Effects of a Narrative HPV Vaccination Intervention Aimed at Reaching College Women: A Randomized Controlled Trial

This longitudinal study reports on the development and evaluation of a narrative intervention aimed at increasing human papillomavirus (HPV) vaccination among college women. The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer, the second leading cause of cancer deaths among women worldwide. Pilot work utilizing culture-centric narrative theory guided development of the intervention content. Exemplification theory led to hypotheses comparing communication sources of the narrative messages (peer only, medical expert only, or a combination of the two source types) in a four-arm randomized controlled trial (N = 404; 18–26 year olds). The combined peer-expert narrative intervention nearly doubled vaccination compared to controls (22% vs. 12%). The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported. As predicted, the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women. Furthermore, the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent. Theoretical and practical implications for designing effective HPV vaccine messages are discussed.     

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.     

Giving Boys a Shot: The HPV Vaccine’s Portrayal in Canadian Newspapers

In January 2012, the National Advisory Committee on Immunization (NACI) of Canada recommended that males aged 9–26 years receive the human papillomavirus (HPV) vaccine to protect against genital warts and HPV-associated cancers. Estimated HPV vaccine uptake rates for Canadian males are extremely low. Using a content analysis of Canadian newspaper articles, this study investigated what information about the HPV vaccine was relayed to the public, and how this content was portrayed following the 2012 male HPV vaccine recommendation. A search was conducted using Proquest Canadian Newsstand Complete for newspaper articles published between January 1, 2012, and September 1, 2014. Researchers coded 232 articles on several relevant dimensions: article information; epidemiological information; public policy information; article topic; article and title tone; and informant testimony. The majority of articles (93%) mentioned that girls are eligible for the HPV vaccine, whereas only half (49%) mentioned male eligibility. While most articles associated HPV with cervical cancer (85%), fewer indicated its relation to other HPV-associated cancers (59%) or genital warts (52%). Most articles (60%) were positive or neutral (22%) in tone toward the HPV vaccine, while few had mixed messages (11%) or were negative (6%). Less than 5% of articles reported on issues of morality, suggesting that fears that the HPV vaccine causes promiscuity have largely subsided. Notably, article tone toward male vaccination became progressively more positive over time. However, half of the articles did not mention the vaccine’s approval for males, and articles tended to report HPV’s relation to cervical cancer over other HPV-associated cancers. The Canadian public may thus be unaware of male eligibility and the importance of HPV vaccine for males. The collaboration of researchers, health care providers, and policymakers with journalists is critical in order to disseminate complete and accurate HPV and HPV vaccine information.     

A content analysis of HPV vaccination messages available online

Parents have varied HPV vaccine communication needs, which presents a challenge for healthcare providers. To improve communication resources for providers, we sought to characterize HPV vaccination messages available in existing educational materials. In fall 2016, we searched PubMed, educational material clearinghouses, and Google for English language HPV vaccination messages. We extracted messages that a provider might use when raising the topic of HPV vaccination, answering common questions, and motivating vaccination. Two reviewers independently coded each message. The search identified 267 unique messages about HPV vaccination. Messages generally were long (mean no. of words = 44, standard deviation [SD] = 33) and required a high level of education to read (mean reading grade level = 10, SD = 3). Only 32% of messages were shorter than 25 words, and 12% had a readability at or below grade 6. Most frequent were messages to address common parent questions or concerns (62%); the most common topics were diseases prevented by HPV vaccine (18%) and safety and side effects (16%). Many messages included information about cancer prevention (26%) and same-day vaccination (13%). Few messages (6%) used a presumptive style to recommend HPV vaccination. In conclusion, available messages about HPV vaccination were markedly varied. We identified few messages that were both brief (to facilitate providers memorizing them) and accessible (to facilitate parents understanding them). Future research should identify which messages lead to HPV vaccine uptake.     

An exploratory study of adolescent female reactions to direct-to-consumer advertising: the case of the Human Papillomavirus (HPV) Vaccine

When the human papillomavirus (HPV) vaccine was approved in 2006, an extensive direct-to-consumer (DTC) advertising campaign raised awareness and promoted vaccination. This study explores adolescents' exposure to and understanding of the messages in these advertisements. Sixty-seven African American females participated in a focus group about DTC advertising for the HPV vaccine. Virtually all adolescents had seen an HPV vaccine DTC advertisement, but most did not understand the health information contained in it. If DTC advertising is to be an effective source of health information for adolescents in the future, it must take into account the unique features of an adolescent audience.     

An Exploratory Study of Adolescent Female Reactions to Direct-to-Consumer Advertising: The Case of the Human Papillomavirus (HPV) Vaccine

When the human papillomavirus (HPV) vaccine was approved in 2006, an extensive direct-to-consumer (DTC) advertising campaign raised awareness and promoted vaccination. This study explores adolescents' exposure to and understanding of the messages in these advertisements. Sixty-seven African American females participated in a focus group about DTC advertising for the HPV vaccine. Virtually all adolescents had seen an HPV vaccine DTC advertisement, but most did not understand the health information contained in it. If DTC advertising is to be an effective source of health information for adolescents in the future, it must take into account the unique features of an adolescent audience.     

Development of a Cost-Effective Educational Tool to Promote Acceptance of the HPV Vaccination by Hispanic Mothers

Although vaccination against the Human Papilloma Virus (HPV) reduces the risk of related morbidities, the vaccine uptake remains low in adolescents. This has been attributed to limited parental knowledge and misconceptions. In this cross sectional study, we assessed the (1) clarity of educational material informing Hispanic mothers about HPV, cervical cancer and the HPV vaccine, (2) determined vaccination acceptability and (3) identified predictors of vaccine acceptance in an underserved health setting. 418 Hispanic mothers received the educational material and completed an anonymous survey. 91 % of participants understood most or all of the information provided. 77 % of participants reported vaccine acceptance for their children; this increased to 84 % when only those with children eligible to receive vaccination were included. Significant positive predictors of maternal acceptance of the HPV vaccine for their children were understanding most or all of the provided information, older age and acceptance of the HPV vaccine for themselves. Concerns about safety and general dislike of vaccines were negatively associated with HPV vaccine acceptance. Prior knowledge, level of education, previous relevant gynecologic history, general willingness to vaccinate and other general beliefs about vaccines were not significantly associated with HPV vaccine acceptance. The majority of participants reported understanding of the provided educational material. Vaccine acceptability was fairly high, but was even higher among those who understood the information. This study documents a cost-effective way to provide Hispanic mothers with easy-to-understand HPV-related information that could increase parental vaccine acceptability and future vaccine uptake among their children.     

From bad to worse: The representation of the HPV vaccine Facebook

BackgroundAnti-HPV vaccination social media messages may increase vaccine hesitancy and avoidance. This study analyzed (1) the first decade of public, HPV-vaccine related Facebook posts’ characteristics, engagement, and health belief messages; (2) relationships between variables; (3) how those variables changed over time; and (4) identified and analyzed the posts with the most engagement.MethodsThe data sample consisted of 6,506 public HPV vaccine-related Facebook posts (n = 6,506) published within the first decade following the FDA’s first HPV vaccine approval (June 8, 2006 – June 8, 2016). Post characteristics, engagement, and health belief model (HBM) messages were coded (Krippendorf’s alpha range: 0.71–1.00).ResultsBarriers to HPV vaccination appeared more often (47.1%) than benefits (19.8%). Regarding the tone towards the vaccine, negative was dominant (45.0%) and the average sample sentiment was negative (M = -0.15, SD = 0.851). Tone positivity was negatively correlated with barriers to HPV vaccine (r = -0.631, p < 0.0001). The post with the most engagement (11,000 reactions, 6,100 comments, and 329,000 shares displayed) was anti-HPV vaccine, and negative posts received significantly greater engagement. Over time, negative tone and barriers had a greater presence. The data showed evidence for forward momentum (Durbin-Watson values) of HPV infection susceptibility (0.004), HPV infection severity (0.426), HPV vaccine benefits (0.297), and barriers to HPV vaccination (0.226) messages, tone (0.690), and the number of reactions (1.589), comments (1.389), and shares (1.340).ConclusionFacebook posts about the HPV vaccine were mostly negative with a frequent focus on barriers to vaccination. Time effects suggest that anti-HPV vaccine posts have encouraged more anti-HPV vaccine posts. Research should continue to address the influence of time. The influence of messages that are pro-HPV vaccine, but perhaps are negative in tone, address barriers, and/or presented by individual stakeholders, should be tested inside and outside of social media channels.     

High vaccine effectiveness persists for ten years after HPV16/18 vaccination among young Dutch women

The current study describes the long-term effectiveness of three-dose HPV16/18 vaccination among Dutch women who were eligible for vaccination during a catch-up campaign and were followed in an observational cohort study. Ten years post vaccination, vaccine effectiveness (VE) was estimated using generalized estimating equation models. VE against persistent infections with vaccine type infections (HPV16/18) was high at 95.8%. For cross protective type persistent infections (HPV31/33/45) this was 64.6%. There were no indications of waning of protection over time. This indicates solid long-term protection is provided by the vaccine and is promising with regard to the future clinical impact.     

Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting

Although the HPV vaccine has been shown to be highly effective in preventing cervical dysplasia, vaccination rates remain low. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the postpartum setting. We conducted a pre-post intervention study among postpartum women ages 18–26 seen at an outpatient clinic from 09/01/2012–08/31/2013 (pre-intervention) and from 10/01/2013–03/31/2014 (post-intervention). The intervention was a drop-down menu that was inserted into the EMR postpartum note template inquiring about the patient’s HPV vaccination status and whether or not the vaccine was administered at that visit. HPV vaccination uptake was compared pre and post-intervention. Of the 278 postpartum visits during the study period, 241 were eligible for analysis. There was a significant increase of the HPV vaccine uptake, from 1.2 % (2/173) among pre-intervention visits to 26.5 % (18/68) among post-intervention visits (p < 0.001). After adjusting for age, ethnicity, insurance, and religion, HPV vaccination was significantly higher at postpartum visits during the intervention period, with an adjusted OR = 93.49 [95 % CI 15.29–571.52]. Among visits in which the vaccine was not given, HPV vaccination was not discussed in 46 % and patients refused the vaccine in 40 % of visits. An EMR prompt in the postpartum note could be an effective way to promote HPV vaccination in the postpartum setting. It will likely take a combination of strategies to optimize vaccination uptake.     

On the implications of desexualizing vaccines against sexually transmitted diseases: reflections from a practicing pediatrician

Human papillomavirus (HPV) vaccination holds great promise for drastically reducing the incidence of HPV-associated cancers of the genital tract, and possibly also certain head and neck cancers. Unfortunately, rates of HPV vaccine utilization among adolescents are low in many countries. Many research studies have identified the fact that HPV is a sexually transmitted infection as a barrier to higher vaccination rates. This is related to providers’ and parents’ reluctance to discuss or consider the burgeoning sexuality of their child. An approach suggested to overcome this barrier is to “desexualize” the vaccine. This entails focusing discussions and public messages on the cancer-preventing properties of the vaccine and ignoring or minimizing information about HPV’s sexual transmissibility. In an article by Velan and Yadgar, the authors argue that this approach does more harm than good. This associated commentary offers a slightly different viewpoint from one who has been “in the trenches” both clinically and from a research standpoint for many years.     

HPV Vaccine and Latino Immigrant Parents: If They Offer It,We Will Get It

HPV vaccination rates remain low in the fast growing Latino children population while we continue to observe large HPV-associated cancer disparities in the Latino population. In this study, we sought to elucidate Latino immigrant parents’ barriers to obtaining the HPV vaccine for their children. Five focus groups were conducted with Latino immigrant parents of minors (i.e., 9–17 year old) who had not yet initiated the HPV vaccine series. Three major findings were identified from the focus groups: (1) low levels of awareness and knowledge of HPV and the HPV vaccine, (2) high confidence that parent can get the vaccine for their eligible child and (3) lack of provider recommendation as the main barrier to vaccination. Children of Latino immigrant parents could benefit from increased provider recommendation for the HPV vaccine while providing tailored HPV information to parents.     

基于手机应用软件的健康教育对女大学生HPV疫苗的认知和接种意愿的干预效果评价

目的 了解女大学生群体HPV疫苗接种率和对HPV疫苗的认知和接种意愿,探讨基于手机应用软件的健康教育对其认知和接种意愿的干预效果。方法 2020年3-4月期间选取山西省某高校本科一年级的女性学生作为研究对象,研究对象被随机分为干预组和对照组。干预组接受连续7天基于手机应用软件的健康教育,对照组不接受任何干预。7天后,评估干预组和对照组对HPV疫苗的认知水平和接种意愿。结果 共402名女大学生完成基线和7天后问卷调查。干预前,仅1.19%的学生接种过HPV疫苗。培训后,96.0%、91.2%和93.0%的学生表示听说过HPV、HPV相关疾病和HPV疫苗,显著高于对照组（86.6%、73.6%和79.1%,P值均≤0.001）。但培训后,学生接种HPV疫苗的意愿并未显著提升（干预组为30.0%,对照组为24.5%,P=0.217）。拒绝接种HPV疫苗的原因是怀疑疫苗的安全性和有效性、定期接种太麻烦、害怕针刺痛、尚无性生活。结论 通过手机应用软件开展针对HPV疫苗的健康教育是一种简便、可行、有效的方式,能有效提高女大学生群体对HPV疫苗的认知和接受度。在疫情常态化管控下,该方式能为开展公众健康教育提供新方案。     

Correlates of Human Papillomavirus Vaccination Among Female University Students

Human papillomavirus (HPV) is the most frequently occurring sexually transmitted infection in the United States, but only one third of adolescent girls have received the HPV vaccine (Centers for Disease Control and Prevention [CDC], 2012; Committee on Infectious Diseases, 2012). Understanding correlates of vaccination behavior among young women has important implications for health care delivery and public service messages targeting HPV vaccination. Female college students (N = 313) completed web-based surveys during their sophomore (second) year of college, fall 2008. Surveys included questions about HPV vaccination, demographic factors (ethnicity/race, socioeconomic status [SES]), individual characteristics (romantic relationship status, grade point average, religiosity), and sexual behavior. Lifetime HPV vaccination was reported by 46.5% of participants. Being African American/Black was associated with a lower likelihood of vaccination. Having a mother with more education, adhering to religious teachings about sex-related principles, and having engaged in recent penetrative sex were associated with a higher likelihood of vaccination. Health care providers should consider young women to be an important group for HPV vaccine education and catch-up, particularly for African American/Black young women and young women from lower SES backgrounds. Providing vaccine education and access to young women before they become sexually active is critical.     

Knowledge of human papillomavirus among dental providers: A mixed methods study

Dental professionals are encouraged by the American Dental Association (ADA) to recommend the HPV vaccine to eligible patients. To better understand their comfort level in following this recommendation, we conducted a mixed methods study of dentists and dental hygienists. A total of 173 providers were surveyed and 8 interviewed. The majority felt they had an important role in preventing HPV-related OPC and that they should educate their patients and encourage HPV vaccination. However, most providers had low knowledge about HPV and expressed a need to obtain more information on the topic. In particular, they desired information about the HPV vaccine, its connection to cancer and where to refer patients for vaccination. They also wanted access to visual aids to help them bring up the topic. This study demonstrates the need to develop and disseminate educational programs for dental providers so they can assist with efforts to raise HPV vaccination rates.     

Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia

Objective: To describe the process and challenges in the roll out of a large cervical cancer vaccination program to protect against human papilloma virus (HPV) infection.
Methods: This article describes the process of planning and implementing a HPV vaccination program using the existing state-wide framework that supports vaccine delivery to all 219 high schools in South Australia. The decision was made to offer three doses of HPV vaccine to 50,191 female students in Years 8-12 during the 2007 school year.
Results: By November 2007, despite many challenges, the school vaccination program had delivered 107,541 doses of HPV vaccine. Coverage of dose 1 was highest in Years 8 (83%) and 10 (70%), but was reduced for doses 2 and 3 in all year levels, with dose 3 coverage ranging from 55% (Year 11) to 77% (Year 8).
Conclusions: The introduction of a large school-based vaccination program at short notice posed new challenges for the co-ordination and implementation. Not all schools supported the introduction of HPV vaccine, resulting in reduced access for some students. Negative media messages provided a strong platform for individuals who opposed vaccination. These factors may have contributed to the less-than-expected uptake of HPV vaccine.
Implications: Historically, there has been high uptake of other vaccines given to adolescents. However, the introduction of HPV vaccine may have adversely affected the uptake of Hepatitis B vaccine, given concurrently in the school program. Further studies are needed to determine if this is likely to have a negative effect on the public perception of the value of vaccine programs in general.     

Australian newspaper coverage of human papillomavirus vaccination, October 2006-December 2009

Vaccination against human papillomavirus (HPV) is now routine practice for adolescent females in Australia. Media information about HPV vaccination is likely to affect girls' and parents' decisions about vaccination. This article reports a content analysis of 131 Australian print media news stories published between October 2006 and December 2009. Each story was coded for main themes of the article; completeness and accuracy of information presented; potential issues and concerns related to HPV vaccination; phrasing, emphasis, and language used; and representation of experts. Resulting themes were as follows: Australian pride in vaccine development; details and progress of the National Vaccination Program; vaccine safety; HPV vaccination's future; whether or not males could and/or should get the vaccine; issues related to sexual activity and the vaccine; and issues about decision making for acceptance of HPV vaccine. To fill gaps that are created by media representations of HPV vaccination, educational interventions should include information about HPV transmission and male vaccination and should promote adolescent involvement in decision making.