1. Among a cohort of college-age young adults, having appropriate knowledge of the HPV vaccine was associated with increased uptake, while high uncertainty was associated with decreased uptake.
Evidence Rating Level: 2 (Good)
Study Rundown: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S., and can lead to numerous health concerns, including cancers of the cervix, penis, anus, and oropharynx. The HPV vaccination can prevent over 90% of HPV-related cancers; as such, the Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination for everyone aged 9 to 26. Uptake, however, is low, with only 48.6% of adolescents aged 13 to 17 up to date with the recommended series as of 2017. Much of this stems from parental attitudes towards and understanding of the HPV vaccine. Thus, this study explored college students’ knowledge of, attitudes towards, and beliefs regarding uptake of the HPV vaccine, since these students aged 18 to 26 can make their own decisions regarding vaccination.
Students from a Southern California state university were asked to complete a questionnaire that recorded demographic information; outcome variables of having received HPV vaccination in the past and/or intention to receive the vaccine in the next six months; and overall knowledge, attitudes, and beliefs regarding HPV vaccination. The modified Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) was used utilized. It was found that, overall, there was no significant difference in the level of HPV knowledge across the three outcome groups (i.e. those vaccinated, those intending to be vaccinated, and those not intending to be vaccinated). However, the overall level of HPV vaccine knowledge was higher among students who were previously vaccinated. In a regression analysis, knowledge of the HPV vaccine was found to be associated with increased vaccine uptake, while a high level of uncertainty was inversely associated with uptake.
This study is limited by a sample drawn exclusively from a college environment. Additionally, 85.1% and 91.2% of participants identified as female and heterosexual, respectively, while 86.7% of participants had health insurance. Furthermore, 36.5% identified as Hispanic, which is higher than the 26% of the general population aged 16 to 33 that identifies as such. These demographic data may limit this study’s generalizability. Overall, this study has important public health implications by identifying discrete areas of intervention, such as enhancing education to reduce uncertainty, that may help increase HPV vaccine uptake among young adults.
In-depth [qualitative cross-sectional study]: A total of 181 college students (mean [SD] age = 21.4 [2.22] years) completed the questionnaire. Among them, 101 (55.8%) had received at least one dose of the HPV vaccine, 52 (28.7%) intended to receive the vaccine, and 28 (15.5%) did not intend to receive the vaccine. This is far lower than the Healthy People target goal of 80% coverage for those aged 13 to 15. Knowledge concerning HPV did not differ significantly between the three outcome groups, but knowledge concerning the HPV vaccine was higher among those who had previously received the vaccine. In multivariate logistic regression, a higher level of HPV vaccine knowledge was most strongly associated with vaccine uptake (OR 1.17, 95% CI 1.06 to 1.28, p = 0.002). Conversely, a higher level of uncertainty was inversely associated with vaccine uptake (OR 0.62, 95% CI 0.41 to 0.93, p = 0.02). Finally, gender, race, religion, and having health insurance had no impact on HPV vaccine uptake in regression analysis.
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