Influencers and Preference Predictors of HPV Vaccine Uptake among US Male and Female Young Adult College Students

The purpose of this study is to evaluate, as predictors of human papillomavirus (HPV) vaccine uptake, knowledge levels of young college-attending adults in Kentucky, United States (US) about HPV-associated cancers and HPV vaccines, as well as their attitudes, beliefs, and behaviours regarding HPV vaccination. In addition, the study initiates an assessment of the perceived influence the student felt he or she had in the vaccination decision.

A self-selected cross-sectional sample of 585 college students completed an evidence-based online survey. The average age was 20.6 (SD 3.15); 78% were female; and 84% of the population had had one or more sexual partners. Of the 585 respondents, 46% had 3 doses of either Gardasil or Cervarix, and 56% had at least one dose of either HPV vaccine.

About 50% of respondents, regardless of vaccination status, said they were likely or very likely to discuss their vaccination status with a new sex partner. On the other hand, significantly more unvaccinated than vaccinated were unlikely or very unlikely to discuss HPV vaccine status prior to a new relationship (36% vs 26%, p<0.05), and the vaccinated were significantly more "undecided" about the discussion than the unvaccinated (26% vs 15%, p<0.05).

Respondents were asked who was most important in making the decision to be vaccinated. Options included: "it was a shared choice between the doctor and me", "myself", "my doctor", or "my parents or guardians". Overall, 69% of respondents chose "myself"; the unvaccinated chose "myself" more frequently (78% vs 63%, p<0.001) than the vaccinated. Overall, 13% indicated that participating in a shared choice was the most important influence to receive vaccination, and this rate was similar between the unvaccinated and vaccinated (10% and 15%, respectively). Although "my parents or guardians" was selected by a small percentage (11% overall), those choosing "my parents or guardians" were more often vaccinated than not (16% vs 4%, p<0.001). "My doctor" was chosen least often (7% overall) and at a similar rate among the unvaccinated and vaccinated respondents (9% and 6%, respectively).

The importance of protection against sexually transmitted infections (STIs), for self or partner, including HPV, was rated highly by males and females and did not differ between the vaccinated and unvaccinated respondents. Concerns about HPV vaccine safety were significantly higher among the unvaccinated than the vaccinated (38% vs 26%, p<0.001), yet neither concern for HPV vaccine safety nor potential need for boosters significantly deterred vaccine uptake. Likewise, knowledge about HPV associated cancers was not predictive of vaccine uptake. On the other hand, parental influence for vaccination was a strong predictor for vaccine uptake (adjusted odds ratio (aOR) = 5.32, 2.71-13.03), and free vaccine nearly doubled the likelihood of being vaccinated (aOR 1.90, 1.05-3.41). In addition, the strong preference for the respondent's partner to be HPV vaccinated predicted vaccine uptake (aOR = 4.04, 95% confidence interval (CI): 2.31-7.05), but the lack of preference for partner vaccination predicted an unvaccinated self (aOR = 0.50, 0.27-0.93).

According to the researchers, one of the most important outcomes of this study was the finding that a very strong/strong preferences for their sexual partner to be vaccinated was a highly significant predictor of HPV vaccine uptake. This projection of health benefit due to a partner's actions rather than taking one's own responsibility is a familiar health conundrum suggesting that future behavioural communication and psychology work in this area is needed. Relatedly, while the respondents overwhelmingly claimed the decision as their own (69%), this self-determination did not result in increased vaccine uptake.

Parental influence (11%) was also a significant predictor of vaccine uptake. Positive parenting has been shown to reverse or negate the effects of peer influence/neighbourhood influence in late adolescence, potentially indicating a possible success in renewed effort at directing health training and education to all adults who act in a parenting role. These findings support the need for lay articles about HPV-associated cancer prevention in age-directed media outlets.

In conclusion: "Finding mechanisms to move young adults to prefer partner vaccination may offer an increase in HPV vaccine uptake, similar to peer pressure or peer education for contraceptive choices. In general, to observe population effects in cervical cancer prevention, we must include post adolescent young adults in the vaccination drive. Co-messaging HPV vaccination and cervical cancer screening to young adults may be the best approach for reducing cervical cancer burden later in life....Lastly, educating young adults on how to navigate difficult discussions about condom usage and other STI protection methods may lead to increased frank communication and more confidence in protecting one's sexual health..."