HPV Vaccination Among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion

Objectives. Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.). Despite widespread availability and healthcare provider recommendations, states in the south have some of the nation’s lowest HPV vaccination rates and some of the highest rates of HPV-associated cancers. The goal of this study was to examine factors related to HPV vaccination, especially the role of health literacy, among college students in a southern state.

Methods. This study utilized a cross-sectional research design to investigate college students’ HPV knowledge and vaccination. Electronic data was collected separately from two public universities in the south. Informed consent was provided to participants before beginning the questionnaire. A total sample of 2,249 participants completed the respective surveys: 327 from the first university and 1,922 from the second university. Primary outcomes were initial HPV vaccine series initiation and completion. Binary logistic regressions were performed to explore factors associated with these outcomes. Health literacy variables, healthcare service access variables, and demographic variables were included in the logistic regression models.

Results. Among total participants, about 62% had initiated HPV vaccination and about 29% had completed the vaccination. Among total participants, students who were aware that HPV could be transmitted even without symptoms (OR=.62), and those who were older (OR=.88) and international students (OR=.32) were less likely to initiate HPV vaccination. Among students having initiated HPV vaccination, those who were aware that HPV could be transmitted without symptoms (OR=1.56), and those who were older (OR=1.06), White (OR=2.16), and international students (OR=16.37) were more likely to complete vaccination. Females were more likely to both initiate (OR=2.57) and complete HPV vaccination (OR=2.08).

Discussion. College students with more HPV knowledge were less likely to initiate HPV vaccination, but among those who initiated, students with more knowledge were more likely to complete the full series. This finding indicates that even though college students are aware of the importance of HPV vaccination to their health, other factors may exist that stop them from initiating HPV vaccination. Researchers need to find out student concerns, educate, and motivate them to initiate HPV vaccination. Furthermore, the higher completion rates among participants with higher HPV literacy indicate the importance of HPV literacy. Health policymakers and practitioners need to design and conduct more HPV literacy education programs to promote college students’ HPV literacy.