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Alarcão, Violeta, and Bilyana Zdravkova. "Attitudes and Practices towards HPV Vaccination and Its Social Processes in Europe: An Equity-Focused Scoping Review." Societies 12, no. 5 (September 18, 2022): 131. http://dx.doi.org/10.3390/soc12050131.
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The sociological understanding of the human papillomavirus (HPV) vaccination offers the possibility to understand society better as the processes that shape health beliefs and influence HPV vaccine decisions relate to gender, power, and identity. This research aimed to locate, select, and critically assess scientific evidence regarding the attitudes and practices towards HPV vaccination and its social processes with a focus on health equity. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) and the recommendations made by the Joanna Briggs Institute was undertaken. Medline and Scopus were searched from their start date until December 2021. The review followed the Population/Concept/Context (PCC) inclusion criteria: Population = General population, adults and adolescents, Concept = Empirical data on determinants of HPV vaccination, Context= Studies on attitudes and practices towards HPV vaccination and its social processes with a focus on gender, class, and ethnic/racial inequalities. Of the 235 selected articles, 28 were from European countries and were the focus of this review, with special attention to socio-economic determinants in HPV vaccine hesitancy in Europe, a region increasingly affected by vaccination public distrust and criticism. Barriers and facilitators of HPV vaccine uptake and determinants of immunization were identified. Given the emphasis on health equity, these data are relevant to strengthening vaccination programs to promote vaccination for all people.
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Wahidin, Mugi, and Rini Febrianti. "Determinants of Human Papilloma Virus (HPV) Vaccination among Elementary Students in Central Jakarta." Indonesian Journal of Cancer 15, no. 1 (March 31, 2021): 26. http://dx.doi.org/10.33371/ijoc.v15i1.783.
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Background: Human Papilloma Virus (HPV) is the leading risk factor of cervical cancer. World Health Organization (WHO) has recommended including HPV vaccination in national immunization programs in all countries. Specifically, Jakarta Province has been implementing HPV vaccination since 2016. In this case, several factors influence vaccination coverage. However, there is limited evidence about determinants associated with HPV vaccination. Therefore, this study aimed to investigate the factors associated with HPV vaccination among elementary students in Central Jakarta.Methods: This was a cross-sectional study conducted from March until June 2020. The study population involved 167 female students of the 6th level of the elementary school in Central Jakarta. There were eight elementary schools in Kemayoran and Cempaka Putih Sub Districts selected purposively. Primary data was collected employing an online questionnaire, which was fulfilled by respondents (mothers and students). Data were analyzed utilizing statistic software for descriptive and bivariate analysis. For the bivariate analysis, Chi-Square Test was performed.Results: The HPV vaccination coverage was 80.84%. It was also showed that the last education level of the respondents’ father and mother was mainly senior high school (SMA) for 50.3% and 47.9%, respectively. The mothers’ knowledge was mainly in the middle (56.9%), and they had a positive attitude/support (67.1%). There were only 2.4% of the respondents with a family history of cervical cancer. In terms of family economic status, the main part of respondents had low expenditure for 2-3 million IDR (59.3%) a month. Meanwhile, human resources (vaccination providers) and HPV vaccine were 100% available in the vaccination service. Of the respondent, 47.9% of those said that the vaccine price was affordable. Children who had no support to get HPV vaccination from their father, mother, and siblings were 14.4%, 6.6%, and 21.6%, respectively. Besides, children who were not supported by their teachers was 3.6% and not supported by their peers was 23.4%. Meanwhile, father and mother’s supports were significantly associated with HPV vaccination.Conclusions: Factors associated with HPV vaccination were the support from the father and mother.
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Olagoke, Ayokunle A., Leslie R. Carnahan, Olakanmi Olagoke, and Yamilé Molina. "Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation." American Journal of Health Promotion 36, no. 3 (November 5, 2021): 506–9. http://dx.doi.org/10.1177/08901171211053933.
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Purpose This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination. Design Cross-sectional survey data. Setting Online Qualtrics recruitment panel. Subject Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%). Measures Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors. Analysis We conducted multivariate linear regressions on each outcome variable after controlling for covariates. Result Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β = .37, 95% confidence interval [CI] = .25–.48), child (β = .32, .21–.44), and HPV for child (β = .38, .27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β = .46, .33–.59), child (β = .41, .28–.53), and HPV for child (β = .75, .64–.85). Conclusion Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.
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Jean, Stephen, Malak Elshafei, and Alison Buttenheim. "Social determinants of community-level human papillomavirus vaccination coverage in aschool-based vaccination programme." Sexually Transmitted Infections 94, no. 4 (January 12, 2018): 248–53. http://dx.doi.org/10.1136/sextrans-2017-053357.
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ObjectiveTo assess social patterns in human papillomavirus (HPV) vaccine coverage in a school-based, government-funded vaccination programme located within a single-payer universal healthcare system.DesignWe conducted a cross-sectional analysis of HPV vaccine uptake data for the 2013–2014 school year for 131 local authorities in England, and then evaluated the association between vaccine uptake and socioeconomic status at the aggregate level.Data sourcesHPV vaccination coverage data from Public Health England’s vaccine uptake guidance and the UK’s March 2011 Census.Main outcome measuresWe measured three-dose local authority-level vaccine series initiation to completion.ResultsWe found that in local authorities where there are more high-income families, the vaccination rate is lower than in local authorities with more low-income families. Local authorities with a higher percentage of whites, compared with non-whites, had higher HPV vaccination rates. Additionally, local authorities with more non-migrants had higher rates of vaccination. Local authorities with more education deprivation had higher rates of vaccination. Local authorities’ higher proportions of high-status occupations had worse vaccination coverage. In bivariate analyses across all the socioeconomic indicators, a 1 SD change in the indicators was associated with about a 2.25 percentage point decrease (for income, education and occupation) or increase (for race and migrant composition) in HPV dose coverage in the local authority. In multivariable analyses, only race remained as a significant predictor of HPV coverage at the local authority level.ConclusionsAcross all three doses, there are notable variations by socioeconomic status, with steep reverse gradients in three socioeconomic indicators. More quantitative and qualitative research needs to be conducted to determine the effects of the 2014 transition from a three-dose regimen to two-dose regimen on vaccination coverage, especially in groups that experience lower rates of vaccination.
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Pot, Mirjam, Theo GWM Paulussen, Robert AC Ruiter, Iris Eekhout, Hester E. de Melker, Maxine EA Spoelstra, and Hilde M. van Keulen. "Effectiveness of a Web-Based Tailored Intervention With Virtual Assistants Promoting the Acceptability of HPV Vaccination Among Mothers of Invited Girls: Randomized Controlled Trial." Journal of Medical Internet Research 19, no. 9 (September 6, 2017): e312. http://dx.doi.org/10.2196/jmir.7449.
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Background In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61% versus 70%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers’ degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P<.001). No effect was found on uptake (P=.60). This may be attributed to the overall high uptake rates in both conditions. Mothers evaluated the intervention as highly positive, including the website as well as the virtual assistants that were used to deliver the tailored feedback. Conclusions This computer-tailored intervention has the potential to improve HPV vaccination acceptability and IDM and to decrease decisional conflict among mothers of invited girls. Implications for future research are discussed. Trial Registration Trialregister.nl NTR4935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4935 (Archived by WebCite at http://www.webcitation.org/6srT7l9EM)
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Grdadolnik, Urška, and Maja Sočan. "The Impact of Socio-Economic Determinants on the Vaccination Rates with Rotavirus and Human Papiloma Virus Vaccine." Slovenian Journal of Public Health 55, no. 1 (March 1, 2016): 43–52. http://dx.doi.org/10.1515/sjph-2016-0007.
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Abstract Background Socio-economic inequalities may have an impact on the uptake of selfpaid vaccines. The aim of the study was to identify the effect of some socio economic determinants on vaccination rates with self-paid human papilloma virus (HPV) and rotavirus (RV) vaccines. Methods Vaccination coverage data, available in electronic database cepljenje.net (administered by the National Institute of Public Health), were collected at administrative unit level. The socio-economic determinants (the average gross pay in euros, the unemployment rate, the educational and households structure, the population density, the number of inhabitants, the number of children aged from 0 to 4, the number of women aged from 15 to 30) were extracted from Statistical Office of the Republic of Slovenia web page. The strength of the correlation between socioeconomic variables and self-paid HPV and RV vaccination rates was determined. Results Rotavirus vaccination rates show a slight negative correlation with the number of residents per administrative unit (ρ=-0.29, p=0.04), and no correlation with other socio-economic variables. Likewise, no correlation has been found between HPV vaccination rates and the selected socio-economic variables. Conclusion Ecological study did not reveal any correlations between socio economic variables and vaccination rates with RV and HPV self-paid vaccines on administrative unit level.
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Mlakar, Jana, Anja Oštrbenk Valenčak, Jožefa Kežar, Lara Beseničar-Pregelj, and Mario Poljak. "Assessment of Acceptability and Determinants of Uptake and Schedule Completion of Human Papillomavirus (HPV) Vaccine by 25 to 45 Years Old Women in Slovenia." Vaccines 11, no. 2 (February 12, 2023): 423. http://dx.doi.org/10.3390/vaccines11020423.
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HPV immunization programs are mainly focused on girls and boys, but adult women and men could also benefit from vaccination. A multinational CoheaHr-WP4 study investigated the acceptability of HPV vaccination among 25–45 years old women. A total of 607 women from Slovenia participated in the study, and 49.6% (301/607) agreed with HPV vaccination, with a significant difference (p < 0.0001) between the two centers. Non-vaccinated women had a higher education (p = 0.0068) and were more frequently in a committed relationship or married (p = 0.01). The most trusted source of medical and vaccination information was healthcare providers (55.2%). The main reasons for vaccine acceptance were protection against HPV-related disease (93.4%), severity of preventable diseases (82.7%), HPV vaccine safety (66.8%), free HPV vaccine availability (62.8%), and the existence of vaccination recommendations (55.5%). The main reasons for refusing vaccination were the need for additional vaccine-related information (31.4%) and vaccine safety concerns (29.4%). To increase vaccine coverage, information about the benefits and safety of HPV vaccination must be widely disseminated to all health professionals and the general public. We are convinced that the knowledge obtained in this study can be reliably applied to other countries in the region that lack such information and have a very high cervical cancer burden.
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Morales, Crystal G., Nicole R. Jimenez, Melissa M. Herbst-Kralovetz, and Naomi R. Lee. "Novel Vaccine Strategies and Factors to Consider in Addressing Health Disparities of HPV Infection and Cervical Cancer Development among Native American Women." Medical Sciences 10, no. 3 (September 13, 2022): 52. http://dx.doi.org/10.3390/medsci10030052.
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Cervical cancer is the 4th most common type of cancer in women world-wide. Many factors play a role in cervical cancer development/progression that include genetics, social behaviors, social determinants of health, and even the microbiome. The prevalence of HPV infections and cervical cancer is high and often understudied among Native American communities. While effective HPV vaccines exist, less than 60% of 13- to 17-year-olds in the general population are up to date on their HPV vaccination as of 2020. Vaccination rates are higher among Native American adolescents, approximately 85% for females and 60% for males in the same age group. Unfortunately, the burden of cervical cancer remains high in many Native American populations. In this paper, we will discuss HPV infection, vaccination and the cervicovaginal microbiome with a Native American perspective. We will also provide insight into new strategies for developing novel methods and therapeutics to prevent HPV infections and limit HPV persistence and progression to cervical cancer in all populations.
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Choi, Jihye, Irene Tamí-Maury, Paula Cuccaro, Sooyoun Kim, and Christine Markham. "Digital Health Interventions to Improve Adolescent HPV Vaccination: A Systematic Review." Vaccines 11, no. 2 (January 22, 2023): 249. http://dx.doi.org/10.3390/vaccines11020249.
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Digital technologies are being increasingly utilized in healthcare to provide pertinent and timely information for primary prevention, such as vaccination. This study aimed to conduct a systematic review to describe and assess current digital health interventions to promote HPV vaccination among adolescents and parents of adolescents, and to recommend directions for future interventions of this kind. Using appropriate medical subject headings and keywords, we searched multiple databases to identify relevant studies published in English between 1 January 2017 and 31 July 2022. We screened and selected eligible studies for inclusion in the final analysis. We reviewed a total of 24 studies, which included interventions using text messages (4), mobile apps (4), social media and websites (8), digital games (4), and videos (4). The interventions generally improved determinants of HPV vaccination, such as HPV-related knowledge, vaccine-related conversations, and vaccination intentions. In particular, text message and social media interventions targeted improved vaccine uptake behaviors, but little meaningful change was observed. In conclusion, digital health interventions can cost-effectively provide education about HPV vaccination, offer interactive environments to alleviate parental vaccine hesitancy, and ultimately help adolescents engage in HPV vaccine uptake.
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Wheldon, Christopher W., Ellen M. Daley, Eric R. Walsh-Buhi, Julie A. Baldwin, Alan G. Nyitray, and Anna R. Giuliano. "An Integrative Theoretical Framework for HPV Vaccine Promotion Among Male Sexual Minorities." American Journal of Men's Health 12, no. 5 (June 6, 2016): 1409–20. http://dx.doi.org/10.1177/1557988316652937.
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The objective of the current study was to quantify the behavioral intentions of young adult male sexual minorities (MSM) to initiate human papillomavirus (HPV) vaccination and test an integrative model of HPV vaccine decision making. Participants were 575 MSM who were residing in the United States and were between ages 18 and 26 years. Standard direct and indirect measures of attitudes, perceived norms, and perceived behavioral control were employed to explain variation in behavioral intention. Additional background factors—such as concealment of one’s sexual identity, suspicion of health care provider competence in LGBT health issues, perceived threat, and information orientation—were also included in the model. The final model fit the data well and identified a set of salient attitudinal and control beliefs as the strongest determinants of intention ( R2 = .38). Perceived threat and information orientation were positively correlated with HPV-related beliefs. Perceived threat was higher among men infected with HIV and lower among men in monogamous relationships. Self-efficacy, as an indirect measure of perceived behavioral control, was inversely related to the general tendency to conceal aspects of one’s sexual orientation and a suspicion of health care providers. Bisexual identified men were more likely to conceal their sexual orientation and be more suspicious of health care providers. In this study, a number of modifiable determinants of HPV vaccine intentions—both psychosocial and environmental—were identified and have implications for targeted and tailored behavioral interventions to promote HPV vaccination among MSM.
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Fallucca, Alessandra, Palmira Immordino, Luca Riggio, Alessandra Casuccio, Francesco Vitale, and Vincenzo Restivo. "Acceptability of HPV Vaccination in Young Students by Exploring Health Belief Model and Health Literacy." Vaccines 10, no. 7 (June 22, 2022): 998. http://dx.doi.org/10.3390/vaccines10070998.
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Evidence on the human papillomavirus (HPV) vaccine shows that it is effective in reducing the burden of HPV-related diseases. For more than 15 years the HPV vaccine has been offered free of charge in Italy to girls from the age of 12. Over time, the free offer of the HPV vaccine has also been extended to boys and to young adults at risk of developing HPV lesions. Despite the HPV vaccine’s effectiveness and availability, vaccination coverage is low in Italy, with a reported value of 46.5% in 2020. Furthermore, in the southern administrative regions, vaccination coverage is even lower than national values, with 25.9% coverage in Sicily. A cross-sectional study was conducted among university and high school students in the Palermo area (Sicily, Italy) in order to identify the determinants of HPV vaccination adherence by using a questionnaire that investigated factors of HPV vaccine practice. The study explored the behavioral attitude by using the Health Belief Model (HBM), and also used the SILS test and the METER test to investigate the level of health literacy (HL). Overall, 3,073 students were enrolled, and less than a third reported they had completed the vaccination schedule (n = 925, 30.1%). Multivariable analysis showed that the factors directly associated with the adherence to HPV vaccination were female sex (OR = 4.43, p < 0.001), high HBM total score (OR = 4.23, p < 0.001), good HL level (OR = 1.26, p = 0.047), parents (OR = 1.78, p = 0.004), general practitioner (OR = 1.88, p = 0.001), and educational material provided by public vaccination services (OR = 1.97, p = 0.001) as HPV vaccine information sources. Further health-promotion programs focused on improving HL and perception of the HPV vaccine’s benefits should be implemented in order to achieve the desirable 95% vaccination coverage.
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Rodriguez, S. A., A. M. Roncancio, L. S. Savas, D. M. Lopez, S. V. Vernon, and M. E. Fernandez. "Using Intervention Mapping to Develop and Adapt Two Educational Interventions to Increase HPV Vaccination Among Hispanic Adolescents." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 16s. http://dx.doi.org/10.1200/jgo.18.46400.
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Background: HPV vaccination among Hispanic adolescents falls below the national goal. Tailored interventions to increase vaccination among Hispanic populations are needed to reach national goals and to reduce HPV-related cancer disparities. Aim: We used the intervention mapping (IM) framework to develop and adapt two educational interventions, a print fotonovela and a tailored interactive multimedia intervention (TIMI), targeting Hispanic parents of adolescents to increase HPV vaccine uptake. Methods: To develop the interventions, we followed IM steps 1-6 to 1) develop a logic model of the problem and identify modifiable factors associated with vaccination by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; 2) develop behavioral outcomes, identify determinants, and develop a matrix of change objectives; 3) develop a program theme and program components, identify theoretical methods, and operationalize methods as practical applications; 4) develop an intervention design plan; 5) develop implementation strategies; and 6) evaluate the interventions. To adapt the interventions, we followed steps 1-6 for the new target population, Hispanic parents of adolescent males. Throughout the adaptation process, we assessed the outputs from the original intervention development process to identify needed adaptations. Results: Through formative research in step 1, we identified modifiable determinants associated with parental decision-making about vaccinating their daughters. In step 2, we crossed performance objectives with these factors to produce a matrix of change objectives that served as a blueprint for program development. We then identified tailoring and targeting, framing and anticipated regret, modeling, skill building, and education and counseling as theoretical methods to address the determinants and create behavior change. We produced two program components, a print fotonovela and TIMI, with the theme “For Our Daughters.” Our implementation plan identified lay health workers as implementers. A logic model of change guided evaluation planning. We later adapted the intervention content for parents of Hispanic adolescent males and changed the theme to “For Our Children.” We identified new knowledge gaps as parents were less informed about the HPV vaccine for males. We made surface adaptations including filming new scenes to produce a new fotonovela and TIMI. We conducted content analysis to ensure intervention messages corresponded to change objectives. Conclusion: IM provided a systematic methodology for program development and adaptation to produce two educational interventions to increase HPV vaccination among Hispanic adolescents. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.
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Niu, Zhaomeng, Trishnee Bhurosy, David C. Jeong, Elliot J. Coups, Carolyn J. Heckman, and Jerod L. Stapleton. "Associations of Social Media Use, Patient-centered Communication, and Knowledge with Perceived Human Papillomavirus Vaccine Effectiveness." American Journal of Health Behavior 44, no. 5 (September 1, 2020): 642–51. http://dx.doi.org/10.5993/ajhb.44.5.8.
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Objectives: Given the effectiveness of human papillomavirus (HPV) vaccination in preventing cervical cancer and other diseases, as well as the low rates of HPV vaccination in the United States, it is important to examine the determinants of perceived HPV vaccine effectiveness. In this study, we examined the associations between potential factors associated with perceived HPV vaccine effectiveness. Methods: We utilized data (N = 718) from the nationally representative 2017 Health Information National Trends Survey (HINTS). We examined the associations of health-related social media use, patient-centered communication, and HPV knowledge with perceived HPV vaccine effectiveness in preventing cervical cancer. We reported descriptive statistics, and conducted bivariable analyses, multivariable analysis, and mediation analyses. Results: Perceived HPV vaccine effectiveness was associated with sex, age, education, health-related social media use, and HPV knowledge. Additionally, HPV knowledge mediated the associations of health-related social media use and patient-centered communication with perceived HPV vaccine effectiveness. Conclusions: Improving health-related information from social media, patient-centered communication, and HPV knowledge may increase perceived HPV vaccine effectiveness and ultimately, vaccine adoption.
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Ukumo, Eshetu Y., Feleke G. Weldehawariat, Samuel A. Dessalegn, Desta M. Minamo, and Haymanot N. Weldehawaryat. "Acceptance of Human Papillomavirus Vaccination and Associated Factors among Girls in Arba Minch Town, Southern Ethiopia, 2020." Infectious Diseases in Obstetrics and Gynecology 2022 (December 7, 2022): 1–11. http://dx.doi.org/10.1155/2022/7303801.
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Background. Cervical cancer is Ethiopia’s second biggest cause of cancer-related death among women. The introduction of human papilloma virus (HPV) vaccination is expected to have a significant impact on the burden of cervical cancer. In Ethiopia, particularly in our study area, little is known regarding girls’ acceptance of HPV vaccination. Therefore, this study has assessed the acceptance of HPV vaccination and associated factors among girls in Arba Minch town, southern Ethiopia. Methods. A school-based cross-sectional study was conducted on January 1, 2020. Based on convenience, Arba Minch town was purposefully selected. Stratification was done to stratify private and public schools, then simple random sampling to select sample schools from each, and finally, a proportional allocation of sample size to each school. The determinants and independent variables that influence the acceptance of the human papillomavirus vaccination were determined using a multivariable logistic regression model. Results. This study’s overall acceptance rate for study participants was 50.4% (95% CI) (45.9–55.2). Girls’ age ( AOR = 2.93 , 95% CI (1.57_5.47), P value 0.001), mothers’ educational level (secondary and more than secondary, AOR = 2.40 , 95% CI (1.01_5.73), P value 0.048, and 3.64, 95% CI (1.61_8.25), P value 0.002, respectively), positive attitude ( AOR = 5.22 , 95% CI (2.96_9.19), P value ≤ 0.001 ), good knowledge ( AOR = 2.49 , 95% CI (1.19_5.24), P value 0.001), and receiving childhood immunization ( AOR = 14.85 , 95% CI (8.58_25.72), P value ≤ 0.001 ) were factors associated with girls’ acceptance of the human papillomavirus vaccination. Conclusions and Recommendation. Only half of the study participants accepted HPV vaccination. Therefore, Arba Minch town health institutions should better boost the acceptance of HPV vaccination by improving the knowledge and attitudes of girls. Factors associated with girls’ acceptance of HPV vaccination were age, mothers’ educational status, positive attitude, knowledge of HPV vaccination, and receiving childhood immunization.
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Pot, Mirjam, Theo GWM Paulussen, Robert AC Ruiter, Liesbeth Mollema, Miranda Hofstra, and Hilde M. Van Keulen. "Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial." Journal of Medical Internet Research 22, no. 7 (July 17, 2020): e14822. http://dx.doi.org/10.2196/14822.
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Background In the Netherlands, human papillomavirus (HPV) vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, web-based tailored intervention to which mothers of Dutch girls were invited to participate. Objective The aim of this study was to provide insight into the intervention’s working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with program acceptability and intervention effects (ie, dose-response relationship). Methods Only mothers from the intervention arm of a randomized controlled trial that assessed the effectiveness of the web-based, tailored intervention were included in this study. They were invited to visit the website of the web-based intervention between baseline (January 2015, just before access to the intervention) and follow up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (ie, duration of intervention exposure) and completeness (ie, proportion of all available web pages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were IDM, decisional conflict, and social-psychological determinants of HPV vaccination uptake. Results Among the 3995 invited mothers, 2509 (62.80%) logged on to the website, 2239 of whom (89.24%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes (SD 12.41) on the website and completed 50.04% (SD 26.18%) of the website components. Participants rated the website 7.64 (SD 1.39) on a 10-point scale. Program acceptability was significantly associated with completeness (β=4.36, P<.001), but not with time of website use (β=–.07, P=.77). Intention-to-treat analysis (N=3995) showed a significant positive effect of completeness on all outcome measures (all P<.003; Bonferroni-corrected α=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (all P<.003), except for uptake (P=.20), risk perception when not vaccinated (P=.14), subjective norms (P=.03), and habit (P=.01). Conclusions Program use and acceptability of the intervention were adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (ie, dose-response effects) were found for completeness and time of website use on the mothers’ IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters’ vaccination uptake. This indicates that the web-based, tailored intervention fits well with the mothers’ needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. Trial Registration Netherlands Trial Register NTR4795; https://www.trialregister.nl/trial/4795
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Huang, Yan, Cheng Chen, Lei Wang, Huamei Wu, Ting Chen, and Luying Zhang. "HPV Vaccine Hesitancy and Influencing Factors among University Students in China: A Cross-Sectional Survey Based on the 3Cs Model." International Journal of Environmental Research and Public Health 19, no. 21 (October 28, 2022): 14025. http://dx.doi.org/10.3390/ijerph192114025.
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The burden of disease caused by cervical cancer ranked second among female tumors in China. The HPV vaccine has been proven to be a cost-effective measure to prevent cervical cancer, but the vaccination rate remained low to date among university students. This study aimed to understand the status quo of HPV vaccine hesitancy among university students across China during the COVID-19 pandemics and systematically analyze determinants of HPV vaccine hesitancy based on the WHO 3Cs model. Cross-sectional data were collected using an online survey of female university students in four cities across China in June 2022. Multinomial logistic regression was adopted to determine factors influencing vaccine hesitancy based on the 3Cs model with three dimensions, namely complacency, convenience, and confidence. Among 1438 female university students surveyed in this study, 89.7% did not hesitate to vaccinate against HPV, only 8.9% hesitated to some extent, and 1.4% refused to vaccinate. The actual vaccination rate for the HPV vaccine was 34.2%. Based on the 3Cs model, this study found that the trust on the efficacy of vaccines, risk perception of being infected by HPV, price, and distance/time were influencing factors of vaccine hesitancy. Knowledge of the HPV vaccine and sociodemographic characteristics, such as education levels, were also statistically relevant. Therefore, it is recommended that relevant scientific knowledge on cervical cancer and the HPV vaccine should be spread on campus, the vaccination appointment procedure should be simplified, and the affordability of vaccination should be increased through strategic purchasing or providing subsidies, so as to reduce HPV vaccine hesitancy.
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Pot, Mirjam, Hilde M. van Keulen, Robert A. C. Ruiter, Iris Eekhout, Liesbeth Mollema, and Theo W. G. M. Paulussen. "Motivational and contextual determinants of HPV-vaccination uptake: A longitudinal study among mothers of girls invited for the HPV-vaccination." Preventive Medicine 100 (July 2017): 41–49. http://dx.doi.org/10.1016/j.ypmed.2017.04.005.
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Chiang, Ellen Dias De Oliveira, Misha L. Baker, Daniella Figueroa-Downing, Maria Luiza Baggio, Luisa Villa, Jose Eluf Neto, Craig Hadley, Robert A. Bednarczyk, and Dabney P. Evans. "“THOSE WHO LOVE, VACCINATE”: PARENTAL PERCEPTIONS OF HPV VACCINATION." Journal of Human Growth and Development 25, no. 3 (October 25, 2015): 341. http://dx.doi.org/10.7322/jhgd.106013.
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Introduction: In March 2014, Brazil began its national HPV immunization campaign targeting girls ages 9-13. Objective: Describe determinants of parental decisions to vaccinate their daughters against HPV.Method: In this qualitative study, thirty semi-structured interviews were conducted at five health posts in São Paulo, Brazil. Interview questions explored parental opinions of disease prevention methods, vaccines in general, and the HPV vaccine. Interviews were analyzed using grounded theory. Results: Overall, parental knowledge about HPV and the vaccine was low, yet most eligible daughters had been vaccinated. Parents perceived the HPV vaccine to be normal, preventative, and protective. Parents viewed themselves as accountable for their children’s health, and saw the vaccine as a parenting tool for indirect control. Trust in healthcare professionals and an awareness of the dangers of “nowadays” (uncertainties regarding disease and sexual behavior) were also important in vaccine decision-making. These factors held more explanatory power for decisions to vaccinate than parental knowledge levels. This was the first study to qualitatively examine the perception of publically provided HPV vaccination among parents with eligible daughters in Brazil. The findings help interpret the greater than 90% coverage for the first HPV vaccine dose in Brazil. The results indicate that attempts to understand, maintain, or modify vaccination rates require the consideration of context specific factors, which influence both parent perspectives and vaccination decisions. Conclusion: HPV knowledge levels are not predictive of parental decisions to vaccinate daughters. Context specific factors from the sociocultural dimensions of parenting, sexuality, gender, and the healthcare system are more influential in vaccine decision-making.
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Vautrin, Hanna, Nicolas Senn, and Christine Cohidon. "Primary prevention of sexually transmitted infections in Switzerland: practices of family physicians and their determinants—a national cross-sectional survey." BMJ Open 10, no. 9 (September 2020): e032950. http://dx.doi.org/10.1136/bmjopen-2019-032950.
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ObjectivesTo describe the activities of general practitioners (GPs) pertaining to primary prevention in the field of affective and sexual life, studying the advice they provide as well as their vaccination practices.DesignCross-sectional national survey.Setting/participantsThe study was carried out using the Swiss Primary Care Active Monitoring GPs’ network, a national GP network created in 2012. One hundred and seventy Swiss GPs, from a random sample from professional lists stratified by canton, participated in the present study.Primary and secondary outcome measuresPrevention practices against sexually transmitted infections (STIs) performed by GPs through advice provided as well as their vaccination practices. Predictive factor of these practices through their links with the doctors’ relevant characteristics and their opinions about STI prevention.ResultsApproximately 80% consider prevention in the area of affective and sexual life to be part of their duty and discuss it easily with patients. Most of them spontaneously give advice regarding STIs during a routine consultation. Regarding human papillomavirus (HPV) immunisation in adults, almost half of GPs report never doing it, while almost 75% often or always immunise their adult patients against hepatitis B. Higher numbers of consultations per day are associated with vaccinating more adults against HPV (OR 1.13 (1.05 to 1.23)) and against hepatitis A (OR 1.17 (1.05 to 1.31)). Vaccinating children against hepatitis B is associated with practising in rural areas (OR 4.64 (1.20 to 17.98)). GPs practising in the French-speaking region of Switzerland immunise children less against HPV (OR 0.40 (0.20 to 0.80)). Longer consultations are associated with providing advice on affective and sexual life during a first consultation (OR 1.08 (1.01 to 1.14)).ConclusionSwiss GPs are involved in primary prevention against STIs and consider it as their responsibility. Prevention practices are associated with GPs’ favourable opinions on prevention.
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Ulendorf Jacobsen, Stine, Palle Valentiner-Branth, and Kåre Mølbak. "Examining determinants for reporting suspected adverse events following HPV vaccination in Denmark." Vaccine 36, no. 41 (October 2018): 6158–62. http://dx.doi.org/10.1016/j.vaccine.2018.08.061.
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Gainforth, Heather L., Wei Cao, and Amy E. Latimer-Cheung. "Determinants of Human Papillomavirus (HPV) Vaccination Intent Among Three Canadian Target Groups." Journal of Cancer Education 27, no. 4 (August 4, 2012): 717–24. http://dx.doi.org/10.1007/s13187-012-0389-1.
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Maness, Sarah B., and Erika L. Thompson. "Social Determinants of Human Papillomavirus Vaccine Uptake: An Assessment of Publicly Available Data." Public Health Reports 134, no. 3 (April 5, 2019): 264–73. http://dx.doi.org/10.1177/0033354919838219.
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Objectives: Despite cancer prevention benefits associated with the human papillomavirus (HPV) vaccine, uptake in the United States is relatively low among males and females. Our objective was to use the Healthy People 2020 social determinants of health framework to determine the availability and characteristics of data on economic, educational, social, health care, and community factors affecting HPV vaccine uptake in the United States. Methods: We included the most recent data sets from 6 publicly available, US-based, federally funded surveys that contained at least 1 measure of HPV vaccination among adolescents and young adults. We searched each data set for any social determinants of health measures within the 5 domains of the framework: economic stability, education, social and community context, health and health care, and neighborhood and built environment. Results: The social determinants of health domains of education, economic stability, and health and health care appeared in all data sets. The domains of social and community context and neighborhood and built environment appeared in only 3 data sets. Even when domains were represented, we discovered gaps in the data sets, in which only limited measures of the social determinants were available. Conclusion: The addition of questions about the social determinants of health to the surveys that generate these data sets, particularly in the domains of social and community context and neighborhood and built environment, would strengthen the ability of public health researchers, policy makers, and professionals to identify associations between the social determinants of health and HPV vaccine uptake.
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Washington, A., J. Chabaan, A. Fakih, S. Ford, L. Rutledge, J. Lilly, P. Clemons, and H. Thompson. "“Should I Give it to My Kids?”: Factors that Influence HPV Vaccine Hesitancy Among African American Parents." Cancer Epidemiology, Biomarkers & Prevention 31, no. 7 (July 1, 2022): 1512. http://dx.doi.org/10.1158/1055-9965.epi-22-0478.
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Purpose: The purpose of our study was to describe the influences that impact vaccine hesitancy in African American parents who have previously delayed or denied vaccinating their children against HPV. Methods: We conducted three focus groups, approx. 90 minutes each. Participants were recruited from various community clinics and organizations in Michigan. Using thematic analysis and the Vaccine Hesitancy Determinants framework, we described the experiences of parents who have delayed or denied vaccinating their children against HPV. Results: Twenty parents participated in the focus groups; the majority of the parents had Medicaid (75%), were employed full-time (55%), and had some college education but no degree (50%). Several contextual factors influenced decision-making: historical events, perceptions of both pharmaceutical and governmental figures, and perceived discrimination based on race and socioeconomic status. Whether it was the result of mistrust due to the ongoing Flint water crisis or concern over the profit-driven industry of pharmaceutical companies, these parents were deeply mistrustful of the motivations behind vaccination programs. Parental beliefs and attitudes focused on ensuring the health and safety of their children, which involved being hesitant to vaccinate. Some parents were swayed by vaccination experiences of personal acquaintances, while others maintained their hesitancy status. Knowledge and awareness in this group were mixed regarding the HPV vaccine. Most struggled to articulate the purpose of the vaccine thoroughly and often refused to vaccinate their children. Meanwhile, only a few vaccine-specific issues were relevant in group discussions, such as vaccination schedule and provider recommendation. Some parents viewed weak recommendations as a subtle signal to not vaccinate their children, while others viewed too strong of a recommendation as a cause for concern. Conclusion: Findings highlight parents' willingness to stick with their strong beliefs, despite recommendations from healthcare providers and personal acquaintances. Effective communications strategies are essential for health education and establishing a trustworthy patient-provider relationship.
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Geshnizjani, Alireza, Kristen N. Jozkowski, and Susan E. Middlestadt. "Factors Influencing the Intention of Getting the HPV Vaccine among College Women." Californian Journal of Health Promotion 11, no. 2 (September 1, 2013): 01–11. http://dx.doi.org/10.32398/cjhp.v11i2.1526.
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Purpose: Although at high risk for contracting HPV, less than half of college women have been vaccinated. The purpose of the current study was to examine underlying factors influencing college women’s intention to get the HPV vaccine using the Reasoned Action Approach (RAA). Methods: Data were collected from two different samples of college women at a large Mid-west university via two phases. In Phase 1, a salient-belief elicitation survey based on the RAA was utilized to collect quantitative and qualitative data from 43 college women. Phase 1 data were then utilized to create a quantitative closed-ended instrument, which was administered to a large sample (n=279) of female college students in Phase 2. Results: Results indicated that the perceived consequences of getting the vaccine, such as protection against HPV and cervical cancer, were primary determinants influencing intention to get the HPV vaccine. Participants perceived healthcare providers and mothers as salient referents influencing their vaccination decisions. Attitude towards the act and perceived norm were the major predictors of intention to get a vaccine. Conclusions: Results suggest the importance of attitudes and perceived norms (especially mothers and healthcare providers) in predicting intention to get the HPV vaccine. Utilizing theory-based approaches to design interventions may be beneficial to increase vaccination rates among college women. Such interventions could focus on the attitudes and perceived norms of college students’ regarding getting the HPV vaccine.
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Aldossri, Musfer, Chimere Okoronkwo, Virginia Dodd, Heather Manson, and Sonica Singhal. "Determinants of dentists’ readiness to assess HPV risk and recommend immunization: A transtheoretical model of change-based cross-sectional study of Ontario dentists." PLOS ONE 16, no. 2 (February 17, 2021): e0247043. http://dx.doi.org/10.1371/journal.pone.0247043.
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Objectives To evaluate dentists’ readiness to assess the history of human papilloma virus (HPV) infections and recommend immunization among their patients. Materials and methods A link to a self-administered questionnaire was emailed to Ontario dentists. Dentists’ readiness and its determinants were assessed based on Transtheoretical Model’s ‘stages’ and ‘processes’ of change, respectively. Based on their current practices, dentists were either assigned to ‘pre-action’ or ‘action+’ stages. Results Of the 9,975 dentists contacted, 932 completed the survey; 51.9% participants were in action stage to assess the history of HPV infections and 20.5% to recommend immunization. Internationally-trained and those whose office’s physical layout was not a concern to discuss patients’ sexual history were more likely to assess the history. Dentists with higher knowledge about HPV vaccines, not concerned about the HPV vaccine safety, comfortable discussing sex-related topics with patients, or willing to exceed their scope of practice were more ready to recommend HPV immunization to their patients. Conclusion Improving Ontario dentists’ knowledge and communication skills and changing their self-perceived role regarding HPV infections and vaccination can increase their capacity to minimize the burden of HPV infections.
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Héquet, Delphine, and Roman Rouzier. "Determinants of geographic inequalities in HPV vaccination in the most populated region of France." PLOS ONE 12, no. 3 (March 3, 2017): e0172906. http://dx.doi.org/10.1371/journal.pone.0172906.
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Wang, Linda Dong-Ling, Wendy Wing Tak Lam, Joseph Wu, and Richard Fielding. "Psychosocial determinants of Chinese parental HPV vaccination intention for adolescent girls: preventing cervical cancer." Psycho-Oncology 24, no. 10 (June 4, 2015): 1233–40. http://dx.doi.org/10.1002/pon.3859.
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Brouwer, Andrew F., Lora P. Campredon, Heather M. Walline, Brittany M. Marinelli, Christine M. Goudsmit, Trey B. Thomas, Rachel L. Delinger, et al. "Prevalence and determinants of oral and cervicogenital HPV infection: Baseline analysis of the Michigan HPV and Oropharyngeal Cancer (MHOC) cohort study." PLOS ONE 17, no. 5 (May 16, 2022): e0268104. http://dx.doi.org/10.1371/journal.pone.0268104.
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We determined baseline oral and cervicogenital human papillomavirus (HPV) prevalence and determinants of infection in the Michigan HPV and Oropharyngeal Cancer (MHOC) study. We enrolled 394 college-age and older participants of both sexes in Ann Arbor, Michigan and the surrounding area. All participants provided an oral sample at baseline, and 130 females provided a cervicogenital sample. Samples were tested for 18 HPV genotypes using polymerase chain reaction (PCR) MassArray. Participants filled out sociodemographic and behavioral questionnaires. Prevalence ratios for HPV oral or cervicogenital prevalence by predictor variables were estimated in univariable log-binomial models. Analysis was conducted 2018–20. In the full cohort, baseline oral HPV prevalence was 10.0% for any detected genotype (among the 338 valid oral tests at baseline) and 6.5% for high-risk types, and cervicogenital prevalence was 20.0% and 10.8%, respectively (among the 130 first valid cervicogenital tests). Oral HPV prevalence did not vary by sex, with 10.5% of women and 9.0% of men having an infection. We found a high prevalence of oral and cervicogenital HPV infection in college-age participants reporting no lifetime sexual partners. Reporting a single recent partner was associated with a lower oral HPV prevalence (PR 0.39, 95% CI: 0.16, 0.96) than reporting no recent (but at least one ever) partner. No similar protective effect was seen for cervicogenital HPV. Both oral and cervicogenital prevalence increased with the number of recent partners for most sexual behaviors. We observed an ecological fallacy masking the direction of impact of vaccination on HPV prevalence in the full cohort compared to the college-aged and the age 23+ populations considered separately. Substance use was not significantly associated with oral or cervicogenital HPV infection. Many studies report substantially higher oral HPV infection prevalence in men than in women. That difference may not be uniform across populations in the US.
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Zhang, Hansi, Christopher Wheldon, Adam G. Dunn, Cui Tao, Jinhai Huo, Rui Zhang, Mattia Prosperi, Yi Guo, and Jiang Bian. "Mining Twitter to assess the determinants of health behavior toward human papillomavirus vaccination in the United States." Journal of the American Medical Informatics Association 27, no. 2 (November 11, 2019): 225–35. http://dx.doi.org/10.1093/jamia/ocz191.
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Abstract Objectives The study sought to test the feasibility of using Twitter data to assess determinants of consumers’ health behavior toward human papillomavirus (HPV) vaccination informed by the Integrated Behavior Model (IBM). Materials and Methods We used 3 Twitter datasets spanning from 2014 to 2018. We preprocessed and geocoded the tweets, and then built a rule-based model that classified each tweet into either promotional information or consumers’ discussions. We applied topic modeling to discover major themes and subsequently explored the associations between the topics learned from consumers’ discussions and the responses of HPV-related questions in the Health Information National Trends Survey (HINTS). Results We collected 2 846 495 tweets and analyzed 335 681 geocoded tweets. Through topic modeling, we identified 122 high-quality topics. The most discussed consumer topic is “cervical cancer screening”; while in promotional tweets, the most popular topic is to increase awareness of “HPV causes cancer.” A total of 87 of the 122 topics are correlated between promotional information and consumers’ discussions. Guided by IBM, we examined the alignment between our Twitter findings and the results obtained from HINTS. Thirty-five topics can be mapped to HINTS questions by keywords, 112 topics can be mapped to IBM constructs, and 45 topics have statistically significant correlations with HINTS responses in terms of geographic distributions. Conclusions Mining Twitter to assess consumers’ health behaviors can not only obtain results comparable to surveys, but also yield additional insights via a theory-driven approach. Limitations exist; nevertheless, these encouraging results impel us to develop innovative ways of leveraging social media in the changing health communication landscape.
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Muwonge, Richard, Partha Basu, Tarik Gheit, Devasena Anantharaman, Yogesh Verma, Neerja Bhatla, Smita Joshi, et al. "Acquisition, prevalence and clearance of type-specific human papillomavirus infections in young sexually active Indian women: A community-based multicentric cohort study." PLOS ONE 15, no. 12 (December 29, 2020): e0244242. http://dx.doi.org/10.1371/journal.pone.0244242.
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In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18–23 years were recruited in 2012–2015 as age-matched controls to the vaccinated women and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types. HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9–5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4–63%) lower among women with 2-<3 years between marriage and first cervical sample collection compared to those with <2 years. HPV prevalence and acquisition rates in young Indian women were lower than their Western counterparts. HPV 16 infections being most common shows the importance and potential impact of HPV vaccination in India. Women with 2–3 years exposure had reduced risk possibly due to higher infections clearance.
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de Paz-Silava, Sheriah Laine M., Ian Kim B. Tabios, Ourlad Alzeus G. Tantengco, Fresthel Monica M. Climacosa, Clarissa L. Velayo, Ryan C. V. Lintao, Leslie Faye T. Cando, et al. "Determinants of Acquisition, Persistence, and Clearance of Oncogenic Cervical Human Papillomavirus Infection in the Philippines Using a Multi-Omics Approach: DEFEAT HPV Study Protocol." Healthcare 11, no. 5 (February 23, 2023): 658. http://dx.doi.org/10.3390/healthcare11050658.
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HPV infection is one of the most studied risk factors in cervical cancer—the second most common cancer site and cause of death due to cancer in the Philippines. However, there is a lack of population-based epidemiological data on cervical HPV infection in the Philippines. Local reports on co-infections with other lower genital tract pathogens, commonly reported globally, are also lacking, which emphasizes the need to increase efforts in targeting HPV prevalence, genotype, and distribution. Hence, we aim to determine the molecular epidemiology and natural history of HPV infection among reproductive-age Filipino women using a community-based prospective cohort design. Women from rural and urban centers will be screened until the target sample size of 110 HPV-positive women (55 from rural sites and 55 from urban sites) is reached. Cervical and vaginal swabs will be collected from all screened participants. For HPV-positive patients, HPV genotypes will be determined. One hundred ten healthy controls will be selected from previously screened volunteers. The cases and controls will comprise the multi-omics subset of participants and will be followed up after 6 and 12 months for repeat HPV screening. Metagenomic and metabolomic analyses of the vaginal swabs will also be performed at baseline, after 6 months, and after 12 months. The results of this study will update the prevalence and genotypic distribution of cervical HPV infection among Filipino women, determine whether the current vaccines used for HPV vaccination programs capture the most prevalent high-risk HPV genotypes in the country, and identify vaginal community state types and bacterial taxa associated with the natural history of cervical HPV infection. The results of this study will be used as the basis for developing a biomarker that can help predict the risk of developing persistent cervical HPV infection in Filipino women.
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Andujar, Miguel, Esther Roura, Alejandra Torres, Begoña Vega, Marta Pavcovich, Miguel Angel Sanchez, Amina Lubrano, et al. "Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands." BMJ Open 10, no. 9 (September 2020): e037402. http://dx.doi.org/10.1136/bmjopen-2020-037402.
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ObjectiveNational Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18–65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors.MethodsBased on the Primary Health Care database, a sample of adult women (aged 18–65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection.Results6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%–14.5%) and 11.1% (CI 10.3%–11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18–29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts.ConclusionsIt is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations.
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Burdette, Amy M., Hanna Gordon-Jokinen, and Terrence D. Hill. "Social determinants of HPV vaccination delay rationales: Evidence from the 2011 National Immunization Survey–Teen." Preventive Medicine Reports 1 (2014): 21–26. http://dx.doi.org/10.1016/j.pmedr.2014.09.003.
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Schiffman, Mark, and Philip E. Castle. "Human Papillomavirus: Epidemiology and Public Health." Archives of Pathology & Laboratory Medicine 127, no. 8 (August 1, 2003): 930–34. http://dx.doi.org/10.5858/2003-127-930-hpeaph.
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Abstract Approximately 15 types of human papillomavirus (HPV) infection cause virtually all cases of cervical cancer. Human papillomavirus 16 is the major type, accounting for approximately 50% of cases. The major steps of cervical carcinogenesis include HPV infection, viral persistence and progression to precancer (as opposed to viral clearance), and invasion. Human papillomavirus is the most common sexually transmitted infection. However, most HPV infections become undetectable by even sensitive HPV DNA testing within 1 to 2 years. The prevalence of infection peaks at young ages and declines thereafter, perhaps as the result of HPV type-specific acquired immunity. Most HPV infections are neither microscopically evident nor visible, making HPV DNA detection the diagnostic reference standard. Poorly defined immunologic factors are the major determinants of viral outcome. Smoking, multiparity, and long-term oral contraceptive use increase the risk of persistence and progression. Other sexually transmitted infections (eg, Chlamydia trachomatis), chronic inflammation, and nutritional factors might also play a role. Overt, long-term viral persistence in the absence of precancer is uncommon. New prevention strategies can be derived from the evolving knowledge of HPV carcinogenesis. Human papillomavirus vaccination is the ultimate prevention strategy, and large-scale trials are already underway. In the meantime, HPV DNA diagnostics are more sensitive although less specific than cytology, permitting a consideration of lengthened screening intervals. In terms of public health education, clinicians and patients will need to shift discussions of the mildly abnormal Papanicolaou test to consideration of HPV infection as a common sexually transmitted infection that rarely causes cervical cancer.
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Elizondo-Alzola, Usue, Mireia G. Carrasco, Laia Pinós, Camila Andrea Picchio, Cristina Rius, and Elia Diez. "Vaccine hesitancy among paediatric nurses: Prevalence and associated factors." PLOS ONE 16, no. 5 (May 19, 2021): e0251735. http://dx.doi.org/10.1371/journal.pone.0251735.
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Objective This study describes the prevalence of vaccine hesitancy associated with the Catalan systematic childhood vaccination calendar and some related psychosocial determinants among paediatric primary care nurses in Barcelona (Spain). Methods Cross-sectional descriptive study. In 2017 we invited the paediatric nurses (N = 165) working in Barcelona public primary health centres with paediatric departments (N = 41) to participate. They answered a questionnaire with sociodemographic and behavioural variables: severity and perceived probability of contracting the diseases of the vaccines in the vaccination schedule; safety and protection offered by each vaccine; and beliefs, social norms, and knowledge about vaccines. Outcome variable was vaccine hesitancy, dichotomized into not hesitant (nurses who would vaccinate their own offspring), and hesitant (including those who would not vaccinate them, those who had doubts and those who would delay the administration of one or more vaccines). We performed bivariate analysis and adjusted logistic regression models. Results 83% of paediatric nurses (N = 137) agreed to participate. 67.9% had the intention to vaccinate their children of all the vaccines in the systematic schedule. 32.1% of nurses experienced vaccine hesitancy, especially about the HPV (21.9%) and varicella (17.5%) vaccines. The multivariate analysis suggests associations between hesitancy and low perception of the severity of whooping cough (aOR: 3.88; 95%CI:1.32–11.4), low perception of safety of the HPV vaccine (aOR:8.5;95%CI:1.24–57.8), the belief that vaccines are administered too early (aOR:6.09;95%CI:1.98–18.8), and not having children (aOR:4.05;95%CI:1.22–13.3). Conclusions Although most paediatric nurses had the intention to vaccinate their own children, almost one-third reported some kind of vaccine hesitancy, mainly related to doubts about HPV and varicella vaccines, as well as some misconceptions. These factors should be addressed to enhance nurses’ fundamental role in promoting vaccination to families.
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Karafillakis, Emilie, Clarissa Simas, Caitlin Jarrett, Pierre Verger, Patrick Peretti-Watel, Fadia Dib, Stefania De Angelis, et al. "HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe." Human Vaccines & Immunotherapeutics 15, no. 7-8 (February 20, 2019): 1615–27. http://dx.doi.org/10.1080/21645515.2018.1564436.
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Bordeaux, Skyler J., Anthony W. Baca, Rene L. Begay, Francine C. Gachupin, J. Gregory Caporaso, Melissa M. Herbst-Kralovetz, and Naomi R. Lee. "Designing Inclusive HPV Cancer Vaccines and Increasing Uptake among Native Americans—A Cultural Perspective Review." Current Oncology 28, no. 5 (September 24, 2021): 3705–16. http://dx.doi.org/10.3390/curroncol28050316.
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Despite a global and nationwide decrease, Native Americans continue to experience high rates of cancer morbidity and mortality. Vaccination is one approach to decrease cancer incidence such as the case of cervical cancer. However, the availability of vaccines does not guarantee uptake, as evident in the Coronavirus 2019 pandemic. Therefore, as we consider current and future cancer vaccines, there are certain considerations to be mindful of to increase uptake among Native Americans such as the incidence of disease, social determinants of health, vaccine hesitancy, and historical exclusion in clinical trials. This paper primarily focuses on human papillomavirus (HPV) and potential vaccines for Native Americans. However, we also aim to inform researchers on factors that influence Native American choices surrounding vaccination and interventions including cancer therapies. We begin by providing an overview of the historical distrust and trauma Native Americans experience, both past and present. In addition, we offer guidance and considerations when engaging with sovereign Tribal Nations in vaccine development and clinical trials in order to increase trust and encourage vaccine uptake.
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Kreidl, Peter, Maria-Magdalena Breitwieser, Reinhard Würzner, and Wegene Borena. "14-year-old Schoolchildren can Consent to Get Vaccinated in Tyrol, Austria: What do They know about Diseases and Vaccinations?" Vaccines 8, no. 4 (October 15, 2020): 610. http://dx.doi.org/10.3390/vaccines8040610.
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In Austria, consent to receiving vaccines is regulated at the federal state level and in Tyrol, children aged 14 years are allowed to consent to receiving vaccination. In August 2017, we investigated determinants associated with vaccine hesitancy, having been vaccinated against measles and human papillomavirus (HPV) and the intention to vaccinate among schoolchildren born in 2002 and 2003. Those who consider measles and HPV a severe disease had a significantly higher intention to be vaccinated (prevalence ratio (PR) of 3.5 (95% CI 1.97–6.32) for measles and a PR of 3.2 (95% CI 1.62–6.35) for HPV). One-third of the participants (32.4%; 95% CI 27.8–37.4) were not aware that they are allowed to consent to receiving vaccines. The most common trusted source reported by respondents (n = 311) was the medical doctor (80.7%; 95% CI 75.7–84.7). The main finding related to the aim of the study was that the proportion of objectors is below 4% and therefore it should still be possible to reach measles elimination for which a 95% uptake is necessary. Although the proportion of objectors is not higher compared to adults, we recommend to intensify health education to increase health literacy.
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Kuitto, Kati, Susanne Pickel, Henning Neumann, Detlef Jahn, and Hans-Robert Metelmann. "Attitudinal and socio-structural determinants of cervical cancer screening and HPV vaccination uptake: a quantitative multivariate analysis." Journal of Public Health 18, no. 2 (February 5, 2010): 179–88. http://dx.doi.org/10.1007/s10389-009-0308-z.
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Gobert, Cathy, Pascal Semaille, Thierry Van der Schueren, Pierre Verger, and Nicolas Dauby. "Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies among General Practitioners in French-Speaking Parts of Belgium." Vaccines 9, no. 7 (July 10, 2021): 771. http://dx.doi.org/10.3390/vaccines9070771.
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General practitioners (GPs) play a critical role in patient acceptance of vaccination. Vaccine hesitancy (VH) is a growing phenomenon in the general population but also affects GPs. Few data exist on VH among GPs. The objectives of this analysis of a population of GPs in the Belgian Wallonia-Brussels Federation (WBF) were to: (1) determine the prevalence and the features of VH, (2) identify the correlates, and (3) estimate the discrepancy in vaccination’s behaviors between the GPs’ children and the recommendations made to their patients. An online survey was carried out among the population of general practitioners practicing in the WBF between 7 January and 18 March 2020. A hierarchical cluster analysis was carried out based on various dimensions of vaccine hesitancy: perception of the risks and the usefulness of vaccines as well as vaccine recommendations for their patients. A total of 251 GPs answered the survey. The average percentage of moderate to high vaccine hesitancy was 50.6%. Three factors were independently associated with increased risk of vaccine hesitancy: an age <50 years old, having no children, and having no contact with selected vaccine-preventable disease (measles, complicated influenza, chronic hepatitis B (HBV), bacterial meningitis, or cervical cancer) in the past 5 years. VH was associated with controversies on vaccines’ safety. GPs who had vaccinated their children against six diseases (MMR, meningococcus C (MenC), HBV, and HPV) tended not to recommend the same vaccines to their patients. Among GPs with all children vaccinated against HBV, only 37.5% recommended catch-up HBV immunization to their patients. In this small cohort of GP, moderate to high VH was associated with controversies on vaccines’ safety and with specific personal characteristics (age <50, no children, and no recent experience with a serious VPD). As previously reported, GPs have different vaccine prescription attitude toward their patients and children. These findings should be confirmed in larger cohorts.
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Rees, Hannah D., Alexandra R. Lombardo, Caroline G. Tangoren, Sara J. Meyers, Vishnu R. Muppala, and Linda M. Niccolai. "Knowledge and beliefs regarding cervical cancer screening and HPV vaccination among urban and rural women in León, Nicaragua." PeerJ 5 (October 25, 2017): e3871. http://dx.doi.org/10.7717/peerj.3871.
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Background In Nicaragua, cervical cancer is the leading cause of cancer-related death for women ages 15–44, yet access to the HPV vaccine is limited to those with financial resources to pay for it. Cervical cytology is provided free of charge in public clinics; however, only 10% of women receive Pap smears at the nationally recommended frequency. Previous studies have not investigated how beliefs regarding cervical cancer screening may differ for urban and rural populations in Nicaragua. Furthermore, no investigation has assessed Nicaraguan women’s beliefs about a potential HPV immunization campaign. Given beliefs’ influence on health behavior, we investigated the structural, sociocultural, and knowledge-based factors influencing women’s beliefs regarding cervical cancer screening among urban and rural women in León, Nicaragua, and assessed acceptance of a potential HPV immunization program. Methods Our sequential explanatory mixed-methods study consisted of two phases: (1) a close-ended questionnaire, followed by (2) a qualitative, in-depth interview. Our quantitative sample contained 117 urban and 112 rural participants aged 18–49. We assessed beliefs regarding cervical cancer screening using a 22-item scale, with higher scores indicating screening-promoting beliefs in simple linear and multiple linear regressions. Twenty qualitative interviews, exploring the sociocultural dimensions of knowledge and attitudes indicated by our quantitative findings, were conducted with a sample of 13 urban and 7 rural women aged 19–46. Results The multiple linear regression indicates that greater knowledge of Pap smears, HPV, and cervical cancer is significantly associated with screening-promoting beliefs after adjusting for other relevant factors. There was no significant difference in screening knowledge and beliefs for urban and rural women. Four recurrent themes representing determinants of knowledge, beliefs, and attitudes regarding cervical cancer screening arose from interviews and built on quantitative findings: (1) women’s embarrassment due to the intimate nature of the Pap smear and male gender of exam provider discourages screening; (2) women believe Pap smears and cervical cancer are associated with sexual promiscuity, and this association stigmatizes women with the disease; (3) knowledge of cervical cancer prevention is limited to those who regularly attend health centers; and (4) women find screening inconvenient, believing understaffed clinics increase patient wait time, limit time patients spend with clinicians, and delay Pap results. A fifth theme indicates (5) participants’ acceptance of a potential HPV immunization program. Discussion Future interventions should focus on increasing access to information about cervical cancer prevention for women who do not regularly attend health centers. Furthermore, our results suggest that if funding were allocated to make the HPV vaccine accessible in Nicaragua, it would be well received.
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Palikhe, Bishnu, and Shanti Pokhrel. "Knowledge Attitude and Practice of Cervical Cancer Screening Among the Healthcare Workers of Western Region, Nepal." Nepal Journal of Medical Sciences 7, no. 2 (July 31, 2022): 19–23. http://dx.doi.org/10.3126/njms.v7i2.47211.
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Introduction: Cancer cervix being the only preventable cancer in the world is still the leading cause of cancer-related death in developing countries. Awareness and screening programs are a must for health care workers whose direct impact goes on society. Healthy people are found to be given services, but their health is often neglected. This study highlights health care workers' knowledge, attitude and practices on cervical cancer screening. This study aims to assess healthcare workers' knowledge, attitude and practice toward cervical cancer screening in the western region, of Nepal.
Methods: A semi-structured questionnaire was distributed to health care workers from September 2020 to March 2021 eligible to participate in the study were included. A total of 115 participants were enrolled in the study. A descriptive measure for socio-demographic data was done. Determinants of knowledge and practice for screening were determined using the Chi-square test.
Results: The mean age of the participant was 27.92±5.49 (SD). More than half had poor knowledge (51%), followed by moderate knowledge (37%) and less than one eight had good knowledge (12%). 92 % know that cervical cancer is preventable but very less have undergone screening tests.
Conclusion: There is an urgent need for educational intervention to change their attitude towards HPV vaccination and encourage cervical cancer screening program that helps in the prevention of cervical cancer. HPV vaccination should be kept in the immunization schedule and made easily available at a low cost.
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Banik, Suranjana, Dinesh Prasad Sahu, and Himadri Bhattacharjya. "Knowledge and practice regarding cervical cancer prevention among women in a rural area of Tripura, India." International Journal Of Community Medicine And Public Health 9, no. 2 (January 28, 2022): 763. http://dx.doi.org/10.18203/2394-6040.ijcmph20220236.
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Background: Cervical cancer is commonest in developing countries and the third most common form of cancer among women worldwide which presents a later stage causing high morbidity and mortality. PAP smear discovered in 1941 was a revolutionary screening test but acceptance is poor. Objective was to detect the level of awareness regarding prevention of cervical cancer among rural women and to study the determinants of awareness regarding prevention of cervical cancer.Methods:A community based cross-sectional study was conducted in rural field practice area of Agartala Government Medical College for two months among 131 women chosen by multistage sampling, aged 15 years and above. Quantitative data were collected by administering a structured interview schedule. Chi square test was applied for testing the significance of study findings and p<0.05 was considered statistically significant.Results: About 78% of the study women were primary educated and 33.3% of the study women have heard about cervical cancer and health care providers were the source of information for 34.04% of the respondents. 99.2% of the women didn’t hear about PAP smear, nor they have any idea of vaccination. They didn’t undergo any screening test and cited “absence of symptoms” as the main reason.Conclusions:Majority of the studied women didn’t have any clear idea of cervical cancer, screening and vaccination and level of awareness was very low. Intensified health educational programs should be launched. Health workers and physicians must play critical role in counselling. Information about safety, efficacy, insurance coverage etc. to be facilitated for active HPV vaccination.
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Miko, Costache, Colosi, Neculicioiu, and Colosi. "Qualitative Assessment of Vaccine Hesitancy in Romania." Medicina 55, no. 6 (June 17, 2019): 282. http://dx.doi.org/10.3390/medicina55060282.
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Background and objectives: Health systems all over the world are confronted with an alarming rise of cases in which individuals hesitate, delay, and even refuse vaccination, despite availability of quality vaccine services. In order to mitigate and combat this phenomenon, which are now defined by the World Health Organization (WHO) as vaccine hesitancy (VH), we must first understand the factors that lead to its occurrence in an era characterized by wide access to safe and effective vaccines. To achieve this, we conducted field testing of the Vaccine Hesitancy Scale (VHS), as it was developed by the Strategic Advisory Group of Experts Working Group (SAGE WG), in Cluj-Napoca city, Cluj County, Romania. The scale is designed to quantify VH prevalence in a population, establish which vaccines generate the highest percentage of hesitancy, and allow a qualitative assessment of the individual’s reasons for hesitance. Materials and Methods: We conducted an observational cross-sectional survey, which was comprised of descriptive, analytical, and qualitative elements regarding VH. The necessary sample size was 452 individuals. The VHS and Matrix of Determinants (recommended by SAGE WG) for reasons people gave to justify their hesitance, was interpreted by qualitative thematic analysis (QTA) to ensure the validity and reliability in detecting hesitancy across various cultural settings and permit global comparisons. Results: We found a VH of 30.3% and 11.7% of parents reported refusing to vaccinate their child. Among the VH responders, the varicella vaccine generated 35% hesitancy, measles vaccine 27.7%, Human Papillomavirus (HPV) 24.1%, and mumps vaccine 23.4%, respectively. The QTA values for percent agreement ranged from 91% to 100%. Cohen’s Kappa values ranged from 0.45 to 0.95. Contextual influences identified for VH were "media," "leaders and lobbies," and "perception of the pharmaceutical industry." Individual and group influences for VH were "beliefs," "knowledge," and "risk/benefits (perceived).” Vaccine and vaccination specific issues for VH were "risk/benefit (rational)" and "health care practitioners (trustworthiness, competence).” Conclusions: One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.
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Öhlschläger, Peter, Wolfram Osen, Kerstin Dell, Stefan Faath, Robert L. Garcea, Ingrid Jochmus, Martin Müller, et al. "Human Papillomavirus Type 16 L1 Capsomeres Induce L1-Specific Cytotoxic T Lymphocytes and Tumor Regression in C57BL/6 Mice." Journal of Virology 77, no. 8 (April 15, 2003): 4635–45. http://dx.doi.org/10.1128/jvi.77.8.4635-4645.2003.
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ABSTRACT We analyzed capsomeres of human papillomavirus type 16 (HPV16) consisting of the L1 major structural protein for their ability to trigger a cytotoxic T-cell (CTL) response. To this end, we immunized C57BL/6 mice and used the L1165-173 peptide for ex vivo restimulation of splenocytes prior to analysis (51Cr release assay and enzyme-linked immunospot assay [ELISPOT]). This peptide was identified in this study as a Db-restricted naturally processed CTL epitope by HPV16 L1 sequence analysis, major histocompatibility complex class I binding, and 51Cr release assays following immunization of C57BL/6 mice with HPV16 L1 virus-like particles (VLPs). HPV16 L1 capsomeres were obtained by purification of HPV16 L1 lacking 10 N-terminal amino acids after expression in Escherichia coli as a glutathione S-transferase fusion protein (GST-HPV16 L1ΔN10). Sedimentation analysis revealed that the majority of the purified protein consisted of pentameric capsomeres, and assembled particles were not observed in minor contaminating higher-molecular-weight material. Subcutaneous (s.c.) as well as intranasal immunization of C57BL/6 mice with HPV16 L1 capsomeres triggered an L1-specific CTL response in a dose-dependent manner as measured by ELISPOT and 51Cr release assay. Significant reduction of contaminating bacterial endotoxin (lipopolysaccharide) from the capsomere preparation did not diminish the immunogenicity. Antibody responses (serum and vaginal) were less robust under the experimental conditions employed. In addition, s.c. vaccination with HPV16 L1 capsomeres induced regression of established tumors expressing L1 determinants (C3 tumor cells). Our data demonstrate that capsomeres are potent inducers of CTL responses similar to completely assembled T=7 VLPs. This result is of potential relevance for the development of (combined prophylactic and therapeutic) HPV-specific vaccines, since capsomeres can be produced easily and also can be modified to incorporate heterologous sequences such as early HPV proteins.
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Mulherkar, Tania H., Daniel Joseph Gómez, Grace Sandel, and Pooja Jain. "Co-Infection and Cancer: Host–Pathogen Interaction between Dendritic Cells and HIV-1, HTLV-1, and Other Oncogenic Viruses." Viruses 14, no. 9 (September 14, 2022): 2037. http://dx.doi.org/10.3390/v14092037.
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Dendritic cells (DCs) function as a link between innate and adaptive immune responses. Retroviruses HIV-1 and HTLV-1 modulate DCs to their advantage and utilize them to propagate infection. Coinfection of HTLV-1 and HIV-1 has implications for cancer malignancies. Both viruses initially infect DCs and propagate the infection to CD4+ T cells through cell-to-cell transmission using mechanisms including the formation of virologic synapses, viral biofilms, and conduits. These retroviruses are both neurotrophic with neurovirulence determinants. The neuropathogenesis of HIV-1 and HTLV-1 results in neurodegenerative diseases such as HIV-associated neurocognitive disorders (HAND) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Infected DCs are known to traffic to the brain (CNS) and periphery (PNS, lymphatics) to induce neurodegeneration in HAND and HAM/TSP patients. Elevated levels of neuroinflammation have been correlated with cognitive decline and impairment of motor control performance. Current vaccinations and therapeutics for HIV-1 and HTLV-1 are assessed and can be applied to patients with HIV-1-associated cancers and adult T cell leukemia/lymphoma (ATL). These diseases caused by co-infections can result in both neurodegeneration and cancer. There are associations with cancer malignancies and HIV-1 and HTLV-1 as well as other human oncogenic viruses (EBV, HBV, HCV, HDV, and HPV). This review contains current knowledge on DC sensing of HIV-1 and HTLV-1 including DC-SIGN, Tat, Tax, and current viral therapies. An overview of DC interaction with oncogenic viruses including EBV, Hepatitis viruses, and HPV is also provided. Vaccines and therapeutics targeting host–pathogen interactions can provide a solution to co-infections, neurodegeneration, and cancer.
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Geraets, Daan T., Antoon W. Grünberg, Jannie J. van der Helm, Maarten F. Schim van der Loeff, Koen D. Quint, Leslie O. A. Sabajo, and Henry J. C. de Vries. "Cross-sectional study of genital carcinogenic HPV infections in Paramaribo, Suriname: prevalence and determinants in an ethnically diverse population of women in a pre-vaccination era." Sexually Transmitted Infections 90, no. 8 (June 11, 2014): 627–33. http://dx.doi.org/10.1136/sextrans-2013-051384.
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Wiyeh, Alison B., Sara Cooper, Anelisa Jaca, Edison Mavundza, Duduzile Ndwandwe, and Charles S. Wiysonge. "Social media and HPV vaccination: Unsolicited public comments on a Facebook post by the Western Cape Department of Health provide insights into determinants of vaccine hesitancy in South Africa." Vaccine 37, no. 43 (October 2019): 6317–23. http://dx.doi.org/10.1016/j.vaccine.2019.09.019.
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Gilbert, Nicolas L., Heather Gilmour, Ève Dubé, Sarah E. Wilson, and Julie Laroche. "Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013." Human Vaccines & Immunotherapeutics 12, no. 6 (March 4, 2016): 1484–90. http://dx.doi.org/10.1080/21645515.2016.1153207.
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Guo, Na, Jian Wang, Stephen Nicholas, Elizabeth Maitland, and Dawei Zhu. "Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment." Vaccines 8, no. 3 (September 14, 2020): 527. http://dx.doi.org/10.3390/vaccines8030527.
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Understanding behavioral factors differences in the preferences for vaccinations can improve predictions of vaccine uptake rates and identify effective policy interventions to increase the demand for vaccinations. In this study, 353 adults in Shandong province in China were interviewed about their preferences for hepatitis B virus (HBV) vaccination. A discrete choice experiment (DCE) was employed to analyze the preference for HBV vaccinations, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE. While the protection rate against hepatitis B (HB), duration of protection, risk of side-effects, and vaccination cost were shown to influence adults’ preferences for HBV vaccination, adults valued “99% hepatitis B protection” above other attributes, followed by “20 years’ protection duration” and “1 in 150,000 risk of side-effects”. Individuals with lower time discount rates, non-overconfidence, or higher risk aversion were more likely to choose a vaccine. Lower risk aversion individuals showed a higher preference for lower risk of side-effects. Lower time discount rate individuals showed a higher preference for longer protection duration. Non-overconfidence individuals showed a higher preference for higher hepatitis B protection and cost. Interventions should be targeted to the behavioral determinants impeding vaccination.