Fear of HPV Vaccine Safety Affects Self-Reported Likelihood to Be Vaccinated after Interventions among University Undergraduates Open Access

Piccione, Christopher Michael (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/r781wg97p?locale=en
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Abstract

Background

Human papillomavirus (HPV) burdens college women and men with the highest risk for acquisition and prevalence. Despite the protection HPV vaccines provide and the little or no evidence of severe side effects associated, vaccination coverage is not on track to meet the Healthy People 2020 goal of 80%. Assessing how fear of HPV vaccine safety affects interventions to increase coverage among 18 to 26 year old university students will shed light on viable catch-up vaccination programs.

Methods

A secondary analysis was performed with data obtained by a HPV Vaccine and Decisions Making Behaviors Survey administered to undergraduate students. Inverse probability treatment weighting (IPTW) was used to create a pseudo data set in which confounding covariates were balanced between persons who perceived the HPV vaccine as unsafe or safe. Odds ratios were calculated with logistic regression models using stabilized weights to identify relationships between perceived vaccine safety and likelihood to be vaccinated after interventions.

Results

Overall, 50 (11.5%) students perceived the HPV vaccine as unsafe, while 386 (88.5%) perceived the vaccine as safe. The odds of being self-reported likely to get the HPV vaccine after CDC recommendation was 59% lower among persons who perceived the HPV vaccine as unsafe compared with those who believed it to be safe (OR = 0.405, 95% CI: 0.22, 0.74). Similarly, the likelihood to be influenced to get the vaccine after an HPV awareness program on campus was 49% lower (OR = 0.512, 95% CI: 0.28, 0.94). All other associations between interventions and perceived vaccine safety registered unstable confidence intervals.

Conclusions

A minority of university undergraduates perceive the HPV vaccine as unsafe, but interventions to address vaccination coverage can be substantially affected by these perceptions. The characteristics of an intervention's target audience should be assessed beforehand to ensure efficacy of catch-up HPV vaccination programs.

Table of Contents

1. BACKGROUND ........................................................................................................... 1

_1.1. Human papillomavirus (HPV) ............................................................................... 1

__1.1.1. Introduction ....................................................................................................... 1

__1.1.2. Biology .............................................................................................................. 1

__1.1.3. Epidemiology ...................................................................................................... 2

__1.1.4. Vaccine acceptance & hesitancy ............................................................................ 3

__1.1.5. Catch-up vaccination programs ............................................................................. 4

_1.2. Inverse probability treatment weighting (IPTW) ................................................. 5

__1.2.1. Introduction ....................................................................................................... 5

__1.2.2. Variable selection ............................................................................................... 6

__1.2.3. Assumptions ...................................................................................................... 6

__1.2.4. Diagnostics ........................................................................................................ 6

2. MANUSCRIPT ............................................................................................................ 8

_2.1. Introduction ....................................................................................................... 11

_2.2. Methods ............................................................................................................. 13

__2.2.1. Design ............................................................................................................. 13

__2.2.2. Survey ............................................................................................................. 13

__2.2.3. Study population ............................................................................................... 14

__2.2.4. Data analysis .................................................................................................... 14

_2.3. Results ............................................................................................................... 16

_2.4. Discussion .......................................................................................................... 17

_2.5. References ......................................................................................................... 20

_2.6. Tables ................................................................................................................ 26

_2.7. Figures ............................................................................................................... 28

3. PUBLIC HEALTH IMPLICATIONS .............................................................................. 30

_3.1. Summary ............................................................................................................ 31

_3.2. Possible Future Directions .................................................................................. 31

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