Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states

BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake.MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015–2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25th percentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage.ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates.ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.     

Barriers to receiving human papillomavirus vaccination among female students in a university in Hong Kong

This paper investigates, using a qualitative approach, barriers to receiving Human Papillomavirus (HPV) vaccine among female undergraduate students in a Hong Kong university. By conducting individual semi-structured interviews with 35 young women aged 19 to 23, seven intertwining perceptual, social and cultural, healthcare provider and financial barriers were identified. These barriers included the perception as being low-risk due to an absence of sexual contact, lack of confidence in the safety of the vaccine, suspicion of parents concerning the intention to get vaccinated, lack of positive discussion among peers, insufficient information from primary-care doctors, difficulty in choosing a suitable HPV vaccine and cost of the vaccine. Future HPV-vaccination promotion therefore not only needs to enhance risk perception and needs awareness of young women, but also educate parents and correct their misconceptions. As primary care doctors are the first line of contact with patients, providing more support to enhance their knowledge of the HPV vaccine and to encourage their enthusiasm in providing responsive disease-prevention education can motivate young women to get vaccinated.     

Perceptions and acceptability of HPV vaccination among parents of young adolescents: A multicenter national survey in China

Prophylactic HPV vaccines target young adolescents to prevent related cervical lesions and even genital warts prior to onset of sexual activity. Parental consent is often essential for success of vaccination program for this age group. We conducted a national multicenter study to explore the acceptability of HPV vaccination among parents of young adolescents and associated factors in relevant parent decision making in China. A total of 2899 parents of young adolescents (11–17 years) participated in the survey between November 28, 2011 and May 9, 2012, but four were excluded from analysis because of inconsistencies in their given information in the questionnaire. Mothers accounted for 62.8% of the parent participants. The mean age of the parents was 40.40 (standard deviation, 4.68) years. Only 36.2% of the parents accepted the vaccine for their children. Knowledge about HPV and HPV vaccine was a positive correlate with HPV vaccination acceptability (P_trend = 0.003). Grade of child (P_trend = 0.015), prior vaccination experience outside the National Expanded Program on Immunization (OR: 1.43; 95%CI: 1.19–1.72), fear of cervical cancer and/or genital warts (OR: 2.47; 95%CI: 2.00–3.05), and prior consultation regarding HPV vaccine information (OR: 2.35; 95%CI: 1.57–3.52) were also positively associated with higher HPV vaccine acceptability. The acceptability was lower in mothers (OR: 0.45; 95%CI: 0.37–0.54) and who had better education (P_trend = 0.009). 57.3% of the parents agreed that the most appropriate venue for HPV vaccination was the local center for disease prevention and control. In conclusion, our study indicates a low acceptability of HPV vaccination among parents of young adolescents in China. We understand there are many challenges in implementing HPV vaccination program. Our findings will serve as valuable references for future HPV vaccination policies and campaigns after HPV vaccines are approved in China.     

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong

Purpose: To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes.

Methods: A cross-sectional questionnaire survey of 3355 participating secondary school students (response RATE = 98%).

Results: Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care.

Conclusions: This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students’ attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.     

Preparing for HPV vaccination in South Africa: key challenges and opinions

This article reports on qualitative research investigating key challenges and barriers towards human papillomavirus (HPV) vaccine introduction in the Western Cape Province, South Africa. A total of 50 in-depth interviews and 6 focus groups were conducted at policy, health service and community levels of enquiry. Respondents expressed overall support for the HPV vaccine, underscored by difficulties associated with the current cervical screening programmes and the burgeoning HIV/AIDS epidemic in South Africa. Overall poor community knowledge of cervical cancer and the causal relationship between HPV and cervical cancer suggests the need for continued education around the importance of regular cervical screening. The optimal target populations for HPV vaccination was influenced by the perceived median age of sexual activity in South African girls (9-15 years), with an underlying concern that high levels of sexual abuse had significantly decreased the age of sexual exposure suggesting vaccination should commence as early as 9 years. Vaccination through schools with the involvement of other stakeholders such as sexual and reproductive health and the advanced programme on immunization (EPI) were suggested. Opposition to the HPV vaccine was not anticipated if the vaccine was marketed as preventing cervical cancer rather than a sexually transmitted infection. The findings assist in identifying potential barriers and facilitating factors towards HPV vaccines and will inform the development of policy and programs to support HPV vaccination introduction in South Africa and other African countries.     

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

ObjectivesHuman 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.MethodsThis 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.ResultsA 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.ConclusionOmani 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.     

Repeat suicide attempts in Hong Kong community adolescents

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.     

Predictors of interest in HPV vaccination: A study of British adolescents

Human papillomavirus (HPV) vaccination is now offered to adolescent girls in the UK. Adolescents over 16 years old are likely to make their own decision about the vaccination. The purpose of this cross-sectional study was to assess acceptability of HPV vaccination among female adolescents (16–19 years) and investigate socio-cultural variation in intended acceptance. Participants were recruited through two further-education colleges in England. They read information about HPV before responding to questions assessing acceptability, demographics and attitudes based on the Health Belief Model. There were 367 cases included in analyses. Most participants said they would be likely to accept HPV vaccination (89%). Ethnicity, religion and English as a first language were associated with acceptability (pseudo-R² = 0.11). In multivariate analysis only religion remained significant, with girls from Muslim (OR = 0.20, CI: 0.05–0.90) or Hindu/Sikh (OR = 0.09, CI: 0.01–0.56) backgrounds less likely to accept vaccination. Perceived susceptibility, benefits and barriers were also associated with acceptability (pseudo-R² = 0.25), but did not mediate the effect of the ethnicity-related variables. Interventions based on the health belief model may help encourage HPV vaccine acceptance among adolescents. Future research to understand the issues associated with HPV vaccination in different religious groups is needed.     

Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls

To better understand how to achieve high uptake rates of human papillomavirus (HPV) vaccination in Japan, we investigated acceptance of and attitudes towards HPV vaccination in 2192 mothers of girls aged 11-14yrs. A school-based survey was conducted in five elementary and fourteen junior high schools in Sapporo, Japan. Responses from 862 participants were analyzed. Ninety-three percent of mothers would accept the vaccine for their daughter if free, but only 1.5% was willing to pay the minimum recommended price of ￥40,000. Vaccine acceptance was higher in mothers who had heard of HPV vaccine (adjusted odds ratio, aOR=2.58, confidence interval, CI=1.47-4.53), and who believed susceptibility to (aOR=2.30, CI=1.34-3.92) and severity of (aOR=3.73, CI=1.41-9.88) HPV to be high. Recommendations from a doctor (aOR=12.60, CI=7.06-21.48) and local health board (aOR=27.80, CI=13.88-55.86) were also positively associated with increased HPV vaccine acceptance. Concerns about side effects of both the HPV vaccine (aOR=0.03, CI=0.01-0.08) and routine childhood vaccines in general (aOR=0.11, CI=0.02-0.78) emerged as barriers to vaccination. Not participating in routine cervical screening also emerged as a deterrent (aOR=0.49, CI=0.27-0.91). While most mothers (66.8%) agreed that 10-14yr was an appropriate age for vaccination, a further 30.6% believed >15yr to be more appropriate. In conclusion, attitudes of Japanese mothers toward HPV vaccination are encouraging. While lower vaccine acceptance in mothers who do not undergo regular cervical screening needs further investigation, this study indicates that high uptake may be possible in a publically funded HPV vaccination program if physicians actively address safety concerns and justify why the vaccine is needed at a particular age.     

Political attitudes and efficacy of health expert communication on the support for COVID-19 vaccination program: Findings from a survey in Hong Kong

Despite evidence suggesting that vaccines offer protection against COVID-19, the uptake rates of COVID-19 vaccines have been low in some high-income regions. Support for vaccination program is important to fight the pandemic. This study aimed at exploring two research questions: first, to what extent political attitudes are associated with support for COVID-19 vaccination program; and second, whether health expert communication is effective in increasing the support. An online survey was undertaken by 1079 Hong Kong residents aged 18–77 years from May 26 to June 3, 2021. The survey found higher support in pro-government respondents, and lower support in political opposition. A strategy of positive communication by health experts could increase support in the opposition and politically attentive respondents. Other variables that were positively related to program support were quarantine experience, trust in government, preference for pandemic control over freedom, political attentiveness, and disagreement with China’s influence on Hong Kong’s COVID-19 policymaking. This study contributes to understanding the relationship between political attitudes and support for vaccination program and provides empirical evidence of the efficacy of health expert communication strategy in improving support for vaccination program for people with certain political attitudes.     

Acceptability and clinical performance of a copper-containing frameless IUCD in Hong Kong

This is the first study conducted in Hong Kong to evaluate the acceptability and clinical performance of a copper-containing frameless intrauterine contraceptive device (IUCD; GyneFix/Ji Ni). Sixty-two women chose to use the frameless IUCD for contraception. A learning curve was demonstrated in the insertion technique of this new device. Pain associated with insertion was acceptable. No pregnancy was reported during the 1-year trial period. Objectively, the amount of menstrual loss did not change and dysmenorrhea improved, but the duration of menstrual flow was slightly prolonged during the use of this device. However, there was a 10.7% request rate for removal of the device because of its side effects. The expulsion rate during the first year was 5.3%, and the continuation rate at the end of the first year was 76.7%. It was found that 85% of the 40 subjects interviewed upon the completion of the 1-year trial period wished to replace the same device after the product expiration date and that 92.5% would recommend this device to their friends. In summary, the clinical performance of the frameless IUCD was comparable to its framed counterparts. The device was considered acceptable to a majority of the women.     

Urban blue space and health and wellbeing in Hong Kong: Results from a survey of older adults

The potential benefits of aquatic environments for public health have been understudied in Asia. We investigated the relationships between blue space exposures and health outcomes among a sample of predominantly older adults in Hong Kong. Those with a view of blue space from the home were more likely to report good general health, while intentional exposure was linked to greater odds of high wellbeing. Visiting blue space regularly was more likely for those within a 10–15 min walk, and who believed visit locations had good facilities and wildlife present. Longer blue space visits, and those involving higher intensity activities, were associated with higher recalled wellbeing. Our evidence suggests that, at least for older citizens, Hong Kong's blue spaces could be an important public health resource.     

Attitudes to HPV vaccination among mothers in the British Jewish community: reasons for accepting or declining the vaccine

Objective

This study aimed to explore attitudes to human papillomavirus (HPV) vaccination and reasons for accepting or declining the vaccine in the British Jewish community.

Methods

A qualitative approach was used to explore maternal attitudes towards HPV vaccination. Participants were mothers of girls who had been offered HPV vaccination and were purposively sampled through Jewish secondary schools. Face-to-face interviews were conducted with vaccine-accepting (n = 10) and vaccine-declining (n = 10) mothers. Interviews were transcribed verbatim and analysed using a framework approach.

Results

HPV and cervical cancer knowledge varied, with poor knowledge attributed to lack of contact with the disease. Although mothers thought HPV vaccination was a good idea in general, many did not perceive it as necessary for their daughter, citing Jewish religious laws governing family purity and abstinence until marriage as reasons for daughter's low susceptibility. These beliefs combined with concerns about the novelty of the vaccination were the main reasons given for declining the vaccine. Mothers who accepted the vaccine generally did so to protect their daughters health and because they felt unable to predict their daughters future behaviour and HPV susceptibility. Many mothers expressed a wish to wait until their daughter was older and the vaccine was more established before consenting. Among some mothers there was disappointment in the information they had received and a feeling that the concerns and questions of the Jewish community had not been addressed.

Conclusion

Attitudes to HPV vaccine in religious communities may lead to reduced vaccine coverage. The development of community-specific information about the importance of the vaccine may help address concerns.     

Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment

BackgroundCervical cancer is the second most common cancer in Chinese women. Human papillomavirus (HPV) vaccines have not yet been introduced in the Chinese national immunization program, and people vaccinate voluntarily at their own expense. Therefore, it is important to study the factors that could impact parents' decisions for HPV vaccination.ObjectiveTo quantify parental preferences regarding HPV vaccination for junior middle school-aged girls.MethodA discrete choice experiment (DCE) survey was conducted to assess parents' preferences for HPV vaccines. Data were collected from parents of girls aged 12–16 years in 11 middle schools of Shandong Province. We evaluated preferences for five attributes of HPV vaccination (vaccine effectiveness, protection duration, risk of side effects, cost, and vaccination location). Conditional logit regressions were adopted for analyses.Results995 parents completed valid DCE questions. All attributes influenced parents’ willingness to vaccinate. Comparatively highly educated parents preferred more on higher vaccine effectiveness and lower side effects risks while more intended to accept higher prices. Parents were willing to trade 2326.32 CNY for an increase in HPV vaccine effectiveness from 50% to 90%. Nearly 70% percent of the respondents were predicted to prefer multiple improvements in HPV vaccination (protection increased from 70% to 95%, duration increased from 9 years to 15 years, and vaccination location changed from vaccination center to school) to the base case.ConclusionVarious vaccine characteristics and implementation strategies influence respondents’ preferences. Health education with evidence-based information about HPV vaccines would help parents make informed decisions. The findings can also assist agencies responsible for HPV vaccination implementation and cervical cancer prevention in China in decisions regarding vaccination financing and vaccine approval.     

HPV vaccine acceptance among adolescent males and their parents in two suburban pediatric practices

PurposeTo measure HPV vaccine acceptance among unvaccinated adolescent males and parents and correlate acceptance with knowledge, awareness, and personal experience.MethodsAdolescent males ages 11–21 years old and their parents completed questionnaires measuring attitudes and knowledge about HPV vaccination and personal experience. Acceptance was defined as wanting the vaccine and conditional acceptance as wanting the vaccine if it would protect against genital warts or cervical cancer.ResultsAdolescent (n = 154) and parent (n = 121) vaccine acceptance was low (16% and 34%, respectively); however, conditional acceptance was higher. While adolescents had similar conditional acceptance for a vaccine against genital warts and cervical cancer, parents reported higher conditional acceptance for protection against genital warts. Independent predictors of acceptance included personal experience and demographic variables.ConclusionsHPV vaccine acceptance among adolescents and parents was low. Conditional acceptance levels highlight the importance of education about a few important benefits of HPV vaccination, which may increase vaccination rates.     

Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales

BackgroundSchool-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages.MethodsWe carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided.ResultsAmong 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine.ConclusionsOur findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate.     

Stigma and sex work from the perspective of female sex workers in Hong Kong

While the stigma surrounding sex work is both well documented and easily recognised, few studies examine stigma in this context from the perspective of the sex workers themselves. In this article we report on a study using a modified grounded theory approach to analyse a series of semi-structured interviews with 49 female sex workers in Hong Kong, in order to examine the ways in which this group experiences and negotiates the stigma which arises from their employment in the sex industry. Sex workers in Hong Kong were subject to various stigmatising forces in their daily lives in their interactions with the public, the police and their families. These processes could have a negative impact on the sex workers' health, both through obvious manifestations such as physical or verbal abuse and through more subtle processes such as those which generated or perpetuated vulnerability and those which compelled the sex workers to conceal their identities and withdraw themselves from social networks. These findings are situated in the context of broader research surrounding sex work, drawing attention to the consequences of stigma on health and their interaction with health-service providers, before briefly discussing possible means of overcoming stigma-related barriers to providing adequate healthcare for this marginalised group.     

Pre-pubescent girls' evaluations of female images in Hong Kong media

Interviews with pre-pubescent girls in Hong Kong explored their satisfaction with the images of females presented in the media. Sixteen girls aged 10 to 12 were asked to take images from media that are about “what girls or women should be or should not be; and what girls or women should do or should not do”. They were asked who created the images they collected and whether they were satisfied with the content. Most of these young girls were able to identify some of the individuals and the institutions involved in the creation of female images. They identified promoting sales, beautifying, reflection, and questionable motives as the intentions behind creating the images as they were. The girls were dissatisfied with female images in the media. They found them too sexy, too passive, or too artificial and expressed a preference for images of girls or women that are active, natural, and healthy.     

Knowledge and attitude of students studying at health department towards HPV and HPV vaccination

The human papillomavirus (HPV) is the most common diagnosed sexually transmitted infection in the world. The most frequent disease linked to HPV is cervical cancer as well as other cancers including those of the vulva, vagina, penis, anus, and oropharynx.Our research sought to evaluate the knowledge and attitudes concerning human papillomaviruses and their vaccine among students enrolled in Alt?nba? University's faculties of health sciences.MethodA cross-sectional study was carried out using a survey containing 41 questions about demographic variables, knowledge, and attitudes toward HPV and HPV vaccines. The questions were distributed to students via Google form using social media applications such as WhatsApp.ResultsThe study involved 144 students, 71.5 % of whom were female. 37.5 % of the participants learned about HPV from social media. Knowledge of HPV is present in 82 % of females and 25 % of males. Most of the questions had more accurate replies from female than from male students p < 0.05. As a result, 88 %, 46 % of female respondents and 27 %, 14 % of male respondents, respectively, correctly answered the questions about who should receive HPV vaccinations p < 0.001 and how many doses are necessary.ConclusionParticipants' awareness of HPV, HPV vaccination, and cervical cancer was rather high when compared to other research. However, there are knowledge gaps that need to be corrected and provided through educational programs.     

Knowledge of human papillomavirus (HPV) and HPV vaccination: An international comparison

Since vaccination against human papillomavirus (HPV) became available, awareness of HPV has dramatically increased. Implementation of a vaccine program varies internationally yet no studies have explored the influence this has on the public's knowledge of HPV. The present study aimed to explore differences in awareness of HPV and HPV knowledge across three countries: The US, UK and Australia.