Human papillomavirus (HPV) vaccine status and knowledge of students at a university in rural Thailand

Knowledge and health literacy related to human papillomavirus infection, cervical cancer, and cervical cancer screening among nursing students in rural and urban areas of Thailand

BACKGROUND

Cervical cancer is the second leading cause of death among women in Thailand. Understanding health literacy and knowledge of HPV, cervical cancer, and their screening is vital for nursing students as they prepare for professional practice.

OBJECTIVES

To identify factors influencing health literacy and knowledge of HPV infection, cervical cancer, and screening among Thai nursing students at rural and urban universities.

DESIGN

A cross-sectional descriptive comparative study.

PARTICIPANTS/SETTINGS

Current undergraduate nursing students from rural and urban universities in Thailand.

METHODS

A self-administered survey assessed health literacy and knowledge related to HPV infection, cervical cancer, and their screening. Descriptive and logistic regression analyses were used to identify factors associated with these variables.

RESULTS

Among 641 nursing students (255 rural students and 386 urban students), rural students had significantly higher mean scores in cervical cancer screening knowledge (t = -4.86, p < 0.001) and health literacy compared to urban students (t = -2.57, p = 0.01). Rural students using the internet more than three days per week were 1.92 times more likely to have better knowledge of HPV and cervical cancer (95 % CI: 1.10-7.73). Awareness of HPV (ORa = 2.51, 95 % CI: 1.31-4.80) and frequent internet use (ORa = 2.31, 95 % CI: 1.04-5.12) were associated with higher knowledge about cervical cancer screening and health literacy among rural nursing students.

CONCLUSIONS

Rural students exhibit higher health literacy and knowledge about cervical cancer screening than urban students. These findings highlight the need for diverse teaching strategies to enhance students' understanding and competency.

From awareness to acceptance: understanding HPV and vaccine knowledge, attitudes and beliefs among university students in Punjab, Pakistan

Background

Human Papillomavirus (HPV) infections can lead to various cancers globally, and immunization can prevent HPV-associated cancers. This study intended to evaluate university students' knowledge, awareness, and attitudes/beliefs toward HPV and HPV vaccine uptake in Punjab, Pakistan.

Methods

A descriptive cross-sectional study was conducted in ten institutes across six cities using pre-validated questionnaires. Descriptive statistics and Rasch analysis were utilized to describe awareness levels, knowledge, and attitudes scores respectively. Regression analysis was utilized to explore association between demographic factors, knowledge levels, and attitudes/ beliefs. SPSS® (IBM, version 23.0) and Winstep® (version 3.75.0) software were used for analysis.

Results

Out of 1200 students approached, 1056 responded (response rate 88.0%). The mean age of students was 19.5 ± 0.5 years; 31.3% had heard about HPV, 16.4% were aware of the HPV vaccine's availability, and 2.3% were vaccinated against HPV. The mean Rasch knowledge score was -0.368 logits (SD: 0.893; SEM: 0.027), depicting below-average HPV knowledge. The mean Rasch attitudes/beliefs score was 0.049 logits (SD: 1.013; SEM: 0.031), which depicted positive attitudes towards HPV and its vaccination. Females (OR:1.742; 95%CI: 1.352-2.320), health-sciences students (OR: 1.692; 95%CI: 1.290-2.220), and urban residents (OR:1.621; 95%CI: 1.244-2.223) possessed positive attitudes towards HPV vaccination. Recommendations from physicians (Median: 4.0; IQR: 4.0-5.0) followed by parents (Median: 4.0; IQR: 3.0-5.0), and friends (Median: 4.0; IQR: 3.0-4.0) shaped vaccination decisions.

Conclusion

Despite their inadequate knowledge levels and poor vaccine uptake, students showed positive attitudes towards HPV vaccination. Awareness about HPV, including testing and vaccination, should be raised through community outreach programs, social media, and university curricula.

Human papillomavirus vaccination hesitancy among young girls in Ethiopia: factors and barriers to uptake

Background

Human papillomavirus (HPV) vaccinations protect against HPV infections. The infection might lead to vaginal cancer, vulvar cancer, genital warts, cervical intraepithelial neoplasia lesions, and cervical cancer. This study assessed hesitancy of HPV vaccination, associated factors, and barriers to vaccination among youth girls in Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among female undergraduate students at the University of Gondar, College of Medicine and Health Sciences, between July and August 2022. The data was collected using a self-administered questionnaire. A simple random sampling method was used to recruit participants. The data were entered and analyzed with SPSS version 26. Descriptive statistics were used to describe the participants' demographic characteristics. Logistic regression was performed to identify the significant factors associated with acceptance of the HPV vaccine. A p-value <0.05 was considered statistically significant.

Results

The study included 423 participants with a mean age of 22.5 ± 6.7 years. Only more than one-third (35.2, 95% CI: 27.2-44.1) received the HPV vaccine. Currently, more than one-fourth (27.9, 95% Cl: 21.4-33.8) of participants are hesitant to receive the HPV vaccine. Higher monthly income (AOR = 1.52, 95% CI: 1.08-6.34), good knowledge of the HPV vaccine (AOR = 2.12, 95% CI: 1.12-4.87), and a positive attitude towards the vaccine (AOR = 3.03, 95% CI: 1.63-9.56) were significantly associated with acceptance of HPV vaccination. Safety concerns (63.1%), misinformation (42.8%), and parental concerns (42.3%) about the HPV vaccine were among the top perceived reported barriers to receiving the HPV vaccine.

Conclusion

This result showed that more than a quarter number of youth girls are still hesitant to receive HPV vaccinations. To increase vaccination acceptance, interventions should focus on awareness-raising programs about HPV infection and vaccines and addressing safety and parental concerns.

Knowledge, attitude, and reasons for non-uptake of human papilloma virus vaccination among nursing students

BACKGROUND

Cervical cancer is a significant health issue, especially in low- and middle-income countries like India, where it ranks fourth among women. The Human papillomavirus (HPV) vaccination, a vital preventive measure, has suboptimal uptake among nursing students. We aimed to assess the level of knowledge, attitudes, willingness, and reasons for non-uptake of HPV vaccination among nursing students.

METHODS

A descriptive cross-sectional study was conducted from April to June 2023, using a total enumeration method. Data were collected from 313 nursing students using a validated questionnaire covering sociodemographic information, knowledge, attitudes, and reasons for non-uptake of HPV vaccination. Statistical analysis was performed using SPSS version 26.0. Descriptive statistics summarized the data, while binary and multivariable logistic regression analyses identified factors associated with knowledge, attitude, and willingness for HPV vaccination.

RESULTS

The mean age of the students was 20.98 ± 2.38 years, with the majority being females (81.2%) and unmarried (93.0%). About half of the participants demonstrated moderate knowledge (52.4%) and negative attitudes (50.1%) towards HPV vaccination, with none having received the vaccine. Female students had 4.24 times the odds of having good knowledge (AOR = 4.24, 95% CI = 1.66-10.80), while those pursuing a bachelor's degree exhibited 2.70 times the odds of good knowledge (AOR = 2.70, 95% CI = 1.40-5.21). In contrast, first-year students had 0.30 times the odds of having good knowledge (AOR = 0.30, 95% CI = 0.11-0.79) but displayed 4.69 times the odds of having a positive attitude (AOR = 4.69, 95% CI = 1.92-11.41). Additionally, Hindu students had 2.44 times the odds of being willing to receive the vaccine (AOR = 2.44, 95% CI = 1.15-5.20). Most participants expressed willingness to receive the vaccine (62.0%), citing reasons such as not being sexually active (35.8%) and needing more information (18.2%) for non-uptake of the vaccine.

CONCLUSIONS

The study highlights gaps in knowledge and negative attitudes towards HPV vaccination among nursing students. Targeted educational interventions and policy initiatives are essential to improve awareness, promote positive attitudes, and increase HPV vaccination uptake among nursing students.

Human papillomavirus vaccination status among university students in Southern Thailand: A cross-sectional study

Objective

Human papillomavirus (HPV) commonly causes transmissible diseases worldwide; however, HPV vaccines are not available among some at-risk populations. Since 2017, HPV vaccination has been recommended for females aged 11-12 years in Thailand. However, studies on the coverage and HPV vaccination prevalence are limited. This study aimed to explore the prevalence and factors associated with HPV vaccination among Thai university students.

Methods

Data for this cross-sectional study were randomly collected using paper-based questionnaires from university students aged 18-26 years during October 17-27, 2023.

Results

Of 1,093 participants, 57.6 % were female, and 53.5 % were from non-urban areas. The median age was 20 years. One-third of the participants were from low-income families. The overall HPV vaccine coverage rates were 7.51 % and 0.87 % in female and male students, respectively. Female sex, being from a high-income family, studying in health science faculties, originating from an urban area, having one or both parents completing university educations, and having healthcare providers as family members increased the odds of receiving the HPV vaccine. The accuracy of HPV vaccine literacy among participants who reported that they "know about the HPV vaccine" was adequate, except for the fact that HPV vaccine was sex-neutral.

Conclusions

The HPV vaccine coverage rate among Thai university students was low owing to several factors. HPV and HPV vaccine education should be provided to populations that can still benefit from receiving the HPV vaccine.

Perceptions of Taiwanese college students toward human papillomavirus infection: A qualitative descriptive study

PURPOSE

The aim of this study was to explore college students' perceptions of human papillomavirus (HPV) infection and their thoughts on prevention measures.

DESIGN AND METHODS

A qualitative descriptive design was used. The study adopted purposive sampling at two universities in northern Taiwan and one in central Taiwan. Twenty-six college students participated, and data saturation was reached. Content analysis was undertaken.

RESULTS

Four main themes emerged from the data narratives: 1) having very little knowledge of HPV infection, 2) being concerned about outcomes of HPV infection, 3) taking measures to protect oneself, and 4) expecting to have HPV prevention resources.

CONCLUSIONS

The results indicated that college students needed a more complete understanding of HPV and prevention methods to protect themselves from infection. Schools were an ideal place to provide adequate information on HPV prevention.

PRACTICE IMPLICATIONS

The study suggested providing HPV-related information through school health centers and government health departments to resolve common questions and misunderstandings about HPV infection. Healthcare professionals should have a complete understanding of HPV-related knowledge in order to provide detailed information to young people.

Cervical cancer in Thailand: 2023 update

Cervical cancer continues to pose a challenge to the health of Thai women, as the second most common cancer after breast cancer. Since high-risk human papillomavirus (HPV) types are the main cause for cervical cancer, cervical cancer screening and HPV vaccination are necessary to reduce the incidence of this disease. At present, the World Health Organization hopes to reduce the incidence of cervical cancer to 4 or less cases per 100,000 women-years using 90%- 70%-90% intervention by 2030. The first intervention involves vaccinating 90% of women aged 15 years with the HPV vaccine. The second intervention involves screening 70% of women between the ages of 35 and 45 years using a high-performance screening test. The third intervention involves detecting cervical lesions in 90% of affected women to enable diagnosis and treatment. In this context, this study reviews trends in the incidence and mortality rates of cervical cancer in Thailand, in addition to providing an up-to-date overview of the causes and necessary risk factors for cervical cancer, as well as reporting on cervical screening and HPV vaccination rates and cervical cancer during the coronavirus disease 2019 (COVID-19) pandemic. This study may prove useful for the formulation of policy aimed at eliminating cervical cancer in Thailand, such as the implementation of a free HPV vaccine service and providing athome kits for cervical screening through clinics and pharmacies. In addition, this review also highlights the need for further research on the effects of the COVID-19 pandemic on cervical cancer screening rates in Thailand.

Knowledge and Behaviors toward Human Papillomavirus and Cervical Cancer in the Women of Reproductive Age in Thailand-Myanmar Border Areas

BACKGROUND

Infectious disease is an important health problem in border areas as there is a possibility that the migrants may carry the disease into the area. The purpose of this study is to evaluate the knowledge and behaviors toward human papillomavirus (HPV) and cervical cancer in the women of reproductive age in the Thailand-Myanmar border area.

METHODS

A survey study in a population of 418 women of reproductive age in Mae Hong Son Province in the Thailand-Myanmar border area. Knowledge and risk behaviors of HPV and cervical cancer were described using descriptive statistics.

RESULTS

Fifty percent of the participants had sexual debut at age less than 20 years, 27% had more than one lifetime sexual partner and only 3% had sex outside a monogamous relationship during the past 12 months. In term of knowledge, 62.5% knew about HPV. The proportion of correct answers about HPV and cervical cancer questions ranged from 14-95% and 52-94%, respectively. Among the cervical cancer screening target, 69.4% accessed the screening. The factors associated with better knowledge about HPV and cervical cancer were education level higher than high school and sexual debut.

CONCLUSION

The women of reproductive age in the Thailand-Myanmar border areas showed relatively low sexually risk behaviors for HPV infection. More than one-third of the participants did not know about HPV. The percentage of correct answer to questions about cervical cancer were low.  We encourage the Thai Ministry of Public Health to increase health promotion and health literacy on prevention of HPV and cervical cancer in the women of pre- and reproductive age in the Thailand-Myanmar border area.

Human Papilloma Virus Infection and Vaccine Knowledge Levels, Attitudes, Beliefs in University Students: Turkey and Ghana Comparison

Purpose: Studies reported that early diagnosis, treatment, and prevention of cervical cancer are influenced by knowledge, beliefs, and attitude toward screening. This descriptive-comparative study aimed to assess human papilloma virus (HPV) knowledge, attitudes, and beliefs in university students and the affecting factors and to compare between Turkish and Ghanaian students. Methods: The sample consists of 933 university students studying in 4 different faculties in 2 universities from Turkey and Ghana. The data were collected between November 2019 and February 2020. The study's data were analyzed using Analysis of Variance, Pearson Correlation test, t-test, and Mann-Whitney U test. Results: The findings of the study showed that none of the students in both countries had HPV vaccination. It was found that students have low level of knowledge about HPV infection and vaccine (3.28 ± 2.14) and positive attitudes (16.57 ± 3.28) and beliefs (36.74 ± 6.55) toward vaccine. The attitude score of the Ghanaian students (17.54 ± 3.23) was found to be significantly higher than the Turkish students (15.74 ± 3.09). The knowledge score of the Ghanaian students who had sexual intercourse was found to be significantly higher than others. The findings of the study revealed that the students of both countries had low level of knowledge about HPV infection and vaccine and positive attitudes and beliefs toward the vaccine. Conclusions: It is recommended to increase effective interventions to increase the knowledge level of university students about HPV infection and vaccine. In addition, the vaccine should be included in the immunization program in both countries.

Acceptance and Associated Risk Factors of Human Papillomavirus Vaccine Among Parents of Daughters in Intermediate Schools in Tabuk City, Saudi Arabia

BACKGROUND

Women in Saudi Arabia have little knowledge of cervical cancer, human papillomavirus (HPV), and its vaccine. This study assessed the acceptance, barriers, and facilitators of HPV vaccination and its associated factors among parents of daughters in intermediate schools during the academic year September 2022-June 2023 in Tabuk City, Saudi Arabia.

PURPOSE

The objective of this study was to evaluate the barriers and facilitators of HPV vaccination and its associated factors among parents of daughters in intermediate schools in Tabuk City, Saudi Arabia.

METHODS

This was an analytical community-based cross-sectional study that targeted 947 parents of girls older than 15 in intermediate schools in Tabuk City. A structured questionnaire was used to collect data using a web-based survey.

RESULTS

The knowledge about HPV and its vaccine in mothers was 1.627 times higher than in fathers, mainly when employed, highly educated, aged <40 years, and earning a higher income. In addition, the Saudis' knowledge of HPV and its vaccine was 1.275 times higher than non-Saudis. The HPV vaccine acceptability among mothers was 1.259 times higher than the fathers, especially when non-employed, aged <40 years, and with higher income. The parent who knows the relationship between HPV and cervical cancer accepts the vaccine 1.794 times higher than those who ignore this relationship. On the other hand, the Saudi's acceptability of the vaccine was 0.671 times lower than non-Saudis.

Prevalence of HPV infection among Thai schoolgirls in the north-eastern provinces in 2018: implications for HPV immunization policy

OBJECTIVE

The aim of this study was to determine the prevalence of high-risk (HR) and vaccine-type human papillomavirus (HPV) infection among Thai schoolgirls who were not included in the national HPV immunization program.

METHODS

Cross-sectional surveys were conducted among grade 10 (15-16 years old) and grade 12 (17-18 years old) schoolgirls in two provinces of Thailand. Urine samples were collected using the Colli-PeeⓇ device from November 2018 to February 2019. The samples were initially tested using CobasⓇ 4800. Subsequently, all Cobas-positive samples and 1:1 matched Cobas-negative samples were tested by AnyplexⓇ assay. Prevalences of any HPV, any HR HPV, vaccine-type HPV, and individual HR HPV types were estimated by school grade.

RESULTS

Prevalences of any HPV and any HR HPV were 11.6% and 8.6% for grade 10, and 18.5% and 12.4% for grade 12 schoolgirls, respectively. Prevalences of bivalent vaccine-type HPV infection in grades 10 and 12 were 3.4% and 4.5%, respectively. Prevalences of quadrivalent and nonavalent vaccine-type HPV infections were 4.0%/6.6% and 6.4%/10.4% in grades 10 and 12, respectively. HPV16 was the most common type detected, followed by HPV58, 51, and 52. Circulating HR HPV types were similar between the school grades.

CONCLUSION

A substantial burden of HR HPV infections was found among unvaccinated high school girls in Thailand.

A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia

This scoping review synthesizes literature to examine the extent of research focusing on knowledge, awareness, perceptions, attitudes, and risky behaviors related to sexually transmitted infections (STIs) in Southeast Asia (SEA). The PRISMA-Scoping approach was adopted targeting articles published from 2018 to 2022, sought from CINALH, PubMed, Web of Science and Scopus. A process of screening and elimination resulted in a total of 70 articles reviewed. Most of the studies were conducted in Indonesia, Thailand, Vietnam, and Malaysia, with the majority focusing on HIV/AIDS. In general, studies examining knowledge, awareness, and risky behaviors related to STIs in SEA reported low levels across various cohorts. However, evidence suggests that these issues are more prominent among individuals with low levels of education or low socioeconomic status, those living in rural areas or those working in the sex/industrial sectors. Engaging in unsafe sex and having multiple partners are the key examples for risky sexual behavior, while fear of being rejected/discriminated/stigmatized and lacking STI awareness were identified as social risky behaviors in SEA. Overall, cultural, societal, economic and gender inequality (male dominance) greatly impact people's knowledge, awareness, perceptions, attitudes, and risky behaviors in SEA. Education is an important factor influencing healthy behavior; therefore, this scoping review calls for increased investment in educating vulnerable populations to prevent STIs, particularly in less-developed countries/regions of SEA.

Characteristics of HIV/sexually transmitted infections among men who have sex with men and women in Bangkok, Thailand

BACKGROUND

Men who have sex with men (MSM) are a key HIV target population in Thailand. An important subgroup is men who have sex with men and women (MSMW) as they can sexually transmit infections between individuals with different gender identities. This study compared the sexually transmitted infection risk behavior of different types of men in Thailand.

METHODS

We retrospectively reviewed the medical records of 839 consecutive male patients who visited an STI clinic in Bangkok, Thailand, between 2014 and 2020.

RESULTS

Men who have sex with women only (MSWO) predominated (58.0%), followed by men who have sex with men only (MSMO, 32.2%) and MSMW (9.8%). MSMW and MSMO shared similar sexual risk behaviors, such as significantly higher median numbers of sex partners (10 and 8, respectively) than MSWO (5; Kruskal-Wallis, p < 0.001). MSMW had the highest prevalence of concurrent sexual partnerships (91.4%), significantly different from MSWO (61.2%) and MSMO (76.7%; chi-squared, p < 0.001). HIV and syphilis prevalence was significantly higher for MSMO (48.9% and 51.1%) and MSMW (42.7% and 48.8%) than MSWO (12.3% and 20.9%; chi-squared, p < 0.001).

CONCLUSIONS

MSMW exhibited similar sexual risk behavior and high HIV/STI prevalence comparable to MSMO.

The psychosocial burden of anogenital warts on Syrian patients: study of quality of life

Purpose

The prevalence of anogenital warts caused by HPV has been on the rise in the war-torn country of Syria recently. Although physically mildly symptomatic, this disease has a considerable negative psychological effect on patients. This study showed up to reveal information on the quality of life (QoL) of these patients and its connection to age, gender, disease severity, educational level and marital status.

Methods

The study sample consisted of 57 males and 45 females aged between 18 and 64 years old. The patients were recruited from the main university hospital in Latakia, Syria. The assessment was done using two questionnaires: EQ-5D and CECA10.

Results

The data from the EQ-5D revealed no problems in Mobility, Self-care or Usual Activities. Whereas, our study showed extreme levels of anxiety and depression in roughly 50% of the sample. A noticeable impact was seen in 31% of participants describing moderate pain and discomfort. The CECA10 questionnaire revealed an average of disease-specific QoL of 2.48 which indicates a moderate to severe impact. We noticed a statistically significant relationship between the QoL and the patient's age. The age group of 20–29 has suffered the most. Without statistical significance, the psychological burden was at its worst in single patients with severe disease and a high level of education. Females suffered a slightly worse emotional impact compared to males.

Conclusion

This study proved a negative effect of genital warts on patients mainly young educated individuals, females and severe cases.

Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination

Background

Few studies explored Indonesian understanding of cervical cancer (CC) and the human papillomavirus (HPV) vaccination. We aimed to investigate the association between knowledge, attitudes, and practices (KAP) and socio-demographical influences related to HPV, CC, and vaccination among Indonesian urban citizens.

Methods

We conducted an online survey during March 2020-August 2021 using the Snowball sampling technique. The socio-demographic characteristic and KAP responses were collected via Google Forms from 400 respondents in Jakarta. The knowledge and attitudes were divided into HPV and CC (aspect 1) and HPV vaccination (aspect 2). Correlation between KAP scores was performed using Spearman’s test, and multiple logistic regression analyses were conducted to determine KAP predictors.

Results

Indonesian urban citizens in Jakarta were found to have poor knowledge in individual aspects of the inquiry but moderate knowledge overall, good attitude in inquiry both in each aspect and overall, and unsatisfying practices. Overall, in the general population, men, and women respectively: 50.8%, 32.4%, and 53.6% had good knowledge; 82.0%, 75.2%, and 84.4% expressed positive attitude; and 30.3%, 15.2%, and 35.6% applied favorable practice regarding questions inquired. Knowledge was weakly correlated towards attitude (ρ = 0.385) but moderately correlated with practice (ρ = 0.485); attitude was moderately correlated with practice (ρ = 0.577), all results: p<0.001. Significant odds ratio (OR) for predictors to good knowledge were female sex (OR = 2.99), higher education (OR = 2.91), and higher mother’s education (OR = 2.15). Factors related to positive attitudes were higher mother’s education (OR = 4.13), younger age (OR = 1.86), and better results in the knowledge inquiries (OR = 2.96). Factors that suggested better practices were female sex (OR = 2.33), being employed (OR = 1.68), excellent knowledge scores (OR = 4.56), and positive attitudes expressions (OR = 8.05). Having done one vaccination dose and intention to receive vaccines were significantly influenced by good KAP.

Conclusions

KAP had inter-association to successful CC and HPV prevention programs, and socio-demographical characteristics are critical to influencing better KAP.

Perception and knowledge of human papillomavirus (HPV) vaccine for cervical cancer prevention among fully vaccinated female university students in the era of HPV vaccination: a cross-sectional study

OBJECTIVE

To assess the perception and knowledge of cervical cancer prevention among fully vaccinated female university students in the era of human papillomavirus (HPV) vaccination.

DESIGN

Cross-sectional using a validated questionnaire.

SETTING

Face-to-face interview at a public university in Malaysia.

PARTICIPANTS

384 fully vaccinated female students were included in the study.

RESULTS

The total knowledge score in the questionnaire was 18 and was ranked according to score level into three groups: poor (score ≤5), moderate (score 6-10) and good (score ≥11). Mean score for knowledge of cervical cancer prevention was 8.24 (SD ±3.85), with 170 respondents (44.3%) scoring moderate knowledge level. The mean score for knowledge of HPV infection and its association with cervical cancer was 4.56±2.47, while the mean score for knowledge of HPV vaccination for cervical cancer prevention was 3.68 (SD ±1.98). A total of 186 (48.4%) respondents perceived that regular Pap smear was unnecessary after HPV vaccination. Respondents' perceived seriousness and susceptibility of HPV infection correlated well with knowledge of cervical cancer prevention. Two main reasons for their acceptance of HPV vaccine were self-health awareness and free vaccination.

CONCLUSION

The knowledge of HPV vaccination for cervical cancer prevention was average among vaccinated university students. Many of them had poor knowledge about Pap smear and did not consider regular Pap smear as an important cervical cancer screening tool following HPV vaccination. There is still a need for continued health education to improve the perception and knowledge about HPV infection and cervical cancer prevention among young adults in the community.

Have you ever heard of Human Papillomavirus (HPV) vaccine? The awareness of HPV vaccine for college students in China based on meta-analysis

Objective: To evaluate the awareness of College Students (CSs) of HPV vaccine in China and provide evidence-based recommendations for HPV vaccine's publicity and promotion.Methods: Web of Science, PubMed, Science of Direct, EBSCO, China National Knowledge Infrastructure and Wanfang Data were searched. A random effects meta-analysis was conducted to determine pooled estimates of Awareness Rate (AR) for HPV vaccine.Results: Of the 36 studies included, the estimated AR of HPV vaccine was 40.27% (95% CI: 30.86%, 50.06%) among Chinese CSs. The AR of HPV vaccine was stratified by factors as gender, major, area, city, survey time, and sampling method of the study. The pooled AR of HPV vaccine among CSs was as follows: 44.17% (95% CI: 31.65%, 57.09%) and 31.93% (95% CI: 13.25%, 54.30%) for females and males; 44.47% (95% CI: 29.90%, 59.55%) and 12.02% (95% CI: 7.69%, 17.15%) for medical-related and nonmedical majors; 44.47% (95% CI: 28.71-60.82%) and 41.16% (95% CI: 26.48-56.64%) for Eastern and Midwestern region; 48.86% (95% CI: 30.63-67.25%) and 33.19% (95% CI: 22.27-45.12%) for first-tier and second- and third-tier city; 29.67 (95% CI: 11.44-52.16%) and 38.81 (95% CI: 27.14-51.21%) for AR before and after HPV vaccine entered in China; 51.51% (95% CI: 32.21%, 70.53%) and 26.21% (95% CI: 17.41%, 36.10%) for nonrandom and random sampling.Conclusion: This review indicates that awareness of HPV vaccine among CSs remains relatively low in China compared with European countries. Our findings may provide useful information to better understand the HPV vaccine awareness status among Chinese CSs.