Medical students' knowledge about human papillomavirus (HPV), HPV vaccine and head and neck cancer

The Human Papillomavirus (HPV) is a sexually transmitted infection that significantly affects the population worldwide. HPV preventive methods include vaccination, prophylactics, and education. Different types of cancers associated with HPV usually take years or decades to develop after infections, such as Head and Neck Cancer(HNC). Therefore, HPV prevention can be considered cancer prevention. A sample of medical students in Puerto Rico was evaluated to assess their knowledge about HPV, HPV vaccine, and HNC through two previously validated online questionnaires composed of 38 dichotomized questions, we measured HPV, HPV vaccination(HPVK), and HNC knowledge (HNCK). Out of 104 students surveyed, the mean HPVK score obtained was 20.07/26, SD = 3.86, while the mean score for HNCK was 6.37/12, SD = 1.78. Bidirectional stepwise regression showed study year and HPV Vaccine name had been the most influential variables on HPVK and HNCK. MS1 participants scored lower than MS2-MS4 participants, with no significant difference between MS2-MS4 scores. The results reveal knowledge gaps in HPV/HPV Vaccine and HNC among surveyed medical students. Our findings also suggest an association between knowledge of personal vaccination status, self-perceived risk, and how uncertainty in these factors may affect the medical students' understanding of HPV, HPV vaccination, and associated cancers.

Validity and reliability of a Turkish version of the human papillomavirus knowledge scale: a methodological study

Objective

The aim of the study was to test validity and reliability of the Human Papilloma Virus Knowledge Scale (HPV-KS) in Turkish.

Material and Methods

The methodological study was conducted with 920 participants at a training and research hospital in Ankara, Turkey, between February and May 2019. The data collection form consisted of descriptive characteristics of the participants and HPV-KS. Guidelines for the Process of Cross-Cultural Adaptation of Self-Reported Measures were followed for the language and cultural adaptation of the scale. Content validity, exploratory, and confirmatory factor analyses were performed to test the validity of the scale. The scale's reliability was assessed using the item-total correlation, Cronbach's alpha, and test-retest analysis.

Results

In line with the experts' suggestions, two item were excluded from the scale. The scale content validity index was found to be 0.96. The exploratory factor analysis determined the four subscales of the scale with 33-items. The explained variance was found to be 64.56%. In the confirmatory factor analysis, all the goodness of fit indexes had acceptable values. The item-total correlations determined that each item was positively correlated with the total scale ranging from 0.53 to 0.80. The Cronbach's alpha coefficient calculated for the overall scale was 0.96. It was found that there was a statistically significant positive relationship between test and retest (r=0.166; p=0.05).

Conclusion

The scale was shown to be a valid and reliable standard measurement that can be used to accurately evaluate the efficacy of health education provided by healthcare professionals.

HPV Vaccination among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion

BACKGROUND

The purpose of this study was to examine factors related to HPV vaccination initiation and completion, especially the role of health knowledge, among college students in a southern state.

METHODS

College students ages 17-45 (n=1,708) were analyzed in this study. Primary outcomes were HPV vaccine series initiation and completion; binary logistic regressions were performed to identify associated factors.

RESULTS

Among total participants, students who were aware that HPV could be transmitted even without symptoms were less likely to initiate HPV vaccination. However, among students who have initiated the vaccine series, those who were aware that HPV could be transmitted without symptoms and that men should receive the HPV vaccine were more likely to complete the vaccine series. Other significant variables included age, gender, race, and international student status.

CONCLUSION

Future studies are needed to investigate students' concerns regarding initiating HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series.

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

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

Knowledge, attitudes and acceptance toward Human papillomavirus (HPV) vaccination: Perspectives of Muslim women and men

OBJECTIVES

Human papillomavirus (HPV) infection is the leading risk factor for the development of anogenital cancers. Most Arab countries lack both HPV education and national HPV vaccination programs. The objective of this study was to assess knowledge, attitudes, and acceptance toward HPV vaccination in men and women from Oman, a country in the Middle Eastern North Africa region.

METHODS

This cross-sectional quantitative study used convenience sampling to recruit male and female participants, aged 18 years and above from all 11 governorates of Oman to complete a validated self-administered questionnaire online in the Arabic language. The questionnaire comprised five sections, with a total of 32 questions. The questionnaire, including Arabic and English versions, was content validated and piloted.

RESULTS

A total of 1403 participants, including 952 parents and 369 healthcare providers, completed the survey. The results showed a lack of knowledge regarding HPV infection and vaccines, including among healthcare providers. Less than a quarter of the participants had heard of HPV infection, with digital sources of information being the most common. Factors such as being a woman or a healthcare provider or completing higher levels of education were independently and significantly positively association with HPV awareness (p < 0.001). The majority of the participants lacked vaccine safety knowledge, had concerns about the vaccine's side effects, and sought reassurance of its protection against HPV infection (62%, 71.5%, and 84.6%, respectively). Nevertheless, nearly two-thirds of the participants agreed to take the HPV vaccine, with support for both boys and girls being vaccinated. There was almost universal agreement among the participants regarding the need for parental and adolescent HPV educational programs.

CONCLUSION

Omani women and men showed a high level of acceptance and favorable attitude toward HPV vaccination. The study findings support future efforts to implement school and public-level HPV education and a national HPV vaccination program in Oman.

Knowledge on human papillomavirus (HPV), HPV screening and HPV vaccine among sexual health clinic patients in Martinique, French West Indies

OBJECTIVES

To assess the level of knowledge about HPV in a population attending a sexual health clinic in the University Hospital of Martinique.

METHODS

Cross sectional observational study based on a validated questionnaire among 500 young adults between June 2020 and March 2021. First question was "Have you ever heard of HPV?". If the answer was "Yes", the person was invited to answer the next 28 questions.

RESULTS

Overall, 68% of participants had never heard of HPV, rising to 74.6% of women. Out of 28 questions, the median of correct answers by participants was 15 (IQR 8-19). We did not find any difference related to age. Women had more correct answers than men on most of the items related to screening and vaccine.

CONCLUSION

In Martinique, knowledge about HPV is poor. New communication methods are required to reach young boys and girls.

Willingness of parents of 9-to-18-year-old females in China to vaccinate their daughters with HPV vaccine

OBJECTIVE

To assess knowledge about HPV and HPV vaccine, willingness to have their daughters receive HPV vaccine, and factors associated with knowledge and willingness among parents of females 9 to 18 years of age in China.

METHODS

We conducted a cross-sectional survey of parents with daughters 9 to 18 years of age in four provinces of China using a self-administered questionnaire. We used multivariable regression analyses to determine factors associated with willingness vaccinate.

RESULTS

We received completed surveys from 5,215 parents. Among respondents, 846 (16.24 %) had a high level of knowledge about HPV (total score ≥ 5). High level of HPV knowledge was associated with having daughters who were <15 years old; having experience paying out-of-pocket for other vaccines; being a mother; having higher educational achievement; being a medical staff member; being in a higher-income category; and residing in an urban area. There were 2,419 (46.39 %) parents who were willing to vaccinate their daughter against HPV and 2,757 (52.87 %) who were willing to receive vaccine themselves (for female respondents) or indicated willingness of their spouse to be vaccinated (for male respondents). Willingness of mothers to be vaccinated was associated with daughters' age being greater than 14 years; having previously purchased self-paid vaccines; having higher educational achievement; being in a higher-income category; having a higher level of knowledge; and residing in an urban area. Parental willingness to vaccinate daughters was associated with daughters' age being greater than 14 years, age of parents younger 40, a history of purchasing self-paid vaccines; higher educational achievement; having a higher level of knowledge; being willing to receive HPV vaccine (themselves or their spouse); and residing in an urban area.

CONCLUSIONS

Level of knowledge and willingness to have daughters vaccinated with HPV vaccine are low among Chinese parents. For universal HPV vaccination of females 9-18 years of age, it is necessary to educate parents about HPV and HPV vaccine, and to reduce the price of HPV vaccine.

Factors associated with knowledge and vaccination intention for human papillomavirus on trans girls by their main caregiver: A cross-sectional study

Introduction

Trans women are highly affected by the human papillomavirus (HPV) and are at risk of suffering from HPV-related diseases such as oropharyngeal, anal, penile, or neovaginal neoplasia. HPV vaccination seems to be a good strategy to reduce HPV-related diseases, mainly during the early age before the first sexual intercourse, but only cisgender girls are covered by the National Health Services, while some high-risk groups such as trans girls are not included. Achieving a high vaccination rate is important in the adolescent population, but there are many factors that could affect it, such as lack of knowledge about HPV or fear of side effects by patients and main caregivers. The aim of our study is to analyze the knowledge of trans girls' main caregivers about HPV-related diseases in the general population and, in particular, in trans women, as well as factors associated with HPV vaccination intention.

Methods

A cross-sectional study was performed with the collaboration of main caregivers of adolescent trans girls, between 9 and 16 years old, assisted in two reference centers' multidisciplinary Gender Diversity Units. Information was requested through a self-completed questionnaire: HPV-related diseases Knowledge Transwomen questionnaire (HPV-TQ) was elaborated based on a 19-item self-administered questionnaire and score was standardized from 0 to 19 points. Percentage of correct answers was calculated and defined by the group of high scores that showed over 70% correct answers.

Results

A total of 65 main caregivers were included. Almost all main caregivers were mothers with a Caucasian ethnicity. The HPV-TQ average score was 11 (3.7) with an average correct answer of 58.1% (19.6). Only 17/65 (26.1%) of main caregivers were highly knowledgeable in HPV. Of 65 trans girls, 14 were already vaccinated (29.8% of trans girls over 12 years old); 78.5% were not vaccinated and only 21.5% had intentions to be vaccinated. The group with a high score in HPV-TQ had a longer follow-up at the transgender unit, a higher maternal vaccination rate, and a positive family history of HPV-related disease, especially in mothers.

Conclusion

Adolescent trans girls attended to in our units had a low rate and a low intention of vaccination against HPV. Education on and promotion and prevention of transgender HPV-related diseases should probably be implemented to achieve a higher knowledge and vaccination coverage in adolescent trans girls.

Evaluation of human papillomavirus (HPV) knowledge among healthcare professionals: A study of conference attendees in Angola

Human papillomavirus (HPV) plays an essential role in cervical cancer development. Angola has a high cervical cancer incidence rate (36.1 per 100,000); therefore, knowledge of HPV among clinicians is essential for the prevention of cervical cancer and educating at-risk individuals. This study aimed to evaluate knowledge of HPV among healthcare professionals in Angola. A 44-item questionnaire was distributed to 65 healthcare professionals who attended a conference on the cancer burden in Angola. Non-parametric and multiple regression analyses were conducted. Of the participants (55.6%) were male, and 33.3% were aged 31-40 years, 56.3% had an undergraduate degree, and 35.9% had a postgraduate degree. All participants worked in healthcare in academic and/or clinical settings, with 36.7% in joint contracts. Most (62.2%) knew that early sexual debut increases the risk of contracting HPV, and HPV vaccines are most effective if administered before sexual debut. However, there was limited knowledge regarding the virus transmission. The mean HPV knowledge score was 11.08 ± 8.76 and knowledge was higher among older healthcare workers (>50 years) with a postgraduate degree and working in a clinical role. Overall, HPV knowledge was limited among the respondents. Policymakers should consider promoting knowledge and targeted public health initiatives among healthcare professionals in Angola.

Human Papillomavirus, Related Diseases, and Vaccination: Knowledge and Awareness Among Health Care Students and Professionals in Nepal

Human papillomavirus (HPV) is a common sexually transmitted disease worldwide. While burden of HPV-associated cancers and mortality is higher in low-income countries, there is limited data about knowledge of it among health care students and professionals. We assessed awareness and knowledge of HPV, its related diseases, and HPV vaccine among 333 participants, composed of 146 medical students (MSs) and professionals (MPs) and 187 nursing students (NSs) and professionals (NPs) using a 40-question survey between July 2018 and February 2019. Surveys were conducted in English language using both paper and an online version. Most participants reported that they had heard of HPV and cervical cancer. However, 91.76% of MPs and 77.97% of MSs, but only 41.11% of NPs and 36.17% NSs reported knowing that HPV types 16 and 18 caused cervical cancer. Likewise, about two-thirds of MPs and MSs reported having the knowledge that HPV 6 and 11 caused genital warts versus only a little over one-fourth of NPs and NSs. Only 55.91% of NPs and 51.61% of NSs were aware that HPV could cause cancer in both men and women, whereas 42.35% of MPs, 64.41% of MSs, 41.76% of NPs, and 40.66% of NSs were aware that the vaccine could be given to both boys and girls. While medical professionals were relatively more knowledgeable about HPV and related diseases, overall, knowledge about the HPV vaccine was low among all groups. This knowledge gap is concerning and warrants further attention to fight HPV-related public health burden in Nepal.

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.

Human papillomavirus (HPV) knowledge, beliefs, and vaccine uptake among United States and international college students

Objective: The purpose of this study was to compare knowledge about human papillomavirus (HPV) and HPV vaccine, college student's beliefs toward HPV, and HPV vaccine uptake between US and international college students studying in the US. Participants: The study was conducted using a sample (N = 588) of college students from a university in the South Central US. Methods: Study measures was derived from previously validated measures. Data were collected via an online survey using Qualtrics. Results: Significant differences were found in HPV awareness, HPV vaccine awareness, and HPV vaccine uptake between US and international college students. Conclusion: This study showed existing disparities between US and international college students regarding HPV and HPV vaccine awareness, and HPV vaccine uptake. College health centers can play a crucial role in raising awareness of HPV and HPV vaccination rates by organizing various intervention programs to reduce these disparities.

HPV knowledge, screening barriers and facilitators, and sources of health information among women living with HIV: perspectives from the DC community during the COVID-19 pandemic

Background

High-risk human papillomavirus (HPV) causes 99% of cervical cancer cases. Despite available prevention methods through the HPV vaccine and two screening modalities, women continue to die from cervical cancer worldwide. Cervical cancer is preventable, yet affects a great number of women living with HIV (WLH). Low screening rates among WLH further exacerbate their already high risk of developing cervical cancer due to immunosuppression. This study explores WLH’s current cervical cancer knowledge, screening barriers and facilitators, and sources of health information.

Methods

Focus group discussions were conducted with 39 WLH aged 21 years old or older, who resided in the Washington-Baltimore Metropolitan Area. Emergent themes were classified and organized into overarching domains and assembled with representative quotations.

Results

The women had limited knowledge of HPV and the cervical cancer screening guidelines for WLH. Coronavirus 2019 (COVID-19) pandemic has amplified screening barriers due to decreased accessibility to usual medical appointment and cervical cancer screenings. Screening facilitators included knowing someone diagnosed with cervical cancer and provider recommendations. WLH indicated that they obtained health information through in-person education (providers, peer groups) and written literature. Due to the pandemic, they also had to increasingly rely on remote and technology-based communication channels such as the internet, social media, television, radio, email, and short message service (SMS) text messaging.

Conclusions

Future health interventions need to explore the possibility of sharing messages and increasing cervical cancer and HPV knowledge of WLH through the use of SMS and other technology-based channels.

Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study

OBJECTIVES

Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.

DESIGN

A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.

METHODS

Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis.

RESULTS

Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding.

CONCLUSIONS

The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.

What do Young People Think About HPV and HPV Vaccination? The Role of Health Education Interventions and Health Professionals

Background

Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and its highest prevalence is observed in adolescents and young adults. This review examined studies that explore awareness about HPV among adolescents and young adults, as well as their attitudes and willingness towards the HPV vaccine. Besides, the impact of health professionals and health education interventions on HPV awareness and attitudes towards HPV vaccine is identified.

Objective

The aim of this review is, firstly, to systematically identify the studies that explore awareness about HPV among adolescents and young adults, as well as their attitudes and willingness towards the HPV vaccine. Secondly, the aim is to identify the impact of health professionals and health education interventions on HPV awareness and attitudes towards HPV vaccine among the same group.

Methods

The systematic review was conducted in the international databases PubMed, Scopus, and Google Scholar, between 2016-2019.

Results

The review revealed low to moderate levels of awareness and knowledge regarding HPV (10 studies), while a more favorable attitude towards the HPV vaccine (3 studies). The role of health professionals was ineffective (4 studies), while studies focused on the impact of health education interventions showed a positive impact on knowledge and awareness of HPV (4 studies).

Conclusion

Continuous training of health personnel is necessary and new studies are needed to identify barriers to adolescents not being vaccinated.

A New Strategy for Cervical Cancer Prevention Among Chinese Women: How Much Do They Know and How Do They React Toward the HPV Immunization?

In 2017, HPV vaccines were first marketed in China. We carried out an investigation among parents of high school students to assess parents' knowledge of cervical cancer and human papillomavirus (HPV)/HPV vaccines, along with their acceptance of HPV vaccination and the factors that influence it, all of which are essential for targeted education regarding HPV vaccination. A cross-sectional study was conducted among parents of high school students in East China using a pretested questionnaire. Data regarding knowledge of cervical cancer, HPV, HPV vaccines, and acceptance of the vaccines were collected and analyzed. In total, 1,200 questionnaires were distributed, with 1,125 valid responses. Overall, 87.5% of respondents knew that cervical cancer is one of the most common genital system cancers; 78.67% knew that HPV causes cervical cancer; 69.2% knew that HPV is primarily transmitted through sex; 54.3% knew that HPV vaccines exist; and 35.6% knew the optimal age for HPV vaccination. Only 4.4% had vaccinated their daughters for HPV, and 35.4% were willing to do so. Reasons for refusal primarily concerned the vaccines' safety (77.4%) and efficacy (61.5%). Multivariate analyses showed that parents who had obtained pneumococcal conjugate vaccines for their daughters showed higher acceptance of HPV vaccines, as well as higher knowledge of cervical cancer, the association of HPV and cervical cancer, and the main transmission route of HPV. Although parents' knowledge level regarding cervical cancer was moderate, it was very low regarding HPV and HPV vaccines. Teenagers' HPV vaccine uptake and parents' willingness to vaccinate their children was also quite low. Educational interventions and awareness campaigns are needed to ensure the success of HPV immunization programs in East China.

Coverage of HPV-Related Information on Chinese Social Media: a Content Analysis of Articles in Zhihu

Information about human papillomavirus (HPV) disease and its vaccination has been increasingly communicated and discussed on social media platforms. The current study aims to investigate the coverage of HPV-related information on one of the most popular Chinese social media - Zhihu. Data for this study were user-generated articles, which were identified and collected by a Python web crawler with keyword searching. The final sample included a total of 115 articles, covering a two-year period between 2017 and 2018. Each article was coded for several key characteristics, including HPV epidemiological information, health belief model (HBM) constructs, framing strategy, and responses to the article. Results suggested that most of the articles reported HPV's relationship to cervical cancer, HPV severity, and vaccination benefits. Thematic framing was more often used by the Zhihu articles to disseminate HPV-related issues, and a significant relationship between framing strategy and information coverage was found. The study has not only theoretically extended the literature of online HPV vaccine information coverage, but also practically suggested the needs to communicate comprehensive and detailed knowledge about HPV vaccination on Chinese social media.

Human papillomavirus (HPV) vaccine status and knowledge of students at a university in rural Thailand

Background

Human papillomavirus (HPV) is a sexually transmitted virus that causes cancers of the cervix, anus, vagina, penis, and oropharynx. HPV vaccination prevents HPV types that commonly cause these cancers. HPV vaccines have been approved in Thailand since 2007. However, the vaccination rate remains low, particularly in young people.

Objectives

This study aimed to investigate the information level regarding HPV infection and vaccination in the younger Thai population, the self-reported vaccination rate, the vaccine intention, and factors affecting the intention.

Methods

This cross-sectional study enrolled a total of 521 undergraduate students (77% female). We used a 34 items self-administered questionnaire (18 questions assessing knowledge level).

Results

The mean score of knowledge was 7.53 ± 4.95 (total score 18), indicating a low-to-moderate level of knowledge. Female gender and health-related majors were significant factors associated with greater knowledge. The self-reported vaccination rate was 1.9% among only female participants. Only 30.3% of the unvaccinated subjects had the intention to receive the vaccine. The factors affecting vaccine intention were female gender and having knowledge score ≥7. The barriers to HPV vaccination were cost (52.2%), and the perception of no need due to low-risk behavior (45.1%).

Conclusion

Education programs on HPV infection and vaccination should be included in the curriculum earlier, if possible, since primary school because the vaccine works best before the onset of sexual activity. In university students, the education programs may encourage the sexually inexperienced students to receive the vaccines, as they are still the ideal group for catch-up vaccination. Moreover, parental education is essential, as national vaccination programs usually target younger people. Knowledge sharing by educated people and organizations could enhance the information level in the communities. Consequently, people become aware of primary prevention by vaccination, which may lead to an increase in vaccination rates and eventually decrease HPV-related cancers.

Persistent Disparities in Cervical Cancer Screening Uptake: Knowledge and Sociodemographic Determinants of Papanicolaou and Human Papillomavirus Testing Among Women in the United States

OBJECTIVES

Cervical cancer is the second-most common type of cancer among women aged 15-44, and racial, ethnic, and economic disparities exist in survival rates despite widely available screening tests and early treatment options. The objective of this study was to describe the association among knowledge, sociodemographic characteristics, and cervical cancer screening, with the goal of developing interventions to prevent cervical cancer in populations at risk of the disease.

METHODS

In 2017, we conducted a nationwide survey of women in the United States aged ≥18 who had ever received a Papanicolaou (Pap) test (N = 630). We conducted t tests and one-way analysis of variance to determine sociodemographic differences (age, education, race, ethnicity, income, type of health insurance) in knowledge about cervical cancer screening (Pap test and human papillomavirus [HPV] test). We used logistic regressions to define significant determinants of cervical cancer screening behaviors in the previous 5 years.

RESULTS

Of 629 respondents, 407 (64.7%) had an annual household income <$30 000, and 322 of 536 (60.1%) respondents had government-provided health insurance. Of 630 women who had ever had a Pap test, 425 (67.5%) had an HPV test. Hispanic and non-Hispanic white women were more likely than Hispanic and non-Hispanic black women (odds ratio [OR] = 2.49; 95% CI, 1.12-4.54; P = .02) and women with government-provided health insurance (OR = 1.91; 95% CI, 1.08-3.37; P = .03) were more likely than women with private health insurance to have received a Pap test in the previous 5 years. Knowledge of HPV was a significant predictor of having received an HPV test in the previous 5 years (OR = 1.37; 95% CI, 1.22-1.54; P < .001).

CONCLUSION

Disparities in cervical cancer screening among sociodemographic groups of women suggest the need for targeted interventions to improve knowledge about Pap and HPV tests.

A National Survey of Canadian Adults on HPV: Knowledge, Attitudes, and Barriers to the HPV Vaccine

OBJECTIVE

Identifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public.

METHODS

An online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women.

RESULTS

The majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants.

CONCLUSION

Canadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.

Human papillomavirus knowledge, attitudes, and vaccination among Chinese college students in the United States

Human papilloma virus (HPV) is the most common sexually transmitted infection in the USA with some strains increasing the risk of certain cancers. The HPV vaccine, introduced in 2006, has reduced the infection rate, although racial/ethnic disparities in vaccination exist. Asian college students are among those with the lowest vaccination rates, however there has been little exploration as to why. The purposes of this study were to assess (a) knowledge and attitudes regarding HPV and its vaccine, (b) HPV vaccination practices, and (c) factors associated with HPV-related knowledge and attitudes, and vaccination among Chinese college students in the USA. This cross-sectional quantitative survey collected data face-to-face and online from 449 participants. The mean scores for HPV knowledge and attitudes were 40.87 and 2.36 indicating a low-to-moderate level of knowledge but a moderately positive attitude regrading HPV transmission and vaccination. Only half (50.8%) knew that the vaccination could be received after the age of 18 years. Only 38.3% reported having receiving at least one dose of the vaccine, with 92.4% receiving their first HPV vaccines in the USA. Multiple logistic regression showed that men and non-health sciences majors had lower knowledge about HPV. Older students, those without a primary care provider, and those who completed the survey in English had more negative attitudes about the HPV and vaccine. Participants who were younger, female, had a higher level of knowledge, had more positive attitudes, and completed the survey online were associated with better vaccination status. Findings from this study provide insight into Chinese college students' knowledge and attitudes about HPV and HPV vaccination and may be used to develop culturally sensitive programs that address the risk of HPV and the benefits of HPV vaccine.

State of knowledge of human papillomavirus (HPV), HPV vaccine and testing: a cross-sectional study among female university students in Cyprus

This study aimed to evaluate human papillomavirus (HPV)-related knowledge of women aged 18-25 years and estimate the reported uptake of HPV vaccine and testing. A cross-sectional study was conducted among female students of the University of Cyprus between March and April 2017. The participants self-completed a questionnaire, which consisted of 37 items on demographics, general HPV-related knowledge, and HPV vaccination and testing. In total, 283 young females (mean age: 19.7 ± 1.5 years) took part in the study. Of these, about half (53.7%) reported that they were aware of HPV; one-third (30.7%) reported having been vaccinated; 38.8% had been informed of the recent introduction of the HPV vaccine in the National Immunization Schedule in Cyprus, while 14.3% reported a previous Pap-test and 3.4% a previous HPV DNA test. The mean Overall Knowledge Index (max: 25 correct answers) was 6.1 (±3.8) and was positively associated with the reported uptake of the HPV vaccine (adjusted Odds ratio: 1.14, 95% Confidence Interval (CI): 1.04-1.24). Knowledge about HPV has to be improved as it is associated with increased reported rates of HPV vaccination.

Exploring HPV Knowledge, Awareness, Beliefs, Attitudes, and Vaccine Acceptability of Latino Fathers Living in the United States: An Integrative Review

To conduct an integrative review to identify and synthesize studies exploring human papillomavirus (HPV) knowledge, awareness, beliefs, attitudes, and acceptability of the HPV vaccine among Latino fathers living in the United States. The review methodology was informed by those developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed methods studies. Using the preferred reporting items for systematic reviews meta-analyses guidelines, five electronic databases (PubMed, Medline, PsycINFO, CINAHL, Science Direct) were searched for peer-reviewed, full-text studies published in English with samples that included Latino fathers and examined knowledge, awareness, beliefs, attitudes about the HPV and the HPV vaccines. Studies that did not provide information on the inclusion of fathers in the sample were excluded. Identified eligible studies were analyzed and synthesized using the matrix method. Eleven eligible studies were identified. Most (n = 10) included mothers and fathers. One study included only fathers, and this study determined that although fathers held positive attitudes toward the HPV vaccine, a notable number of participants were unsure of or had not formed an opinion about the HPV vaccine. Fathers felt that a recommendation from their child's physician would impact whether they vaccinated their child. Moreover, of the ten studies including both parents, only two specifically compared fathers' and mothers' knowledge and awareness about the HPV and vaccine acceptability. These two studies determined that fathers were less aware of the HPV and had lower HPV vaccine-related knowledge than mothers. Nevertheless, all of the 11 examined studies, found moderate to high acceptability of the HPV vaccine among Latino parents despite uncertainty about possible vaccine risks and costs. Only 11 studies were identified that included Latino fathers. Of these studies, only one was conducted exclusively with Latino fathers and two compared fathers and mothers. Additional research focusing on Latino fathers is needed given the central role of the family in the Latino culture and the shared role fathers and mothers have in decision-making related to their children's health.

Nurses' Knowledge and Opinions on HPV Vaccination: a Cross-Sectional Study from Istanbul

Implementing a HPV vaccination program is currently under evaluation by the Turkish health ministry. For screening and vaccination programs to be successful, the cooperation of nurses is essential. We aimed to evaluate (1) basic knowledge of nurses and nursing interns regarding HPV infection and cervical cancer, (2) their attitudes towards smear testing and HPV vaccination, and (3) their viewpoint on vaccination of school age children. This cross-sectional study was undertaken at Bezmialem Vakif University. The survey was designed to assess knowledge about HPV infection, Pap smear testing, cervical cancer, HPV vaccine, attitudes towards HPV vaccination, and school-based vaccination programs. Validity content was determined by expert gynecologists, and a pilot study was performed on 10 nurses. A total of 550 questionnaires were handed out; 499 were completed. Our response rate was 90.7%. Fifty-nine participants answered all the knowledge questions correctly. The calculated knowledge score of the female participants was 6.99 ± 2.22, the male participants was 5.89 ± 2.92. Female participants were more knowledgeable (p < 0.0001). Out of the 353 female participants, 18.6% (n = 66) had undergone smear testing. There were 20 (5.6%) female and 6 (4%) male participants who were vaccinated against HPV. The leading answer for not having a HPV vaccine was "I'm not at risk for a HPV infection" (n = 106, 34.9%). There was a statistical relationship between "HPV knowledge score" and answering "Yes" to "Do you want your children/future children to be vaccinated? (p = 0.001) and "Do you think including the vaccine in the Turkish immunization program is necessary?" (p = 0.001). Nurses in our cohort seem to have satisfactory basic knowledge regarding HPV infection; however, their viewpoints on vaccination were not favorable. Strategies and intervention materials for HPV vaccination will be necessary if a national immunization program will be initiated.

A National Survey of Canadian Physicians on HPV: Knowledge, Barriers, and Preventive Practices

OBJECTIVE

Physicians are the sole prescribers of the human papillomavirus (HPV) vaccine for adults in Canada. This survey of Canadian physicians aimed to explore knowledge, barriers, and preventive practices regarding HPV vaccination.

METHOD

A survey of general practitioners (GPs) (n = 337) and obstetrician/gynaecologists (OB/GYNs) (n = 81) was conducted in May and June 2016 using an online panel. Demographic data and information pertaining to HPV knowledge, attitudes, and vaccination practices were collected by using a 22-item questionnaire.

RESULTS

A total of 83% of GPs recommended or administered HPV vaccine to adults. Among physicians, 99% to 100% strongly agreed that vaccination is an important aspect of disease prevention. Physicians were rarely concerned about vaccine safety (5%-11%). Cost was seen as the number one barrier by 92% to 95% of physicians. Physicians rated consumers' understanding of HPV to be low (11%-14%, very good; and 49%-56%, somewhat good knowledge). Among physicians, 60% to 66% of said they routinely discussed HPV vaccination with patients. Female physicians demonstrated greater knowledge of HPV than their male counterparts.

CONCLUSION

GPs and obstetrician/gynaecologists routinely recommend and administer the HPV vaccine to patients. The majority of physicians showed high levels of knowledge regarding HPV vaccine and associated cancers; however, perceived barriers of cost may limit recommendations for vaccination, particularly among older women or men.

Human papillomavirus knowledge, beliefs, and behaviors: A questionnaire adaptation

OBJECTIVE

This study aims to adapt a questionnaire about the knowledge, beliefs and behaviors regarding HPV and related subjects into Brazilian Portuguese.

STUDY DESIGN

National Survey.

METHODS

The instrument was translated into Portuguese and retranslated into English separately. Experts assessed the validity of the content and cross-cultural adaptation of the instrument. The instrument was administered to 8580 male and female Brazilian adolescents and young adults (aged between 16 and 25 years) who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District.

RESULTS

The full questionnaire is composed of 30 questions, with a good absolute agreement between its two halves (61.16 ± 9.97). The preventive behavior section showed the lowest agreement. Men and women showed a difference concerning their knowledge about HPV (score for men 0.48 (± 8.93) vs. women 0.55 (± 4.51), p < 0.001).

CONCLUSION

The proposed questionnaire is the first instrument able to describe the knowledge, beliefs and behaviors regarding HPV and related subjects in Brazilian women and men. This questionnaire appears to be adequate for use in future studies that may produce evidence and knowledge on these specific topics.

Knowledge of HPV and acceptability of HPV vaccine among women in western China: a cross-sectional survey

BACKGROUND

Since most cervical cancer cases are caused by persistent high-risk human papillomavirus (HR-HPV) infection, knowledge of HPV among women is essential for the prevent of cervical cancer. This study was aimed to assess knowledge among women in western China about HPV and its association with cervical cancer, and to assess their acceptance of HPV vaccination.

METHODS

A sample of healthy women undergoing routine physical examinations in the Health Management Center of West China Hospital, Sichuan University between January and December 2014 completed a questionnaire.

RESULTS

A total of 1300 questionnaires were distributed, and 1109 were completed and analyzed. Only 28.85% of respondents (n = 320) had heard of HPV; among this subgroup, only half (53.44%) knew that it causes cervical cancer, only 26 (8.13%) correctly answered all questions about HPV. Multivariate analysis showed that respondents who had heard of HPV were more likely than other respondents to have a family history of any cancer, to undergo regular Pap tests and to have completed at least secondary education. Half of all respondents (51.22%) reported that they would be willing to be vaccinated against HPV.

CONCLUSION

Although most women in western China lack basic knowledge about HPV, at least half are willing to take the HPV vaccine. Public health efforts to educate the public about HPV and its connection to cervical cancer should be strengthened and expanded.

Awareness and Knowledge About HPV and HPV Vaccine Among Romanian Women

Cervical cancer is one of the most prevalent gynecological malignancies worldwide. Romania has the highest incidence of this type of cancer in Europe. A successful prevention strategy has to consider the primary prevention measures (including health education on human papilloma virus (HPV) infection but also vaccination). The aim of this study was to assess the knowledge and attitudes of Romanian women about HPV and HPV vaccine. We conducted a cross-sectional study survey of 454 women using an anonymously completed questionnaire covering the awareness and knowledge of HPV infection and attitudes to vaccination. We also analyzed the discussions and conclusion from a focus group of healthcare professionals regarding (1) HPV and HPV awareness and attitude, and (2) suggestions for improving HPV vaccine knowledge and acceptance. 69.2% of women were aware about HPV but their knowledge was minimal and incomplete. While 62.3% had heard about HPV vaccine, only 50.7% had a positive attitude toward it. The main barriers to vaccination were the fear of side effects, the perception that is risky, and the financial concerns. Deficiencies in knowledge were noted for vaccine, genital warts, or risks factors for HPV infection like the early onset of sexual life. The information regarding HPV and vaccine is not always accurate and complete, and only 50.7% of women have a positive attitude toward the vaccine. More educational programs and clearer communication are needed to raise awareness and knowledge regarding HPV and HPV vaccine.

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.

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

Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men.

Association Between Parental HPV Knowledge and Intentions to Have Their Daughters Vaccinated

Human papillomavirus (HPV) 16 and 18 causes 66% of cervical cancers (Dunne et al., 2014). Vaccination during adolescence can prevent HPV-associated cervical cancers, yet less than half of adolescent girls are vaccinated. This study examined the association between HPV knowledge and parental intentions to vaccinate daughters against HPV. A retrospective, cross-sectional, national data set from the 2006-2007 Health Information National Trends Survey (HINTS) was used. A multivariate multinomial logistic regression analysis was used to estimate the association between intent to vaccinate and HPV knowledge. After controlling for other covariates, parents who were knowledgeable were more likely to intend to have their daughters vaccinated compared with those who were not knowledgeable (adjusted relative risk ratio [aRRR] = 3.96, p = .004). Having HPV knowledge would significantly increase parents' intent for vaccination against the disease for their daughters. Health care providers should integrate HPV-related education for parents within their services, and policymakers should consider requiring HPV vaccination for school attendance.