Logo Medical Science Monitor

Call: +1.631.470.9640
Mon - Fri 10:00 am - 02:00 pm EST

Contact Us

Logo Medical Science Monitor Logo Medical Science Monitor Logo Medical Science Monitor

30 June 2020: Clinical Research  

Do Male University Students Know Enough About Human Papillomavirus (HPV) to Make Informed Decisions About Vaccination?

Shuai Wang12ABCDEF, Bingfeng Han1ABCD, Yongmei Wan3ABC, Jiang Liu1ABC, Tianshuo Zhao1ABF, Hanyu Liu1ABF, Fuqiang Cui1ABCDEFG*

DOI: 10.12659/MSM.924840

Med Sci Monit 2020; 26:e924840

0 Comments

Abstract

BACKGROUND: The aim of this study was to evaluate the awareness of human papillomavirus (HPV), knowledge of HPV-associated diseases, as well as willingness to undergo HPV vaccination among male university students in China, especially factors influencing vaccination willingness.

MATERIAL AND METHODS: We conducted a cross-sectional study among university students in Beijing, Tianjin, and Hebei, China by using a convenience sampling method. We assessed a) the awareness of HPV, b) knowledge of HPV-associated diseases, c) willingness to undergo HPV vaccination, and d) sexual behaviors among male university students.

RESULTS: A total of 1274 male university students aged 16 to 26 years old were recruited to complete a self-administered questionnaire. In total, 39.6% of students had awareness of HPV. Among students who were aware of HPV, the percentage of participating students who knew that HPV causes cervical cancer, genital warts, penile cancer, anal cancer, and oropharyngeal cancer were 94.0%, 66.1%, 32.7%, 20.4%, and 18.7%, respectively. In total, 79.0% knew that men can acquire HPV; 38.7% were willing to receive HPV vaccination. Age, region, and major were related to the awareness of HPV. In addition, students who had previous sexual experiences had more knowledge about HPV and were more likely to express willingness to vaccinate.

CONCLUSIONS: Male university students do not know enough about HPV infection, and males’ attitudes regarding vaccination are not sufficient. Education should be provided to promote awareness of HPV-associated diseases and vaccination.

Keywords: Attitude, Awareness, Papillomavirus Vaccines, Students, young adult, Adolescent, Adult, Alphapapillomavirus, China, Decision Making, Health Knowledge, Attitudes, Practice, Immunization, Immunization Programs, Papillomavirus Infections, Surveys and Questionnaires, Universities, Uterine Cervical Neoplasms, Vaccination

Background

Human papillomavirus (HPV) infection is one of the most commonly encountered sexually transmitted infection (STI) worldwide [1]. HPV can be divided into high-risk and low-risk types according to its malignant potential [2]. Low-risk HPV types generally cause genital warts, while high-risk HPV types are associated with several cancers in different areas of the body, including cervical cancer, anal cancer, vaginal cancer, penile cancer, and oropharyngeal cancer, which together are responsible for 630 000 new cases of cancer per year worldwide [3–5]. Of these diseases, cervical cancer is the most common HPV-associated disease in females [6]. However, it cannot be neglected that HPV infections also remain common in males. According to the results of a population-based study, the prevalence of HPV infection among males in China is 10.5% [7]. HPV concordance levels are high among heterosexual couples, therefore infected males also put their female partners at increased risk of cervical cancer [8].

HPV vaccination is safe and highly effective against targeted HPV types and reduces the burden of HPV-associated diseases [9,10]. However, the HPV vaccine has not yet been approved for males in mainland China. A successful vaccination program depends on the population having adequate HPV-associated knowledge [11].

A number of researchers have investigated the awareness and knowledge of HPV in different populations and their willingness to undergo HPV vaccination [12–14]. Generally, limited HPV-associated awareness and knowledge were observed in China [15–17]. According to a meta-analysis of 58 studies, the awareness rate of HPV among the Chinese population was 16.0% [15]. However, only limited studies assessing the awareness and knowledge of HPV in young males are available. Tian et al. reported that the level of HPV awareness was 47.6% among men who have sex with men [18]. A study investigated a total of 1004 male university students in Hong Kong, revealing that 66.2% of participants had heard of HPV and 23.3% considered vaccinating for HPV acceptable [19]. While more studies are needed for further analyzing the association between sexual behavior and willingness to undergo HPV vaccination.

Young males at high risk for HPV due to risky sexual behaviors such as short-term partnerships, casual partnerships, and high number of sex partners [20,21]. Therefore, the aim of this study was to assess the awareness of HPV, knowledge of HPV-associated diseases, and willingness to undergo HPV vaccination among Chinese male university students.

Material and Methods

STUDY AREA AND PARTICIPANTS:

This cross-sectional descriptive study was conducted over a period of 4 months from September 2018 to December 2018. Male university students aged 16 to 26 years were included, and foreign students were excluded. A convenience sampling approach was employed to recruit participants for this study from 16 public universities in Beijing, Tianjin, and Hebei, China. This group represented a population with higher education in China.

The survey was conducted using the Wenjuanxing Online Survey System. Students completed the survey using a smartphone application. All potential participating students accessed the questionnaires by scanning the WeChat (a Chinese social media app) QR code. Participants were each supplied a unique IP address to only submit a questionnaire once.

The sample size was assuming a prevalence of 50% for HPV awareness, a 95% confidence interval, and a sample error of 3%; a sample of 1067 was calculated.

QUESTIONNAIRES: A modified questionnaire was adopted according to a study published by Blödt et al. [22]. The questions were structured into 4 sections and included 26 items. The questionnaire was pre-tested with 40 university students, and revisions were made after repeated discussions with experts. The final version of the questionnaire is shown in Supplementary Material.

ETHICAL APPROVAL:

The study was approved by the Peking University Health Science Center Ethics Committee. Participants were briefed on the purpose of the study. Oral informed consent for participation in the survey was obtained from each university students. All the responses were collected voluntarily, and the information was processed with a high level of confidentiality and anonymity.

DATA ANALYSIS:

Data collection was performed by trained research assistants. The Statistical Packages for Social Sciences (SPSS, version 20.0, IBM) was used for all data entry and analyses. All descriptive statistics were presented as proportions. Chi square tests of heterogeneity were used to compare proportions. P-values <0.05 were regarded as statistically significant.

Results

PARTICIPANTS’ CHARACTERISTICS: The demographic characteristics are shown in Table 1. A total of 1274 male university students participated in the study; the mean±standard deviation (SD) age of participants was 20.4±2.4 years (range 16 to 26 years). Most of participants were Han, which is the main ethnic group in China.

AWARENESS ABOUT HPV: Male university students’ awareness about HPV is shown in Table 1. Before the study, 60.4% (770 out of 1274 students) had never heard of HPV. The main variables influencing HPV knowledge were age, region, and education major. Older participants had higher levels of awareness about HPV than the younger participants (47.8% versus 34.2%, P<0.001). Medical students were more aware than students of other majors. The awareness of students from different regions (northern and southern; urban and rural) were also different. Ethnicity was not related to HPV awareness.

KNOWLEDGE ABOUT HPV-ASSOCIATED DISEASES: Among the participants who had heard of HPV, 94.0% (474 out of 504 participants) knew that HPV causes cervical cancer, but only 66.1%, 32.7%, 20.4%, and 18.7% knew HPV can cause genital warts, penile cancer, anal cancer, and oropharyngeal cancer respectively. Regarding transmission route, most students (94.0%) knew that HPV might be transmitted through sex, 73.6% knew about blood transmission, and 32.1% knew that close contact was one of the HPV transmission routes. When asked about whether women can acquire HPV, almost all participants (96.2%) answered correctly; however, when asked about whether men can acquire HPV, a smaller portion (79.0%) answered correctly (Table 2).

WILLINGNESS TO UNDERGO HPV VACCINATION: Among all participants, 38.7% (493 out of 1274 participants) reported being willing to undergo HPV vaccination, 12.4% refused to receive the vaccine, and approximately half of them (48.9%) hesitated to receive the vaccine. As shown in Table 3, age, ethnicity, region, and education major were not related to the willingness to undergo HPV vaccination.

In addition, the reasons for refusing vaccination and the measures to promote vaccination were investigated. The most common reasons for denial of the vaccination were “I’m not at risk for getting HPV” (51.9%), “I worry about the safety of vaccine” (40.5%), and “The vaccine has not been widely used” (38.0%). The main measures to promote vaccination among students who hesitated to take the vaccine included “Doctor recommends vaccination” (80.7%) and “The safety and efficacy of the vaccine are confirmed” (75.4%).

The relationship between the knowledge level regarding HPV and the willingness to undergo HPV vaccination are displayed in Table 4. Students who know that HPV infection may lead to penile cancer, anal cancer, and oropharyngeal cancer were more likely to accept HPV vaccination than students who did not have previous knowledge (P<0.05). Similarly, students who knew that HPV could affect males were more likely to uptake of vaccination than students who did not have the relevant knowledge (P<0.001).

SEXUAL BEHAVIORS OF PARTICIPANTS: Among male university students, 75.7% of participants (965/1274) had no sexual experience. In total, 24.3% (309/1274) had sexual experience, of whom 64.2% reported that the age of sexual debut was ≤20 years old, only 58.5% reported that a condom was always used during sexual intercourse, and 87.0% reported that the number of sexual partners was ≤3 (Table 5).

In addition, students who had sexual experience had a higher level of awareness of HPV (50.5% vs. 36.1%, P<0.001), and were more likely to express willingness to vaccinate (44.7% vs. 36.8%, P=0.016). The awareness and attitude were negatively associated with the age of sexual debut, number of sexual partners, and condom usage (P>0.05).

Discussion

Vaccinating males is expected to reduce virus transmission, enhance herd immunity, and prevent HPV-associated diseases in both genders [23]. Higher education is associated with better awareness of health [24]. In our study, we chose male university students as the target population, which has higher education and more knowledge about HPV. The level of knowledge about HPV in the male general population may be lower than the target population. In addition, university age males are potentially the most interested in HPV vaccination and other preventive measures.

Our data showed that 39.6% had previously heard of HPV, and the results were similar to recent studies [19,25–27]. Of note, the awareness rate of HPV vaccines in China are lower than those in some developed countries (e.g., the United States, Italy, and Korea) [28–30]. Among participants who had heard of HPV, the majority correctly recognized that HPV is the cause of cervical cancer (94.0%). However, the relationship between HPV and other cancers, such as penile cancer (32.7%), anal cancer (20.4%), and oropharyngeal cancer (18.7%), is less known. Knowledge about the association of HPV with male cancer types was also low in other studies [19,31,32]. Whether in males or females, HPV is actually a very common infection. However, in our research, 3.8% of the population were unaware that HPV could affect females, and 21.0% were unaware that HPV could affect males. These findings reflect these male university students had poor knowledge about HPV-related diseases. Due to most participating students from national key universities, we can infer that the general male population lacks knowledge of HPV. This knowledge gap should be filled by strengthening HPV-associated health education.

In our study, 38.7% of participants indicated they would agree to be vaccinated, 48.9% were unsure whether they would receive vaccination, and 12.4% refused to be vaccinated. Lower acceptability was found in several studies [33]. The results of a survey conducted in the United States showed that the 28.9% of male university students aged 18 to 27 years had positive attitude toward HPV vaccination [34]. The findings in our study support that there is a clear need for improving the knowledge about HPV infection and the corresponding vaccines among young males, with the goal to reduce HPV-associated diseases burden.

The results indicated university students may not be aware of their risk for HPV or other STIs, and many of them had unprotected sexual behaviors. 51.9% of participants who refused to be vaccinated declared that they were not at risk of HPV infection. When we investigated factors that would increase the willingness among the participants who hesitated to be vaccinated, doctors’ recommendation ranked as the top factor (80.7%). While recommendations to be vaccinated from parents or friends did not seem to have a major impact on vaccination acceptance. Interestingly, participants were more likely to uptake vaccination if they were aware that men were susceptible to HPV infection.

Furthermore, the results showed that among medical students, 62.2% had heard of HPV, significantly higher than other majors; while 41.9% were willing to receive HPV vaccination, no difference from other majors. The difference between awareness of HPV and willingness of vaccination in medical students, suggested that vaccination intention might not be only influenced by the level of medical knowledge, but also by economic, cultural, policy, and other factors.

The results in the study have some limitations. First, because of limited manpower available, we used convenience sampling for data collection. The sample may be not representative of all male students in these study universities; in addition, the results cannot be generalized to other types of colleges in China. Second, this study was reliant on self-reported data. Therefore, responses to sensitive questions may be biased.

Conclusions

Male university students in China were not knowledgeable about HPV, and they did not have enough information to make an informed decision about HPV vaccine. There are numerous barriers to HPV vaccination in young adults. Considering the present findings, future research should evaluate interventions that could effectively enhance the awareness and knowledge of HPV-associated diseases, develop strategies to remove barriers to immunization and achieve high level of immunity in the young adult males.

References

1. Schiffman M, Doorbar J, Wentzensen N, Carcinogenic human papillomavirus infection: Nat Rev Dis Primers, 2016; 2; 16086

2. de Villiers EM, Cross-roads in the classification of papillomaviruses: Virology, 2013; 445(1–2); 2-10

3. Tommasino M, The human papillomavirus family and its role in carcinogenesis: Semin Cancer Biol, 2014; 26; 13-21

4. Herrero R, Gonzalez P, Markowitz LE, Present status of human papillomavirus vaccine development and implementation: Lancet Oncol, 2015; 16(5); e206-16

5. de Martel C, Plummer M, Vignat J, Franceschi S, Worldwide burden of cancer attributable to HPV by site, country and HPV type: Int J Cancer, 2017; 141(4); 664-70

6. Cohen PA, Jhingran A, Oaknin A, Denny L, Cervical cancer: Lancet, 2019; 393(10167); 169-82

7. Wei F, Yin K, Wu X, Human papillomavirus prevalence and associated factors in women and men in south: A China population-based study: Emerg Microbes Infect, 2016; 5(11); e119

8. Reiter PL, McRee AL, Kadis JA, Brewer NT, HPV vaccine and adolescent males: Vaccine, 2011; 29(34); 5595-602

9. Harper DM, DeMars LR, HPV vaccines – a review of the first decade: Gynecol Oncol, 2017; 146; 196-204

10. , Human papillomavirus vaccines: WHO position paper, May 2017: Wkly Epidemiol Rec, 2017; 92; 241-68

11. Rashid S, Labani S, Das BC, Knowledge, awareness and attitude on HPV, HPV vaccine and cervical cancer among the college students in India: PLoS One, 2016; 11(11); e166713

12. Bianco A, Pileggi C, Iozzo F, Vaccination against human papilloma virus infection in male adolescents: Knowledge, attitudes, and acceptability among parents in Italy: Hum Vaccin Immunother, 2014; 10(9); 2536-42

13. Clark SJ, Cowan AE, Filipp SL, Parent HPV vaccine perspectives and the likelihood of HPV vaccination of adolescent males: Hum Vaccin Immunother, 2016; 12(1); 47-51

14. Napolitano F, Gualdieri L, Santagati G, Angelillo IF, Knowledge and attitudes toward HPV infection and vaccination among immigrants and refugees in Italy: Vaccine, 2018; 36(49); 7536-41

15. Zhang Y, Wang Y, Liu L, Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: A meta-analysis of 58 observational studies: BMC Public Health, 2016; 16; 216

16. Liu CR, Liang H, Zhang X, Effect of an educational intervention on HPV knowledge and attitudes towards HPV and its vaccines among junior middle school students in Chengdu, China: BMC Public Health, 2019; 19(1); 488

17. Baloch Z, Yasmeen N, Li Y, Knowledge and awareness of cervical cancer, human papillomavirus (HPV), and HPV vaccine among HPV-infected Chinese women: Med Sci Monit, 2017; 23; 4269-77

18. Tian T, Wang D, Papamichael C, HPV vaccination acceptability among men who have sex with men in Urumqi, China: Hum Vaccin Immunother, 2019; 15(4); 1005-12

19. Cheung T, Lau J, Wang JZ, Acceptability of HPV vaccines and associations with perceptions related to HPV and HPV vaccines among male baccalaureate students in Hong Kong: PLoS One, 2018; 13(6); e198615

20. Cassidy C, Curran J, Steenbeek A, Langille D, University students’ sexual health knowledge: A scoping literature review: Can J Nurs Res, 2015; 47(3); 18-38

21. Kasymova S, Harrison SE, Pascal C, Knowledge and awareness of human papillomavirus among college students in South Carolina: Infect Dis (Auckl), 2019; 12 203522165

22. Blödt S, Holmberg C, Müller-Nordhorn J, Rieckmann N, Human papillomavirus awareness, knowledge and vaccine acceptance: A survey among 18–25 year old male and female vocational school students in Berlin, Germany: Eur J Public Health, 2012; 22(6); 808-13

23. Crosignani P, De Stefani A, Fara GM, Towards the eradication of HPV infection through universal specific vaccination: BMC Public Health, 2013; 13; 642

24. Hahn RA, Truman BI, Education improves public health and promotes health equity: Int J Health Serv, 2015; 45(4); 657-78

25. Choi E, Wong J, Lau A, Fong D, Gender and sexual orientation differences in human papillomavirus (HPV) vaccine uptake among Chinese young adults: Int J Environ Res Public Health, 2018; 15(6); E1099

26. Zou H, Wang W, Ma Y, How university students view human papillomavirus (HPV) vaccination: A cross-sectional study in Jinan, China: Hum Vaccin Immunother, 2016; 12(1); 39-46

27. Chiang VC, Wong HT, Yeung PC, Attitude, acceptability and knowledge of HPV vaccination among local university students in Hong Kong: Int J Environ Res Public Health, 2016; 13(5); E486

28. Napolitano F, Napolitano P, Liguori G, Angelillo IF, Human papillomavirus infection and vaccination: Knowledge and attitudes among young males in Italy: Hum Vaccin Immunother, 2016; 12(6); 1504-10

29. Choi JS, Park S, A study on the predictors of Korean male students’ intention to receive human papillomavirus vaccination: J Clin Nurs, 2016; 25(21–22); 3354-62

30. Barnard M, George P, Perryman ML, Wolff LA, Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model: PLoS One, 2017; 12(8); e182266

31. Ortashi O, Raheel H, Khamis J, Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates: Vaccine, 2013; 31(44); 5141-44

32. Khan TM, Buksh MA, Rehman IU, Saleem A, Knowledge, attitudes, and perception towards human papillomavirus among university students in Pakistan: Papillomavirus Res, 2016; 2; 122-27

33. Ortashi O, Raheel H, Khamis J, Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates: Vaccine, 2013; 31(44); 5141-44

34. Cooper DL, Zellner-Lawrence T, Mubasher M, Examining HPV awareness, sexual behavior, and intent to receive the HPV vaccine among racial/ethnic male college students 18–27 years: Am J Mens Health, 2018; 12(6); 1966-75

SARS-CoV-2/COVID-19

24 May 2022 : Clinical Research  

Screening for SARS-CoV-2 Infection in Students at the Medical University of Warsaw, Poland Between November...

Med Sci Monit In Press; DOI: 10.12659/MSM.936962  

04 May 2022 : Clinical Research  

Effects of Wearing Face Masks on Exercise Capacity and Ventilatory Anaerobic Threshold in Healthy Subjects ...

Med Sci Monit In Press; DOI: 10.12659/MSM.936069  

27 May 2022 : Clinical Research  

Factors Associated with Falls During Hospitalization for Coronavirus Disease 2019 (COVID-19)

Med Sci Monit 2022; 28:e936547

In Press

27 May 2022 : Clinical Research  

Prognostic Significance of Preoperative Integrated Liver Inflammatory Score in Patients with Hepatocellular...

Med Sci Monit In Press; DOI: 10.12659/MSM.937005  

25 May 2022 : Review article  

Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation

Med Sci Monit In Press; DOI: 10.12659/MSM.935665  

24 May 2022 : Clinical Research  

Remimazolam Tosilate Sedation with Adjuvant Sufentanil in Chinese Patients with Liver Cirrhosis Undergoing ...

Med Sci Monit In Press; DOI: 10.12659/MSM.936580  

24 May 2022 : Clinical Research  

Screening for SARS-CoV-2 Infection in Students at the Medical University of Warsaw, Poland Between November...

Med Sci Monit In Press; DOI: 10.12659/MSM.936962  

Most Viewed Current Articles

30 Dec 2021 : Clinical Research  

Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...

DOI :10.12659/MSM.935379

Med Sci Monit 2021; 27:e935379

08 Mar 2022 : Review article  

A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...

DOI :10.12659/MSM.936292

Med Sci Monit 2022; 28:e936292

01 Nov 2020 : Review article  

Long-Term Respiratory and Neurological Sequelae of COVID-19

DOI :10.12659/MSM.928996

Med Sci Monit 2020; 26:e928996

01 Jan 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...

DOI :10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750