Stages of HPV Vaccine Hesitancy Among Guardians of Female Secondary School Students in China

PurposeFemale secondary school students are the primary recommended population for human papillomavirus (HPV) vaccines. However, vaccine hesitancy may affect uptake. In this study, we assessed the vaccine hesitancy levels among the guardians of female secondary school students in China.MethodsWe developed a questionnaire and conducted cross-sectional surveys among guardians of secondary school girls aged 12–19 years in mainland China based on the Increasing Vaccination Model and the Precaution Adoption Process Model.ResultsWe collected 3,225 valid samples. Among the participating guardians, 53.9% were vaccine hesitant, although only 0.9% had refused HPV vaccines. Some individual characteristics of guardians (e.g. sex, education/income level) were associated with understanding HPV vaccines. Better knowledge of HPV vaccines and communication with reliable sources of information were associated with vaccine nonhesitancy. Practical barriers such as vaccine shortage and busy schedules prevented nonhesitant guardians from vaccinating their children.DiscussionA substantial proportion of the guardians surveyed were HPV vaccine hesitant. Promoting HPV knowledge and communication with reliable sources (e.g. clinical doctors) could help fight against vaccine hesitancy.     

Factors influencing intention to obtain the HPV vaccine and acceptability of 2-, 4- and 9-valent HPV vaccines: A study of undergraduate female health sciences students in Fujian,China

BackgroundLittle research has been conducted on the intention to obtain HPV vaccine now that the vaccine is approved for use in China. Acceptance of the three HPV vaccines, which differ in valency and price, has never been investigated.MethodsAn online cross-sectional survey assessing female undergraduate students’ intention to obtain the HPV vaccine and their acceptability of 2-, 4- and 9-valent HPV vaccines (2vHPV, 4vHPV, and 9vHPV, respectively).ResultsOf a total of 997 complete responses, 55.2% reported intent to obtain the HPV vaccine. Some of the significant factors exerting influence on intent to obtain HPV vaccination were high knowledge score (OR = 1.469, 95% CI:1.087–1.987), perceived high risk of HPV infection (OR = 1.466, 95%CI:1.017–2.114), perception of no serious side effects (OR = 1.562, 95%CI:1.150–2.121), and mass media exposure to HPV vaccination information (OR = 2.196, 95%CI: 1.625–2.966). Socioeconomic status indicators did not significantly influence intent to obtain the HPV vaccine. A higher proportion of respondents were willing to pay for 2vHPV (78.6%) and 4vHPV (68.0%) compared with 9vHPV (49.3%). Socioeconomic status indicators were the strongest correlates of acceptability for all the three vaccines. Exposure to mass media reporting about HPV vaccination is the factor which exerts the most influence on acceptance of 9vHPV after socioeconomic status indicators.ConclusionsIt is important to improve knowledge and health beliefs, and to establish a mass media marketing strategy to promote HPV vaccination in order to enhance HPV vaccine uptake. Undergraduate female students should be provided with detailed information about the different valency vaccine choices to help them make informed decisions about immunization.     

长治市医学和非医学大学生HPV疫苗相关知识现况调查

目的探讨大学生对宫颈癌疾病相关知识及预防性HPV疫苗的认知现状,为学校进行宫颈癌及HPV病毒相关健康教育提供理论依据,为预防性HPV疫苗的推广接种和宫颈癌的防治提供参考资料。方法以长治地区高校大学生为研究对象;采取自行设计的电子问卷,于2018年3-9月组织在校大学生进行在线问卷调查。结果共收回570份问卷,有效问卷552份,有效率96. 84%。其中23. 73%(131/552)的学生了解宫颈癌发病时主要的临床表现,28. 09%(160/552)的学生知道诱发宫颈癌的最常见HPV高危型别,仅有17. 39%(96/552)的学生认为二价与四价预防性HPV疫苗对于预防宫颈癌的效果是相当的。结论应加强大学生关于宫颈癌疾病及预防性HPV疫苗相关知识的全面、系统宣教,健康教育的重点可放在关于HPV疫苗有效性、安全性及接种相关知识背景等方面,可一定程度上对宫颈癌疾病的防控和HPV疫苗的接种推广起到积极作用。     

Knowledge and awareness of HPV and the HPV vaccine among young women in the first routinely vaccinated cohort in England

A national school-based human papillomavirus (HPV) vaccination programme has been available for 12–13 year old females in the UK since 2008, offering protection against HPV types 16 and 18, which are responsible for the majority of cervical cancer. Little is known about HPV knowledge in girls who have been offered the vaccine. Girls offered the school-based vaccine in the first routine cohort (n = 1033) were recruited from 13 schools in London three years post-vaccination. Participants completed a questionnaire about HPV awareness, knowledge about HPV and the vaccine, and demographic characteristics including vaccine status. About a fifth of the girls reported they were unaware of the HPV infection. Among those who reported being aware of HPV (n = 759) knowledge was relatively low. Approximately half of the participants knew that HPV infection causes cervical cancer, condoms can reduce the risk of transmission and that cervical screening is needed regardless of vaccination status. These results are helpful in benchmarking HPV-related knowledge in vaccinated girls and could be used in the development of appropriate educational messages to accompany the first cervical screening invitation in this cohort in the future.     

An intervention for increasing HPV vaccination on a university campus

PurposeTo evaluate the effects of a human papillomavirus (HPV) vaccination intervention implemented on a large university campus in the United States.MethodsThe intervention consisted of student-directed campaign materials promoting HPV vaccination (e.g., posters, yard signs, social media posts) and provider recommendation for HPV vaccine to students attending university health services (UHS) from January through March of 2019.ResultsWe observed a 75% increase in HPV vaccine doses administered at UHS in the spring semester of 2019 vs. 2018. In both semesters a higher percentage of doses was given to females than males. Further, the increase from 2018 to 2019 was larger for females than males. Age at vaccine receipt did not differ by year.ConclusionsPartnering with college and university health centers to implement HPV vaccine interventions could be a promising strategy for increasing HPV vaccination coverage among young adult college students across the country.     

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.     

Outsmart HPV: Acceptability and short-term effects of a web-based HPV vaccination intervention for young adult gay and bisexual men

BackgroundEffective interventions to promote human papillomavirus (HPV) vaccination are needed, particularly among populations at increased risk of HPV-related disease. We developed and pilot tested a web-based intervention, Outsmart HPV, to promote HPV vaccination among young gay and bisexual men (YGBM).MethodsIn 2016, we recruited a national sample (n = 150) of YGBM ages 18–25 in the United States who had not received any doses of HPV vaccine. Participants were randomized to receive either standard HPV vaccination information (control) or population-targeted, individually-tailored content (Outsmart HPV intervention). We assessed between group differences in HPV vaccination attitudes and beliefs immediately following the intervention using multiple linear regression.ResultsThere were no differences in HPV vaccination attitudes, beliefs and intentions between groups at baseline. Compared to participants in the control group, intervention participants reported: greater perception that men who have sex with men are at higher risk for anal cancer relative to other men (b = 0.34); greater HPV vaccination self-efficacy (b = 0.15); and fewer perceived harms of HPV vaccine (b = −0.34) on posttest surveys (all p < .05). Overall, intervention participants reported high levels of acceptability and satisfaction with the Outsmart HPV intervention (all > 4.4 on a 5-point scale).ConclusionsFindings from this study provide preliminary support for a brief, tailored web-based intervention in improving HPV vaccination attitudes and beliefs among YGBM. An important next step is to determine the effects of Outsmart HPV on HPV vaccine uptake.Clinical trials registrationClinicalTrials.gov identifier NCT02835755.     

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

ABSTRACT

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.     

高职院校女大学生HPV疫苗接种认知及需求情况调查分析

目的通过对高职院校在校女生不同年级、不同专业对人乳头状瘤病毒(human papillomavirus,HPV)、人乳头状瘤病毒疫苗及相关疾病的认知情况进行调查分析,找出影响因素,为提高疫苗接种率、预防疾病发生提供理论依据。方法采用分层抽样方法,于2017年10—12月对某高职院校600名女生进行HPV及其疫苗认知和需求的问卷调查,共回收583份有效问卷。采用数值定性方法,对不同影响因素进行对比分析。结果高职院校女大学生对HPV及HPV疫苗知晓率为58.70%,只有39.27%的女生认为HPV能引起相应疾病,34.00%的女生考虑接种HPV疫苗。结论高校女生对HPV相关知识了解欠缺,对疾病的严重程度认识不足,故应在在校学生中加强健康教育,普及HPV及HPV疫苗的相关知识,提高接种率。     

Improving adolescent human papillomavirus (HPV) immunization uptake in school-based health centers through awareness campaigns

PurposeThe aim of this study was to measure the effect of a multicomponent human papillomavirus (HPV) vaccine promotion campaign on adolescent HPV vaccine uptake at school-based health centers (SBHCs) in Seattle, WA.MethodsYouth-led HPV vaccine promotion campaigns were introduced in 2016 in 13 schools with SBHCs in Seattle. Five other schools with SBHCs served as controls. Vaccination records for students were obtained from the Washington Immunization Information System from September 2012 to August 2018. We compared increase in HPV vaccine uptake in SBHCs between 1) intervention and control schools, and 2) pre- and post-intervention periods in intervention schools using generalized estimating equations.ResultsHPV vaccine uptake was high at baseline among students that use SBHCs for vaccines and has steadily increased between 2012 and 2018. Implementing the promotion campaign resulted in 14% higher (95% Confidence Interval (CI): 1%, 30%) HPV vaccine uptake in intervention SBHCs compared to control SBHCs, adjusting for time and confounders. Comparing pre-and post-intervention periods in intervention SBHCs, HPV vaccine uptake was 14% higher (95% CI: −4%, 35%) in the post-intervention period. SBHCs that received more active intervention activities saw 9% higher (95% CI: 1%, 21%) vaccine uptake compared to those that received passive intervention.ConclusionThe vaccination promotion program implemented in a school-based setting resulted in higher HPV vaccine uptake in the post-intervention period compared to pre-intervention period, but this increase was not statistically significant. Even so, schools that received more intervention activities for longer periods of time had higher HPV vaccine uptake.     

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

ObjectiveTo 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.MethodsWe 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.ResultsWe 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.ConclusionsLevel 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.     

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

PurposeYoung 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.MethodsWe 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.ResultsMany 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.ConclusionsAlthough 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.     

Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices

ObjectivesHPV vaccination at the recommended ages of 11–12 is highly effective yet has stalled well below the goal of 80% of the population. We evaluated a statewide practice-based communication intervention (tools: brochures, posters, online training for providers and resources for parents, video game for preteens) to persuade parents, preteens and providers to vaccinate against HPV. The 9-month intervention started May 1, 2015.MethodsWe compared vaccine initiation and completion rates over three 9-month periods (baseline, intervention, post-intervention) between practices enrolled in the intervention and a comparable comparison group. All practices reported to the North Carolina Immunization Registry (NCIR) and had at least 100 11- and 12-year-olds who had not completed the HPV vaccine series. Of 175 eligible practices, the 14 intervention practices included 19,398 individuals and the 161 comparison practices included 127,896 individuals. An extended Cox model was used to test the intervention effect.ResultsThe intervention had a significant effect on both initiation and completion during the intervention and post-intervention periods; the estimated hazard ratio (HR) for initiation was 1.17 (p = .004) during the intervention and 1.11 (p = .005) post-intervention. Likewise, completion during the intervention period was 17% higher in intervention practices, after controlling for baseline differences. This effect increased in the post-intervention period to 30% higher (p = .03).ConclusionsIndividuals in the intervention practices were 17% more likely to initiate and complete HPV vaccination than in the comparison practices during the intervention period and the effect was sustained post-intervention. This intervention is promising for increasing rates of HPV vaccination at ages 11–12.     

Factors influencing HPV vaccination status in a Latino population; and parental attitudes towards vaccine mandates

We performed a retrospective cohort study in a largely Latino population in Los Angeles, surveying 95 parents of 11–17 year old girls between May and June 2008 to examine factors associated with [1] parental consent for Human Papillomavirus (HPV) immunization one year after vaccine implementation and [2] parental support of an HPV vaccine mandate for adolescents prior to middle school entry. 73% of participants had heard of the HPV vaccine and 37% of daughters had already received the vaccine. Variables associated with vaccination included Latino ethnicity, the belief that vaccines are safe, and that HPV vaccine prevents cervical cancer. The most frequent reasons for refusing vaccination included parental request for more information and missed opportunities in clinic. Variables associated with parents agreeing with a law mandating HPV vaccination included: belief in vaccine safety, recent maternal Pap Smear, HPV vaccination of participant's daughter prior to survey, and Latino ethnicity. Our survey supports the work of previous studies recommending continued educational campaigns emphasizing the safety of HPV vaccine, and its efficacy in reducing cervical cancer.     

High-risk HPV prevalence among women undergoing cervical cancer screening: Findings a decade after HPV vaccine implementation in British Columbia,Canada

BackgroundBritish Columbia (BC) introduced a publicly funded, school-based human papillomavirus (HPV) immunization program in 2008 with the quadrivalent vaccine. In 2010/2011, a baseline evaluation of HPV prevalence was conducted among women undergoing cervical cancer screening. After 10 years of publicly funded HPV vaccination, HPV-type prevalence was re-evaluated.MethodsFrom August 2017 to March 2018, 1107 physicians were invited to return cytobrushes used during routine Pap screening to the Cervical Cancer Screening Laboratory for HPV testing. Only age or year of birth was collected. Specimens were screened for high-risk HPV (hrHPV) and positive samples were genotyped. HPV type prevalence was compared for females 15–22 yrs (those eligible for the school-based vaccination) and 23+ yrs (ineligible for school-based vaccination) for the 2010/2011 and the 2017/2018 data.ResultsThere were 3309 valid samples received for testing; of these, 3107 were included in the analysis. The overall hrHPV prevalence was 12.2% (95% CI 11.3–13.3) in 2010/11, and 12.0% (95% CI 10.9–13.2) in 2017/18. For the 15–22 age group, the prevalence for any hrHPV was 26.8% (95% CI 23.1–30.8) in 2010/11 and 25.4% (95% CI 15.3–37.9) in 2017/18. For those aged 15–22, HPV16 prevalence in 2010/11 was 8.8% (95% CI 6.5–11.5) and in 2017/18 was 6.3% (95% CI 1.8–15.5), with corresponding figures for HPV18 3.7% (95% CI 2.3–5.7) and 0% (95% CI 0.0–5.7), respectively. For all hrHPV types, there were no statistically significant differences between the 2010/11 and 2017/18 periods.ConclusionsThis study illustrates the prevalence of hrHPV in BC over time in women undergoing cervical cancer screening, where an indication of a decline in HPV16/18 is seen in vaccine eligible women.     

Influences of sociodemographic characteristics and parental HPV vaccination hesitancy on HPV vaccination coverage in five US states

BackgroundIn the United States (US), half of new human papillomavirus (HPV) infections occur among young people aged 15–24 years. Despite the effectiveness of HPV vaccination in protecting against HPV-associated cancers, its coverage among adolescents remains suboptimal. This study examined the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage in five US states with disproportionately low adolescent coverage rates compared to the national average.MethodsResponses to an online Qualtrics survey from 926 parents of children aged 9–17 years in Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois in July 2021 were analyzed using multivariate logistic regression to estimate the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage.ResultsOf the parents, 78 % were female, 76 % were non-Hispanic White, 61.9 % lived in rural areas, 22 % were classified as HPV vaccine hesitant, and 42 % had vaccinated their oldest child between the ages of 9–17 years against HPV. Children of vaccine hesitant parents were less likely to have received any doses of the HPV vaccine than children of non-vaccine hesitant parents (AOR: 0.17, 95 % CI:0.11–0.27). Male children were less likely to have initiated the HPV vaccine series than female children (AOR: 0.70, 95 % CI:0.50–0.97). Older children (13–17 vs 9–12 years), receiving the meningococcal conjugate or most recent seasonal influenza vaccine were all associated with higher likelihoods of receiving any doses of the HPV vaccine (AOR: 6.01, 95 % CI:3.98–9.08; AOR: 2.24, 95 % CI:1.27–3.95; AOR: 2.41, 95 % CI:1.73–3.36, respectively).ConclusionsAdolescent HPV vaccination coverage remains low in our targeted states. Children’s age, sex, and parental vaccine hesitancy were significantly associated with likelihood of HPV vaccination. These findings offer the opportunity for targeted interventions among parents in regions with low vaccine uptake and underscore the importance of developing and implementing strategies to address parental HPV vaccination hesitancy to improve uptake in the US.     

Mothers' support for voluntary provision of HPV vaccine in schools

HPV vaccination rates among adolescents in the United States lag behind some other developed countries, many of which routinely offer the vaccine in schools. We sought to assess mothers’ willingness to have their adolescent daughters receive HPV vaccine at school. A national sample of mothers of adolescent females ages 11-14 completed our internet survey (response rate = 66%). The final sample (n = 496) excluded mothers who did not intend to have their daughters receive HPV vaccine in the next year. Overall, 67% of mothers who intended to vaccinate their daughters or had vaccinated their daughters reported being willing to have their daughters receive HPV vaccine at school. Mothers were more willing to allow their daughters to receive HPV vaccine in schools if they had not yet initiated the vaccine series for their daughters or resided in the Midwest or West (all p < .05). The two concerns about voluntary school-based provision of HPV vaccine that mothers most frequently cited were that their daughters’ doctors should keep track of her shots (64%) and that they wished to be present when their daughters were vaccinated (40%). Our study suggests that most mothers who support adolescent vaccination for HPV find school-based HPV vaccination an acceptable option. Ensuring communication of immunization records with doctors and allowing parents to be present during immunization may increase parental support.     

潍坊市女大学生人乳头瘤病毒疫苗接种犹豫现状及影响因素

目的 调查潍坊市女大学生人乳头瘤病毒(HPV)疫苗接种犹豫现状及其影响因素,为提高女大学生HPV疫苗接种率提供对策建议.方法 采用分层随机抽样的方法,抽取潍坊市1所医学院校和3所非医学院校408名女大学生,使用"女大学生HPV疫苗犹豫调查问卷"进行调查,使用x2检验和Logistic回归分析探究疫苗接种犹豫的影响因素....