Cheryl A. Vamos

Influences on Human Papillomavirus Vaccination Status Among Female College Students

OBJECTIVE In 2006, the Food and Drug Administration (FDA) approved the human papillomavirus (HPV) vaccine Gardasil® (Merck) for girls and women aged 9-26 years. Although the vaccine is ideally administered to 11 and 12 year olds, college-aged women may be uniquely at risk for HPV due to high rates of sexual activity and, thus, serve as an important catch-up population for the HPV vaccine. The purpose of this study is to examine factors associated with HPV vaccination status among college women. METHODS In fall 2008, a convenience sample of 256 undergraduate women enrolled in an introductory social science course at a large, public, urban university in the southeastern United States was surveyed. The 30-item paper-and-pencil questionnaire asked for demographic information, HPV knowledge, HPV vaccine beliefs, and HPV vaccination status. The overall survey response rate was 89.6%. RESULTS Most women were unmarried/single (91.7%), with a mean age of 18.9 years (range 17-42). Race/ethnicity status included 73.0% white, 17.5% Hispanic, and 7.7% black/African American. One hundred eleven (40.5%) women reported receiving the vaccine. Nonvaccinated women were less likely to have heard of the vaccine through a healthcare provider (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.35) or from a family member (OR 0.33, 95% CI 0.16-0.68) and more likely to consider a healthcare provider recommendation as being only somewhat important (OR 2.91, 95% CI 1.32-6.41) or not important at all (OR 5.61, 95% CI 0.44-71.87) vs. very important. CONCLUSIONS Findings suggest that healthcare providers have an important role in encouraging HPV vaccination. Continuing education for providers who see preadolescent girls in conjunction with a parent or who treat women of college age may be a worthwhile endeavor.

The Psychosocial Burden of HPV A Mixed-method Study of Knowledge, Attitudes and Behaviors among HPV+ Women

Despite an increased awareness and ‘normalization’ of Human Papillomavirus (HPV) following the release of the HPV vaccine, the psychosocial impact of an HPV infection, the most common sexually transmissible infection (STI), must not be overshadowed. This study employed in-depth interviews (N = 52) and quantitative surveys (N = 154) to assess the knowledge, emotional impact and behavioral consequences of an HPV-related diagnosis in women who had received abnormal Pap test results. Findings revealed confusion over test results and themes related to stigma, fear, self-blame, powerlessness and anger emerged. The promotion of the HPV vaccine should not obfuscate the psychosocial burden associated with an HPV diagnosis.

HPV knowledge among HPV+ women.

OBJECTIVE To assess knowledge and information seeking among women recently receiving an HPV+ diagnosis. METHODS A 2-phase mixed methods design was used. In both phase I (qualitative) and phase II (quantitative), women with scheduled gynecological exams and Pap smears at clinic sites were approached to participate. RESULTS Women expressed confusion about HPV, and most could not correctly articulate the meaning of their diagnosis. Women do engage in further information seeking, especially through the Internet. CONCLUSION Identifying gaps in knowledge among HPV+ women who need clear messages to facilitate their comprehension of the diagnosis is an important public health activity.

Ethnic and Racial Differences in HPV Knowledge and Vaccine Intentions among Men Receiving HPV Test Results

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N=477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.

Confusion about Pap smears: lack of knowledge among high-risk women.

BACKGROUND The impact of the Papanicolaou (Pap) smear on the prevention of cervical cancer is one of the greatest public health success stories. However, it is not clear if women understand the purpose of the Pap smear despite recent advancements and national attention over cervical cancer prevention. The purpose of this study was to examine Pap smear knowledge among three high-risk populations at different points in time. METHODS Women from three separate human papillomavirus (HPV) psychosocial studies completed surveys assessing Pap smear knowledge: (1) HPV-positive women (prevaccine population in 2005-2006, n=154, mean age 23.5), (2) college women (postvaccine population in 2008, n=276, mean age 18.9), and (3) minority college women (postvaccine population in 2011, n=711, mean age 23.3). Frequencies and logistic regression were employed to examine associations between demographic factors and accurate knowledge of Pap smear testing within each study. RESULTS Approximately one quarter of participants across all three samples did not know that the Pap smear is a test for cervical cancer. Participants also incorrectly believed that the Pap smear tests for HPV (82%-91%), vaginal infections (76%-92%), yeast infections (65%-86%), gonorrhea (55%-81%), herpes (53%-80%), HIV/AIDS (22%-59%), and pregnancy (17%-38%). Among all three studies, older age was the only factor significant with higher Pap knowledge. Higher HPV knowledge scores were significantly associated with higher Pap knowledge in studies 2 and 3 only. CONCLUSIONS Knowledge about the purpose of the Pap smear remains low. Findings underscore the significant need for clear and consistent messages among high-risk women regarding the prevention of cervical cancer and other reproductive health conditions.

Men's responses to HPV test results: development of a theory-based survey.

OBJECTIVE To develop and perform psychometric testing on an instrument designed to assess cognitive/emotional responses among men receiving HPV testing. METHODS Men enrolled in an HPV natural history study (N = 139) completed a computer-assisted survey instrument based on Leventhals parallel processing/common-sense model. Data were analyzed using SPSS and Mplus. RESULTS Reliability analyses resulted in Cronbach alpha of 0.72 (knowledge), 0.86 (perceived threat), 0.83 (self-efficacy), and 0.55 (response efficacy). A revised measurement model exhibited evidence of construct validity, as indicated by acceptable model fit statistics. CONCLUSION To our knowledge, this is the only validated instrument assessing mens reactions to an HPV test result.

Trends and predictors of HPV vaccination among U.S. College women and men.

BACKGROUND HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females. METHODS The National College Health Assessment-II (Fall 2009-2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015. RESULTS Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18-21 vs. 22-26years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only. CONCLUSIONS These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.

The Feminization of HPV: Reversing Gender Biases in US Human Papillomavirus Vaccine Policy.

In the article, the authors discuss developments in the prevention of human papillomavirus (HPV)-related cancers in the U.S. as of mid-2016, particularly the approval of a nine-valent HPV vaccines. They cite that the vaccines provide protection against five additional oncogenic HPV types and reverse the feminization of HPV. Also cited are the variability in vaccination rates among age groups and genders and the effectiveness of Papanicolau test screening in HPV cancer prevention.

Oral health promotion interventions during pregnancy: a systematic review

OBJECTIVES Maternal oral disease during pregnancy is a significant public health issue due to its prevalence and lifecourse connections with adverse pregnancy/birth outcomes, early childhood caries, and chronic diseases. Although both medical and dental professional organizations have discipline-specific and co-endorsed guidelines, whether interventions exist that translate oral health evidence into practice remains unknown. Thus, we conducted a systematic review to examine the range, scope and impact of existing oral health promotion interventions during pregnancy. METHODS Search terms related to oral health, health promotion, and pregnancy produced 7754 articles published before March 2013 from five search engines. INCLUSION CRITERIA (i) intervention-based; (ii) quasi-experimental, experimental, or pretest/post-test design; (iii) pregnant women participants; (iv) outcomes including oral health knowledge, attitudes, and/or behaviors; (v) ≥5 participants; (vi) peer-review publication; and (vii) English language. RESULTS All interventions (n = 7) were delivered in prenatal care settings and focused on education. Modalities varied, including the use of oral instruction and audiovisual presentations, in both individual and group formats; however, content was directed toward infant oral health. Few studies specifically addressed prenatal oral health guidelines. Primary outcomes measured included knowledge, beliefs, attitudes, self-efficacy and oral hygiene, and health-seeking behaviors. All but one study showed significant improvement in one of these outcomes postintervention. CONCLUSIONS Few oral health interventions among pregnant women addressed oral-related symptoms, hygiene behaviors, and potential oral-systemic implications specific to mothers. Subsequently, more theory- and evidence-based interventions addressing current prenatal oral health guidelines using rigorous designs are needed to improve oral and systemic health for both women and their offspring.

The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation

Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.