Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model

Graduate and Health Professional Student Knowledge, Attitudes, Beliefs, and Behavior Related to Human Papillomavirus and Human Papillomavirus Vaccination: A Scoping Review of the Literature

Human papillomavirus (HPV) is a common sexually transmitted infection. Despite a safe and effective vaccine, uptake continues to be suboptimal. Recently, focus has moved to college campuses in an effort to increase vaccination rates. Little is known about the extent of efforts to reach graduate students on college campuses in the United States and the vaccination rates within this subpopulation. This scoping review assessed the literature on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination among graduate and post-baccalaureate professional students in the United States. This review also aims to identify areas for further research to improve institutions' abilities to create health programming to increase HPV awareness and HPV vaccination coverage on their campuses. Publications focusing on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination in post-baccalaureate students were included. The systematic review of PubMed, CINAHL, and Embase identified 2562 articles, and 56 articles met all inclusion criteria and were included in this scoping review. A majority of the reviewed studies investigated some combination of knowledge, attitudes, behaviors, and beliefs about HPV and the HPV vaccine in students in professional programs such as medicine. Study design approaches were primarily cross-sectional, utilizing web-based survey distribution methods. HPV vaccination status and HPV screening behaviors were primarily measured through participant self-report. There is limited research investigating post-baccalaureate student knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination. There is a need for researchers to further investigate the needs of graduate students to create informative and effective HPV programming.

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.

HPV education and vaccination uptake in college students: A DNP project

INTRODUCTION

The purpose of this DNP project was to establish baseline human papillomavirus (HPV) vaccination rates, improve baseline knowledge of HPV and HPV vaccines, reduce barriers to HPV vaccination, and increase intention of HPV vaccine uptake among college students.

METHODS

A precaution adoption process model-based survey, in-person education session, and posteducation survey were administered to college students in a Midwestern university to measure perceptions of HPV and HPV vaccination as well as to identify barriers to HPV vaccination.

RESULTS

From the preeducation survey to the posteducation survey, correct answers to questions increased, and barriers and misconceptions about HPV and the HPV vaccine decreased, indicating successful education. HPV vaccination intent, defined as indication of "likely" or "very likely" to receive the vaccine on the surveys, rose from 28.0% to 90.7% among participating college students.

CONCLUSION

This study showed that implementing engaging, in-person HPV prevention education is an effective method for decreasing barriers related to vaccination and increasing vaccination intention.

Human papillomavirus vaccination: a quantitative cross-sectional study of perceived barriers, influential advisors, and acculturation among Chinese college students aged 18-26 in the USA

HPV vaccines are highly effective in preventing HPV-associated cancers; however, HPV vaccination uptake is low among Chinese students studying at U.S. colleges. The purposes of this study were to evaluate (a) perceived barriers and influential others trusted for advice regarding HPV vaccination and (b) factors (i.e. HPV vaccination, acculturation) related to barriers and influential advisors among 18- to 26-year-old Chinese students attending U.S. colleges. We used a cross-sectional design to obtain self-reported data in 2019 from a chain-referral sample of 213 Chinese students. Among 125 respondents who were unvaccinated or partially vaccinated, the reported barriers to receiving the HPV vaccine included: (a) lack of recommendations from a healthcare provider, (b) lack of risk perception for HPV infection, and (c) limited knowledge about HPV vaccination locations. The influential advisors for receiving HPV vaccination were doctors, parents, self, nurses, and same-sex friends. Multivariate analysis revealed that unvaccinated respondents were more likely to report the following barriers to HPV vaccination: (a) lack of recommendations from a healthcare provider, (b) lack of risk perception for HPV infection, (c) limited knowledge about vaccination locations, and (d) uncertainty about effectiveness. High Asian identified respondents were more likely to perceive barriers related to limited knowledge about vaccination locations and uncertainty about effectiveness, while they were less likely to state nurses as influential advisors. Individuals who received one or more HPV vaccine doses were more inclined to view same-sex friends and nurses as influential advisors for HPV vaccination. The influence of culture on preferences for information sources, such as specific providers and provider gender, needs to be addressed. Programs designed to decrease barriers and improve HPV vaccination among Chinese students should also focus on acculturation status.

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.

Identification of organizational barriers to HPV vaccination uptake in medical students in southern Italy: a cross-sectional study

Introduction

Despite proven efficacy, HPV vaccination coverage is still suboptimal. Factors influencing vaccination uptake are education attainment, socio-economic position, and knowledge about HPV. This study aimed to assess HPV vaccination uptake and its correlates among medical students and identify logistic-organizational barriers, knowledge, and attitudes with regard towards HPV vaccination to improve current public health vaccination strategies. Medical students, with their acquired biological knowledge, were selected as a low-risk groups for HPV vaccination uptake. This cross-sectional study was conducted using a validated questionnaire.

Methods

Students in their the first 3 years of study students were preferentially invited. Eventually, the invitation was extended to every medical student. Logistic multivariable regression was used to assess determinants of HPV vaccination uptake. Additional analysis explored determinants of knowledge of and attitude toward HPV vaccination. Finally, a sensitive analysis was conducted to further assess the effect of knowledge and attitude on the HPV vaccination rate.

Results

A total of 882 medical students participated, with 74.5% enrolled in the first 3 years of their training. HPV vaccination uptake was 55.5%, ranging from 78.5% for females to 16.5% for males. Male sex and increasing age were consistently associated with a lower vaccination uptake (males sex: OR 0.03, CI 0.02-0.05; age: OR 0.77, CI 0.68-0.88), whereasilst progress in their academic career was associated with a to higher likelihood of being vaccinated (6th year: OR 3.45, CI 1.24-9.57). These associations were confirmed when considering the knowledge of and attitude towards HPV. Additionally also, an active outreach from healthcare institutions was associated with a higher likelihood of receiving HPV vaccination (OR 1.70, CI 1.09-2.65.

Conclusion

HPV vaccination in medical students was higher than in the general population; however, it was still suboptimal. An active and up-to-date call strategy and extending the free-of-charge offer are essential measures for to improvinge vaccination uptake. The findings support the need to improve public health strategies and increase awareness and knowledge ofregarding HPV vaccination.

Human papillomavirus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte city, Western Ethiopia, 2020

BACKGROUND

Cervical cancer is the leading cause of cancer death in adult women in the developing world including Ethiopia. To combat cervical cancer, the World Health Organization (WHO) recommends that girls aged 9-14 years have to take the human papillomavirus vaccine. However, there is a lack of information regarding the uptake of human papillomavirus vaccine in the study area. Therefore, this study aimed to assess the Human Papilloma Virus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte City, Western Ethiopia, 2020.

METHODS

A cross-sectional study design was employed among adolescent girls attending grade 9 and age 15 enrolled at schools in Nekemte City from July 15-30, 2020. Six hundred twenty-six (626) randomly selected adolescent girls were interviewed. The data were entered into Epi Info 7 and analyzed by SPSS 25. Multivariable analysis was computed and a P-value < 0.05 was taken as a cut-off point to declare the statistically significant association.

RESULT

The uptake of the HPV vaccine was 61.2%, 95%CI (57.2%, 65%). The Place where adolescents grow up (AOR = 3.46, 95%CI [1.95,6.15]), having a mobile phone(AOR = 1.71, 95%CI [1.05, 2.79]), ever heard about HPV (AOR = 5.69, 95%CI [1.33, 24.27]), ever heard about HPV vaccine(AOR = 1.917, 95%CI [1.002, 3.667]), Ever had sexual intercourse (AOR = 3.04, 95% [1.49,6.20]) and Perceived risk of towards HPV(AOR = 4.63 [2.49, 8.63]) has shown statistically significant association with Uptake of the HPV vaccine.

CONCLUSION

Nearly two-thirds of the study participants had taken at least one dose of the HPV vaccine. It is better if health information on HPV is disseminated considering the available technology like mobile phones and reaching rural girls.

Determinant Factors of Voluntary or Mandatory Vaccination against COVID-19: A Survey Study among Students at Albanian University

INTRODUCTION

The world faced serious health and socioeconomic issues with the advent of COVID-19. Along with handwashing, social distancing, and the wearing of masks, vaccination was considered by medical authorities as a key way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations is the mandatory policy. The purpose of this study was to compare the determinants of voluntary and mandatory vaccination among students at Albanian University.

METHODOLOGY

This cross-sectional study, conducted by means of an online survey, was conducted among students enrolled at the private Albanian University, Tirana, Albania during the last week of the winter semester, 7-14 February 2022.

RESULTS

In sum, 878 students participated in this study, among whom 612 (69.7%) were females and 266 (30%) were males. Of the participants, 506 (57%) were enrolled in medical science (MS) and 372 (42.3%) were in the non-medical science (Non-MS) group. A total of 773 (88%) were vaccinated against COVID-19, and 105 (11.8%) were not vaccinated. A total of 466 (53%) reported voluntary vaccination, and 412 (46.9%) reported mandatory vaccination. Among the students who were vaccinated voluntarily, 266 (57%) were from the MS group and 200 (42.9%) were from the Non-MS group. A total of 237 (57.5%) of students in the mandatory vaccination group were from the MS group, and 175 (42.4%) were from the Non-MS group.

CONCLUSIONS

Vaccine safety and efficacy were hindering factors in vaccination. Additionally, based on the results of this study, the students felt encouraged by the academic staff to vaccinate. This clearly demonstrates that the staff does not lack the skills to enhance students' knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence students' attitudes as much as possible toward vaccination, comprehensive educational programs, including modifications of existing curricula, should be considered.

Factors Associated with College Students' Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study

Human papillomavirus (HPV) vaccination protects against six types of cancer-cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18-26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students' perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population.

The Effect of University Students' Levels of Knowledge about HPV Infection and the HPV Vaccine on Their Health Beliefs: Health Sciences Students

The aim of this study was to determine health sciences students' levels of knowledge about HPV infection and the vaccine and their health beliefs, to compare them in terms of individual characteristics, and to examine the relationship between their knowledge of the HPV infection/vaccine and their health beliefs. The data of the study were collected from Health Sciences Faculty students through a face-to-face setting (n: 824). The data tools used in the study were the identification form, the health belief model scale for human papillomavirus infection and vaccination, and the human papillomavirus knowledge scale. The results showed that (1) although the students' levels of knowledge about HPV infection and the vaccine were low, (2) they did perceive HPV infection to be a severe problem. According to the multilinear regression analysis performed, the main predictor of the perceived severity (β = 0.29; 95% Cl: 0.04, 0.07), obstacle (β = 0.21; 95% Cl: 0.01, 0.04), and sensitivity (β = 0.22; 95% Cl: 0.02, 0.06) subscales of the HBMS-HPVV was general HPV knowledge. It was also determined that as the students' knowledge about HPV increased, their health belief levels regarding HPV infection and the vaccine increased as well (n: 824). In conclusion, for nurses and other healthcare professionals to be effective in informing individuals, they should have knowledge of HPV infection and the vaccine. In this context, the necessary education and advice about the importance of HPV infection and the vaccine should be provided to students receiving education in the field of healthcare.

Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey

BACKGROUND

For a HPV vaccination program to be successful, it is important that the target population has sufficient knowledge about HPV and HPV vaccines. The aim of this study was to evaluate HPV-related knowledge levels among students at a university in northern Turkey, to assess vaccination willingness, and to determine factors associated with HPV-related knowledge.

METHODS

This cross-sectional study was conducted on 824 (93.1%) students studying at 16 different faculties. The study population was identified through the proportional stratified sampling method. Data were collected through a questionnaire including socio-demographic characteristics and the HPV Knowledge Scale. Multiple linear regression analysis was performed to identify factors that may be associated with knowledge scores.

RESULTS

43.6% of the students had never heard of HPV, 50.6% of them had never heard of HPV screening tests or HPV vaccination. Only 2.7% of the students were vaccinated against HPV and 15.7% were willing to receive HPV vaccination. Awareness of HPV and willingness to receive vaccination were found to be higher among women, while previous experience with sexual intercourse was higher in men (p < 0.05). The mean HPV knowledge score was quite low (6.74 ± 7.13 out of 29 points). The studying in a field related to health sciences, being a senior student, intending to be vaccinated, being a woman, having had sex were found to be associated with high knowledge levels (p < 0.05).

CONCLUSIONS

Educational programmes should be developed to increase university students' knowledge about HPV and the HPV vaccine.

HPV Vaccination among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion

BACKGROUND

The purpose of this study was to examine factors related to HPV vaccination initiation and completion, especially the role of health knowledge, among college students in a southern state.

METHODS

College students ages 17-45 (n=1,708) were analyzed in this study. Primary outcomes were HPV vaccine series initiation and completion; binary logistic regressions were performed to identify associated factors.

RESULTS

Among total participants, students who were aware that HPV could be transmitted even without symptoms were less likely to initiate HPV vaccination. However, among students who have initiated the vaccine series, those who were aware that HPV could be transmitted without symptoms and that men should receive the HPV vaccine were more likely to complete the vaccine series. Other significant variables included age, gender, race, and international student status.

CONCLUSION

Future studies are needed to investigate students' concerns regarding initiating HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series.

Human Papillomavirus Knowledge, Perception, and Willingness to Receive Vaccination Among Female University Students in Addis Ababa University, Ethiopia, 2022: A Cross-Sectional Study

Background

Cervical cancer is considered a leading cause of morbidity and mortality among females worldwide. Human papillomavirus is a highly prevalent sexually transmitted infection associated with increased cancer risks. Effective human papillomavirus vaccines are recommended for females in the adolescent years, but uptake has been less than optimal.

Objective

The objective of the study is to assess human papillomavirus knowledge, perception, and willingness to receive vaccination among female students in Addis Ababa University, Addis Ababa, Ethiopia, in 2022.

Methods

Institutional-based cross-sectional study was applied. The data were collected from 7 February to 15 April 2022. A total of 398 female students were recruited, and a multistage sampling technique was used to select the study participants. The data were entered into EpiData version 4.6 and analyzed using SPSS version 25. Bivariate and multivariable logistic regression analyses were used to determine the associations of variables.

Results

In this study, 161 (41%) of the students had good knowledge. About 226 (57.5%) had a more favorable perception regarding human papillomavirus and its vaccine, and 30% of the respondents were willing to receive the vaccine. The year level of study, having a history of sexual intercourse, having a family history of vaccination, and perception toward human papillomavirus and its vaccine were factors associated with students' willingness to receive the human papillomavirus vaccine.

Conclusion

Educational programs are required to aware female students in Ethiopia considering their poor knowledge of human papillomavirus and its vaccine and the willingness of the students to receive the vaccine and related diseases. The inclusion of the HPV vaccine in the national immunization program that is in line with the World Health Organization's recommendation should be considered as 118 (30%) of the participants show willingness to be vaccinated worldwide.

HPV Knowledge, Vaccine Status, and Health Literacy Among University Students

The aim of this study was to assess university students' knowledge and understanding about HPV and its association with their vaccination status and health literacy. A sample of 383 undergraduate university students between the ages of 18 and 26 were recruited between February 14 and March 22, 2018. An electronic survey was administered to assess knowledge and HPV awareness, vaccination status, and health literacy. Participants had moderate mean knowledge scores of 6.02 of a possible 11 (SD = 3.06). There was a positive association between health literacy and HPV knowledge and a statistically significant difference in knowledge scores between those who are vaccinated and unvaccinated p < 0.001. This study expanded available research on HPV vaccine and its uptake among university students and can be used to develop educational interventions. Continuous examination of HPV knowledge gaps and identifying factors that affect vaccine uptake is pivotal to increasing vaccination rates.

Medical students' knowledge of HPV, HPV vaccine, and HPV-associated head and neck cancer

On the basis of their training, medical students are considered "the best case scenario" among university students in knowledge of the human papillomavirus (HPV). We evaluated differences in knowledge of HPV, HPV vaccine, and head and neck cancer (HNC) among medical students. A previously validated questionnaire was completed by 247 medical students at a Midwestern university. Outcomes of interest were knowledge score for HPV and HPV vaccine, and HNC, derived from combining questionnaire items to form HPV knowledge and HNC scores, and analyzed using multivariate linear regression. Mean scores for HPV knowledge were 19.4 out of 26, and 7.2 out of 12 for HNC knowledge. In the final multivariate linear regression model, sex, race, and year of study were independently associated with HPV and HPV vaccine knowledge. Males had significantly lower HPV vaccine knowledge than females (β = -1.53; 95% CI: -2.53, -0.52), as did nonwhite students (β = -1.05; 95% CI: -2.07, -0.03). There was a gradient in HPV vaccine knowledge based on the year of study, highest among fourth year students (β = 6.75; 95% CI: 5.17, 8.33). Results were similar for factors associated with HNC knowledge, except for sex. HNC knowledge similarly increased based on year of study, highest for fourth year students (β = 2.50; 95% CI: 1.72, 3.29). Among medical students, gaps remain in knowledge of HPV, HPV vaccine, and HPV-linked HNC. Male medical students have significantly lower knowledge of HPV. This highlights the need to increase medical student knowledge of HPV and HPV-linked HNC.

Human papillomavirus (HPV) knowledge, beliefs, and vaccine uptake among United States and international college students

Objective: The purpose of this study was to compare knowledge about human papillomavirus (HPV) and HPV vaccine, college student's beliefs toward HPV, and HPV vaccine uptake between US and international college students studying in the US. Participants: The study was conducted using a sample (N = 588) of college students from a university in the South Central US. Methods: Study measures was derived from previously validated measures. Data were collected via an online survey using Qualtrics. Results: Significant differences were found in HPV awareness, HPV vaccine awareness, and HPV vaccine uptake between US and international college students. Conclusion: This study showed existing disparities between US and international college students regarding HPV and HPV vaccine awareness, and HPV vaccine uptake. College health centers can play a crucial role in raising awareness of HPV and HPV vaccination rates by organizing various intervention programs to reduce these disparities.

Knowledge, Attitudes, and Behaviors of Medical School Students about Human Papilloma Virus (HPV) And HPV Vaccine

Objective The objective of study was to measure the knowledge, attitudes and behaviors about Human Papilloma Virus (HPV) and HPV vaccine and to detect the HPV vaccination status of medical school students. Material and Methods This descriptive cross-sectional study was conducted on students in a medical school. A sociodemographic data form and HPV Knowledge Scale were used in the study. Statistical analysis was done using chi-square, independent samples t-test, one-way test ANOVA. A p-value of less than 0.05 was considered statistical significance, with a 95% CI. Results Of the 518 students who participated in the study, 57.9% were women, and 61.6% were preclinical students. Rates of smoking (p=0.018) and alcohol consumption (p=0.001) and sexual activity status (p

Healthcare Provider Recommendations and Observed Changes in HPV Vaccination Acceptance during the COVID-19 Pandemic

Healthcare provider (HCP) recommendation of the human papillomavirus (HPV) vaccination is crucial for HPV vaccination acceptance and uptake. It is unclear to what extent the disruptive effect of the COVID-19 pandemic impacted the recommendation and acceptance of HPV vaccination. HCPs practicing in Texas were invited to complete an online survey between January and April 2021. This population-based survey examined the association between HPV vaccination recommendation by HCPs and their observed changes in HPV vaccination acceptance during the COVID-19 pandemic. Of the total 715 HCPs included in this study, 13.9% reported a decrease, 8.7% reported an increase, and 77.5% reported no change in HPV vaccination acceptance during the COVID-19 pandemic. Compared to the HCPs who never/sometimes recommend HPV vaccination, those who often/always recommend HPV vaccination were less likely to observe a decrease (12.3% vs. 22.1%) and more likely to observe an increase in HPV vaccination (9.1% vs. 6.2%), during the COVID-19 pandemic. Furthermore, those who provided recommendations often/always had 46% (odds ratio: 0.54; 95%CI: 0.30–0.96) lower odds of reporting a decrease in HPV vaccination acceptance during the COVID-19 pandemic. This study adds to prior evidence of the positive influence of provider recommendations on HPV vaccination acceptance despite the disruptive effect of the COVID-19 pandemic on cancer prevention services.

Designing and psychometric assessment of the scale of factors influencing HPV vaccine uptake behaviors in young adults

Background

In order to increase HPV vaccination, it is necessary to identify the factors influencing vaccination behavior among different cultures and the young adult populations. To evaluate the factors influencing HPV vaccine uptake behaviors, valid, reliable, and culture-compatible scales are required. This study was conducted with the aim of designing and psychometric assessment of the scale of factors influencing HPV vaccine uptake behaviors in Young Adults (FI(HPV)VUBYA) in Iran.

Methods

The present study was carried out in a mixed-method in two steps: (a) Generating items using a qualitative study and literature review and (b) Reducing items by psychometric assessment of the designed scale. The initial set of items (N = 80) was prepared based on a qualitative study and literature review. A total of 400 young adults participated in online data collection from November 2019 to February 2020. The validity (face, content, and construct) and reliability (internal consistency and stability) of the scale were evaluated.

Results

The exploratory factor analysis (EFA) revealed that the scale has 7 factors, explaining 57.84% of the total extracted variance. There was also a knowledge factor that EFA did not analyze, but its validity and reliability were evaluated with 7 other factors. The results of confirmatory factor analysis showed a good model fit. Convergent and divergent validity of the scale was accepted for all factors. Good reliability was also reported for the scale.

Conclusion

FI(HPV)VUBYA 8-factor scale has good validity and reliability among young Iranian adults. Due to its appropriate psychometric properties, this scale can be used on this population in future studies.

Papillomavirus Infection and Prevention: How Much Does the Sicilian Population Know? An Observational Study

Human papillomavirus is a sexually transmitted virus that is responsible not only for uterine cervical cancer, but also for the oral and oropharyngeal cancers. In this latter case, the virus indiscriminately affects both sexes at any age. Vaccination plays a key role in preventing infection and its possible consequences. Therefore, this study aimed to assess the degree of awareness of papillomavirus infection and its possible prevention in the Sicilian population. A prospective observational study was carried out on the Sicilian population through a self-administered questionnaire, consisting of 10 multiple-choice questions. The survey lasted from June 2021 to December 2021. A total of 844 respondents were included: 60.90% were female and 53.55% were aged between 21 and 30 years. Most of the surveyed population knew about the virus and the existence of the vaccine, however, many of them did not know about virus's effects on the oral and oropharyngeal sites (49.17%), or about the indication for vaccination for males (39.69%). Oral and oropharyngeal papillomavirus-related cancers are an increasingly frequent finding, especially in young adults. Therefore, it is necessary and quite mandatory to educate the population about the risks that certain voluptuous habits may cause, with the help of general practitioners, schools, social media, and social networks.

Pharmacy fall prevention services for the community-dwelling elderly: Patient engagement and expectations

Medication use is an important risk factor for falls. Community pharmacists should therefore organise fall prevention care; however, little is known about patients' expectations of such services. This qualitative study aims to explore the expectations of community-dwelling older patients regarding fall prevention services provided by community pharmacies. Telephone intakes, followed by three focus groups, were conducted with 17 patients, who were aged ≥75 years, used at least one fall risk-increasing drug (FRID) and were registered at a community pharmacy in Amsterdam, the Netherlands. Some time of the focus groups was spent on playing a game involving knowledge questions and activities to stimulate discussion of topics related to falling. Data were collected between January 2020 and April 2020, and all focus groups were audiotaped and transcribed verbatim. The precaution adoption process model (PAPM) was applied during data analysis. Patients who had already experienced a fall more often mentioned that they took precautions to prevent falling. In general, patients were unaware that their medication use could increase their fall risk. Therefore, they did not expect pharmacists to play a role in fall prevention. However, many patients were interested in deprescribing. Patients also wanted to be informed about which medication could increase fall risk. In conclusion, although patients initially did not see a role for pharmacists in fall prevention, their perception changed when they were informed about the potential fall risk-increasing effects of some medications. Patients expected pharmacists to focus on drug-related interventions to reduce fall risk, such as deprescribing.

Human papillomavirus (HPV) and HPV vaccine knowledge, the intention to vaccinate, and HPV vaccination uptake among male college students

ObjectiveThis systematic mixed studies review aims to summarize the results of available research on knowledge of the human papillomavirus (HPV) and HPV vaccine, the intention to vaccinate, and HPV vaccination uptake among male college students. Methods: PubMed, ProQuest, EBSCO, PsycINFO, JSTOR, MEDLINE, and Google Scholar searches were performed to identify studies. A total of 39 studies were included in this review. Results: Most studies were cross-sectional (n = 27) and used convenience samples (n = 18). Although many students were aware of HPV and the HPV vaccine, gaps in their knowledge about the mode of transmission, symptoms, risk factors, and HPV vaccine mechanism were evident. The cost of HPV vaccination and concerns about safety and side effects were the most frequently reported barriers to obtaining the vaccination. Conclusion: More effort to increase knowledge about HPV and the uptake of the HPV vaccination among college men in the United States is necessary.

Trends in HPV and HPV Vaccine Awareness among Gay and Bisexual Males in the U.S

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (US). It is often discussed within the context of women’s sexual health due to its association with cervical cancer. However, HPV is also associated with other cancers and conditions which affect men. Gay and bisexual males (GBM) in the US have higher risks of HPV infection and a higher incidence of HPV-associated anal cancer than heterosexual males. In addition, GBM in the US have a higher prevalence of some high-risk strains of HPV than in other regions. HPV vaccination is highly effective at preventing HPV-associated cancers and genital warts. Several resources have been directed towards improving HPV awareness in the US over the past couple of years to improve vaccination rates. Given the low rates of HPV vaccination among GBM in the US, this study aimed to assess the trends in HPV and HPV vaccine awareness using a nationally representative sample of GBM. We found an overall increase in HPV and HPV vaccine awareness between 2017 and 2020. However, the sociodemographic differences in awareness levels highlight the need for more interventions to improve vaccination rates, especially in this high-risk population.

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.

Empowering Active-Duty Service Members to Initiate the Human Papillomavirus Vaccine

Human papillomavirus (HPV) is a common sexually transmitted infection that can lead to cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancers. Active-duty service members are disproportionately affected by HPV, yet this population has very low HPV vaccination rates. Increasing these rates has the potential to prevent HPV-associated cancers. This case study describes a brief and focused educational intervention designed to improve HPV vaccination rates among active-duty service members.

To Tailor or Not to Tailor: An Investigation of Narrative Tailoring for Health Communication

One possible way of enhancing the effectiveness of health narratives is by using tailoring. However, evidence of the effectiveness of narrative tailoring is mixed. Some studies have found tailoring to be effective, while others have found no difference between tailored and non-tailored stories. One explanation for these mixed results is that much of the previous research in this area has focused on purely demographic factors. This study aimed to determine whether or not adding theoretically derived tailoring dimensions provides benefits above and beyond demographic tailoring. Participants (N = 812, aged 18-26) were assigned to either a facts only control condition, a non-tailored narrative, a demographically tailored narrative, or a demographically and theoretically tailored narrative. Across all conditions, the stimuli focused on the benefits of the HPV vaccine. Results found that the narrative conditions outperformed the control, but there was no significant difference between tailoring conditions on vaccination expectations, narrative transportation, identification, or perceived personalization. Further analysis showed that perceived personalization and narrative transportation predicted vaccination expectations across all narrative conditions.

HPV vaccine awareness, knowledge and information sources among youth in Switzerland: a mixed methods study

OBJECTIVES

We aimed to provide a detailed characterisation of human papillomavirus (HPV) vaccine awareness, knowledge and information sources in the HPV vaccine decision-making process of youth, both male and female, in Switzerland.

DESIGN

With a mixed-method study design, we conducted quantitative questionnaires and qualitative interviews, which lasted 20-45 min.

SETTING AND PARTICIPANTS

We recruited participants, 15-26 years of age, in physicians' offices, in a local sexual health clinic, and during military enlistment. We administered quantitative questionnaires to 997 youth participants (585 male, 412 female) and conducted qualitative interviews with 31 youth (17 male, 14 female).

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed HPV vaccine awareness, knowledge, information sources and vaccination status.

RESULTS

In the study's quantitative component, 108 (20%) male and 262 (65%) female participants had received ≥1 dose of HPV vaccine. 697 (70%) participants were knowledgeable about the HPV vaccine. Females were more likely to be knowledgeable than males (342/412 (83%) vs 355/585 (61%); p<0.01). Younger participants in the sample compared with older participants were more likely to be aware of HPV vaccine (135/148 (91%) vs 695/849 (82%); p<0.01). The three most mentioned information sources were school health programmes (442 (53%)), healthcare providers (190 (23%)) and participants' social networks (163 (20%)). Overall, 554/710 (78%) participants had a female-gendered perception of HPV vaccine, a finding which was further supported and explained by qualitative data.

CONCLUSIONS

Despite a male HPV vaccine recommendation being made >4 years prior to the data collection, HPV vaccine knowledge was higher among females than males, and a female-gendered perception of HPV vaccine remains prevalent. Internet and social media were minor HPV vaccine information sources. Study findings demonstrate that HPV knowledge matters for HPV vaccine uptake and suggest that we should improve HPV information quality and access for youth, particularly by tailoring knowledge campaigns to young men.

mHealth video gaming for human papillomavirus vaccination among college men-qualitative inquiry for development

BACKGROUND

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Persistent infection with HPV can cause various cancers; however, HPV vaccination can prevent infections associated with high risk, cancerous strains of the virus. As it relates to HPV, college age men have been identified as one of the catch-up vaccination groups. Among college age men, gaming is an extremely popular extracurricular activity. Further, video games have emerged as a popular public health intervention tool. Therefore, this study aims to collect qualitative data on how to develop, implement and evaluate the effectiveness of a gaming intervention to increase HPV risk perceptions, improve self-efficacy and increase intention to receive the HPV vaccine among male college students (18-26 years old).

METHODS

Four focus group sessions ranging from eight to ten individuals were conducted among male college students from one large research-intensive university in the South. Using grounded theory, data from focus group interviews were coded using NVivo software to identify emergent themes.

RESULTS

Participants emphasized that although customization was not viewed as important by college aged males, the ability to tailor in game experiences or experience different things each time they played (creative freedom) was more important. They encouraged that the digital game be created on a mobile platform, incorporate health messages, and be informative to reach their population. Furthermore, they suggested innovative way to disseminate the game, which included having health department/health care providers prescribe the game to patients as an end of clinical interaction strategy.

CONCLUSIONS

College age men, are natural avid gamers, enjoy game play, and can engage in learning online or offline. While platform preference varies among gamer type, college age men in our study emphasized that mobile based gaming is the most advantageous way to increase knowledge/awareness and encourage positive in game behavior which can impact out of game behaviors such as vaccination. Because of the level of access and natural disposition of mHealth technology seen as an "extension of the self", games for health developers should consider the mobile platform as the ideal for the target demographic.

"I don't think I have a chance to get it": International university student HPV knowledge and preventive behaviors

Objective: Half of new human papilloma virus ( (HPV)) infections occur between the ages of 15 and 24. As preventive measures are underutilized globally; international university students are at particular risk for HPV infection and sequelae. The study aim was to explore HPV knowledge and preventive behaviors in this population. Participants: Eighty-one undergraduate and graduate international university students (49 females, 32 males) at a southeastern university. Methods: Exploratory sequential mixed methods guided by the Health Belief Model. Results: Integrated qualitative/quantitative data revealed four themes mapped to relevant HBM constructs: Perceived susceptibility to HPV; Perceived benefits/Perceived barriers to HPV prevention; Cues to Action; and Likelihood of Engaging in Health-Promoting Behavior. Over half believed they were not at risk for HPV/sequelae. Only a quarter had received HPV vaccination. Conclusions: International university students represent an important catch-up population for HPV screening/vaccination. Results can be used to design and tailor interventions for this vulnerable population.

Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India

Background: Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants (N = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, p < 0.05 was considered significant. Results: A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83-6.04), p < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02-2.08), p < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334-2.946, p < 0.00]. Conclusion: This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.

COVID-19 Vaccination and Intention to Vaccinate Among a Sample of College Students in New Jersey

Vaccines are critical for curtailing the COVID-19 pandemic and may represent an important tool for return to "normalcy" on college campuses in the Fall of 2021. The purpose of this study was to investigate the extent of vaccination coverage and intention to vaccinate among college students. College students (N = 457) enrolled in the Spring 2021 semester at a university in New Jersey completed a cross-sectional survey. The survey collected information on demographics, COVID-19 and vaccination history, knowledge levels and sources of COVID-19 vaccine information, and vaccine attitudes. Multivariable regression analysis was performed to identify factors associated with vaccination, and the intention to vaccinate among non-vaccinated students. Results indicate that 23% (n = 105) of participants reported being vaccinated already. Among non-vaccinated students, 52.8% indicated their intention to receive the vaccine when it is made available to college students. Students who were health care workers (adjusted odds ratio, aOR = 4.17, p < 0.001), had a family member who had received a COVID-19 vaccine (aOR = 5.03, p < 0.001), exhibited greater positive attitudes regarding vaccination (aOR = 1.12, p < 0.001), and received a seasonal flu vaccine (aOR = 1.97, p < 0.05) were more likely to have received the COVID-19 vaccine. Among non-vaccinated students, those who discussed COVID-19 vaccine information with others (aOR = 5.38, p < 0.001), and exhibited more overall positive attitudes regarding vaccination (aOR = 2.69, p < 0.001), were more likely to indicate their willingness to receive the COVID-19 vaccine. Findings of this study highlight the need for additional education and vaccine outreach aimed at promoting uptake of the COVID-19 vaccine among college students.

Using the Theory of Planned behavior to identify correlates of HPV vaccination uptake among college students attending a rural university in Alabama

INTRODUCTION

Humanpapillomavirus (HPV) has infected nearly 80 million people in the U.S., and is associated with most cervical cancer cases. Alabama ranks first in the country for cervical cancer mortality and third for incidence. Although the HPV vaccine can prevent HPV and reduce cancer rates, Alabama is well-below the national average for HPV vaccination. Using the Theory of Planned Behavior (TPB), this Alabama-based study aimed to examine college students' intentions to get the HPV vaccine; to examine the relationship between the relationship between religious beliefs and HPV vaccination uptake status among college students.

METHODS

Students (n = 257) from a university in rural Alabama completed the survey. Multiple regression analysis, Mann-Whitney U tests, and moderation analysis were used to examine associations among the variables of interest.

FINDINGS

Consistent with TPB, results showed that attitudes and subjective norms were significant predictors of intention to get vaccinated. Knowledge that both sexes can experience HPV-related health problems, that HPV can cause genital warts, and that the vaccine protects against HPV were each associated with higher attitude scores. The results indicated that the odds of getting at least one HPV shot were higher for females than for males for non-Caucasians than for Caucasians. Students who were not vaccinated were more likely to report that religion influenced their health beliefs. *Abstract.

CONCLUSION

TPB was helpful in understanding HPV-related intentions. Communication and education efforts are needed to increase understanding of HPV illnesses and HPV vaccination benefits among peers, parents, and other loved ones of students. in the rural areas of Alabama.

Attitude and practice on human papilloma virus infection and vaccination among students from secondary occupational health school: a cross-sectional study

Cervical cancer (CC) is reported as the second-most common female cancer worldwide, of which 99% is caused by persistent human papillomavirus (HPV) infection. HPV vaccine protects against HPV infection and most cases of CC, which has only been introduced for a short time in mainland China. This study aimed to evaluate the attitude and practice related to HPV infection and vaccination among students at secondary occupational health school (SOHS) in China. We conducted a cross-sectional study in Southern China where data of 2248 participants were collected through questionnaires to estimate attitude and practice of students. Only 4.1% believed they were easily infected by HPV, 38.2% were willing to receive HPV vaccine and 30.8% intended to do regular screening of HPV infection in the future. Students in the second grade (OR = 1.51, 95%CI [1.25, 1.81]) and third grade (OR = 3.99, 95%CI [2.53, 6.27]) were more willing to take HPV vaccine compared to students in the first grade. Among the non-vaccinated participants, the most frequent reason for not receiving HPV vaccine was insufficient knowledge about HPV (91.1%). Characteristics of higher grade, personal education before enrollment and academic performance, medical specialty, history of sex experience and HPV vaccine and family history of other cancers were associated with higher attitude scores (p < .05). Considering the increasing prevalence of HPV infection and the need of improvement in attitude and practice toward HPV, more education about HPV infection and vaccination should be incorporated into school curriculum.

Attitudinal Correlates of HPV Vaccination in College Women

This study examined associations between general attitudes toward seeking medical care, attitudes about vaccines/fear of shots, and human papillomavirus (HPV) vaccine uptake and intentions in college women. Hypothesized associations were framed by the Theory of Planned Behavior (TPB). Participants (N = 330, mean age = 18.9 years, 75% White) completed a one-time survey. The majority (61%; n = 201) had received ≥1 HPV vaccine dose. Hierarchical logistic regression examined relationships between attitudes and vaccine uptake. Pearson correlation coefficients and Kruskal-Wallis tests examined associations between attitudes and vaccine intentions. Results were partially consistent with the TPB. In the final model, perceived benefits, but not fear of shots, were associated with vaccine uptake. Among the unvaccinated, perceived benefits, but not fear of shots, were associated with vaccine intentions. Provider recommendation was the strongest predictor of vaccine uptake. Findings suggest interventions incorporating discussion of perceived benefits and provider recommendation may improve HPV vaccine receipt among college women.

Factors Associated with Pre- and Post-Educational Intervention Knowledge Levels of HPV and Cervical Cancer Among the Male and Female University Students, Northwest Ethiopia

BACKGROUND

Human papillomavirus (HPV) infections are sexually transmitted and most frequently associated with cervical cancer in women, but they are also a public health concern in men. There is rising evidence that HPV's role in other cancers, such as anal, vulva, vaginal, penis, head, and neck cancers. The present study aimed to understand the factors associated with HPV and cervical cancer knowledge levels of university students before and after an educational intervention.

METHODS

An Institutional-based cross-sectional study was conducted from October to November 2018. A total of 638 study participants were selected using a simple random multistage sampling technique. A pretested questionnaire was used, consolidated the data, and analyzed with SPSS version 23. Bivariate and multivariate logistic regression analyses were performed to identify which variables were associated with the knowledge levels.

RESULTS

Six hundred thirty-eight study participants with a 100% response rate, and the mean age was 21.07 years (±SD, 1.96). Initial awareness of various broad categories was 4.09, and after the intervention, it increased to 23.4, with an average increase of 19.31 at 99% CI, p≤0.001 significance level. Before the educational intervention, students with <21 years of age [6.16, 95% CI: (2.21-17.18)] and ≤2.5 CGPA [3.44, 95% CI: (1.51-7.81)] were less knowledgeable over other counterparts. After educational intervention, the year of study was significantly associated with increased knowledge of overall and different broad categories of cervical cancer and HPV. Year of study, 1st-year students [AOR: 0.27, 95% CI: (0.14-0.51)] over third years and above are less knowledgeable. First-year students and CGPA ≤2.5 were less improved awareness over others.

CONCLUSION

The educational intervention improved more than fourfold increase knowledge on cervical cancer and HPV, and the year of study was a key factor associated with overall improvement. This study suggests that educational intervention effectively strengthens our understanding of the spread of HPV and cervical cancer disease burden.

Trends in Human Papillomavirus Vaccine Safety Concerns and Adverse Event Reporting in the United States

IMPORTANCE

In the US, safety concern has been identified as a primary barrier to initiating the human papillomavirus (HPV) vaccine. It is unclear if the public's sentiment concerning HPV vaccine safety aligns with postmarketing vaccine safety surveillance data.

OBJECTIVE

To perform a parallel assessment of trends in HPV vaccine safety concerns and HPV vaccine adverse event (AE) reporting.

DESIGN, SETTING, AND PARTICIPANTS

This study was a cross-sectional analysis of the National Immunization Survey (NIS) and Vaccine Adverse Event Reporting System (VAERS). Participants in the NIS were adolescents aged 13 to 17 years. AEs were reported to VAERS by patients, health care clinicians, or other sources. Statistical analysis was performed from October 2020 to May 2021.

MAIN OUTCOMES AND MEASURES

Secular trends in HPV vaccine safety concerns and spontaneous AE reporting for HPV vaccination from 2015 to 2018.

RESULTS

Caregivers of 39 364 unvaccinated adolescents with a mean (SD) age of 15.57 (0.08) years (26 996 White adolescents [62.9%], 22 707 male adolescents [56.1%], 11 392 privately insured [62.6%], and 32 674 above the poverty level [79.3%]) reported their reasons for not initiating the HPV vaccine series in the 2015-2018 NIS. Citing safety concerns as the primary reason for not initiating the HPV vaccine series increased from 13.0% (95% CI, 12.1%-14.0%) in 2015 to 23.4% (95% CI, 21.8%-25.0%) in 2018 (P for trend < .001), equating to a change from 170 046 to 259 157 US adolescents not initiating the vaccine because of safety concerns. The proportion of parents citing safety concerns as the main reason for HPV vaccine hesitancy increased in 30 states. The largest increases (more than 200%) were observed in California, Hawaii, South Dakota, and Mississippi. During 2015 to 2018, 16 621 AE reports following HPV vaccination were reported to VAERS. The AE reporting rate per 100 000 doses distributed decreased from 44.7 in 2015 to 29.4 in 2018 (P for trend < .001). The serious AE reporting rate, including those leading to hospitalizations, disability, life-threatening condition, or death did not change.

CONCLUSIONS AND RELEVANCE

In this descriptive cross-sectional study, a rise in citing safety concerns was observed among parents with HPV vaccine hesitancy, contrary to the nonserious and serious AE reporting trends. These findings suggest an urgent need to combat the rising sentiment of safety concerns among caregivers to increase HPV vaccine confidence.

Using Machine Learning-Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions

Background

The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion.

Objective

The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)–based methods.

Methods

Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation.

Results

A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99%).

Conclusions

ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion.

Reasons and influential recommendations associated with HPV vaccination among Chinese college students in the USA

OBJECTIVES

To evaluate (a) reasons for not receiving recommended doses of the human papillomavirus (HPV) vaccine, (b) the most influential recommending source in getting the HPV vaccine, and (c) associated factors among Chinese college students in the United States.

METHODS

A cross-sectional design utilizing a structured self-report questionnaire was used.

PARTICIPANTS

A network sample of 449 participants aged 18 or older completed the survey between March and May of 2018.

RESULTS

Only 172 participants (38.3%) had received the HPV vaccine. The most common reason was that participants had never received recommendations from healthcare providers regarding HPV vaccines. Recommendations from doctors were the most cited source in deciding HPV vaccine uptake. Factors associated with reasons and recommendation sources included attitudes toward HPV, gender, school year, age, major, and health insurance.

CONCLUSIONS

Healthcare providers play an important role in promoting HPV vaccination among Chinese college students. More research is needed for this understudied population.

A Digital Personal Health Library for Enabling Precision Health Promotion to Prevent Human Papilloma Virus-Associated Cancers

Human papillomavirus (HPV) causes the most prevalent sexually transmitted infection (STI) in the United States. Sexually active young adults are susceptible to HPV, accounting for approximately 50% of new STIs. Oncogenic HPV subtypes 16 and 18 are associated with squamous intraepithelial lesions and cancers and are mostly preventable through prophylactic HPV vaccination. Accordingly, this study's objectives are to (1) summarize SDoH barriers and implication for low HPV vaccination rates among young adults (18-26 years), (2) propose a digital health solution that utilizes the PHL to collect, integrate, and manage personalized sexual and health information, and (3) describe the features of the PHL-based app. Through the application of novel techniques from artificial intelligence, specifically knowledge representation, semantic web, and natural language processing, this proposed PHL-based application will compile clinical, biomedical, and SDoH data from multi-dimensional sources. Therefore, this application will provide digital health interventions that are customized to individuals' specific needs and capacities. The PHL-based application could promote management and usage of personalized digital health information to facilitate precision health promotion thereby, informing health decision-making regarding HPV vaccinations, routine HPV/STI testing, cancer screenings, vaccine safety/efficacy/side effects, and safe sexual practices. In addition to detecting vaccine hesitancy, disparities and perceived barriers, this application could address participants' specific needs/challenges with navigating health literacy, technical skills, peer influence, education, language, cultural and spiritual beliefs. Precision health promotion focused on improving knowledge acquisition and information-seeking behaviors, promoting safe sexual practices, increasing HPV vaccinations, and facilitating cancer screenings could be effective in preventing HPV-associated cancers.

How to increase awareness of additional vaccinations; the case of maternal pertussis vaccination

BACKGROUND

Effective and safe vaccines are available outside national immunization programs (NIP). Increased awareness and vaccine uptake can improve public health. Before the inclusion of maternal pertussis vaccination (MPV) in the Dutch NIP in December 2019, extra communication efforts were undertaken. Here we examine the success of these efforts, investigating women's awareness of and their decision-making process regarding MPV.

METHODS

Between December 2018 and January 2019, one year before the introduction of MPV in the NIP, and about three years after MPV was recommended by the Dutch Health Council, pregnant and non-pregnant women (i.e. child younger than two years) were invited to fill out an online questionnaire. Participant's decision-making processes regarding MPV were assessed with an adapted Precaution Adoption Process Model (PAPM), including stages of awareness, engagement, information-seeking, and vaccination behaviour. Furthermore, factors related to the decision-making process were examined.

RESULTS

In total, 942 women were included, of whom 62% were non-pregnant. Most of the pregnant and nonpregnant women were aware of MPV during pregnancy (respectively 69 and 56%). Most aware women had heard about MPV through their midwife and the Public Health Institute (PHI) website. Women unaware of MPV reported a need for information, preferably from their midwives. Most aware women felt MPV was important to them (88%) and were classified as "engaged". Of the eligible and "engaged" pregnant women, 58% were vaccinated, versus 38% of "engaged" non-pregnant women.

CONCLUSIONS

As the most preferred and trusted source of information, midwives are essential to increasing awareness of MPV. The PHI website is considered to be a reliable information source and is often consulted. To increase awareness, appropriate healthcare workers should be encouraged to actively inform target groups about available, additional vaccinations.

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

PURPOSE

Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university.

METHODS

We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination.

RESULTS

Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.

CONCLUSIONS

Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.

Factors associated with HPV vaccination initiation among United States college students

Human papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.

Human Papillomavirus Vaccination Status and Parental Endorsement Intentions among Undergraduate Student Nurses

We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccination status and their intention to counsel parents on HPV vaccination. Undergraduate student nurses (N = 153) from a large university in the south participated. Descriptive statistics, chi-squared tests, and independent t-tests (p ≤ 0.05) were used to characterize the students’ vaccination status. Logistic regression was used to identify factors associated with vaccination status. HPV vaccination rates were low. Students who were older and married or living with a partner were less likely to have completed the HPV vaccine series. The most commonly cited reason for non-initiation and non-completion was the lack of provider endorsement. Vaccination status did not differ significantly according to race/ethnicity, religion, skills, or intention to counsel parents. While intentions to counsel parents on HPV vaccination are high among student nurses, interventions to improve vaccination rates among student nurses are needed.

COVID-19 vaccine intentions in the United States, a social-ecological framework

Background

COVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions.

Methods

Using an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who intended to be vaccinated against COVID-19 to respondents who did not intend or were ambivalent about COVID-19 vaccination.

Results

Only 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR = 0.29, CI = 0.17–0.50), reported lower social norms of COVID-19 preventive behaviors (aOR = 0.67, CI 0.51–0.88), scored higher on COVID-19 Skepticism (aOR = 1.44, CI = 1.28–1.61), identified as more politically conservative (aOR = 1.23, CI = 1.05–1.45), were less likely to have obtained a flu vaccine in the prior year (aOR = 0.21, CI = 0.11–0.39), were less likely to be female (aOR = 0.51, CI = 0.29–0.87), and were much more likely to be Black compared to White (aOR = 10.70, CI = 4.09–28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one.

Conclusion

The results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race.

Can mHealth interventions contribute to increased HPV vaccination uptake? A systematic review

The objective of this review was to synthesize existing evidence on mobile health (mHealth) interventions geared at improving HPV related knowledge, HPV vaccination intent and HPV vaccination uptake. Between November and December 2019, systematic searches were performed in the databases PubMed, Ebsco/CINAHL, Ebsco/PsycINFO, and Clarivate Analytics/Web of Science Social Science Citation Index (SSCI). We identified 805 articles of which 92 were eligible for inclusion after abstract screening. 19 articles met the inclusion criteria of the review based on full article review and all but one of the included interventions were conducted in the United States. mHealth interventions ranged from text messages, phone calls to interactive voice recordings and software on tablets. All four interventions which attempted to improve HPV knowledge and vaccination intent, reported positive findings, however, only two interventions reported statistically significant improvements between intervention and control groups. 14 interventions reported an increase in HPV vaccination uptake and vaccination series completion among the intervention groups; including when mHealth interventions were compared to control groups or non-mHealth interventions. Some factors noted in the successful interventions included frequency of messages, combinations of multiple interventions including in-person education session, written educational materials, texts alongside call or emails; tailored messages as well as participant's intent to vaccinate at baseline. mHealth interventions potentially show promise as tools in improving short-term vaccination knowledge, intent, and uptake of HPV vaccination. There is however a need to refine components which can promote mHealth interventions' success as well as for the evaluation of such interventions in different contexts and over time.

Reported rationales for HPV vaccination vs. Non-vaccination among undergraduate and medical students in South Carolina

Objective: We sought to identify factors that influence Human Papillomavirus (HPV) vaccination rates in individuals at two higher education institutions in South Carolina (SC).Participants: We surveyed 1007 students with a mean age and standard deviation of 20.3 ± 3.3 from September 2018 to December 2018.Methods: Participants answered 13 questions, assessing HPV vaccination rates, demographics, and rationales for vaccination vs. non-vaccination.Results: Of 1007 respondents, 700 received HPV vaccination, 165 were unvaccinated, 75 received partial vaccination and 138 were uncertain. Commonalities in HPV vaccination existed between females (p = 0.037), individuals who received standard childhood vaccinations (p = 0.04), and those not native-born in SC (p < 0.001). Of non-vaccinated individuals, 37% "never thought about vaccination," 32% did not perceive a need for vaccination, and 31% reported vaccine safety as reasons for not receiving the vaccine.Conclusions: Promotion of HPV vaccination may benefit from targeting SC natives, males, and individuals who are under-vaccinated or unvaccinated.

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by "liking" a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.