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Mussetto I, Bernucci MC, Kaminska AE, Isonne C, Sciurti A, Migliara G, Renzi E, Massimi A, Marzuillo C, De Vito C, Villari P, Baccolini V. Prevalence and determinants of vaccination intention towards routine immunizations in university students: a systematic review and meta-analysis. BMC Public Health 2025; 25:1443. [PMID: 40247258 PMCID: PMC12004673 DOI: 10.1186/s12889-025-22697-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 04/08/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND It is well known that, to be effective, vaccination programs require a high and consistent population uptake. Nevertheless, vaccine coverage is often insufficient. University students occupy a unique position within the broader population: they are highly mobile and socially active individuals who serve as influential figures among their peers and younger age groups, making them an ideal target for educational campaigns. METHODS This review (CRD42022309724) quantified the vaccination intention rates for routine immunizations in university students and systematically examined the determinants of vaccination acceptance. Cross-sectional studies that analyzed vaccination intention for at least one routine immunization using multivariable logistic regression were included. We used random-effects models to calculate the pooled proportions of vaccination intention. Determinants were categorized into contextual factors (such as socio-demographic, economic and cultural factors), individual/group factors (such as knowledge, awareness, peer opinions, infection risk perceptions) and vaccine-specific issues (such as vaccine effectiveness and vaccination policies). RESULTS Thirty-six articles were included: 29 on the human papilloma virus (HPV) vaccine and seven on the influenza vaccine. The pooled proportion of students intending to get vaccinated was 54% (95% CI: 47-60%) for HPV and 43% (95% CI: 26-61%) for influenza. The strongest positive determinants were individual/group factors, such as higher knowledge and awareness, pro-vaccine peer opinions, positive personal experience with vaccinations, and higher risk perception for HPV infection, and higher risk perception for infection and previous vaccination history for influenza. By contrast, contextual influences played a minor role in both vaccinations, while vaccine-specific concerns, particularly about costs and availability, negatively influenced intention for both vaccines. CONCLUSIONS Given the suboptimal rates of vaccination intention towards HPV and influenza vaccine that we found, addressing key determinants, such as awareness of infection risks and perception of vaccination benefits, is essential to increase vaccination acceptance in university students and to achieve high vaccination coverage.
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Affiliation(s)
- Ilaria Mussetto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Bernucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Anna Ewa Kaminska
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Sciurti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Migliara
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy
| | - Erika Renzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
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Tosoni A, Galvani L, Di Nunno V, Gatto L, Bartolini S, Aprile M, D’Angelo E, Pasquini E, Baietti AM, Franceschi E. Awareness of the Link Between Human Papilloma Virus Infection and Head and Neck Cancer Among the General Population and Practitioners: A Literature Review. Cancers (Basel) 2024; 16:3556. [PMID: 39517997 PMCID: PMC11545190 DOI: 10.3390/cancers16213556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 10/14/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Human papilloma virus (HPV) infection is responsible for 4.5% of cancers worldwide, i.e., for around 630,000 new cases per year. Around 38,000 cases per year of HPV-related cancers arise in the head and neck region, of which 21,000 cases are oropharyngeal squamous cell carcinomas (OPSCCs), with an increasing frequency in high-income countries. In our work, we aimed to collect the available evidence about the awareness of the relation between HPV infection and head and neck cancer among patients and practitioners. Methods: This review was based on all available prospective and retrospective studies, case reports, and review articles published up to May 2024 in PubMed. The search keywords used included "human papilloma virus" plus "head and neck cancer", "awareness", "infection", "vaccination", "awareness in patients and practitioners", "oropharyngeal squamous cell carcinoma", "HPV16-18", "HPV awareness", "cervical cancer". Results: In the U.S.A., with more than 150.00 participants interviewed through different studies, the identification of HPV infection as a risk factor for head and neck cancer (HNC) was made by only 12-39% of the participants. Similar conclusions were drawn from European studies in which only 10-52% of the participants recognized HPV as a risk factor for HNC. HPV-related HNC awareness in health care providers and medical/dental students showed a high variability among studies, being otolaryngology and dental sciences specialists the most conscious in comparison to general practitioners, who demonstrated a low level of awareness. Conclusions: There is a dangerous lack of awareness about HPV infection and its potential role in HNC among both general populations and health care practitioners. A great effort should be made to increase awareness in both practitioners and the general population on this topic, also aiming to increase the HPV vaccination coverage.
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Affiliation(s)
- Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (V.D.N.); (L.G.); (S.B.); (E.F.)
| | - Linda Galvani
- Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (L.G.); (M.A.)
| | - Vincenzo Di Nunno
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (V.D.N.); (L.G.); (S.B.); (E.F.)
| | - Lidia Gatto
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (V.D.N.); (L.G.); (S.B.); (E.F.)
| | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (V.D.N.); (L.G.); (S.B.); (E.F.)
| | - Marta Aprile
- Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (L.G.); (M.A.)
| | - Elisa D’Angelo
- Radiation Oncology Department, Bellaria Hospital, AUSL Bologna, 40139 Bologna, Italy;
| | - Ernesto Pasquini
- ENT Unit, Bellaria Hospital, AUSL Bologna, 40139 Bologna, Italy;
| | - Anna Maria Baietti
- Facial Surgery and Dentistry Network—Trauma and Severe Disabilities Path Department, AUSL Bologna, 40139 Bologna, Italy;
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (V.D.N.); (L.G.); (S.B.); (E.F.)
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Dai Y, Li Y, Zhou D, Zhang J. Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey. AIDS Res Ther 2024; 21:46. [PMID: 39061023 PMCID: PMC11282637 DOI: 10.1186/s12981-024-00636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. METHODS The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. RESULTS The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84-11.93; age20-21, AOR = 3.26, 95%CI: 2.04-5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69-3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33-2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03-1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44-0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16-0.43) and confident (AOR = 0.48, 95%CI: 0.34-0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82-4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07-2.20), respectively. CONCLUSION Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.
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Affiliation(s)
- Yingxue Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yajie Li
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, China
| | - Dinglun Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jianxin Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Flood T, Hughes CM, Wilson I, McLaughlin M. Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003100. [PMID: 38630731 PMCID: PMC11023437 DOI: 10.1371/journal.pgph.0003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Ciara M. Hughes
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Marian McLaughlin
- School of Psychology, Ulster University, Londonderry, Derry, United Kingdom
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Terada M, Shimazu T, Saito J, Odawara M, Otsuki A, Yaguchi-Saito A, Miyawaki R, Kuchiba A, Ishikawa H, Fujimori M, Kreps GL. Age, gender and socioeconomic disparities in human papillomavirus (HPV) awareness and knowledge among Japanese adults after a 7-year suspension of proactive recommendation for the HPV vaccine: A nationally representative cross-sectional survey. Vaccine 2023; 41:7147-7158. [PMID: 37866996 DOI: 10.1016/j.vaccine.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
The Japanese government's 2013 suspension of its proactive recommendation for Human papillomavirus (HPV) vaccination resulted in low HPV vaccination coverage and was unique. However, data on awareness and knowledge of HPV vaccines in the general population was limited. Here, to investigate more recent awareness and knowledge of HPV vaccines by age, gender, and socioeconomic status, we used data from the INFORM Study 2020, a nationally representative cross-sectional survey of self-administered questionnaires with 1,998 Japanese individuals aged 20 to 59 years. We found that 47.5% of females and 21.0% of males had heard of HPV, and 33.6% of females and 16.8% of males had knowledge of HPV vaccine efficacy. After adjusting for potential confounders, females aged 50-54 years were more likely to be aware of HPV than females aged 20-24 (AOR, 2.02, 95%CI: 1.12-3.65). Females (AOR, 2.13, 95%CI: 1.48-3.07) and males (AOR, 1.64, 95%CI: 1.03-2.59) with higher education had more awareness than those with less education. Females with higher education had more knowledge about HPV vaccine efficacy than those with less education (AOR, 1.70; 95%CI: 1.16-2.50). We found a generally low level of awareness and knowledge about HPV vaccines in Japan, which might be attributable to the suspension of proactive recommendations. Additionally, we identified disparities in awareness and knowledge by age, gender, socioeconomic status, and health literacy. Enhancing HPV awareness and understanding of HPV vaccines and implementing targeted efforts for specific subpopulations within Japan after the resumption of proactive recommendation for HPV vaccines, are imperative.
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Affiliation(s)
- Marina Terada
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan; Faculty of Human Sciences, Tokiwa University, Ibaraki, Japan
| | - Rina Miyawaki
- School of Arts and Letters, Meiji University, Tokyo, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Institution for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan; Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Hirono Ishikawa
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Gary L Kreps
- Center for Health and Risk Communication, George Mason University, Fairfax, VA, USA
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Barrett D, Dubal R, L Morgan C. The UK public and healthcare professionals' awareness of mouth cancer. Br Dent J 2023; 235:811-815. [PMID: 38001210 DOI: 10.1038/s41415-023-6490-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 11/26/2023]
Abstract
As the rate of new mouth cancer diagnoses continues to increase in the UK, awareness of risk factors and signs and symptoms remains low. This paper focuses on studies showing UK public awareness of risk factors, including alcohol, tobacco and human papillomavirus, as well as public understanding of signs and symptoms of mouth cancer. It includes a review of the effectiveness of campaigns in raising awareness of mouth cancer and examples of campaigns targeting other common cancers or risk factors that may provide useful learning ahead of upcoming mouth cancer campaigns. In addition, the awareness of the wider healthcare team and the importance of their role in identifying mouth cancer is explored. Current live campaigns in the UK are highlighted ahead of future initiatives now that the Mouth Cancer Action Charter has been launched and two new coalitions have been established.
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Affiliation(s)
- Danielle Barrett
- Dental Core Trainee, Barts Health NHS Trust, The Royal London Dental Hospital, Turner Street, London, E1 1FR, United Kingdom.
| | - Raj Dubal
- Consultant in Restorative Dentistry, Dental Core Training Lead for Restorative Dentistry, Barts Health NHS Trust, Royal London Dental Hospital, Turner Street, London, E1 1FR, United Kingdom
| | - Claire L Morgan
- Consultant in Restorative Dentistry, Barts Health Trust, Royal London Hospital, Turner Street, London, E1 1FR, United Kingdom
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Paduano G, Vaienna S, Maisto G, Di Giuseppe G, Pavia M. Investigating women's awareness and perceptions on human papillomavirus infection and oropharyngeal cancer in Italy. Front Public Health 2023; 11:1195588. [PMID: 37701909 PMCID: PMC10493318 DOI: 10.3389/fpubh.2023.1195588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction This study explored knowledge, attitudes and behaviors toward human papillomavirus (HPV) infection and oropharyngeal cancer (OPC) among women attending primary care services. Methods The cross-sectional study was conducted from September to December 2022 in adult women attending three primary care services in Italy, who were invited to complete a self-administered questionnaire. Results Overall, 34.7% of participants know that OPC is HPV-associated; knowledge was higher among women who had personal, familiar or friends' experience of cancer, and who reported to often seek dental care, whereas it was lower in older women. The perception of risk of developing OPC was high for 26.4% of women and was higher in those who had experienced STD, who knew that early sexual debut is a risk factor for OPC, and who considered useful the role of dentists on the provision of information about OPC. Only 22.5% had received HPV vaccination, but 62% intended to receive it in the future. Moreover, 63.2% believe that HPV vaccination is very useful to prevent OPC and only 27% are concerned about health consequences of HPV vaccination. Conclusion These findings indicate that women's awareness of the role of HPV infection in the development of OPC is not satisfactory and underline the role that dentists might have in improving their patients' awareness on HPV related OPC.
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Affiliation(s)
| | | | | | | | - Maria Pavia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Oral cancer detection model in distributed cloud environment via optimized ensemble technique. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grandahl M, Nevéus T. Barriers towards HPV Vaccinations for Boys and Young Men: A Narrative Review. Viruses 2021; 13:v13081644. [PMID: 34452508 PMCID: PMC8402923 DOI: 10.3390/v13081644] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. Results: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. Conclusions: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.
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