What college women know, think, and do about Human Papillomavirus (HPV) and HPV vaccine

Abstract

Background: The development of cervical cancer nearly always begins with a sexuallytransmitted Human Papillomavirus (HPV) infection. Approximately 20 million Americans between the ages of 15 and 49 are currently infected with HPV and another 6 million people become newly infected each year. Among these HPV infections, 74% occur in the 15 to 24 year old age group. In 2006, HPV vaccine (Gardasil®) was approved for girls and women aged 9 to 26. However, the national vaccine uptake rate among young women has been low. HPV vaccine mandatory proposals have also been met with controversy. Some advocacy groups have voiced concerns about whether receipt of HPV vaccine might encourage unsafe sexual behaviors. Little is known about how public controversies have influenced the uptake of HPV vaccine or whether HPV vaccinees indeed engage in more unsafe sexual behaviors, compared to their non-HPV vaccinee counterparts. Purposes: This cross-sectional study aimed to: (1) identify factors that influence HPV vaccine uptake among college women and (2) examine the post-vaccine sexual behaviors of college-aged women. Methods: Participants were a convenience sample of college women (n=384) ages 18 to 26 attending a large, public university in Southern California. An electronic self-administered survey was utilized to collect data. The theory of planned behavior provided a framework for understanding the factors associated with vaccine uptake and with post-vaccine sexual behaviors. Results: College women had good HPV/HPV vaccine knowledge. Over 90% of vaccinees and non-vaccinees knew that Pap test is still needed after the vaccination and an HPV vaccine does not protect against all STIs. Both groups also had positive attitudes toward mandatory vaccination. However, knowledge and attitudes toward the vaccine were not directly linked to the outcome predictors—intention to obtain the vaccine and vaccine uptake. While attitude toward getting vaccinated, subjective norms, and perceived behavioral control were correlated with the outcome predictors, subjective norms consistently predicted intention to obtain HPV vaccine and vaccine uptake. There were no significant differences in sexual behaviors (numbers of sexual partners in a life time, numbers of sexual partners in the past 12 months, condom use, condom use frequency) between non-vaccinees and vaccinees. The numbers of sexual partners before and after vaccination among vaccinees were also not significantly different. Conclusions: Strategies to ensure that those who are eligible for catch-up vaccination are vaccinated should include attention to college women's subjective norms. Vaccine mandatory proposal would not be unacceptable to this population and concerns that the HPV vaccine encourages unsafe sexual behaviors and practices among college aged women may be disregarded.