Influence of Gender and Undergraduate Course on the Knowledge about HPV and HPV Vaccine, and Vaccination Rate among Students of a Public University

Abstract

Objective To evaluate the knowledge related to human papillomavirus (HPV) infection and the rate of HPV vaccination among undergraduate freshmen and senior students of medicine, pharmacy, speech therapy, nursing and physical education in a Brazilian university.

Methods A questionnaire concerning sociodemographic aspects, sexual background, and knowledge about HPV and its vaccine was filled out by 492 students. Three months later, a second questionnaire, concerning the new rate of vaccination, was applied to 233 students.

Results Among the 290 women who answered the first questionnaire, 47% of the freshmen and 13% of the seniors stated they were not sexually active, as well as 11% of the 202 freshman and senior male students. Although the knowledge about HPV was higher among women, they reported a lower use of condoms. More than 83% of the women and 66% of the men knew that HPV can cause cervical cancer, but less than 30% of the students knew that HPV can cause vulvar, anal, penile and oropharyngeal cancer. Less than half of the students knew that HPV causes genital, anal and oropharyngeal warts. Comparing the students, the seniors had more knowledge of the fact that HPV is sexually transmitted, and that HPV infection can be asymptomatic. The rate of vaccination was of 26% for women, and of 8% for men, and it increased to 52% and 27% respectively among the 233 students evaluated in the second questionnaire.

Conclusion As almost half of freshman women declared being sexually inactive, the investment in public health information programs and easier access to the HPV vaccine seem to be a useful strategy for undergraduate students.

Resumo

Objetivo Avaliar o conhecimento sobre a infecção pelo vírus do papiloma humano (human papillomavirus, HPV, em inglês) e a taxa de vacinação entre estudantes calouros e veteranos do quarto ano dos cursos de medicina, farmácia, fonoaudiologia, enfermagem e educação física de uma universidade brasileira.

Métodos Um primeiro questionário sobre aspectos sociodemográficos, antecedentes sexuais e conhecimento sobre o HPV e sua vacina foi aplicado a 492 estudantes. Três meses depois, foi aplicado um novo questionário, a 233 estudantes, que avaliava a nova taxa de vacinação entre eles.

Resultados Entre as 290 mulheres que responderam ao questionário, 47% das calouras e 13% das veteranas negaram início de atividade sexual. Entre os 202 calouros e veteranos do sexo masculino avaliados, essa taxa foi de 11%. Apesar de o conhecimento sobre o HPV ter sido maior entre as mulheres, elas declararam menor uso de preservativo. Mais de 83% das mulheres e 66% dos homens sabiam que o HPV causa câncer de colo de útero, mas menos de 30% de todos os alunos sabiam que o HPV pode causar câncer de vulva, ânus, pênis e orofaringe, e menos de 50% sabiam que o HPV pode causar verrugas genitais, anais e orofaríngeas. Comparando calouros e veteranos, houve um aumento no conhecimento de que o HPV é sexualmente transmitido, e de que sua infecção pode ser assintomática, entre os veteranos em comparação com os calouros. Pela taxa de vacinação analisada no segundo questionário, identificou-se que, antes do início da pesquisa, 26% das mulheres e 8% dos homens haviam sido vacinados, e, no momento da aplicação do segundo questionário, essas taxas subiram para 52% e 27%, respectivamente, entre os 233 alunos avaliados.

Conclusão Quase metade das calouras relataram não ser sexualmente ativas, e a maioria delas ainda não era vacinada contra o HPV. O ingresso no Ensino Superior parece um momento oportuno para a realização de campanhas governamentais de conscientização e vacinação contra o HPV.

Keywords

human papillomavirus - vaccine - students - knowledge - vaccination rate

Palavras-chave

vírus do papiloma humano - vacina - estudantes - conhecimento - taxa de vacinação

Contributors

Biselli-Monteiro M developed the study design, planned the analyses, collected the data, performed the literature search, the statistical analyses, prepared the tables and figures, contributed to the interpretation of data, and wrote the manuscript. Ferracini AC collected the data, contributed to the interpretation of data, and writing and revision of the article. Sarian LO performed the statistical analyses, prepared the tables, contributed to the interpretation of data, and to the revision of the article. Derchain SFM contributed to study design, planned the analyses, performed the literature search, contributed to the interpretation of data, and wrote the manuscript. All authors approved the final submitted version.

• References

• 1 de Sanjosé S, Brotons M, Pavón MA. The natural history of human papillomavirus infection. Best Pract Res Clin Obstet Gynaecol. 2018; 47: 2-13 . Doi: 10.1016/j.bpobgyn.2017.08.015
• 2 Castle PE, Maza M. Prophylactic HPV vaccination: past, present, and future. Epidemiol Infect. 2016; 144 (03) 449-468 . Doi: 10.1017/S0950268815002198
• 3 Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L. , et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012; 30 (Suppl. 05) F12-F23 . Doi: 10.1016/j.vaccine.2012.07.055
• 4 Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX. , et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016; 4 (07) e453-e463 . Doi: 10.1016/S2214-109X(16)30099-7
• 5 Nagpal J, Linares LO, Weiss J, Schlecht NF, Shankar V, Braun-Courville D. , et al. Knowledge about human papillomavirus and time to complete vaccination among vulnerable female youth. J Pediatr. 2016; 171: 122-127 . Doi: 10.1016/j.jpeds.2015.12.070
• 6 McCusker SM, Macqueen I, Lough G, Macdonald AI, Campbell C, Graham SV. Gaps in detailed knowledge of human papillomavirus (HPV) and the HPV vaccine among medical students in Scotland. BMC Public Health. 2013; 13: 264 . Doi: 10.1186/1471-2458-13-264
• 7 R Core Team. R: a language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 2018. [cited 2018 Aug 10]. Available from: https://www.R-project.org/
• 8 Ragin CC, Edwards RP, Jones J, Thurman NE, Hagan KL, Jones EA. , et al. Knowledge about human papillomavirus and the HPV vaccine–a survey of the general population. Infect Agent Cancer. 2009; 4 (Suppl. 01) S10 . Doi: 10.1186/1750-9378-4-S1-S10
• 9 Balla BC, Terebessy A, Tóth E, Balázs P. Young Hungarian students' knowledge about HPV and their attitude toward HPV vaccination. Vaccines (Basel). 2016; 5 (01) 1-9 . Doi: 10.3390/vaccines5010001
• 10 Monteiro DLM, Brollo LCS, Souza TP, Santos JRPD, Santos GR, Correa T. , et al. Knowledge on the HPV vaccine among university students. Rev Inst Med Trop São Paulo. 2018; 60: e46 . Doi: 10.1590/s1678-9946201860046
• 11 Cooper DL, Zellner-Lawrence T, Mubasher M, Banerjee A, Hernandez ND. Examining HPV awareness, sexual behavior, and intent to receive the HPV vaccine among racial/ethnic male college students 18–27 years. Am J Men Health. 2018; 12 (06) 1966-1975 . Doi: 10.1177/1557988318803163
• 12 Chawla PC, Chawla AK, Shrivastava R, Shrivastava A, Chaudhary S. Situation analysis of existing facilities for screening, treatment and prevention of cervical cancer in hospitals/primary health centers of Delhi-NCR region, India. Asian Pac J Cancer Prev. 2014; 15 (13) 5475-5482 . Doi: 10.7314/apjcp.2014.15.13.5475
• 13 Yam PWA, Lam PL, Chan TK, Chau KW, Hsu ML, Lim YM. , et al. A cross sectional study on knowledge, attitude and practice related to human papillomavirus vaccination for cervical cancer prevention between medical and non-medical students in Hong Kong. Asian Pac J Cancer Prev. 2017; 18 (06) 1689-1695 . Doi: 10.22034/APJCP.2017.18.6.1689
• 14 Jelastopulu E, Fafliora E, Plota A, Babalis V, Bartsokas C, Poulas K. , et al. Knowledge, behaviours and attitudes regarding HPV infection and its prevention in female students in West Greece. Eur Rev Med Pharmacol Sci. 2016; 20 (12) 2622-2629
• 15 Chiang VC, Wong HT, Yeung PC, Choi YK, Fok MS, Mak OI. , et al. Attitude, acceptability and knowledge of hpv vaccination among local university students in Hong Kong. Int J Environ Res Public Health. 2016; 13 (05) 486 . Doi: 10.3390/ijerph13050486
• 16 Sherman SM, Bartholomew K, Denison HJ, Patel H, Moss EL, Douwes J. , et al. Knowledge, attitudes and awareness of the human papillomavirus among health professionals in New Zealand. PLoS One. 2018; 13 (12) e0197648 . Doi: 10.1371/journal.pone.0197648
• 17 Attia AC, Wolf J, Núñez AE. On surmounting the barriers to HPV vaccination: we can do better. Ann Med. 2018; 50 (03) 209-225 . Doi: 10.1080/07853890.2018.1426875
• 18 Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Coordenação-Geral do Programa Nacional de Imunizações [Internet]. Informe técnico da ampliação da oferta das vacinas papiloma vírus humano 6, 11, 16 e 18 (recombinante) – vacina HPV quadrivalente e meningocócica C (conjugada). Brasília, DF: Ministério da Saúde; 2018. [cited 2018 Dec 02]. Available from: http://portalarquivos2.saude.gov.br/images/pdf/2018/marco/14/Informe-T–cnico-HPV-MENINGITE.pdf