Human Papillomavirus Vaccine Attitudes Research Articles

Catching Up or Missing Out? Human Papillomavirus Vaccine Acceptability Among 18- to 26-Year-old Men Who Have Sex With Men in a US National Sample

Men who have sex with men (MSM) are disproportionately affected by human papillomavirus (HPV)-related outcomes and would benefit from HPV vaccination in adolescence. We assessed HPV vaccine attitudes, uptake, and barriers in this high-risk young MSM (YMSM) population. An online US sample of 1457 YMSM aged 18 to 26 years were recruited in December 2011 to examine HPV vaccine acceptability and uptake. The online survey included sociodemographics, HPV vaccine attitudes, acceptability, HPV vaccination status, health care use, and HPV knowledge. Despite high use of health care in the past year (86%) and high acceptability (87.8/100) for free HPV vaccine, only 6.8% had received one or more vaccine doses. In addition, only 4% of unvaccinated men had been offered the vaccine by their health care provider (HCP). In a multivariate regression of unvaccinated men, increased vaccine acceptability was associated with an HCP recommendation, worry about getting infected with HPV, and being tested for a sexually transmitted disease in the past year, whereas safety concerns, lower perceived risk of infection, and shame associated with HPV infection/disease were associated with decreased vaccine acceptability. Through logistic regression, vaccine uptake was associated with being tested for a sexually transmitted disease in the past year, disclosure of being gay or bisexual to a doctor, and greater HPV knowledge. Health care providers need to use routine points of contact with YMSM patients to vaccinate against HPV. These data indicated missed opportunities to vaccinate YMSM who are open to HPV vaccination. In the future, HCPs of YMSM should be careful to avoid missed opportunities to vaccinate.

Evaluation of fotonovela to increase human papillomavirus vaccine knowledge, attitudes, and intentions in a low-income Hispanic community.

BackgroundIt has nearly been a decade since the introduction of the vaccine against human papillomavirus (HPV), yet vaccination rates in the United States have remained suboptimal, particularly among Hispanics. Culturally and linguistically relevant health education tools targeting Hispanics are needed to increase the current rate of HPV vaccination. This article evaluates a theory-informed, evidence-guided fotonovela (photographic short story) intervention to improve HPV vaccination knowledge, attitudes, and intention among young adults.MethodsYoung adults (N = 41, aged 18–26 years) in a low-income primary care clinic in Southern California were administered pre- and post-intervention surveys to measure changes in perceived susceptibility to HPV, perceived benefit of vaccination in committed relationship, intention to vaccinate, intention to encourage social networks to vaccinate, and attitude towards vaccination. Post-intervention survey also examined attitudes towards fotonovela. Relationships between attitudes towards fotonovela and demographic characteristics were assessed with Fisher’s exact test. Self-reported gains in knowledge were categorized and tabulated. Changes in perceptions and intentions were analyzed with the marginal homogeneity test.ResultsThe majority of participants were female (78.0 %), Latino/Hispanic (92.7 %), single (70.7 %), and had at least a college education (61.0 %). The mean age was 21.9 years (SD 0.4). The fotonovela was viewed as entertaining (95.1 %), educational (97.6 %), and easy to read (100 %). Following the intervention, Hispanic participants improved in all five variables of interest measured in the survey, including perceived susceptibility (+10.5 %, p = 0.03), benefit of vaccination (+7.8 %, p = 0.25), intent to vaccinate (+18.4 %, p = 0.06), intent to encourage others to vaccinate (+10.5 %, p = 0.14) and attitude towards vaccination (+13.1 %, p = 0.05). Improvements in perceived susceptibility and attitude towards vaccination reached statistical significance (p < 0.05). The most frequent gains in knowledge were the risk of HPV infection despite condom use (N = 16) and relationship status (N = 8), three-dose vaccine administration schedule (N = 13), and burden of HPV infection among males (N = 9).ConclusionResults are promising because they demonstrate that health messages delivered through a narrative format can promote positive changes in knowledge, attitudes, and intentions. The fotonovela may be a powerful vehicle for HPV education, particularly among Hispanics.

“Vaccinations are Safe and Effective”: Inoculating Positive HPV Vaccine Attitudes Against Antivaccination Attack Messages

This study examined the use of two different inoculation messages to confer resistance to persuasive messages attacking the efficacy and safety of the human papilloma virus (HPV) vaccine. A three-phase experiment was conducted involving 110 participants to determine if young women who held positive attitudes toward the HPV vaccine could be inoculated against counterattitudinal attack messages using both a specific and generalized form of an inoculation message. Results found that inoculation treatments aimed at protecting positive attitudes toward vaccinations in general (i.e., all vaccines are safe and effective) were as effective at thwarting attacks on the HPV vaccine as the use of a more specific inoculation treatment (i.e., the HPV vaccine is safe and effective).

Abstract A23: Development and initial feedback about a human papillomavirus (HPV) vaccine comic book for adolescents

Abstract Purpose. Adolescent human papillomavirus (HPV) vaccination rates do not meet the Healthy People 2020 goal of 80%, thus interventions to improve vaccination rates are needed. Focus groups of parents assisting in the development of an intervention to improve HPV vaccination rates suggested that an educational tool for young adolescents be included in the intervention. Parents recommended a comic book format, and provided input into the development of a theoretically-based story. Methods. We conducted a pilot study to obtain initial feedback about a HPV vaccine comic book among parents (n=20) and their adolescents (ages 9 to 14) recruited from a community-based organization. Three adolescents did not participate because of lack of time, difficulty reading, and parental refusal. Parents completed a pre-post test including items addressing HPV knowledge, HPV vaccine attitudes, and about the content of the comic book. Adolescents (n=17) completed a brief interview after reading the comic book. Results. After reading the comic book, HPV knowledge improved (2.7 to 4.6 correct answers on a 0-5 scale; p&amp;lt;0.01) and more positive attitudes toward HPV vaccination (p&amp;lt;0.05) were reported among parents. Most parents confirmed that the comic book's content was acceptable. Adolescents liked the story, found it easy to read, and thought the comic book was a good way to learn about being healthy. Conclusions. Parents provided valuable information in the development of a theoretically-based comic book and the comic book appears to be an acceptable format for providing HPV vaccine information to young adolescents. A comic book format as an educational tool may provide important health information to adolescents. Future research will include the comic book in a study of an intervention to improve HPV vaccination rates among adolescents. Citation Format: Mira L. Katz, Jennifer Goodwin, Paul L. Reiter, Mack T. Ruffin, IV, Electra D. Paskett. Development and initial feedback about a human papillomavirus (HPV) vaccine comic book for adolescents. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A23. doi:10.1158/1538-7755.DISP13-A23

Development and initial feedback about a human papillomavirus (HPV) vaccine comic book for adolescents.

Human papillomavirus (HPV) vaccination rates do not meet the Healthy People 2020 objective of 80% coverage among adolescent females. We describe the development and initial feedback about an HPV vaccine comic book for young adolescents. The comic book is one component of a multilevel intervention to improve HPV vaccination rates among adolescents. Parents suggested and provided input into the development of a HPV vaccine comic book. Following the development of the comic book, we conducted a pilot study to obtain initial feedback about the comic book among parents (n = 20) and their adolescents ages 9 to 14 (n = 17) recruited from a community-based organization. Parents completed a pre-post test including items addressing HPV knowledge, HPV vaccine attitudes, and about the content of the comic book. Adolescents completed a brief interview after reading the comic book. After reading the comic book, HPV knowledge improved (2.7 to 4.6 correct answers on a 0-5 scale; p < 0.01) and more positive attitudes toward HPV vaccination (p < 0.05) were reported among parents. Parents confirmed that the comic book's content was acceptable and adolescents liked the story, found it easy to read, and thought the comic book was a good way to learn about being healthy. Parents provided valuable information in the development of a theoretically-based comic book and the comic book appears to be an acceptable format for providing HPV vaccine information to adolescents. Future research will include the comic book in an intervention study to improve HPV vaccination rates.

Effect of an educational intervention on HPV knowledge and vaccine attitudes among urban employed women and female undergraduate students in China: a cross-sectional study

BackgroundDue to the potential of human papillomavirus (HPV) vaccination for decreasing cervical cancer rates in Mainland China, where some of the highest incidences in the world have been reported, our study aimed to assess HPV and HPV vaccine knowledge, and to evaluate the effect of a brief educational intervention on HPV knowledge and vaccine acceptability in Chinese undergraduate students and employed women.MethodsThis multi-center, cross-sectional study was conducted across five representative cities of the five main geographical regions of Mainland China. Participants were selected from one comprehensive university and three to four companies in each city for a total of six comprehensive universities and 16 companies. A 62-item questionnaire on HPV knowledge and HPV vaccine acceptability was administered to participants before and after an educational intervention. The intervention consisted of an informative group lecture.ResultsA total of 1146 employed women and 557 female undergraduate students were surveyed between August and November 2011. Baseline HPV knowledge was low among both groups— 320/1146 (28%) of employed women and 66/557 (12%) of students had heard of HPV, while only 237/1146 (21%) of employed women and 40/557 (7.2%) of students knew that HPV is related to cervical cancer. After educational instruction, 947/1061 (89%) of employed women and 193/325 (59%) of students knew the relationship between HPV and cervical cancer (χ2 = 1041.8, p < 0.001 and χ2 = 278.5, p < 0.001, respectively). Post-intervention, vaccine acceptability increased from 881/1146 (77%) to 953/1061 (90%), (p = <0.001) in employed women and 405/557 (73%) in students to 266/325 (82%), (p < 0.001). Women in both groups cited concerns about the HPV vaccine’s safety, efficacy, and limited use to date as reasons for being unwilling to receive vaccination. 502/1146 (44%) of women were willing to vaccinate their children at baseline, which increased to 857/1061 (81%) post-intervention, p < 0.001.ConclusionsIncorporation of our lecture-based education initiative into a government-sponsored or school-based program may improve HPV-related knowledge and HPV vaccine acceptability. Further studies are needed to evaluate and standardize HPV education programs in China.

Post Approval Human Papillomavirus Vaccine Uptake Is Higher in Minorities Compared to Whites in Girls Presenting for Well-Child Care.

Since introduction of the human papillomavirus (HPV) vaccine, there remains low uptake compared to other adolescent vaccines. There is limited information postapproval about parental attitudes and barriers when presenting for routine care. This study evaluates HPV vaccine uptake and assesses demographics and attitudes correlating with vaccination for girls aged 11–12 years. A prospective cohort study was performed utilizing the University of Virginia (UVA) Clinical Data Repository (CDR). The CDR was used to identify girls aged 11–12 presenting to any UVA practice for a well-child visit between May 2008 and April 2009. Billing data were searched to determine rates of HPV vaccine uptake. The parents of all identified girls were contacted four to seven months after the visit to complete a telephone questionnaire including insurance information, child’s vaccination status, HPV vaccine attitudes, and demographics. Five hundred and fifty girls were identified, 48.2% of whom received at least one HPV vaccine dose. White race and private insurance were negatively associated with HPV vaccine initiation (RR 0.72, 95% CI 0.61–0.85 and RR 0.85, 95% CI 0.72–1.01, respectively). In the follow-up questionnaire, 242 interviews were conducted and included in the final cohort. In the sample, 183 (75.6%) parents reported white race, 38 (15.7%) black race, and 27 (11.2%) reported other race. Overall 85% of parents understood that the HPV vaccine was recommended and 58.9% of parents believed the HPV vaccine was safe. In multivariate logistic regression, patients of black and other minority races were 4.9 and 4.2 times more likely to receive the HPV vaccine compared to their white counterparts. Safety concerns were the strongest barrier to vaccination. To conclude, HPV vaccine uptake was higher among minority girls and girls with public insurance in this cohort.

A survey on human papillomavirus awareness and acceptance of vaccination among nursing students in a tertiary hospital in Ankara, Turkey

ObjectiveThe purpose of this study was to assess the awareness and knowledge regarding human papillomavirus (HPV), HPV related conditions and HPV vaccine among nursing students, and to identify their attitudes towards HPV vaccination. Materials and methodsThe study was carried out at a tertiary Women's Health Care Center in Ankara, Turkey. Self-administered questionnaires were filled out individually by the nursing students and by a control group including similar aged women. Data regarding demographic information, knowledge and awareness about HPV infection and HPV vaccine, attitudes towards vaccination, acceptance of HPV vaccine and assessment of HPV vaccination attitudes of the nurses with respect to the gender of their children was assessed and recorded. ResultsA total of 752 participants was included in the analysis. Five hundred and twenty (69.14%) of the participants were nursing students and the rest (n=232; 30.8%) were control group. The mean ages of the nursing students and the control group were 19.4 (16–27) and 19.4 (16–25) years, respectively. Majority of the nursing students knew the causal relationship between HPV and cervical cancer. Seventy-eight percent of the nursing students and 22.4% of the control group stated that they had heard of HPV vaccine. While the rate of the willingness to be vaccinated was 33.7% in the nursing student group, it was only 13.4% in the control group. ConclusionThe awareness and knowledge about HPV, its relation with cervical cancer and prevention of cervical cancer by HPV vaccine were favorable among nursing students at a tertiary hospital in Ankara, Turkey. However, although aware of the theoretical implications, they did not seem to apply it to practice, such as not having regular gynecologic examinations and Pap smears. Thus, further studies are needed to evaluate the factors that affect practical applications of health care professionals responsible for providing health education to the public.

Human Papillomavirus Vaccination Practices Among Providers in Indian Health Service, Tribal and Urban Indian Healthcare Facilities

The human papillomavirus (HPV) vaccine is of particular importance in American Indian/Alaska Native women because of the higher rate of cervical cancer incidence compared to non-Hispanic white women. To better understand HPV vaccine knowledge, attitudes, and practices among providers working with American Indian/Alaska Native populations, we conducted a provider survey in Indian Health Service, Tribal and Urban Indian (I/T/U) facilities. During December 2009 and January 2010, we distributed an on-line survey to providers working in I/T/U facilities. We also conducted semistructured interviews with a subset of providers. There were 268 surveys and 51 provider interviews completed. Providers were more likely to administer vaccine to 13-18-year-olds (96%) than to other recommended age groups (89% to 11-12-year-olds and 64% to 19-26-year-olds). Perceived barriers to HPV vaccination for 9-18-year-olds included parental safety and moral/religious concerns. Funding was the main barrier for 19-26-year-olds. Overall, providers were very knowledgeable about HPV, although nearly half of all providers and most obstetricians/gynecologists thought that a pregnancy test should precede vaccination. Sixty-four percent of providers of patients receiving the vaccine do not routinely discuss the importance of cervical cancer screening. Recommendations for HPV vaccination have been broadly implemented in I/T/U settings. Vaccination barriers identified by I/T/U providers are similar to those reported in other provider surveys. Provider education efforts should stress that pregnancy testing is not needed before vaccination and the importance of communicating the need for continued cervical cancer screening.

Human Papillomavirus Vaccination Recommendation May be Linked to Reimbursement: A Survey of Virginia Family Practitioners and Gynecologists

Objective Concerns have been raised about gynecologists as vaccinators. This survey evaluated use of the human papillomavirus (HPV) vaccine, attitudes, and barriers among gynecologists and family practitioners for differences between the 2 specialties. Design A cross-sectional survey was conducted using a 50-item, self-administered questionnaire mailed to participants. Setting The study was conducted in Virginia through the University of Virginia Center for Survey Research. Participants The questionnaire was mailed to 500 family practitioners and 500 gynecologists. Interventions The questionnaire asked provider and practice demographics, vaccine practices, knowledge, HPV vaccine attitudes, and barriers to vaccination. Main Outcome Measures We compared gynecologists to family practitioners for the outcome of offering HPV vaccination. Logistic regression was performed to determine factors associated with providers choosing to offer and recommend the HPV vaccine. Results After exclusion of ineligible physicians, 385 of 790 doctors responded (48.7%). Seventy percent of family practitioners and 73.5% of gynecologists currently offer the HPV vaccine. There were no significant differences in demographics or practice patterns between the specialties. The most frequent barrier to vaccination reported by both groups was reimbursement. In multivariate logistic regression, inadequate reimbursement was negatively associated with offering the HPV vaccine (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.15-1.1) and with recommending the vaccine to patients (OR 0.45; 95% CI 0.26-0.76). Experience treating HPV- related disease was positively associated with offering the HPV vaccine (OR 2.3; 95% CI 1.1-4.8). Conclusions Gynecologists are providing HPV vaccination at rates similar to family practitioners. Reimbursement concerns may negatively have an impact on doctors’ recommendation of the HPV vaccine.

HPV vaccination among ethnic minorities in the UK: knowledge, acceptability and attitudes

Background:Human papillomavirus (HPV) vaccination offers a unique opportunity for the primary prevention of cervical cancer. Studies suggest that knowledge and attitudes about the vaccine are likely to influence uptake. One limitation of most studies assessing HPV vaccine knowledge, attitudes and acceptability is their under representation of ethnic minorities. It is important to ensure that our understanding of HPV knowledge and attitudes include all ethnic groups in the UK. This article reviews research that has considered knowledge, acceptability and attitudes about HPV and the HPV vaccine among ethnic minorities in the UK.Methods:Articles in Medline, CINAHL and PsycINFO (January 2000–March 2010) were searched.Results:A total of 17 UK-based papers examined knowledge, attitudes or acceptability related to HPV vaccination in the ‘lay’ population (parents, adolescents or the general population as opposed to health professionals) and reported findings by ethnicity.Conclusion:Findings seem to suggest lower awareness of HPV and lower acceptability of the vaccination, which could be important if they are reflected in uptake. More research is needed with ethnic minority groups, particularly in the context of the vaccination programme.

P5-S6.30 HPV catch-up vaccination among a community sample of young adult women

BackgroundDespite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to catch-up vaccination exist.MethodsA community sample of 428 women enrolled...

HPV vaccination among a community sample of young adult women

ObjectivesDespite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist. MethodsA community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22. ResultsNineteen percent of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4–3.2) and intention to vaccinate (APR 1.4; 1.1–1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4–0.9) or intention to vaccinate (APR 0.5; 0.4–0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5–0.9). ConclusionsHPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.

Parental Attitudes Toward Human Papillomavirus Vaccination: Evaluation of an Educational Intervention, 2008

The authors' objectives were to improve human papillomavirus (HPV) vaccine educational materials and to determine whether parents who received those materials had improved attitudes about the vaccine. Pretests were sent to 411 parents of girls 11–18 years of age who had not yet received the HPV vaccine. The authors then randomly assigned 270 respondents to an intervention (educational flyer and posttest) or comparison (posttest only) group. The authors conducted a mixed-method analysis of intervention group feedback on improving the flyer and used paired t tests and analysis of covariance to describe within- and between-group attitude changes. The overall posttest response rate was 76%. Among intervention group respondents (n = 131), 88% had a positive impression of the flyer, and 43% reported that it made them more likely to vaccinate their daughters with HPV vaccine in the future. Parents who received the flyer also showed a statistically significant increase in mean attitude scores regarding perceived HPV vaccine safety and access to HPV vaccine information; mean scores also increased among the comparison group, but the changes were not statistically significant. Educational materials improved HPV vaccine knowledge and attitudes among parents and might have helped motivate some parents to have their daughters vaccinated.

The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): Scale Development and Associations With Intentions to Vaccinate

No standardized instruments, to our knowledge, exist to assess attitudes and beliefs about human papillomavirus (HPV) vaccination. We developed the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS), using data collected on 783 parents who had not yet vaccinated their daughters against HPV. We conducted a principal components analysis of 16 HPV vaccine attitude and belief items, assessed the scale's psychometric properties, and used linear regression to examine the relationship of CHIAS factors and parents' vaccination intentions. Analyses identified 4 CHIAS factors, all of which had acceptable scale alphas and 1-year test-retest reliability. In multivariate models, higher vaccination intentions were associated with: believing HPV vaccine is effective (β = 0.06) or has less harmful effects (β = -0.47), perceiving more barriers to access (β = 0.18), and having less uncertainty about the vaccine (β = -0.23) (all P < 0.05). Findings suggest that parent attitudes about HPV vaccine are important to their intentions to vaccinate their adolescent daughters against HPV. The CHIAS offers researchers a compact, standardized measure of important HPV vaccine attitudes and beliefs.

The Health Technology Assessment of bivalent HPV vaccine Cervarix® in Italy

Introduction Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context. Methods Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women's knowledge and attitudes towards vaccination were assessed. Results HPV infections pooled prevalence in Italy was 19% (95%CI: 10–30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in €1745.87 and €2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80–91%) and 78% (95%CI: 62–87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of €22,055. Conclusion The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process.

Pilot Study

The human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) in the world and it is associated with cervical cancer. The development of a prophylactic HPV vaccine has proven effective in clinical trials and it is now available to the public. The HPV vaccine represents a viable prevention strategy against cervical cancer. However, parental preferences, perceptions, and willingness to use the HPV vaccine are crucial, and if not assessed accurately, may threaten the successful implementation of a broad HPV vaccination program. This pilot study explored the views of 60 adult, Mexican women, all of who were mothers of female children between the ages of ten to 14 years old on the following four areas of interest: HPV knowledge; HPV vaccine knowledge and attitudes; barriers to HPV vaccine use; and potential uses and side effects of the HPV vaccine. Only 7% of respondents knew that HPV was a virus or STI. Eighty-six percent had not heard of the HPV vaccine, but 62% felt that the HPV vaccine would prevent HPV infection. However, 38% said the church would not approve of the HPV vaccine use for 10-14-year-old girls. Twenty-seven percent thought that promiscuous behavior would increase following HPV vaccination. Overall, respondents had very little knowledge of the HPV vaccine, were willing to be vaccinated themselves (83%), but were lesser willing to vaccinate their daughters (63%). Ultimately, understanding the beliefs about and identifying the barriers of HPV vaccine use will influence the effectiveness of the vaccine and its potential impact in reducing cervical cancer incidence rates worldwide.