Deciphering Knowledge and Opinions of Human Papillomavirus and Human Papillomavirus Vaccination for Facilitation of Point-of-Care Vaccination in Adults

Abstract

ImportanceHuman papillomavirus (HPV) vaccination rates remain significantly below rates for other common childhood vaccines, which has implications for future rates of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC).ObjectiveTo assess whether individuals who were aware of the association between HPV and OPSCC would be more likely to have been previously vaccinated.Design, Setting, and ParticipantsThis survey study included patients aged 18 to 45 years who sought routine outpatient care at the otolaryngology clinic at Boston Medical Center from September 1, 2020, to May 19, 2021. A survey (HPV-Associated Head and Neck Cancer Epidemiology, Awareness and Demographics) [HEAD]) composed of validated questions to assess patient knowledge of HPV and HPV vaccination and barriers to vaccination was delivered to participants. The survey was paired with a novel point-of-care vaccination program housed within an otolaryngology department.Main Outcomes and MeasuresThe main outcome was prevalence of knowledge of the relationship between HPV infection and OPSCC based on survey responses. The association of knowledge of HPV-associated OPSCC with likelihood of having been vaccinated was assessed in the overall cohort and by demographic characteristics using multivariate logistic regression.ResultsOf 405 patients given the survey, 288 (71.1%) responded. Of these patients, 271 (94.1%) had surveys included; 158 (58.3%) were female, and median age was 29 years (IQR, 24-35 years). The baseline vaccination rate in the surveyed population was low (26.6%; n = 72) overall (10.6% among men [12 of 113]; 37.9% among women [60 of 158]). Few participants understood the relationship between HPV infection and OPSCC (63 of 271 [23.3%]) or that HPV-associated OPSCC is the most common HPV-associated cancer type (9 of 121 [7.4%]). Compared with men, women were more likely to have been previously vaccinated (odds ratio [OR], 6.5; 95% CI, 3.0-13.9), more aware that HPV causes cancer (OR, 3.7; 95% CI, 1.9-7.1), and more likely to have heard about HPV and HPV vaccination from their health care practitioner (OR, 2.6; 95% CI, 1.2-5.7). Knowledge of the relationship between HPV infection and cancer and between HPV and OPSCC was associated with increased likelihood of having been vaccinated (HPV and cancer: OR, 4.1 [95% CI, 1.8-9.5]; HPV and OPSCC: OR, 3.7 [95% CI, 1.8-7.6]). Among 156 unvaccinated participants, 12 of 98 men (12.2%) and 7 of 131 women (5.3%) received point-of-care vaccination.ConclusionsMost participants in this survey study were unaware that HPV causes OPSCC. Understanding that HPV causes OPSCC was associated with increased likelihood of having been vaccinated. However, most patients surveyed were not informed of this relationship by their health care practitioners. Targeted education aimed at unvaccinated adults establishing the relationship between HPV infection and OPSCC, paired with point-of-care vaccination, may be an innovative strategy for increasing HPV vaccination rates in adults.

Intersectionality of Social Determinants of Health in Head and Neck Cancer—From Analysis to Action

“…7 Human papillomavirus vaccination also plays a vital role in prevention, as the public is often not well informed on the potential benefits. 8 Research on HNC should apply an equity lens, emphasizing inclusion and interventional trials that assess strategies to improve outcomes. Health equity can be integrated into research through engaging a diverse research team, striving for representative enrollment in trials, assessing treatment effects across populations, investigating differences in retention, and using tools such as PROGRESS (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, social capital) and PROGRESS-Plus or equity extensions in research projects.…”

“…Collaboration and partnership with local community-based organizations such as a chapter of Support for People With Oral and Head and Neck Cancer can aid in disseminating information on risk factors and early signs of HNC to both local clinicians and the community . Human papillomavirus vaccination also plays a vital role in prevention, as the public is often not well informed on the potential benefits …”

Factors Influencing USA Women to Receive the Human Papillomavirus Vaccine: A Systematic Literature Review

“…Vaccine hesitancy continues to be a prevalent concern attributed to the following factors: lack of confidence in making decisions about vaccines, being provided limited information, as well as unpleasant healthcare provider encounters [17]. Primarily quantitative studies suggest that knowledge of the HPV vaccine is lower in adult women and potentially recommended less often by practitioners [18]. The researchers from the American Association for Cancer Research used data from the 2010-2019 National Immunization Survey (NIS)-Teen to identify a cohort of 16,383 adolescents who had not received any doses of the HPV vaccine.…”