cancer Development and Vaccination, and Their Intention to Recommend Vaccination

Introduction: Human papillomavirus (HPV) is associated with six types of cancer in men and women. A vaccine against HPV, preferably administered before initial sexual intercourse, has been proven to be highly effective in preventing these cancers. An effective healthcare provider recommendation has significant influence on HPV vaccine uptake; therefore, it is critical that medical students receive comprehensive training in this area. Aim: The aim of the study was to assess the knowledge of medical students regarding Human Papillomavirus’s (HPV) ways of transmission, risk of cancer development, and vaccination against HPV. This study also investigated factors among medical students that would affect their intention to recommend HPV vaccination to others. Materials and Methods: The study was conducted among 1061 (678 women and 383 men) medical students who filled in our questionnaire. The medical students were divided into two subgroups: (1) pre-clinical medical students (MS pre-clinical; first-to third-year students; n = 683) and (2) clinical medical students (MS clinical; fourth-to six-year students; n = 378). Results: A total259 (24.41%) of the 1061 medical students were vaccinated against HPV. We found a significant improvement in the general level of knowledge in the later years of education (4–6) compared to the early years of education (1–3). However, it was demonstrated that, despite medical education advancements, there are still significant gaps of knowledge about the relationship between HPV infection and cancers other than cervical cancer, as well as in relation to the routes by which HPV is transmitted. Medical students’ intentions to recommend HPV vaccine to others were related to their own HPV-related knowledge and their own vaccination status. Conclusion: Medical students have gaps of knowledge regarding particular issues and aspects of HPV. It is necessary to further educate medical students in the field of prevention and in the treatment of lesions caused by HPV infection. Medical students’ intention to recommend the HPV vaccine can be improved by including them and members of their families in the HPV vaccination program.

A brief educational intervention can improve nursing students' knowledge of the human papillomavirus vaccine and readiness to counsel

Provider recommendation is a primary reason for patient uptake of the human papillomavirus (HPV) vaccine. Most provider-focused educational interventions are focused on physicians, even though nurses are also important sources of vaccine-related information for their patients. This study examined whether a HPV educational intervention could improve nursing students' HPV knowledge, beliefs, and comfort with counseling. The same lecture on HPV and HPV vaccination was given to both medical and nursing students. To determine the effects of the lecture, students were asked to complete identical pre- and post-lecture tests with questions on demographics, knowledge, attitudes, and comfort with counseling on the HPV vaccine. Pre- and post-lecture test scores were compared between nursing and medical students to assess whether there were differences in pre-lecture test scores and/or changes in post-lecture test scores. On the pre-lecture tests, fewer nursing students responded correctly to knowledge questions, indicated positive attitudes or comfort with counseling about the HPV vaccine compared to medical students. However, similar frequencies of nursing and medical students responded correctly to knowledge questions and indicated a positive attitude, as well as a high comfort level with counseling on the post-lecture tests. Study results show that integrating lectures in a nursing program curriculum could be a feasible way to increase students' HPV knowledge. Having health-care providers with similar levels of knowledge, attitudes, and comfort with counseling on HPV vaccination is ideal, as all share the responsibility of recommending the vaccine to patients.

Correlates of human papillomavirus vaccine knowledge and acceptability among medical and allied health students in Northern Nigeria

Prior to its planned introduction, we investigated predictors of baseline knowledge and acceptability of HPV vaccination among medical and allied health care students in Kano, northern Nigeria. A total of 410 medical, dental and allied health students completed structured validated questionnaires. Knowledge scores and acceptability of HPV vaccine were determined and adjusted odds ratios (AOR) for predictors of HPV knowledge and acceptability were derived from multivariate logistic regression models. Overall, 3.7% (n = 15), 30.7% (n = 126) and 65.6% (n = 269) of respondents had good, moderate, and poor knowledge of HPV, respectively. The majority 334 (81.5%) were willing to accept the HPV vaccine, but only 18 (4.4%) had received at least one dose of the vaccine. Knowledge of HPV was better among females, younger (<20 years) medical students, students at higher levels of study, sexually experienced students, and condom users. HPV vaccine acceptance was higher among female students in the faculty of allied health with a family history of cervical cancer and good or moderate knowledge of HPV. In conclusion, most students were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. We recommend piloting the HPV vaccine in health colleges and recruiting early adopters as peer educators and advocates.IMPACT STATEMENTWhat is already known on this subject? Human Papilloma Virus (HPV) vaccine has been introduced in over 80 countries in the past decade, but evidence suggests low awareness of HPV infection and the vaccine, especially in developing countries. Nigeria proposes to introduce the HPV vaccine as part of the routine immunisation program in early 2021.What do the results of this study add? The majority of medical and allied health students in Kano, Nigeria, were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. Vaccine acceptance was predicted by the respondent's sex, course of study, family history of cervical cancer and knowledge of HPV.What are the implications of these findings for clinical practice and/or further research? The findings could inform program implementation and evaluation as HPV vaccine uptake is scaled up across Africa.

Attitude towards Vaccination among Health Science Students before the COVID-19 Pandemic

Health science students are tomorrow's health professionals, the duties of whom could include vaccination. This work examines the general attitude towards vaccination in students attending the Faculty of Nursing, Physiotherapy and Chiropody at a university in Madrid, Spain, using the 'Attitudes and Behaviour With Regard To Vaccination Among Health Science Students Questionnaire'. The results were subjected to multivariate analysis to identify the influence of sex, the degree being pursued, and 'course year'. The number of students vaccinated against influenza in the campaign preceding the present study was also recorded, as were the factors that influenced decision-making in this regard. A total of 934 students completed the questionnaire. Their beliefs regarding vaccination were positive (mean score 3.23 points out of 4), as was their behaviour (3.35/4). Their general attitude (all variables taken together) was therefore also good (3.27/4). Only 26.8% of the students had been vaccinated against influenza. Beliefs scores among the students of nursing in their more senior course years were significantly better than those recorded for all other groups. These students also showed the best general attitude towards vaccination and formed the largest group vaccinated against influenza. The results obtained are encouraging since nursing students are the most likely of future healthcare professionals to be involved in vaccination programmes.

COVID-19 vaccine hesitancy among medical students in India

The coronavirus disease 2019 (COVID-19) vaccine was launched in India on 16 January 2021, prioritising health care workers which included medical students. We aimed to assess vaccine hesitancy and factors related to it among medical students in India. An online questionnaire was filled by 1068 medical students across 22 states and union territories of India from 2 February to 7 March 2021. Vaccine hesitancy was found among 10.6%. Concern regarding vaccine safety and efficacy, lack of awareness regarding their eligibility for vaccination and lack of trust in government agencies predicted COVID-19 vaccine hesitancy among medical students. On the other hand, the presence of risk perception regarding themselves being affected with COVID-19 reduced vaccine hesitancy as well as hesitancy in participating in COVID-19 vaccine trials. Vaccine-hesitant students were more likely to derive information from social media and less likely from teachers at their medical colleges. Choosing between the two available vaccines (Covishield and Covaxin) was considered important by medical students both for themselves and for their future patients. Covishield was preferred to Covaxin by students. Majority of those willing to take the COVID-19 vaccine felt that it was important for them to resume their clinical posting, face-to-face classes and get their personal life back on track. Around three-fourths medical students viewed that COVID-19 vaccine should be made mandatory for both health care workers and international travellers. Prior adult vaccination did not have an effect on COVID-19 vaccine hesitancy. Targeted awareness campaigns, regulatory oversight of vaccine trials and public release of safety and efficacy data and trust building activities could further reduce COVID-19 vaccine hesitancy among medical students.

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.

Dental students' attitudes and hesitancy toward COVID-19 vaccine

BACKGROUND

Dentists are a group of providers who have been identified by CDC at high risk of exposure to COVID-19 through their contact with patients. This would apply to dental students as well. Thus, it is important to achieve high COVID-19 vaccination rates in this group. Further, as healthcare providers, they are entrusted with providing health recommendations and advocating for their patients, community, and profession, including vaccinations.

METHODS

Using ualtrics^XM an online platform, in 2020, a survey was administered anonymously to dental students at three dental schools to assess the attitudes of dental students to the novel COVID-19 vaccine. Factors and reasons associated with vaccine hesitancy and acceptance toward the COVID-19 vaccine and likelihood of recommending and giving the vaccination to patients were assessed.

RESULTS

Nearly, all participants had positive attitudes toward vaccines in general, agreed they would likely be exposed to COVID-19, and personally knew someone who had COVID-19; however, only 56% are willing to take a COVID-19 vaccine as soon as an FDA-approved vaccine was available. Of those unwilling to take the vaccine, 63% reported they would take it if mandated by the health systems/dental school; however, 16.3% of the overall respondents would not take the COVID-19 vaccine even if mandated. Several factors are associated with vaccine acceptance and the likelihood of recommending the vaccination, such as trusting public health experts, concerns about side effects, and agreeing with vaccine mandates.

CONCLUSION

Our results highlight the need for an educational curriculum about the safety and effectiveness to promote the uptake of COVID-19 vaccine.

COVID-19 vaccine acceptance and hesitancy among dental and medical students

Background

Dental students (DS) and medical students (MS) are exposed to COVID-19. It is important to achieve high COVID-19 vaccination coverage rates in both of these groups. The authors developed a survey to assess COVID-19 vaccine hesitancy among MS and DS.

Methods

The authors conducted the study at 3 US dental schools and 1 US medical school using an online survey that assessed previous immunization behavior, attitudes about and perceptions of COVID-19 vaccines, and personal experience with COVID-19.

Results

A total of 248 DS and 167 MS completed the survey. Forty-five percent of DS and 23% of MS were hesitant about receiving the COVID-19 vaccine. Results of bivariate analyses found that MS were 2.7 times more likely than DS to receive the vaccine (odds ratio, 2.74; 95% CI, 1.76 to 4.31; P = .0001). Although DS were more likely than MS (P < .05) to have had COVID-19 and to personally know someone who had COVID-19, MS were more likely to agree with mandates and trust information about the vaccines. In multivariable analyses, after controlling for demographic variables, experience with COVID-19, and personal vaccination behaviors, being a MS or DS was no longer predictive of willingness to get the vaccine.

Conclusions

These results highlight the need for profession-specific curricula designed to enhance student knowledge about the vaccines and vaccine counseling skills.

Practical Implications

The American Dental Association supports dentists administering vaccines, including the COVID-19 vaccines. Dentists and DS should be willing to receive the vaccines themselves. Education about the vaccines is needed to improve uptake.

Oral health care professionals recommending and administering the HPV vaccine: Understanding the strengths and assessing the barriers

Introduction

Head and neck cancer is a deadly cancer that ranks among the six most common cancers worldwide. The HPV vaccine has been used to prevent head and neck cancer of the oropharynx, and changes in health policies and state law are impacting the role of dental professionals in HPV vaccination. However, relatively little is known about dental professionals’ attitudes regarding the vaccine.

Objectives

Our study assesses dental professionals’ willingness to administer the HPV vaccine, their confidence discussing HPV with patients, beliefs about the vaccine’s efficacy, perceived barriers to administering it, and sites of referral.

Methods

We surveyed 623 dental professionals, including dentists, hygienists, dental students, and hygiene students across Michigan. Attitudes toward the vaccine and predictive characteristics were evaluated by logistic regression, ANOVAs, and t-tests.

Results

The majority of the respondents (51% of dentists, 63% of hygienists, 82% of dental students, and 71% of hygiene students) were willing to administer the HPV vaccine if allowed by law. The role of dental and dental hygiene students would be one of advocacy, educating and recommending the vaccine, and the dental students administering it once licensed. Dental professionals were variably confident discussing HPV with patients and generally believed it enhanced patients’ health. Stronger confidence and beliefs were associated with greater willingness to administer the vaccine. Barriers among professionals opposing the HPV vaccine included lack of knowledge on the subject, liability concerns, and personal beliefs.

Conclusion

Dental professionals can become leaders in preventing HPV-related cancers. Training and continuing education courses could enhance their confidence and willingness to recommend and administer the HPV vaccine.

Policy implications

Legislation that permits dental professionals to administer the vaccine could increase the vaccine’s accessibility to patients, improve vaccination rates, and population health.

HPV and HPV Vaccination Knowledge and Attitudes Among Medical Students in Alabama

In addition to being the most common sexually transmitted infection, the human papillomavirus (HPV) is associated with six types of cancer in men and women. The HPV vaccine provides long-lasting, effective protection from high-risk HPV infection, thus serving as a means of cancer prevention. An effective healthcare provider recommendation is well-established as the most significant influence on HPV vaccine uptake, and, as emerging providers, it is critical that medical students receive comprehensive training in this area. However, the type and extent of such training for current medical students in the USA is unclear. An online survey assessing HPV and HPV vaccine knowledge, attitudes, and vaccine status was distributed to all medical students at an Alabama university. Scales were developed to assess composite HPV and HPV knowledge scores and HPV vaccination intentions. Of those age-eligible, 32.1% reported completion of the HPV vaccine series while 15.2% reported partial completion. Knowledge of both HPV and HPV vaccination significantly increased with program year (p < 0.0001 and p = 0.0069, respectively); however, there were knowledge gaps across all years regarding HPV-associated cancers. Attitudes and intentions showed a similar association, with more advanced students demonstrating more positive attitudes toward HPV vaccination (p = 0.0003). There is a need within the current curriculum to include more education and training on HPV, HPV vaccination, and counseling-particularly for students in the first 2 years of their program. Implementation of a classroom module or interactive workshop would likely improve knowledge and attitudes, better preparing students for their future role as potential immunizers.

COVID-19 vaccine hesitancy among medical students

BACKGROUND

Medical students are among the group of frontline healthcare providers likely to be exposed to COVID-19 patients. It is important to achieve high COVID-19 vaccination coverage rates in this group as soon as a vaccine is available. As future healthcare providers, they will be entrusted with providing vaccine recommendations and counseling vaccine-hesitant patients.

METHODS

This project used self-report to assess vaccine hesitancy and acceptance among medical students towards the novel COVID-19 vaccine.

RESULTS

Nearly all participants had positive attitudes towards vaccines and agreed they would likely be exposed to COVID-19; however, only 53% indicated they would participate in a COVID-19 vaccine trial and 23% were unwilling to take a COVID-19 vaccine immediately upon FDA approval. Students willing to immediately take the vaccine were more likely to trust public health experts, have fewer concerns about side effects and agree with vaccine mandates (P < 0.05). Concern for serious side effects was independently predictive of lower odds of intent to participate in a COVID-19 vaccine trial (AOR = 0.41, P = 0.01).

CONCLUSION

This is the first study to evaluate COVID-19 vaccine hesitancy among US medical students and highlights the need for an educational curriculum about the safety and effectiveness to promote uptake of the COVID-19 vaccine.

Knowledge, Perceptions, and Uptake of the Human Papillomavirus Vaccine in a Sample of US High School Adolescents

OBJECTIVE

To assess high school students' knowledge and perceptions of human papillomavirus (HPV) and HPV vaccines and evaluate high school students' self-reported uptake of the HPV vaccine.

METHODS

This was an observational, descriptive study using a 44-question survey. Participants were ninth grade students in a Colorado public school district. The survey was administered as part of a health education course.

RESULTS

Ninety-two surveys were included in the analysis. Demographic characteristics included 64/92 (69.6%) male and 55/92 (59.8%) Hispanic/Latino students. There was no difference between males and females regarding self-reported vaccination status. Non-Hispanic students were 71.6% less likely to have received the HPV vaccine than Hispanic students (OR 0.284; 95% CI, 0.088–0.920; p = 0.036). The average score on the knowledge section was 42.7% with a standard deviation of 22.6%. When assessing students' perceptions, 71/92 (77.2%) disagreed or strongly disagreed that they felt at risk for getting an HPV infection. There was no significant difference between males and females regarding awareness of the HPV vaccine (p = 0.14). More than half of students (58.7%) did not know if they had received the HPV vaccine.

CONCLUSION

HPV vaccine awareness was low and many students did not know if they had received the HPV vaccine. Ninth grade students did not have accurate knowledge of HPV and HPV vaccines and this study presents opportunities for increased education.

HPV Knowledge and Attitudes Among Medical and Professional Students at a Nevada University: A Focus on Oropharyngeal Cancer and Mandating the Vaccine

Medical professionals and students often feel as if they do not have enough understanding of the human papillomavirus (HPV) vaccine in order to recommend or obtain vaccination themselves. A 25-question online survey regarding knowledge and attitudes about the HPV vaccine was distributed among professional students, including all classes of medical students, at a Nevada university. First- and second-year medical students were administered the same survey 1 week after a new vaccine workshop. One third of respondents were aware of the link between HPV and oropharyngeal cancer, and 63% believed that the HPV vaccine should be mandatory. Reported full vaccination status (OR = 2.63 compared with no vaccination, 95% CI = 1.53, 4.53), awareness of the link to oropharyngeal cancer (OR = 1.85, 95% CI = 1.04, 3.29), and female sex (OR = 1.64, 95% CI = 1.00, 2.70) positively predicted whether a student believed the HPV vaccine should be mandatory. After an interactive workshop, first- and second-year medical students improved on HPV knowledge questions, comfort in HPV vaccine counseling, and having enough information to counsel on the HPV vaccine. Post-test knowledge scores surpassed those of current third- and fourth-year medical students, who never underwent such curriculum. Medical, physician assistant, graduate, and undergraduate students lack HPV knowledge, with a low percentage aware of oropharyngeal cancer as a result of HPV infection. An interactive curriculum implemented for first- and second-year medical students improved knowledge and comfort in counseling on HPV vaccination.

An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students

Many medical students are not comfortable recommending the human papillomavirus (HPV) vaccine because they do not feel prepared to discuss it with their patients. A prior study demonstrated that this is particularly a problem among unvaccinated students. Our purpose was to determine if medical student attitudes and comfort with counseling could be improved by attending a single lecture delivered by an expert on the topic. To assess the effects of the educational program, we conducted pre- and posttests on medical students before and after a single lecture on HPV vaccination. Changes in items related to attitude and comfort were examined. Student characteristics associated with changes in scores were also examined and compared. A total of 256 medical students participated in the pre- and posttests. Before the lecture, students demonstrated low knowledge of HPV vaccination and did not feel comfortable counseling parents of younger patients. However, students <30 years of age demonstrated significant improvements after the lecture in comfort. Asian and Hispanic students showed the greatest improvement in comfort with counseling, as did students who reported they had not received the HPV vaccine. Attending a single lecture given by an expert can improve medical students' attitudes and comfort with HPV vaccine counseling, especially if the students were not vaccinated themselves. This study suggests that including material on HPV vaccination in the standard medical student curriculum could help increase physician recommendation for the HPV vaccine.

Students' HPV vaccination rates are associated with demographics, sexuality, and source of advice but not level of study in medical school

This study aimed to explore how medical students differ regarding the HPV vaccination status according to their demographics, sexuality, medical school year and sources of information regarding the vaccine. The cross-sectional survey included 379 participants from medical school year 1 to 6, in a medical school in Brasilia. Statistical analyses of the data obtained from a questionnaire analyzed contingency tables and highlighted odds ratios effect sizes. The results showed that among all the participants, 80 (21.1%) were vaccinated against HPV, 215 (58.7%) were not vaccinated but wanted to be and 84 (22.2%) were neither vaccinated nor wanted to be vaccinated. . Female gender (OR= 5.88, 95% CI 3.36-10.30), parental advice (OR= 6.95, 95% CI= 3.97-12.16), and absence of sexual initiation before 16 years of age (OR= 3.04, 95% CI= 1.05-8.77) were positively associated with HPV-vaccinated students. In parallel, female gender (OR= 4.74, 95% CI= 2.38-9.44), parental advice (OR= 3.50, 95% CI=1.20-10.22), and reporting two or more recent sexual partners (OR= 2.03, 95% CI= 1.06-3.88) were positively associated with the intention to be vaccinated among unvaccinated students. The high cost of the vaccine was perceived as a barrier among those respondents who wished to be vaccinated. Additionally, among the 84 (81.3% male) students who admitted unwillingness to be vaccinated, approximately two-thirds cited the feeling to be safe, lack of counseling, or low efficacy of the vaccine as the reasons for their reluctance. In conclusion, vaccination coverage was low among these medical students. Nevertheless, female gender, personal advice, and safe sex were the main factors associated with higher levels of vaccination and vaccine acceptance.

Knowledge, Attitudes, and Intentions towards Human Papillomavirus Vaccination among Nursing Students in Spain

Human papillomavirus (HPV), which is linked to specific types of cancer, can be prevented by vaccination. This study aimed to determine the knowledge and attitudes of nursing students about HPV and its vaccine as well as their intentions towards personal vaccination. A total of 536 Spanish nursing students were invited to complete the Spanish version of the questionnaire “Knowledge, attitudes and intentions towards HPV”. Overall, 367 surveys were completed (68.4% response rate). Data analysis included the calculation of three scores: the knowledge score, categorized into low (<33%), moderate (33%–66%), and good knowledge (>66%); the attitude score, sorted into positive (<2.5), neutral (2.5–3.5), and negative attitude (>3.5); and the intention score, categorized into not favorable (<4), neutral (4–7), and favorable intention (>7). Knowledge about HPV and its vaccine was moderate (54.34 ± 0.9%), and the attitude towards vaccination was positive (2.34 ± 0.03). The intention towards personal vaccination increased significantly after completing the questionnaire (before: 4.14 ± 0.27, after: 6.02 ± 0.28; p < 0.001). The present study highlights the need of training future nurses about HPV and its vaccine, considering the important role it plays in the prevention of sexually transmitted diseases.

Immunization attitudes, opinions, and knowledge of healthcare professional students at two Midwestern universities in the United States

BACKGROUND

In addition to administering vaccinations, healthcare professionals (HCPs) also play a crucial role in providing education and advocacy to the public regarding immunizations. Yet, many current and future HCPs are unprepared or reluctant to address the vaccine conversation with hesitant patients. Doctors, pharmacists, and nurses are all recognized as the most trusted sources of vaccine information. By comparing future HCPs in these three distinct programs, we can better understand where potential gaps may lie in their training and education. With insight from students, potential changes to curriculum can improve future HCPs ability to address vaccine hesitancy in their respective careers. The objective of this study was to assess and compare the knowledge, attitudes, and opinions of HCP students on the topic of immunization.

METHODS

A cross-sectional survey was conducted in 2017 to assess students in nursing, medical, and pharmacy programs at two universities in the state of North Dakota in the United States. The survey assessed six key themes: 1) demographic information; 2) basic vaccine knowledge; 3) vaccine hesitancy; 4) likelihood to recommend vaccines; 5) confidence in addressing vaccine-related topics with patients; 6) an appraisal of the education they have received on vaccinations.

RESULTS

The survey was completed by 223 participants (overall response rate = 23.7%). Results indicated that vaccine-related knowledge varied greatly by program; high knowledge scores were achieved by 74.3% of medical students, 62.7% of pharmacy students, 57.1% of doctor of nursing practice (DNP) students, and 24.7% of bachelor of science in nursing (BSN) students. Over a third (34.2%) of BSN students believed that the current recommended immunization schedule places undue burden on a child's immune system, versus only 4.3% of medical students. Additionally, 54.2% of participants believed that spreading out recommended vaccines over several visits was an appropriate means of reducing parental stress about vaccinating.

CONCLUSIONS

Participant responses suggest that negative attitudes, lack of knowledge, and general discomfort exist across all programs, but especially among nursing students, regarding vaccination. Our findings indicate potential areas where targeted interventions could be implemented to better equip future HCPs in their ability to discuss and educate the public regarding vaccination.

TRIAL REGISTRATION

#PH17173.

Understanding medical students' practices and perceptions towards vaccination in China: A qualitative study in a medical university

The qualitative study aims to understand and conceptualize Chinese medical students' practices and perceptions towards vaccination. Focus groups (n = 5) were conducted through convenience sampling in a medical university in October 2016 in Anhui, China. Two years later, 6 participants among them were follow-up interviewed. All the interviews were audio-recorded, then transcribed verbatim, and analyzed using constant comparative method. Opinions of 22 participants (13 females, 9 males) were collected. Results revealed that hepatitis B vaccination was discussed the most frequently, and most of participants were vaccinated against (or had documented immunity to) hepatitis B before or during their clinical internship. None of the participants reported other vaccines uptake. Three dimensions of themes were identified: (i) at individual level, the factor "feeling less infection risk" might strengthen their perceived barriers. The factors "laziness" and "fluke mind" would be used to rationalize their inactive practices about vaccination; (ii) at social level, themes involved "inactive organizational behaviors", "suggestions from people around", and "social norms". Decision-making of medical students' vaccination was more relying on themselves and influenced more by their classmates before or during their internship, rather than being influenced more by their families/universities as before. (iii) at professional level, there are two contradictions about the participants' behaviors and attitudes. One is that they may have inappropriate behaviors because of their lack of knowledge, but sometimes they seem too satisfied about their medical knowledge to vaccination. The other is that there are both vigilance response and desensitization to occupational infection risk. It is suggested that efforts should be strengthened to spread scientific knowledge of infectious diseases and immunization as long as medical students enter the university. Publicity and organizational activities should be strengthened, and related researches should be carried out by the government or scholars.

Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance

Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.