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

Perspectives of HPV vaccine decision-making among young adults: A qualitative systematic review and evidence synthesis

BACKGROUND

Despite the demonstrated safety and effectiveness of HPV vaccines in preventing HPV-related cancers, global vaccine coverage remains low. The suboptimal adolescent HPV vaccine coverage rate leaves many young adults at increased risk for developing vaccine preventable HPV-related cancers. This qualitative evidence synthesis (QES) aims to examine the HPV vaccination perspectives of young adults globally and identify the barriers and facilitators to HPV vaccine uptake and decision-making processes.

METHODS

A comprehensive search was conducted on October 2023 across seven databases to identify studies that reported on HPV vaccination among young adults aged 18-26 years and used qualitive study methods or analysis techniques.

RESULTS

Forty-two studies were purposively sampled for inclusion, presenting 29 findings across 10 thematic categories. Vaccine eligible young adults believed that they had aged out of eligibility for HPV vaccination. There was also a perspective that condom use, and regular screenings were alternatives to vaccination in preventing HPV infections. Challenges included scheduling appointments, requirements for multiple shots, and vaccine cost. There was also concern for the gendered nature of vaccine promotion. Lastly, despite being at the age to make autonomous decisions, parents were still influential and active in the vaccine decision-making process for their children.

CONCLUSION

The novelty of this study, as one of the principal QES on catch-up HPV vaccination, presents findings that underscore the complexity of factors across multiple ecological levels which may aid or impede vaccination uptake among young adults and provide important considerations for interventions, programs, and policies aimed at addressing HPV vaccination disparities among young adults.

Gender-neutral vs. gender-specific strategies in school-based HPV vaccination programs: a systematic review and meta-analysis

Introduction

This systematic review and meta-analysis evaluated whether gender-neutral (GN) or gender-specific (GS) strategies more effectively enhanced knowledge, intention, and uptake of HPV vaccination among students in educational settings.

Methods

A comprehensive literature search of PubMed, Scopus, Web of Science, and Cochrane Library identified 17 randomized controlled trials encompassing 22,435 participants (14,665 females, 7,770 males). Random-effects models were used to calculate standardized mean differences (SMDs) for knowledge and intention, and risk differences for vaccination uptake.

Results

GN strategies achieved higher improvements in knowledge (SMD = 0.95) and intention (SMD = 0.59) compared with GS (SMD = 0.68 for knowledge, SMD = 0.14 for intention), and displayed a greater increase in uptake (5.7% versus 2.5% in GS), although this uptake difference was not statistically significant. Heterogeneity was more pronounced for knowledge outcomes and moderate for GS uptake results.

Discussion

Despite GN approaches seemingly offering more robust enhancements in HPV-related knowledge and vaccination intention, additional research with robust designs and longer follow-up is required to determine whether GN interventions definitively outperform GS strategies in achieving statistically significant increases in actual vaccination uptake.

Adolescent Attitudes Toward the Human Papillomavirus (HPV) Vaccine in Kocaeli, Turkiye

Background The adolescent human papillomavirus (HPV) vaccination rate is relatively high in developed countries and it is not widespread in Turkiye. This paper explores what factors influence the decision on the acceptance of the HPV vaccine by adolescents. Methods Data from 206 adolescents was gathered via a survey completed after consent from the parents and themselves between May 2022 and September 2022. The survey content was based on the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS), each question being based on a 5-point Likert scale, together with additional questions to discover demographic factors. The participants were also questioned about their level of knowledge of HPV and its source. At the end of the questionnaire, once the adolescents were briefed on HPV vaccination by a doctor, questions about immunization against HPV were again redirected. Results The age of 206 participants was between 12 and 26 years old, and it was found that the knowledge level about the HPV vaccine increases as the age gets older. The adolescents believe that HPV protects more from cervical cancer than genital warts. 8.7% (n=18) of adolescents thought that the HPV vaccine could have long-term adverse effects. 33.5% (n=69) of them stated that their families could not afford the vaccine. After they were given more knowledge, it was found that they were more willing to have HPV immunization. Conclusions It is important to realize that teenagers' opinions can shift significantly, particularly in the context of informed decision-making and the provision of government financial assistance to parents. The comprehension of teenagers' perspectives and the extent of their knowledge regarding HPV is of paramount importance, given the likelihood of it being influenced by their own acceptance of the vaccine.

Improving United States HPV vaccination rates: Factors predictive of parental attitudes towards middle school entry requirements

Although the human papillomavirus (HPV) vaccine is effective at preventing infection and certain types of cancer, uptake is suboptimal. HPV vaccine requirements for school entry are an underutilized strategy to increase HPV vaccine uptake among adolescents. The purpose of this study was to understand the factors that are predictive of parents' attitudes toward schools requiring the HPV vaccine for entry into middle school. Parents of adolescents ages 11-12 y were recruited to participate in an online survey via Qualtrics. Descriptive frequencies were obtained, and sequential regression analyses were conducted controlling for demographic characteristics. A total of 1,046 participants were included in the analysis. The mean age was 40.3 y (SD = 6.3) and the majority of participants were White (74.4%) and had some college education or higher (80.9%). Participant's gender, political affiliation, urban/rural setting, and education level were significantly associated with attitudes toward school entry requirements. Adding psychosocial items related to perceptions of benefits, risks, and social norms significantly increased the amount of variance explained in the model [(ΔR2 = .312, F(5, 1036) = 132.621)]. Perceived social norms was the strongest predictor of attitudes [β = 0.321]. The results of this study can be used to inform policy changes around school-entry requirements in the United States. Further studies are needed to assess the influence of perceived social norms in vaccine hesitant groups.

HPV Vaccines Among University Students: Understanding Barriers and Facilitators of Vaccine Uptake

Human papillomavirus (HPV) is the most common sexually transmitted infection and plays a significant role in cervical, penile, anal, vaginal, vulvar, and oropharyngeal cancers as well as non-cancerous genital warts and genital dysplasia. In the United States, there are approximately 46,000 new HPV-related cancers a year. There is an effective vaccine to prevent over 90% of these cancers and other HPV-related diseases; however, those that are aged 18-26 have the lowest vaccine rates among eligible age groups. The objective of this study was to examine student knowledge and perceptions about HPV vaccine hesitancy in university students and their notions of barriers and facilitators for HPV vaccine uptake. We aimed to identify components for an evidence-based community-oriented educational intervention to increase HPV vaccination uptake. The researchers recorded 10 focus groups featuring students from a Northeastern United States university, aged 18-26, which were analyzed using grounded theory and inductive thematic analysis to identify recurring themes. The participants mentioned many barriers and facilitators for attaining the HPV vaccine, with health literacy being prominent for both. They demonstrated some knowledge of what HPV is and ways to avoid it. They also expressed a desire for further information and felt that the way in which this information is presented to the public is vital for increasing vaccine uptake and designing future interventions. In order to increase HPV vaccination rates in the general population and overcome barriers such as family, religious, and cultural values, it is important to emphasize the link between HPV and cancer and its preventative benefits.

'We were having a rather long conversation about the uproar': memorable messages about COVID-19 vaccinations in a mostly young, white sample

BACKGROUND

Interpersonal communication motivates many decisions related to COVID-19 prevention practices. Previous research shows that the frequency of interpersonal communication is significant. Less is known, however, about who messages interpersonal communication about COVID-19 and what information those messages convey. We sought to understand better these interpersonal communication messages for individuals who are asked to become vaccinated against COVID-19.

METHODS

Using a memorable messages approach, we interviewed 149 adults, mostly young, white, college students, about their vaccination choices as they were influenced by messages about vaccination they had received from respected members of their interpersonal networks. Date was analyzed using thematic analysis.

RESULTS

Three themes emerged from these interviews of primarily young, white, college students: a dialectic of feeling forced to become vaccinated vs. choice to become vaccinated; a tension between protecting oneself vs. protecting others through vaccination; and, finally, perceptions that family members who were also medical experts were particularly influential.

CONCLUSIONS

The dialectic between feelings of choice versus force may require further study into the longer-term impacts of messages that may prompt feelings of reactance and produce undesired outcomes. The dialectic between messages being remembered for their altruism as compared to their selfishness opens opportunities to consider the relative influence of these two impulses. These findings also provide insight into broader topics about countering vaccine hesitancy for other diseases. These findings may not be generalizable to older, more diverse populations.

From Diagnosis to Treatment: Exploring the Latest Management Trends in Cervical Intraepithelial Neoplasia

Cervical intraepithelial neoplasia (CIN) stands as a precancerous condition with the potential to progress to invasive cervical cancer. This comprehensive review explores the intricacies of CIN management, beginning with its definition, classification, and etiology. It emphasizes the significance of early detection and outlines the latest trends in diagnosis, including Pap smears, human papillomavirus (HPV) testing, and colposcopy. Grading and staging, pivotal in treatment selection, are elucidated. Current management approaches, encompassing watchful waiting, surgical interventions, emerging minimally invasive techniques, and immunotherapy, are detailed. The factors influencing treatment decisions, informed consent, and patient education are discussed. Potential complications following treatment, the importance of long-term follow-up, and the role of HPV vaccination in prevention are underscored. Finally, the review looks to the future, discussing advances in detection, novel treatments, and the promise of precision medicine. In conclusion, early detection and management remain the cornerstone of CIN care, offering hope for a future where cervical cancer is a preventable and treatable condition.

Association between Religious Beliefs and HPV Vaccination Attitudes among College Students

OBJECTIVE AND PARTICIPANTS

The authors sought an updated examination of attitudes toward Human Papillomavirus (HPV) catch-up vaccination among college students at a private religious university.

METHODS

A total of 1557 college students completed a 62-question survey of religious and HPV vaccination attitudes during the fall of 2021. Students' willingness to receive catch-up HPV vaccination and willingness to vaccinate a future child against HPV were recorded.

RESULTS

Of the 46.8% of students who reported being unvaccinated or unaware of vaccination status, ~26% reported being uninterested in receiving catch-up HPV vaccination; ~22% of all students surveyed reported being unwilling to vaccinate a future child against HPV. The strongest predictors of vaccine hesitancy included religious concerns about sexual abstinence and safety concerns.

CONCLUSIONS

College health professionals can increase the rate of HPV vaccination among college students and subsequent future generations by addressing the safety and utility of the vaccine regardless of intentions for sexual abstinence prior to marriage. Additionally, rather than a uniform approach to all students who self-identify as Christian, an effort to identify and discuss the unique religiously influenced beliefs of individual students is recommended when discussing HPV vaccination.

Strategies to improve human papillomavirus (HPV) vaccination rates among college students

Improve (HPV) vaccination rates in a college-aged population using a strategic toolkit for student health services.

Eighteen to twenty-six year-olds enrolled at Johns Hopkins University who utilized the Student Health & Wellness Center (JHU SHWC) during the study period.

The toolkit comprised of a) continuing medical education (CME) presentation on strategies to improve HPV vaccination, b) campus-wide visual messaging regarding HPV prevalence, genital warts, cancer, and vaccine availability, and c) an electronic medical record (EMR) form prompting discussion about the HPV vaccine during visits.

HPV vaccination rates at JHU SHWC improved from historical baseline 290/2,372 students/year (12.2%) to 515/2,479 students/year (20.8%), [risk ratio (RR) 1.70 (95% CI, 1.47-1.96), p < 0.001]. Additional changes included significant increases in vaccination rate per visit and vaccination rate by gender, especially among male students.

Methods and resources from this toolkit could be successfully adapted and deployed by college health centers.

Oral Human Papillomavirus Benign Lesions and HPV-Related Cancer in Healthy Children: A Systematic Review

The present systematic review aimed to assess the prevalence of oral HPV-related lesions, categorized as benign (verruca vulgaris "VV", squamous cell papilloma "SP", condyloma acuminata "CA", and focal epithelial hyperplasia "FEH") and malignant (oral squamous cell carcinoma "OSCC"), in descending order of occurrence in pediatric subjects (≤18 years of age). The secondary objectives were to evaluate the frequency and types of oral lesions described in relation to HPV genotypes and the HPV vaccine type (if any). The study protocol, compliant with the PRISMA statement, was registered at PROSPERO (CRD42022352268). Data from 60 studies, of which quality was assessed using the ROBINS-I tool, were independently extracted and synthesized. Along with seven poorly described benign HPV-related oral lesions that could not be categorized, a total of 146 HPV-related oral lesions, namely 47.26% (n = 69) VV, SP, and CA, 51.37% (n = 75) FEH, and 1.37% (n = 2) OSSC, were diagnosed in 153 pediatric subjects (M:F ratio = 1:1.4) with a mean age of lesion onset of 8.46 years. The viral genotypes detected were HPV-13 (30.61%), -6 (20.41%), -11 (16.33%), HPV-2 (12.24%), -32 (10.20%), -57 (6.12%), and -16 (4.08%). No HPV vaccination was reported in any case. Further studies should be conducted to evaluate the prevalence of HPV-related benign and malignant lesions and the potential role of HPV and associated vaccination in oral carcinogenesis in pediatric subjects.

Knowledge of human papillomavirus vaccination: A multi-institution, cross-sectional study of allopathic and osteopathic medical students

Human papillomavirus (HPV) vaccination is a well-established and successful tool for preventing HPV-related cancers. However, vaccine uptake remains low, influenced by patient hesitancy around safety concerns and little opportunity to discuss the vaccine with trusted healthcare providers. We conducted a national, cross-sectional study of allopathic and osteopathic medical students regarding knowledge of HPV vaccination guidelines March-April 2021. Analysis sought to identify gaps in knowledge as well as demographic and academic correlates of knowledge. A total of 718 students participated (response rate = 50.8%). While 92.8% of participants identified the connection between HPV and cervical cancer, lower percentages associated HPV with vaginal/vulvar (67.7%), anal (63.3%), and penile (53.9%) cancers. Low percentages of participants correctly identified age of HPV vaccine eligibility (33.3%) and how many doses are needed for full protection (48.1%). This study identifies specific knowledge gaps in medical students' training on HPV-related cancers and HPV vaccination guidelines. Through addressing these gaps, we may improve HPV vaccine uptake and decrease the incidence of HPV-related cancers.

Perception and Coverage of Conventional Vaccination among University Students from Rouen (Normandy), France in 2021

The aim of this study was to assess vaccination perception and the prevalence of the overall vaccination coverage (VC) and associated factors among university students. An online study was conducted among students of a university in Rouen (Normandy), France, in January 2021, with questions about the VC and perception of the vaccines. The convenience sample included 3089 students (response rate of 10.3%), with a mean age of 20.3 (SD = 1.9). The overall VC was 27.8% (39.2% for the healthcare students (HCS) and 21.3% for the non-HCS; p < 0.0001). Confidence (efficacy and security) was lower than the conviction of usefulness. The characteristics associated with VC were having the intention to be vaccinated against COVID-19, high perceptions of usefulness for their own health, having confidence in the vaccines’ efficacy and security, and a high estimated level of knowledge about vaccination. Education about the general interest and mechanism of action of vaccines could improve the perception of vaccines. Then, it is relevant to improve vaccination literacy and confidence in university students, who, as future adults and parents, will vaccinate themselves and their children; as well as healthcare students who are future healthcare workers and, therefore, will vaccinate and counsel their patients.