Factors Associated with HPV Vaccination Among US College Students

Introduction & Puropose:  As the most common sexually transmitted infection in the United States, human papillomaviruses (HPV) are associated with cervical, vulvar, and vaginal cancer in women, penile cancer in men, genital warts and other oropharynx cancers. Almost all sexually active men and women can expect to contract HPV at some point in their lives. Although HPV vaccination has been available for seven years, uptake remains low. Vaccination among females 18-26 years could offset slow vaccination among those 11-17 years, but it is estimated that only 10% of females 18-26 years have completed at least one dose of the HPV vaccine. Male coverage is not well characterized as routine male vaccination is more recent. The purpose of this study is to examine self-reported HPV vaccination in a sample of US college students and determine factors (demographic characteristics, sexual orientation and other vaccine use) associated with self-reported vaccination in this population.   

Method. Using data derived from the National College Health Assessment II study (Fall 2012) of US college students, HPV vaccination status was examined. The analytic sample (N=11,467) consisted of vaccine eligible females (N=7799) and males (N=3668), 18 to 26 years of age. Descriptive statistics provide data on self-reported HPV vaccination and differences in vaccination status by demographic categories (sex, race/ethnicity, region of country, sexual orientation, insurance status and academic classification). Multivariate logistic regressions examine predictors of self-reported vaccination status (yes or no to vaccination).

Results.Just under two-thirds of the sample (64.8%) reported HPV vaccination; females (68%) reported higher vaccination than males (62.9%), ethnic minorities reported higher percentages of vaccination (91.1% to 65.7%) compared to white students (62.7%), with significant variation by region(40.3% Midwest to 88.9% West). Students who reported receiving hepatitis vaccines were almost five times more likely (aOR=4.80, 95% CI=4.09, 5.65) and those reporting receiving flu vaccine more than twice as likely (aOR=2.27, 95% CI=2.10, 2.46) to report receiving HPV vaccination.  Asian American and biracial students were more likely to report HPV vaccination, as were students from western states who were four times more likely than those from the northeast to report vaccination (aOR=4.07, 95% CI=3.49, 4.74, p<.0001). Students with gay/lesbian identification (aOR=1.46, 95% CI=1.19, 1.80) and freshmen status (aOR=1.18, 95% CI=1.02, 1.36) were more likely to report HPV vaccination. 

Conclusion/Implications. Findings indicate that a sizeable proportion of HPV vaccination eligible college students have not been vaccinated. More freshman students were likely to vaccinated, suggesting the need to direct campus HPV and HPV vaccination information to upperclassmen. Because 95% of the sample was insured, cost is not likely a significant barrier to HPV vaccination. The association between other vaccine use and HPV vaccination suggests the importance of making HPV a routine part of the adolescent vaccination regime. Racial/ethnic identity and sexual orientation were associated with HPV vaccination status and may be useful in efforts to tailor HPV health communication and education for college students. Future research should examine western states’ HPV vaccination education and policy efforts for promising practices.