College Students May Neglect to Initiate, Complete HPV Vaccinations

Even though many college students recognize the importance of human papillomavirus (HPV) vaccination to their health, other factors may prevent them from initiating or completing the full vaccination series, according to a study published in the Asian Pacific Journal of Cancer Prevention.

HPV, a group of more than 200 related viruses, is the most common sexually transmitted infection in the United States. HPV can cause several types of cancer, including cervical, oropharyngeal, and anal cancers. Fortunately, there is a highly effective vaccine, Gardasil9, to prevent primary infection of the 9 most common strains.

Despite widespread availability and health care provider recommendations, national rates of HPV vaccination lag far behind the desired objective of 80% coverage of boys and girls aged 13 to 17 years, the authors noted. The 2019 National Immunization Survey-Teen (NIS-Teen) reported 54.2% of adolescents as up-to-date with the HPV vaccination series.

“College-aged individuals are an ideal population on which to focus catch-up efforts as the majority of HPV infections occur during individuals’ late teens and early twenties,” the authors said.

The Advisory Committee on Immunization Practices recommends routine HPV vaccination be given to girls and boys between ages 11 and 12, although it can be given as early as age 9. The vaccine was originally approved for girls and women aged 9 through 26 years, but subsequently the FDA recommended vaccinating both female and male patients.

Youth between the ages of 11 and 14 should receive 2 doses of vaccine over a 6-month period. Teenagers and young adults aged 15 to 26 years should receive 3 doses over the course of 6 months.

The aim of the present study was to examine factors related to HPV vaccine initiation and completion, especially the role of health knowledge, among college students in a Southern US state. Vaccine initiation was defined as having received at least 1 dose, while completion was described as receiving the full series.

States in the Deep South have some of the lowest HPV vaccination rates in the country and some of the highest rates of HPV-related cancers, the researchers explained.

Investigators enrolled 1708 students attending 2 public universities in the South. The mean (SD) age was 21.7 (4.7) years; 76% were female, and 72.3% were White. Because the FDA approved HPV vaccine use for women and men through age 45 years, students aged up to 45 years were included in the analysis.

Participants completed an electronic questionnaire sent to their university accounts. To measure HPV vaccination initiation and completion, they were asked, “Have you ever had the HPV vaccine?” If yes, they were asked, “Have you completed all the shots?” Additional questions, with yes/no responses, measured HPV knowledge and health care service access: “I can transmit HPV to my partner(s) even though I have no HPV symptoms,” and “Young adult men should receive HPV vaccine.”

Participants were also queried about health insurance coverage, having a primary care physician, and receiving regular flu shots. These variables were not found to be significant predictors for HPV vaccination initiation.

The data showed the following: 

• Although 62.4% of participants did initiate HPV vaccination, only 28.8% completed the full series.
• Over three-quarters (78.2%) of participants knew that HPV could be transmitted even without symptoms. Similar results were found when asked if young adult men should receive the vaccine.
• Participants who were aware that HPV could be transmitted without symptoms were less likely to initiate HPV vaccination.
• However, among students who had initiated vaccination, those who were aware that HPV could be transmitted without symptoms and that men should receive HPV vaccine were more likely to complete the series.

The low vaccination completion rate may indicate limited knowledge and/or awareness concerning the number of vaccinations that the students need and/or have received, the investigators suggested.

The authors acknowledged study limitations. Outcomes were measured by self-reported data compiled from 2 universities with 2 different questionnaires. In addition, despite many similarities, participants from the 2 universities differed in mean age and gender proportion.

Surprisingly, the study found that “college students with higher HPV literacy were still less likely to initiate HPV vaccination,” the authors concluded. Despite understanding the importance of receiving treatment, other factors may stop them from initiating HPV vaccination or completing the recommended series. 

“Future studies are needed to investigate students’ concerns regarding HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series,” the authors wrote.

Reference

Lee HY, Daniel CL, Wang K, et.al. HPV vaccination among college students in the south: the role of HPV knowledge on vaccine initiation and completion. Asian Pac J Cancer Prev. 2023;24(6):2149-2156. doi:10.31557/APJCP.2023.24.6.2149