Low Human Papillomavirus Vaccine Uptake Research Articles

Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings

PurposeParental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County. MethodsParents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9–17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV. ResultsA total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information. DiscussionOur findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.

"You Don't Know If It's the Truth or a Lie": Exploring Human Papillomavirus (HPV) Vaccine Hesitancy among Communities with Low HPV Vaccine Uptake in Northern California.

Vaccine hesitancy, delaying or refusing to vaccinate despite the availability of vaccines, impedes the progress of achieving optimal HPV vaccine coverage. Little is known about the sources of human papillomavirus (HPV) vaccine hesitancy among racially/ethnically and geographically diverse communities. The purpose of this paper is to explore HPV vaccine hesitancy among rural, Slavic, and Latino communities that reside in counties with low HPV vaccine uptake rates. Key informant interviews and focus groups were conducted with rural, Slavic, and Latino communities that reside within counties in California that have low HPV vaccine up to date rates (16-25%). Qualitative data were transcribed verbatim and analyzed using inductive and deductive thematic analysis. A total of seven focus groups and 14 key informant interviews were conducted with 39 individuals from seven California counties. Salient themes that contributed to HPV vaccine hesitancy included the following: social media and the anti-vaccination movement; a strong belief in acquiring immunity naturally; prior vaccine experiences; and vaccine timing concerns. Participants suggested the provision of culturally appropriate, in-language, in-person easy to understand HPV vaccine education to mitigate HPV vaccine hesitancy. Our findings can inform future interventions to increase HPV vaccine uptake among hesitant communities.

Human Papillomavirus (HPV) Vaccine Coverage and Confidence in Italy: A Nationwide Cross-Sectional Study, the OBVIOUS Project.

Human Papillomavirus (HPV) vaccination rates are still below the target due to vaccine refusal or delay, lack of knowledge, and logistical challenges. Understanding these barriers is crucial for developing strategies to improve HPV vaccination rates. This cross-sectional study used a questionnaire to investigate social and behavioral factors influencing decision making about the HPV vaccine. The survey was conducted from 11 April to 29 May 2022 and involved 10,000 Italian citizens aged ≥ 18 years. The sample was stratified based on region of residence, gender, and age group. 3160 participants were surveyed about themselves, while 1266 respondents were surveyed about their children's vaccine uptake. Among females aged ≥ 26 years, the national average HPV vaccine uptake was 21.7%, with variations across different regions. In the 18-25 age group, females had a vaccine uptake (80.8%) twice as much as males (38.1%), while vaccine uptake among male and female children aged 9-11 was similar. The OBVIOUS study in Italy reveals factors influencing low HPV vaccine uptake, suggesting targeted approaches, tailored information campaigns, heightened awareness of eligibility, promoting early vaccination, addressing low-risk perception among males, addressing safety concerns, and enhancing perceived accessibility to improve vaccine uptake and mitigate health risks.

Attitudes towards vaccination and HPV vaccine uptake among Croatian university students

Abstract Background The attitudes that underlie vaccine hesitancy are important for predicting individuals’ vaccination behaviour but also for developing effective public health interventions. This study aimed to investigate attitudes towards vaccination among Croatian university students and to evaluate its possible association with human papillomavirus (HPV) vaccine uptake in the same population. Methods This cross-sectional questionnaire study was conducted from February to May 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data about HPV vaccine uptake, as well as the Vaccination Attitudes Examination Scale (VAX scale) was self-administered to a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. The higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study sample included 840 subjects with, a median age of 20 years (interquartile range 20-21), 45.8% males, and 54.2% females. The median VAX scale score was 39.0 (interquartile range 32.0-46.0). The prevalence of vaccination uptake in the studied population was 20.8%. The more negative attitudes towards vaccination were found in students who studied within the scientific area of the social sciences (p &amp;lt; 0.001), students who had a lower average grade of study (p &amp;lt; 0.001), and students who were not vaccinated against HPV (p &amp;lt; 0.001). Conclusions The Croatian university students had rather negative attitudes towards vaccination probably reflected by the observed HPV vaccine uptake in this population. Identifying factors that influence general attitudes towards vaccination in the studied population would enable the design of more adequate public health interventions intended to promote HPV vaccine uptake. Key messages • Croatian university students have shown strong general vaccine hesitancy as well as low HPV vaccine uptake. • Better understanding of the attitudes that underlie vaccine hesitancy is important for developing public health interventions created to increase HPV vaccine uptake among Croatian university students.

Abstract A127: Factors impacting HPV vaccine initiation among English and Spanish speaking parents of Latino adolescents

Abstract Background: Human Papillomavirus (HPV)-associated cancers disproportionately impact Latinos. While data for English-speaking (ES) and Spanish-speaking (SS) Latinos is usually aggregated, differences in acculturation, sociodemographic characteristics, and health behaviors make it important to understand the factors impacting HPV vaccination among these groups separately. This understanding is crucial to improving HPV vaccination disparities as COVID-19 vaccinations have exacerbated issues of vaccine hesitancy and medical mistrust. Methods: Self-administered online surveys examining HPV vaccine hesitancy in an urban, diverse community with low HPV vaccine uptake were completed by parents of adolescents (N=357) in English or Spanish. Bivariate logistic regression analyses were conducted to understand if medical mistrust, vaccine hesitancy, HPV knowledge, healthcare utilization and sociodemographic factors impact adolescent HPV vaccine uptake among ES and SS parents of Latino adolescents ages 12-17. Factors significant at p&amp;lt;.01 in the bivariate analyses were included in multivariable logistic regression models for each group. Results: 136 parents of adolescents aged 12-17 identified as Latino; 56% completed the survey in English and 44% in Spanish. Bivariate analyses found significant associations between decreased HPV vaccine uptake and male parent/caregiver sex, higher HPV vaccine hesitancy, higher HPV knowledge, male adolescent sex, not receiving the flu vaccine and not receiving a provider recommendation to vaccinate against HPV among ES parents. In SS parents, parents aged 41-50 (compared to &amp;lt;40) and higher medical mistrust were associated with higher HPV vaccination; while male adolescent gender, not receiving TDAP immunization, and not receiving a provider recommendation to vaccinate against HPV were associated with lower HPV vaccine uptake. Multivariable regression models found that adolescents of ES parents were less likely to have initiated the HPV vaccine series if the parent/caregiver was male (OR=0.07, 95% CI:0.03,1.28), had higher HPV knowledge (OR=0.53, 95% CI:0.29,0.96), and did not receive a provider recommendation to vaccinate against HPV (OR=0.12, 95% CI:0.003,0.55). SS parents with higher medical mistrust (OR=7.27, 95% CI:1.14,46.41) and those aged 41-50 compared to parents younger than 40 (OR=18.19, 95% CI:0.28,407.78) were more likely to have adolescents who initiated the HPV vaccine series, while those without a provider recommendation to vaccinate had lower odds of HPV vaccine uptake (OR=0.004, 95% CI:&amp;lt;0.01,0.11). Discussion: Aligned with the literature, provider recommendation to vaccinate against HPV significantly impacted vaccination behavior among ES and SS parents. Interventions should focus on improving provider recommendations and communications with Latino parents of adolescents. More research should explore the surprising associations between higher medical mistrust and higher odds of HPV vaccination among SS parents, and more HPV knowledge and lower odds of HPV vaccination among ES parents. Citation Format: Bibiana Martinez, Lourdes Baezconde-Garbanati, Jennifer Tsui. Factors impacting HPV vaccine initiation among English and Spanish speaking parents of Latino adolescents [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A127.

Low human papillomavirus vaccine uptake among women engaged in HIV care in Ontario, Canada

Women living with HIV are at higher risk for human papillomavirus (HPV)-related dysplasia and cancers and thus are prioritized for HPV vaccination. We measured HPV vaccine uptake among women engaged in HIV care in Ontario, Canada, and identified socio-demographic, behavioural, and clinical characteristics associated with HPV vaccination. During annual interviews from 2017 to 2020, women participating in a multi-site, clinical HIV cohort responded to a cross-sectional survey on HPV vaccine knowledge and receipt. We used logistic regression to derive age-adjusted odds ratios and 95% confidence intervals (CI) for factors associated with self-reported vaccine initiation (≥1 dose) or series completion (3 doses). Among 591 women (median age = 48 years; interquartile range = 40–56 years), 13.2% (95%CI = 10.5–15.9%) had received ≥1 dose. Of those vaccinated, 64.6% had received 3 doses. Vaccine initiation (≥1 dose) was significantly higher among women aged 20–29 years at 31.0% but fell to 13.9% in those aged 30–49 years and < 10% in those aged ≥50 years. After age adjustment, vaccine initiation was significantly associated with being employed (vs. unemployed but seeking work), income $40,000–$59,999 (vs. <$20,000), being married/common-law (vs. single), living with children, immigrating to Canada >5 years ago (vs. immigrating ≤5 years ago), never smoking (vs. currently smoking), and being in HIV care longer (per 10 years). Similar factors were identified for series completion (3 doses). HPV vaccine uptake remains low among women living with HIV in our cohort despite regular engagement in care. Recommendations for improving uptake include education of healthcare providers, targeted community outreach, and public funding of HPV vaccination.

Encouraging improvement in HPV vaccination coverage among adolescent girls in Kampala, Uganda.

WHO recommends vaccination against HPV for girls before sexual debut. Uganda started HPV vaccination in 2008 as pilot programs in 2 districts, followed by national roll out in 2015. Despite the availability of vaccines against human papillomavirus (HPV) in Uganda in the period covered by the study, there was reported low HPV vaccine uptake and completion especially of the second dose in Uganda; with little information available on timely completion of HPV vaccine and the associated factors in Uganda. This study was therefore done to determine the HPV vaccine dose 2 completion and describe the possible factors associated with timely HPV vaccine completion and non-completion among girls of age 9-14 years attending the adolescent clinic at Mulago hospital. A retrospective mixed methods study was conducted in Mulago National Referral hospital adolescent clinic. Data were mainly collected through review of charts and folders for clinic attendance by eligible girls and focus group discussions with eligible girls that completed the 2 doses of HPV vaccine on recommended/scheduled time. Out of the 201 girls studied, 87 girls (43.3%) had timely completion of the HPV vaccination. Knowledge about HPV infection and HPV vaccine benefits, positive peer influence and healthcare worker recommendation to get vaccinated at health facility level positively influenced timely completion of HPV vaccine. Among barriers to completion of HPV vaccine identified were: inadequate information about HPV infection and HPV vaccine, concerns about HPV vaccine efficacy and safety, unclear communication with adolescents/caregivers from healthcare workers and -stock out of the HPV vaccine. Timely completion of the second dose of HPV vaccine among girls attending the adolescent clinic of Mulago hospital was low (at 43.3%) but higher when compared to earlier published reports. Interventions around improved social mobilization, enhanced outreach and static vaccination approach and education of eligible girls on HPV vaccination can help increase vaccine uptake.

Human papillomavirus (HPV) infection and vaccination: A cross-sectional study of college students’ knowledge, awareness, and attitudes in Villanova, PA

Human papillomaviruses are major causative agents of multiple cancers including cervical, vulvar, penile, anal, and oropharyngeal cancers. Almost all sexually active individuals are exposed to HPV in their lifetime and although not all HPV genotypes are capable of causing cancers, several high-risk subtypes widely circulate. Several HPV vaccines have been developed and successfully utilized to limit the spread of these viruses and reduce rates of associated cancers. Despite their success, HPV vaccination rates in the United States remain low. Studies estimate the highest prevalence of HPV in the United States is among college students. This makes college students an important target for interventions that promote HPV vaccination and prevention. To this end, we were interested in investigating the relationship between low HPV vaccine uptake and attitudes and awareness about HPV vaccination among college aged students. We designed a survey to assess knowledge and perception of HPV and HPV vaccination that could help identify correlations between this knowledge and vaccination status. Overall, the data suggest that factors beyond basic knowledge about HPV infections, such as vaccine safety and social acceptance of vaccination, may have important impacts on vaccination rates. More robust education in these areas, supplemented with education about the benefits of HPV vaccination could be utilized to improve vaccination rates.

HPV Vaccine Beliefs and Correlates of Uptake Among Hispanic Women and Their Children on the US-Mexico Border.

Introduction:Human Papilloma Virus (HPV) is the most common sexually transmitted infection nationally. Although preventable, uptake of the HPV vaccine is low. The purpose of this study was to describe HPV vaccine knowledge and beliefs and psychosocial correlates of vaccine uptake among adult females and their children in a US-Mexico border community.Materials and Methods:We conducted a survey of uninsured women aged 21-65 years living in Texas who were due for cervical cancer screening. We utilized descriptive statistics to report demographic and psychosocial variables. We used logistic regression analysis to identify correlates of prior vaccine uptake.Results:599 women completed surveys: mean age was 44.69 years, 97.8%, were Hispanic and 86% were Spanish speaking; 5% had been vaccinated. Awareness of HPV infection & HPV vaccine was 81.6% & 68.6% respectively. Scores for mean perceived susceptibility was low and mean perceived benefits was high; the mean score for knowledge was 3.69 out of 6. Common parental barriers to child vaccination were cost, lack of accessibility and lack of information. Correlates of past HPV vaccine uptake among adult women were younger age, monthly income of $2,500-$5,000, full-time employment, US birth, and higher perceived severity of HPV. Older age was a correlate of vaccine uptake for daughters.Discussion and Conclusion:Findings revealed low HPV vaccine uptake among adult Hispanic women, but high vaccine acceptability for their sons and daughters. Culturally tailored educational interventions are needed to improve HPV knowledge and HPV vaccine uptake among adults and their children.

Challenges and opportunities of school-based HPV vaccination in Canada

ABSTRACT Primary prevention of human papillomavirus (HPV) through vaccination is a high priority in Canada’s cancer prevention efforts. All Canadian provinces and territories have introduced publicly funded, school-based vaccination programs against HPV, but vaccine uptake remains suboptimal in some jurisdictions. We conducted a descriptive qualitative study to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance using the socio-ecological model. In Quebec, interviews and focus groups were held in 2015–2016 with 70 key informants including immunization managers, school nurses, school principals, teachers and parents of Grade 4 students (9 years of age). Our findings showed that HPV vaccine uptake was dependent on many interrelated factors at the individual and interpersonal level (e.g. knowledge and attitudes of the different players involved in the vaccination system), at the community level (e.g. social group values and norms, media coverage around the HPV vaccine), at the organizational level (e.g. allocated resources, information provision, consent process, immunization setting and environment) and at the policy level (e.g. changes in provincial HPV vaccine program). We are using the data collection and interpretation tools and approaches developed by our team and used in Quebec to expand our study to four other provinces (British Columbia, Alberta, Ontario and Nova Scotia). We are conducting environmental scans, semi-structured interviews and a survey to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance. Having an in-depth understanding of the determinants of HPV vaccination in school settings is critical in order to identify root causes of the suboptimal vaccine uptake and to develop tailored interventions to address these on both supply- and demand-side issues.

Abstract C56: An online-based storytelling video intervention on promoting Korean American female college students' HPV vaccine uptake

Abstract Introduction: Korean American (KA) women are at high risk for human papillomavirus (HPV) infection and cervical cancer, yet they have low awareness and knowledge about HPV vaccine, and subsequently have low HPV vaccine uptake rates. Therefore, it is imperative to develop culturally appropriate education interventions to reduce the health disparities. Objective: This study aimed to evaluate the effects of an online storytelling intervention to promote HPV vaccine uptake by conducting a pilot randomized controlled trial (RCT). Method: We recruited 104 participants from multiple sites in six different states in Northeast. Participants were eligible if they were current KA female college students between the ages of 18-26 and who have not been vaccinated for HPV. This study was implemented in an innovative online laboratory from data collection to experimentation. Participants were randomly assigned to the experimental group (a storytelling video) or control group (written information). The effects of the intervention were assessed at post-intervention and 2-month follow-up. Results: Both experimental group and control group improved in knowledge and attitudes from baseline to post-intervention. However, the experimental group had higher overall knowledge score, satisfaction with the education program, and intention to get the HPV vaccine within 1 year and was twice as likely to receive or schedule an appointment for the HPV vaccine compared with the control group (15.6% vs. 7.1%). Conclusion: This pilot study provides evidence in support of the effectiveness of the storytelling video intervention in using an innovative online laboratory setting aimed at HPV and HPV-related cancer prevention. Citation Format: Minjin Kim, Haeok Lee, Teri Aronowitz, Lisa Kennedy Sheldon, Peter Kiang, Jeroan Allison, Ling Shi. An online-based storytelling video intervention on promoting Korean American female college students' HPV vaccine uptake [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C56.

Primary care team- and clinic level factors affecting HPV vaccine uptake.

This study examined patient-, care team- and clinic-level factors associated with human papillomavirus (HPV) vaccine initiation and completion. HPV vaccine initiation and completion rates among adolescents aged 9-18years were assessed using administrative data (n=38,277) from a large federally qualified health center serving predominantly Latino patients. Four clinics with particularly high and low adolescent HPV vaccine uptake were selected for in-depth case study analyses. Semi-structured interviews with clinic leaders, providers, and support staff in these clinics (n=36) examined multilevel factors perceived as affecting vaccine initiation and completion. On average, less than half (45%) of patients had initiated the HPV vaccine; of these, 52% of patients completed all recommended doses. Vaccine uptake varied significantly across clinics but was higher among patients seen by providers specializing in pediatrics. Qualitative findings confirmed the importance of provider communication strategies but indicated that other health care team structures and processes also play an important role in vaccine uptake. Care team members in higher performing clinics were more likely to describe vaccination as a team effort rather than solely the provider's responsibility. Support staff in higher performing clinics also spent more time reviewing patient preventive care needs and preparing patients for the provider encounter. Clinic-level factors such as performance management systems and the use of immunization champions were described as important for developing an organizational climate supportive of vaccination. Tracking and reminder systems were described as important but insufficient for ensuring vaccine uptake in the absence of other supports. Efforts to improve HPV initiation and completion could benefit from additional attention to factors at the health care team and clinic levels. Interventions that target factors at multiple levels of influence are most likely to achieve higher vaccination rates. Quality monitoring programs may influence clinic investment in improving vaccination rates.

Latino Parents' Awareness and Receipt of the HPV Vaccine for Sons and Daughters in a State with Low Three-Dose Completion.

Latinos suffer a disproportionate burden of human papillomavirus (HPV)-preventable cancers, yet uptake and completion of the HPV vaccine among Latinos is below recommendations. Reasons for low HPV vaccine uptake among Latinos in Utah are unknown. We surveyed Latino parents of HPV vaccine age-eligible adolescents (N=118). Univariable analyses identified sociodemographic characteristics associated with HPV vaccine awareness, interest, and uptake for daughter(s) and/or son(s) using chi-square tests or Fisher's exact tests. More parents who had lived in the USA for 15 years or more had vaccinated their daughter (43.6 vs. 32.5%, p=0.035) compared to those living in the USA for shorter time periods. Parents born in Mexico reported their son had not received the HPV vaccine (74.6 vs. 58.3%, p=0.049) more than those born elsewhere. Parents with Mexican birthplace and ancestry reported not knowing about the HPV vaccine as the main barrier to vaccinating daughters (47.1 vs. 5.9%, p=0.002 for both) and sons (birthplace 38.3 vs. 10.3%, p=0.007; ancestry 37.1 vs. 11.1%, p=0.013) compared to those born or descending elsewhere. Non-acculturated parents with a son were more likely to report not knowing about the HPV vaccine as the main barrier to vaccine receipt (47.6 vs. 12.5%, p<0.001). Our results focus on Latinos in an understudied region and complement prior research in other regions. This study may have implications for designing culturally tailored interventions to improve uptake of the HPV vaccine among the growing population of Latinos in Utah, and other states in the Intermountain West.

Health care providers' perspectives on low HPV vaccine uptake and adherence in Appalachian Kentucky.

Previous intervention research conducted in Appalachian Kentucky resulted in extremely low uptake and adherence to the human papillomavirus (HPV) vaccine among women ages 18-26, despite provision of free vaccine. Because of these findings, the purpose of this qualitative, follow-up study was to elicit health care providers' perspectives on barriers and facilitators to HPV vaccination and suggested strategies for improving vaccination rates. Researchers conducted semi-structured qualitative interviews with a purposive sample of eight health care providers (seven nursing professionals, one physician) at the health clinic where the original HPV vaccination intervention took place. Interviews were audio-recorded and transcribed and authors used a constant-comparative method to analyze the data. Significant themes emerged from the interviews, centering around two primary issues: vaccine uptake and vaccine adherence. Related to uptake, health care providers identified perceived patient barriers and inadequate HPV vaccine education. They also identified the vaccine schedule and clinic-centered communication deficiencies as adherence-related barriers. These Appalachian Kentucky health care providers provided important insights into barriers and facilitators to HPV vaccine uptake and adherence that need to be readily addressed in this community. As informed by these providers, several suggestions for improving HPV vaccination, such as more targeted education efforts and patient-centered reminder systems, may be applicable to other nursing professionals working in rural and medically underserved communities.

HPV vaccination of adult women: An audit of Australian general practitioners

While initial Human Papillomavirus (HPV) vaccine uptake estimates are encouraging, especially in the school-aged population, it is unclear to what extent general practitioners (GPs) have been recommending and administering the vaccine to adult women and what the uptake has been. A mixed methods study of Australian GPs consisting of a knowledge and attitudes questionnaire and an audit which assessed overall vaccination rates since commencement of the Australian National HPV program and in the last 50 female patients aged 27-45years who consulted them. GPs have a good level of knowledge regarding HPV vaccination and are strongly committed to it for women until 27years but are much less so for women aged 27-45years. From 2007 to 2010, only 1.9% of women aged 27-45 who consulted the GPs commenced HPV vaccination. Of those, however, the majority completed all three doses. Higher rates of commencement of HPV vaccination (11.4%) were demonstrated by auditing the last 50 consecutive patients seen by the GP. In this group of women, 63% had received a Pap test in the last two years. Female GPs had significantly higher rates of vaccination. There is relatively low HPV vaccine uptake in women aged 27-45. Once HPV vaccination is commenced, however, completion rates are high in women in this age group. Low uptake may be due to lack of opportunistic awareness raising in relevant consultations. Clear guidance together with further exploration of patient factors and GP barriers and enablers would assist implementation of HPV vaccination.