Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol

Differences in knowledge, attitudes and intentions towards HPV vaccination among young adults from diverse socio-cultural groups in Israel: A cross-sectional study

In Israel, The Human Papilloma Virus (HPV) vaccine is recommended to both genders up to age 26. Many 18-26 olds missed their opportunity for vaccination during school. Our study described HPV knowledge, attitudes and vaccination intentions among unvaccinated 18-26 Israeli adults across various demographics, aiming to inform future catch-up vaccination strategies. We recruited participants through an anonymous survey and collected information about demographics and HPV knowledge, attitudes and intentions using questions from validated questionnaires adapted to the Israeli context, distributed between December 2023-February 2024. We calculated weighted mean knowledge and attitude scores according to age, gender, ethnicity and sexual orientation. We determined factors associated with vaccination knowledge, attitudes and intentions using multivariate linear regressions. Of 4324 respondents, 36 % were vaccinated. Of 1994 unvaccinated individuals included in the final analysis, <50 % reported being familiar with HPV. The overall mean weighted HPV knowledge score was 9.5/14 (95 % CI 9.3-9.7). Older participants, Jewish non-Ultra-Orthodox, and those with higher education levels reported higher knowledge scores. Attitudes towards HPV vaccination were generally neutral but tended towards the positive, with an overall mean weighted score of 2.9/5 (95 %CI 2.88-2.95). Variation in attitudes across different demographic groups was minimal. Intention to vaccinate within 12 months was low, with <15 % of respondents overall expressing an intention to do so. Factors significantly associated with higher vaccination intention included being Arab, older, female, having multiple sexual partners, and being a student. There was no association between sexual orientation and vaccination intention. Arab participants showed the highest intention to vaccinate despite having the lowest knowledge levels. Young adults in Israel demonstrate low HPV awareness and vaccination intention, with minor variations in attitudes across different demographics. Providing more information may be insufficient to increase vaccine uptake in all groups. Future catch-up campaigns should be tailored to barriers specific to different groups.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study

BACKGROUND

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions.

OBJECTIVE

The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada.

METHODS

Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results.

RESULTS

The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots.

CONCLUSIONS

Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.