Behavioral Frequency Moderates the Effects of Message Framing on HPV Vaccine Acceptability Human Papillomavirus Vaccine Acceptability Among Young Adult Men Human Papillomavirus Vaccine Intent and Uptake Among Female College Students Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study Using message framing to promote acceptance of the human papillomavirus vaccine. Evaluation of a Radionovela to Promote HPV Vaccine Awareness and Knowledge Among Hispanic Parents Effect of a cancer screening intervention conducted by lay health workers among inner-city women. Factors That Are Associated With Parental Acceptance of Human Papillomavirus Vaccines: A Randomized Intervention Study of Written Information About HPV Effects of a Narrative HPV Vaccination Intervention Aimed at Reaching College Women: A Randomized Controlled Trial Acceptability of a human papillomavirus (HPV) trial vaccine among mothers of adolescents in Cuernavaca, Mexico. Is male intent to be vaccinated against HPV a function of the promotion message? Message framing and parents' intentions to have their children vaccinated against HPV. HPV vaccine promotion: does referring to both cervical cancer and genital warts affect intended and actual vaccination behavior? Parental Attitudes Toward Human Papillomavirus Vaccination: Evaluation of an Educational Intervention, 2008 Irish mothers’ intentions to have daughters receive the HPV vaccine How to Inform: Comparing Written and Video Education Interventions to Increase Human Papillomavirus Knowledge and Vaccination Intentions in Young Adults
Background Research suggests that gain-framed messages are generally more effective than loss-framed messages at promoting preventive health behaviors . Virtually all previous studies , however , have examined prevention behaviors that require regular and repeated action to be effective . Little is known about the utility of message framing for promoting low-frequency prevention behaviors such as vaccination . Moreover , few studies have identified mediators of framing effects . Purpose We investigated whether behavioral frequency ( operationalized as the number of shots required ) moderated the effect of framed health messages on women ’s intentions to receive the human papillomavirus ( HPV ) vaccine . We also sought to identify mediators of framing effects . Method Undergraduate women ( N = 237 ) were r and omly assigned to read an  HPV vaccination booklet that varied by message frame ( gain vs. loss ) and behavioral frequency ( one shot vs. six shots ) . Results We observed a frame-by-frequency interaction such that the loss-framed message led to greater vaccination intentions than did the gain-framed message but only among participants in the one-shot condition . Perceived susceptibility to HPV infection mediated the observed framing effects . Conclusions This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors . Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination Background : For human papillomavirus ( HPV ) vaccination to have maximum benefit to public health , both men and women should be vaccinated . Although efficacy trials in men are still ongoing , the HPV vaccine will likely be licensed for men in the near future . Little is known about men 's interest in HPV vaccination . This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s ) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone . Predictors of HPV vaccine acceptability were also identified . Methods : Heterosexual male college students ( n = 356 ) were r and omly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine . Participants provided demographic and sexual history information , HPV-related awareness and knowledge , health beliefs , and HPV vaccination intentions . Results : Men reported moderate interest in the HPV vaccine ; vaccine acceptability did not differ by experimental condition . A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity , perceived susceptibility to HPV , perceived benefits of the vaccine , perceived hassle and cost of vaccination , self-efficacy for vaccination , and perceived norms for vaccination . Conclusion : Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men 's interest in the vaccine . Correlates of vaccine acceptability among men were generally consistent with those identified for women . Findings have important implication s for future HPV vaccination campaigns targeting young adult men Abstract Objective : To examine human papillomavirus ( HPV ) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students . Participants : Females aged 18 to 26 attending a university health service gynecology clinic ( n = 256 ) . Methods : Participants were r and omized to receive either HPV-specific education with a mailed reminder or st and ard care . Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified . Results : At baseline , 41 % intended to undergo HPV vaccination . Participants who were currently sexually active and lacked supplemental health insurance had decreased intent . Perceived parental approval regarding HPV vaccination , perceived vulnerability to HPV infection , and belief in health benefits of HPV vaccine were associated with increased intent . HPV vaccine uptake was low ( 5.5 % ) and did not differ by study group . However , baseline intent was significantly associated with HPV vaccine uptake . Conclusions : Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination Objective To assess the risk of serious adverse events after vaccination of adolescent girls with quadrivalent human papillomavirus ( qHPV ) vaccine .  Design Register based cohort study . Setting Denmark and Sweden , October 2006 to December 2010 . Participants 997 585 girls aged 10 - 17 , among whom 296 826 received a total of 696 420 qHPV vaccine doses . Main outcome measures Incident hospital diagnosed autoimmune , neurological , and venous thromboembolic events ( 53 different outcomes ) up to 180 days after each qHPV vaccine dose . Only events with at least five vaccine exposed cases were considered for further assessment . Rate ratios adjusted for age , country , calendar year , and parental country of birth , education , and socioeconomic status were estimated , comparing vaccinated and unvaccinated person time . For outcomes where the rate ratio was significantly increased , we regarded three criteria as signal strengthening : analysis based on 20 or more vaccine exposed cases ( reliability ) , rate ratio 3.0 or more ( strength ) , and significantly increased rate ratio in country specific analyses ( consistency ) . We additionally assessed clustering of events in time and estimated rate ratios for a risk period that started on day 181 . Results Among the 53 outcomes , at least five vaccine exposed cases occurred in 29 and these were analysed further . Whereas the rate ratios for 20 of 23 autoimmune events were not significantly increased , exposure to qHPV vaccine was significantly associated with Behcet ’s syndrome , Raynaud ’s disease , and type 1 diabetes . Each of these three outcomes fulfilled only one of three predefined signal strengthening criteria . Furthermore , the pattern of distribution in time after vaccination was r and om for all three and the rate ratios for these outcomes in the period from day 181 after vaccination were similar to the rate ratios in the primary risk period . The rate ratios for five neurological events were not significantly increased and there were inverse associations with epilepsy ( rate ratio 0.66 , 95 % confidence interval 0.54 to 0.80 ) and paralysis ( 0.56 , 0.35 to 0.90 ) . There was no association between exposure to qHPV vaccine and venous thromboembolism ( 0.86 , 0.55 to 1.36 ) . Conclusions This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune , neurological , and venous thromboembolic adverse events . Although associations for three autoimmune events were initially observed , on further assessment these were weak and not temporally related to vaccine exposure . Furthermore , the findings need to be interpreted considering the multiple outcomes assessed OBJECTIVE Use of message framing for encouraging vaccination , an increasingly common preventive health behavior , has received little empirical investigation . The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer . DESIGN Undergraduate women ( N = 121 ) were r and omly assigned to read a booklet describing the benefits of receiving ( gain-framed message ) or the costs of not receiving ( loss-framed message ) a prophylactic HPV vaccine . After reading the booklet , participants indicated their intent to obtain the HPV vaccine . MAIN OUTCOME MEASURE A 5-item composite representing intentions to obtain the HPV vaccine . RESULTS The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation . A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms . The loss-frame advantage was also observed among participants high in avoidance motivation . CONCLUSION Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance . This study has practical implication s for the development of health communications promoting vaccination Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States . The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years , though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV ( HPV-16 and HPV-18 ) that cause approximately 70 % of cervical cancer cases . Few culturally-tailored Spanish HPV vaccine awareness programs have been developed . This study evaluates the efficacy of a Spanish radionovela as an educational tool . Rural Hispanic parents of daughters aged 9–17 ( n = 88 ; 78 mothers and 10 fathers ) were r and omized to listen to the HPV vaccine radionovela or to another public service announcement . Participants completed a 30 min pretest posttest question naire . Parents who listened to the HPV radionovela ( intervention group ) scored higher on six knowledge and belief items . They were more likely to confirm that HPV is a common infection ( 70 % vs. 48 % , P = .002 ) , to deny that women are able to detect HPV ( 53 % vs. 31 % , P = .003 ) , to know vaccine age recommendations ( 87 % vs. 68 % , P = .003 ) , and to confirm multiple doses ( 48 % vs. 26 % , P = .03 ) than control group parents . The HPV vaccine radionovela  improved HPV and HPV vaccine knowledge and attitudes .  Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents INTRODUCTION We conducted a r and omized controlled trial to determine if an in-home educational intervention conducted by lay health workers ( LHWs ) could increase adherence among low-income , inner-city , African-American women to breast and cervical cancer screening schedules . METHODS We recruited 321 African-American women from diverse inner-city sources . After baseline interviews , they were r and omly assigned to either the intervention ( n = 163 ) or the control ( n = 158 ) group . Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening . RESULTS Ninety-three ( 93 ) women in the intervention group and 102 in the control group completed the postintervention interview . For Pap smears , the increase in screening was similar in both groups . For clinical breast exams ( CBEs ) , however , there was a modest increase in the intervention group . The improvement was greatest for mammography , for which there was a 10 % to 12 % increase . Among women who were not on recommended schedules at baseline , the improvement was substantial and greater in the intervention group . CONCLUSIONS LHWs ' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms , but had no effect on Pap smears . A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention OBJECTIVES . Prophylactic vaccines against human papillomavirus ( HPV ) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children . Parental acceptance of these vaccines will be critical for their success . The objectives of this study were ( 1 ) to determine the overall acceptance of HPV vaccines for preadolescent children by parents , ( 2 ) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines , and ( 3 ) to identify independent predictors associated with HPV vaccine acceptability by parents . METHODS . A r and omized intervention study within a cross-sectional survey was conducted . Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios . A self-administered survey on the  knowledge , attitudes  , and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children . In addition to a baseline paragraph about HPV that was received by all study participants , a r and om half of the study participants received a detailed “ HPV Information Sheet ” outlining the epidemiology and potential clinical sequelae of HPV infection . Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models . RESULTS . Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group . However , despite this apparent improvement in knowledge , there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups . CONCLUSIONS . Providing parents with an HPV information sheet did seem to improve knowledge about HPV , but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children . Instead , attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents This longitudinal study reports on the development and evaluation of a narrative intervention aim ed at increasing  human papillomavirus ( HPV ) vaccination among college women . The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer , the second leading cause of cancer deaths among women worldwide . Pilot work utilizing culture-centric narrative theory guided development of the intervention content . Exemplification theory led to hypotheses comparing communication sources of the narrative messages ( peer only , medical expert only , or a combination of the two source types ) in a four-arm r and omized controlled trial ( N = 404 ; 18–26 year olds ) . The combined peer-expert narrative intervention nearly doubled vaccination compared to controls ( 22 % vs. 12 % ) . The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported . As predicted , the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women . Furthermore , the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent . Theoretical and practical implication s for design ing effective HPV vaccine messages are discussed BACKGROUND A scenario that must be considered when testing prophylactic human papillomavirus ( HPV ) vaccines in teenagers is the parents ' acceptability of their daughters ' participation in the study . METHODS A survey was carried out in a r and om sample of 880 women between the ages of 15 and 49 years in the metropolitan area of Cuernavaca , Mexico . These women were interviewed to obtain information concerning their knowledge of risk factors for cervical cancer and their perception of the usefulness of vaccines . Afterward , they were provided with information on the main risk factors for cervical cancer and the future availability of a human papillomavirus ( HPV ) vaccine to prevent cervical cancer . Finally , we explored , with parents , the possible acceptability of an HPV vaccine for their teenaged daughters . The degree of acceptability and its association with a series of sociodemographic and reproductive factors were assessed . RESULTS The respondents had little knowledge regarding the etiology of cervical cancer . Only 1.9 % said that the principal risk factor was infection with HPV ; however , 84.2 % were aware of the usefulness of vaccines and 83.6 % of the women indicated that they would allow their daughters to participate in a trial to evaluate the effectiveness of an HPV vaccine that helps prevent cervical cancer . The main factor associated with the acceptance of a possible vaccine against HPV was the knowledge of the usefulness of vaccines [ odds ratio ( OR ) = 6.5 , 95 % confidence interval ( CI ) 5.2 - 8.2 ] . Likewise , a history of two or more sexual partners ( OR = 2.2 , 95 % CI 1.3 - 3.6 ) increased acceptability . Acceptance was not associated with the number of live births ( never vs. ever OR = 0.9 , 95 % CI 0.3 - 2.1 ) . There were 525 women with children over the age of 10 years ( 59.6 % ) ;  prevalence of acceptability among these women was 80.1 % , not statistically different from the remainder of the sample ( p > 0.05 ) . CONCLUSIONS Acceptance of a potential HPV vaccine  was high in this sample of Mexican women . Initiation of HPV vaccine clinical trials and immunization campaigns that target school children and /or teenagers who are not sexually active should include educational programs aim ed at mothers of these individuals . Knowledge of the benefits of a preventive vaccine as well as the etiology and risk factors of cervical cancer should be emphasized We aim ed to determine whether the type of outcome expectation , stemming from HPV vaccination , would have any effect on  young men 's HPV vaccine intent . We recruited young men ( 18–24 years of age ) from two university campuses ( n = 150 ) . After answering a series of questions they were r and omly assigned to one of three information conditions ( all delivered by computer ) : ( 1 ) how women may benefit from men 's HPV vaccination , ( 2 ) preventing genital warts and ( 3 ) preventing head and neck cancers . Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition . A repeated- measures t-test indicated that a significant increase in young men 's intent to be vaccinated after they received the assigned information ( t = 9.48 , [ 147 ] , P = 0.0001 ) . However , the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups ( F = 0.59 , [ 2/144 ] , ( P = 0.56 ) . Information that promotes the outcome expectations of protecting women from cervical cancer , preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men OBJECTIVE Framing a message in terms of the benefits of engaging in the behavior ( gain frame ) , the costs of failing to engage in the behavior ( loss frame ) , or both the benefits and the costs ( mixed frame ) can impact parents ' decisions about their childrens ' and adolescents ' health . This study , investigated the effect of framed messages on parents ' intentions to have their children vaccinated against human papillomavirus ( HPV ) . DESIGN AND SAMPLE The study employed a 2 ( gender of the parent ) × 2 ( gender of the child ) × 3 ( message frame ) between-groups , quasi-experimental design . A convenience sample of 367 parents with children in Grade 5 , 6 , or 7 who had at least one child who had not been vaccinated against HPV . MEASURES Social-cognitive variables relating to intentions to vaccinate a child were assessed . INTERVENTION Participants were r and omly assigned to read one of three framed messages about the HPV vaccine ( gain , loss , or mixed ) . RESULTS Gain-framed messages seemed to persuade mothers of sons to speak to a doctor about the vaccine ( p < .05 ) . Framing effects were not significant for other outcomes . CONCLUSIONS Findings provide preliminary evidence that certain vaccination messages may be more effective for different parent-child dyads BACKGROUND young women have poor awareness that human papillomavirus ( HPV ) can cause both cervical cancer and genital warts , a sexually transmitted infection ( STI ) . A newly developed HPV vaccine can provide protection against both cervical cancer and genital warts . This vaccine could be promoted by health authorities/professionals as preventing cervical cancer plus genital warts , or cervical cancer alone . Because stigma around STIs may reduce acceptance of the vaccine , the effect of information framing ( ' cervical cancer ' versus ' cervical cancer plus genital warts ' ) on intention to receive the HPV vaccine and actual uptake behavior was examined using the health belief model ( HBM ) . METHODS we r and omized 159 young women under the age of 27 to receive one of two variations of a fact-sheet describing the HPV vaccine as 1 ) preventing cervical cancer or 2 ) preventing cervical cancer and genital warts . RESULTS the results revealed low HPV knowledge ( 22 % ) and high HPV vaccination intention ( 79 % ) , which was not influenced by information framing . Receipt of the vaccine at the 2-month follow-up was 37 % , and was also not influenced by information framing . The overall HBM predicted vaccination intention ( p < .001 ) and behavior ( p = .002 ) . However , only barriers ( p = .029 ) and benefits ( p = .001 ) independently predicted HPV vaccination intention ; susceptibility ( p = .023 ) and benefits ( p = .033 ) independently predicted HPV vaccination behavior . CONCLUSION highlighting the sexual transmissibility of HPV does not seem to lower vaccination intentions or behaviors  among young women . Potential challenges for promotion of the HPV vaccination program in Australia and worldwide are discussed The authors ' objectives were to improve human papillomavirus ( HPV ) vaccine educational material s and to determine whether parents who received those material s had improved attitudes about the vaccine . Pretests were sent to 411 parents of girls 11–18 years of age who had not yet received the HPV vaccine . The authors then r and omly assigned 270 respondents to an intervention ( educational flyer and posttest ) or comparison ( posttest only ) group . The authors conducted a mixed- method analysis of intervention group feedback on improving the flyer and used paired t tests and analysis of covariance to describe within- and between-group attitude changes . The overall posttest response rate was 76 % . Among intervention group respondents ( n = 131 ) , 88 % had a positive impression of the flyer , and 43 % reported that it made them more likely to vaccinate their daughters with HPV vaccine in the future . Parents who received the flyer also showed a statistically significant increase in mean attitude scores regarding perceived HPV vaccine safety and access to HPV vaccine information ; mean scores also increased among the comparison group , but the changes were not statistically significant . Educational material s improved HPV vaccine knowledge and attitudes among parents and might have helped motivate some parents to have their daughters vaccinated Background Most cases of cervical cancer are associated with human papillomavirus ( HPV ) types 16 and 18 . This study examined the effect of message framing on mother ’s intentions to obtain HPV vaccination for their teenage daughters and investigated predictors of HPV vaccination intentions . Methods Seventy-two mothers of daughters in the 8–16-year age group were r and omly assigned to read either a gain-framed ( describing the benefits of receiving the vaccine ) or a loss-framed ( describing the costs of not receiving the vaccine ) message and completed measures assessing their intention to have their daughter/s vaccinated , normative beliefs , attitudes and perceived behavioural control . Conclusions Awareness of HPV was low but intentions to vaccinate were high . There was no effect of message frame on vaccination intentions . Attitudes towards HPV vaccination and the influence of both peers and medical professionals are important factors in HPV vaccine acceptability Abstract Objective : To compare the efficacy of 2 human papillomavirus ( HPV ) educational interventions on increasing HPV knowledge and vaccination intentions in college students . Participants : Male ( n = 60 ) and female ( n = 140 ) undergraduates ( M age = 20.4 , SD = 2.3 ) recruited from a university in Montreal , Quebec , Canada , from October 2009 to March 2010 . Methods : Using theory-based interventions , participants were r and omly assigned to either a written HPV pamphlet , an HPV video , or a control .  HPV knowledge and vaccination intentions were assessed pre and postintervention . Results : Low baseline knowledge and intentions were found across groups . Postintervention , participants in the written and video interventions had significantly higher knowledge and intentions than the control . No differences were found between written and video interventions on knowledge or intentions . Conclusion : This study , a first in comparing HPV educational formats , suggests that both written and video interventions are equally effective in educating about HPV and increasing young adults ’ vaccination intentions
BACKGROUND The Human papillomavirus ( HPV ) vaccine has been available for protection against HPV-associated cervical cancer and genital warts since 2006 .
Nonetheless , uptake has varied among countries and population s within countries .
Studies have found that individuals ' knowledge and attitudes toward the vaccine are associated with immunization uptake .
The purpose of the current review is to summarize and evaluate the evidence for educational interventions to increase HPV vaccination acceptance .