Journal of Community Health

Knowledge and Attitude of Female Students of Tertiary Institutions in Imo State, Nigeria Towards Cervical Cancer and Its Screening

Cervical cancer is the second most common cancer in women. It is preventable if detected early. Effective screening can detect the earliest stage of premalignant form. This study was carried out to ascertain the knowledge and attitude of female students in four tertiary institutions in Imo State towards cervical cancer and its screening. Interviewee administered close-ended structured questionnaire was used for data collection. Questionnaires were validated by content and construct validity. A total of 400 female students in tertiary institutions within reproductive age; 16-45 years were recruited as respondents. Of the respondents, 398 (99.5%) completed and returned their questionnaires. These were analyzed using simple statistical methods. Results revealed that 350 (87.9%) have heard of cervical cancer while 265 (66.6%) have heard of cervical screening. Sexually active respondents were 186 (47%) meanwhile only 17 (4.3%) had undergone the screening. Most (93.5%), agreed that having multiple sexual partners was a risk factor. Most respondents (96.2%), knew that Human Papillomavirus (HPV) is the causative agent. The most prevalent (94%) reasons for not undertaking the screening was embarrassment followed by stigmatization 320 (80.4%). This study revealed high knowledge of cervical cancer among the students but poor attitude towards its screening. This calls for continued enlightenment for women of reproductive age including students in tertiary institutions on routine screening for cervical cancer especially as soon as they become sexually active. This will expectedly, increase the rate of early detection and subsequent treatment thereby preventing the high cost of treating and managing full-blown cervical cancer.

Community-level Social Vulnerability and Cervical Cancer Mortality Among Young and Old Adults in the State of Alabama

Abstract In addition to individual factors, differences in community-level factors impact mortality rates of cervical cancer (CC), especially in the Southeast United States, where CC one-year mortality is significantly higher than national average. This study investigated the association between community-level social vulnerability measured using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) and overall and one-year CC mortality in Alabama. Retrospective cohort study using Alabama State Cancer Registry data from 2012 to 2021. Outcome of interest was mortality due to CC. Residential addresses were geocoded to determine SVI scores categorized into quartiles. Cox proportional hazards model was used to assess associations between SVI quartiles and overall and one-year CC mortality adjusting for age at diagnosis, race, marital status, and insurance status. Further, CC mortality in younger adults (≤50 years) was compared with older adults (> 50 years). A total of 1,325 women with CC were included in the study. The median age at diagnosis was 49 years (IQR: 39–62) and 69.73% were White. Median follow-up time was 9 months (IQR: 5–17). Among older adults, we observed statistically significant association between higher SVI quartiles and overall mortality (Q4: aHR 1.86; 95% CI 1.15, 3.01; p = 0.012] and one-year mortality (Q3: aHR 2.66; 95% CI 1.34, 5.29; p = 0.005; Q4: aHR 2.45; 95% CI 1.18, 5.08; p = 0.016). This study highlights the role of community factors in CC mortality among older women. Community-level strategies are needed to reduce the burden of CC mortality in Alabama and other high-risk regions.

Perceived Risk and HPV Vaccination Awareness Among Women in Rural and Underserved Communities in the State of Louisiana

Abstract Despite the availability of effective preventive measures, women in rural and underserved communities of Louisiana face health disparities regarding human papillomavirus infections. This study explores how perceived risk and socioeconomic factors, such as income, influence HPV vaccine awareness and attitudes toward HPV risk. A cross-sectional study was conducted among women in rural and underserved areas of Louisiana from November 2022 to December 2023. Participants were eligible to be included in the study if they were adult females aged 25 to 64 with no history of hysterectomy and no history of cervical cancer. We used convenience sampling through a mobile health unit that travels to rural and underserved areas of north and central Louisiana, offering cervical cancer screening. A total of 141 women participated in the study. Findings revealed significant gaps in HPV awareness and vaccination knowledge. Only 10.6% of participants considered themselves at risk for HPV. Higher HPV knowledge scores were positively associated with perceived HPV risk, increasing by approximately 20% per correct response. Approximately 40% of the participants were unaware of the existence of the HPV vaccine, 96.5% had never received the HPV vaccine, and 91.4% had never been offered it. Only 42% indicated that they would consider vaccination if offered. Addressing health disparities in rural Louisiana requires targeted interventions to improve healthcare access, education, and community engagement. Efforts to enhance education and awareness and foster community engagement should be prioritized.

Evaluation of HPV and Related Cancer Awareness and Vaccination Attitudes Among Patients with Anogenital Warts: a Survey-Based Study

Abstract We aimed to evaluate awareness of HPV and its associated cancers, attitudes toward HPV vaccination, and vaccination rates in individuals with anogenital warts. This cross-sectional study was conducted at Sakarya University Training and Research Hospital using a questionnaire completed by individuals diagnosed with anogenital warts. A total of 105 respondents were included in the study, comprising 80 males (76.2%) and 25 females (23.8%). The mean age of participants was 34.7 ± 11.2 years. HPV awareness was 70.5%, while cervical cancer awareness was 38.1%. Women demonstrated significantly higher levels of HPV and cervical cancer awareness, as well as knowledge of Pap smear testing, compared to men. Women were also significantly more likely than men to express willingness to vaccinate their children against HPV (84.0% vs. 58.8%, p = 0.039). Higher education levels were associated with increased awareness of HPV, HPV vaccination, and willingness to vaccinate children. Physicians were the primary source of HPV-related information across the cohort. HPV vaccine awareness was 73.3%, but the overall vaccination rate was only 10.5%, with women showing significantly higher vaccination rates than men (24% vs. 6.2%, p = 0.021). The most commonly reported barriers to vaccination were cost (60%) and lack of information (45.7%). None of the participants had vaccinated their children. This study highlights that awareness of HPV and its vaccination is associated with gender and education level but does not translate into higher vaccination rates. Efforts should focus on targeting men and individuals with lower educational attainment by strengthening physicians’ roles in public education. Incorporating HPV vaccination into national programs and implementing culturally tailored campaigns may effectively improve vaccination rates.

A Systematic Review of Interventions to Promote Cervical Cancer Screening among Immigrant Vietnamese Women

Abstract Vietnamese women have a higher incidence rate of cervical cancer and are less likely to have ever been screened for cervical cancer than their White counterparts in the US. This review synthesizes findings from published interventions to promote cervical cancer screening in this vulnerable population. Articles were identified through a systematic search of PsycInfo, Embase, Pubmed, Web of Science, and the Cochrane Register of Controlled Trials in October 2022. Articles were included if they were published in a peer-reviewed journal, written in English, included one or more interventions promoting cervical cancer screening, assessed at least one outcome relevant to screening, and included a sample of ≥ 70% Vietnamese participants. Quality assessment scores were computed using the Downs and Black Checklist. Fifteen articles met review inclusion criteria. Studies were, on average, of good quality. Most studies were conducted in the US (n = 12), used a quasi-experimental design (n = 9), and employed multiple intervention strategies (n = 12). Intervention strategies included educational sessions, lay health worker (LHW) outreach, small media, mass media, patient navigation, and community or healthcare-based strategies. The most common study outcomes were screening intention and receipt. All but two studies reported improved cervical cancer screening outcomes following intervention. Findings support the effectiveness of multicomponent culturally tailored interventions to improve cervical cancer screening outcomes in immigrant Vietnamese women. Further research is needed to determine whether these interventions will be as successful in non-US countries and to address broader community- and healthcare-based factors in screening.

Enhancing Adherence to Cervical Cancer Screening Guidelines at a Student-Run Free Clinic

Women who lack health insurance have much lower rates of cervical cancer screening and higher rates of cervical cancer than insured women. The current screening rate for insured patients is 86.9%, while the rate for uninsured women is 68.2%. Student-run free clinics may help increase the rates of cervical cancer screening in uninsured women. As screening rates in this setting are uncertain, this study was performed to determine rates of cervical cancer screening at a student-run free clinic, and therefore determine its effectiveness in increasing screening rates in uninsured women. A retrospective chart review was conducted among female patients ages 21-64 at a student-run free clinic to determine how many patients were up-to-date with cervical cancer screening per American Cancer Society (ACS) guidelines. A total of 239 women were included in the retrospective chart review. At their most recent visit, 87.9% of clinic patients were up-to-date on cervical cancer screening. This screening rate is higher than both the reported uninsured (68.2%) and insured (86.9%) national screening rates in the United States. Although there are multiple barriers that prevent uninsured patients from undergoing cervical cancer screenings, screening rates at our student-run free clinic are higher than national screening rates. This higher screening rate can be attributed to a standardized screening system, access to resources including Pap tests provided by community partners, and the clinic's ability to longitudinally follow patients. However, there remain areas for improvement, such as reducing no-show rates and ensuring that staff screen for cervical cancer at each visit.

Identification of the Knowledge Level of Students Receiving Health Education About the Human Papilloma Virus, Screening Tests, and Human Papilloma Virus Vaccination

This study aims to identify the knowledge level of students receiving health education about the human papilloma virus, screening tests, and human papilloma virus vaccination. The present study was designed as a descriptive study. It was conducted in the Nursing department and First and Emergency Aid programs in a city in the Eastern part of Turkey between November and December 2019. The sample of the study included 312 students who volunteered to participate in the study. The data collection tools used were the Socio-demographic Form and the Human Papilloma Virus Knowledge Scale. The students' Human Papilloma Virus Knowledge Scale total mean score was 5.86 ± 6.40. The HPV knowledge Scale total score, the General HPV Knowledge sub-scale, and the General HPV Vaccination Knowledge subs-scale mean scores were found to be significantly higher in women, in those who were enrolled in 3rd year, and in those who were knowledgeable about sexually transmitted diseases and cervical cancer. The HPV screening Test Knowledge sub-scale mean score was found to be significantly higher in those who were enrolled in 3rd year and who were knowledgeable about cervical cancer (p < 0.05). The results showed that students' knowledge levels about HPV were not sufficient, and variables such as gender, class level, and knowledge about sexually transmitted diseases and cervical cancer were found to affect the knowledge level about HPV, screening tests, and vaccination. It is recommended that similar studies should be conducted in larger groups, and initiations to increase the knowledge levels of students should be planned.

Knowledge, Attitudes and Behaviors of Women who have or have not had human papillomavirus vaccine in Turkey about the Virus and the vaccine

The awareness of Human Papillomavirus (HPV), the most common sexually transmitted disease in the world, and the frequency of vaccination vary across countries. In Turkey, the rate of HPV vaccination is quite low even amongin women, and there is not much data on the frequency of vaccination among men. This study aimedto investigate the difference in knowledge and attitude between Turkish women who had HPV vaccination and those who did not. Women between 18 and 65 living in a province in the central region of Turkey were included. Participants (n = 856) were selected by snowball sampling and with an online questionnaire. The collected data were analyzed by the SPSS programme. Descriptive statistical analysis, chi-square test, T-test for independent samples and one-way ANOVA was used. 67.3% of the participants had heard of HPV and 55.4% had heard of the HPV vaccine. The HPV vaccination rate was 3.6%. The most important source of information for those who reported getting vaccinated on HPV was their family physician. Additionally, the HPV Knowledge Scale total scores of those who received information from family physicians and gynecologists were higher than the others. The most frequent reasons they cited for not getting vaccinated were a lack of information and not having the vaccine covered by social security. It is important to include it in the national vaccination scheme in order to increase the HPV vaccination rate in low-income countries such as Turkey. Also, these findings show the prominence of family physicians in public education.

Knowledge, Attitudes and HPV Vaccine Intention Among Women in India

In India, cervical cancer associated with human papillomavirus (HPV) infection is a leading cause of cancer-related mortality among women. However, uptake of the vaccine in India is low. We assessed knowledge and attitudes towards HPV, assess participants' willingness to accept the vaccination for themselves and their children, and determine factors associated with intention to receive the HPV vaccine among women in Mangalore, India. This cross-sectional study surveyed a convenient sample of 237 women aged 18-45 years using a semi-structured questionnaire. All respondents reported being aware of HPV infection. However, 22.36% (n = 53) of the respondents have never heard about genital warts and 18.57% (n = 44) have never heard about HPV vaccine. Participants displayed good general knowledge of HPV infection (median score, 1.26; Interquartile Range (IQR): 1.04-1.52) and average knowledge of HPV vaccine (e.g., median score, 1.18; IQR: 0.73-1.45). HPV general knowledge and vaccine knowledge were associated with intention to receive the HPV vaccine and recommend it to children. Participant awareness of the HPV vaccine predicted vaccine intent for themselves. Participants' willingness to recommend the vaccine for their children was associated with older age, married status, having one or more children, and having a college education. Lack of awareness about genital warts was strongly associated with participants' refusal to get the HPV vaccine or recommend it for their own children (Relative Risk Ratio RRR: 12.21; 95% C.I.: 2.33-63.99). Our study validated the questionnaire as a reliable tool for assessing HPV and HPV vaccine knowledge, attitudes, awareness, and vaccine intentions in women aged 18-45 years. Public health education should focus on increasing awareness of genital warts as a sequela of HPV, as well as promote awareness of role and safety of HPV vaccination in -children.

Association of Cancer Risk Perception and Patient-provider Communication with Pap Test Among African American and Sub-Saharan African-born Women

Black women bear a disproportionately higher burden of cervical cancer than any ethnic/racial group. Patient's cancer risk perceptions and patient-provider communication behavior may influence uptake of cervical cancer screening with Papanicolaou (Pap) test. We examined the association of cancer risk perceptions and patient-provider communication behavior and Pap test uptake. Black women completed a cross-sectional survey on sociodemographic, cancer perceptions, and perceived patient-centered communication behaviors. Multiple linear regression models were fitted to explore the association of perceptions and patient communication behaviors. Women (N = 116) average age was 40 ± 12.7 years and 73% had ever received a Pap test. Women who agreed with the statement that it seemed like everything causes cancer had over four times the odds of having had a Pap test (OR = 4.40, 95% CI = 1.38-13.97, p = .012) while those that responded that when they think about cancer, they automatically think of death had 73% lower odds of having had a Pap test (OR = 0.27, 95% CI = 0.08-0.95, p = .040). The odds of Pap test completion were over 4-fold among those who said their health care provider always or usually gave them the chance to ask health-related questions, compared to those who responded sometimes or never (OR = 4.11, 95% CI = 1.36-12.44; p = .012). Interventions to dispel myths and promote effective patient-provider communications are warranted to address anecdotal cancer risk perceptions and promote patient engagements.

Evaluation of Human Papillomavirus Vaccination and Cancer Prevention Behaviors among LGBTQI + Individuals: A Cross-Sectional Study

Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Human Papillomavirus Vaccination and Pap Smear Rates Among Burmese Refugee Girls in a Healthcare System in Omaha, Nebraska

While human papilloma virus (HPV) vaccinations and Pap smear screenings are known to improve the survival rates and incidence of cervical cancer, refugee populations have traditionally been disadvantaged within this arena. Due to past and recent political issues in Myanmar, Burmese refugee women in Nebraska may be at particular risk due to their increasing numbers. This study examined 65 female Burmese refugees who were candidates for HPV vaccinations and 106 female Burmese refugees who could have received Pap smear screenings between 2010 and 2020. Of the 65 patients aged 11-26, 49.2% initiated the HPV vaccine series and 30.8% completed the series. In patients aged 13-17, 86.4% initiated the vaccine series and 54.6% completed the series. Of the 106 patients over 18 years of age, 32.1% had a Pap smear within the last 3 years. The need to improve HPV vaccine and Pap smear rates in refugee populations is clear. While focusing on the designated refugee exam may have improved HPV vaccine rates, it is important to examine gaps in knowledge with regards to attitudes surrounding HPV vaccines and Pap smears within the Burmese refugee population.

Cervical Cancer and Human Papillomavirus Vaccine Awareness Among Married Bhutanese Refugee and Nepali Women in Eastern Nepal

This study examined the sexually transmitted infections (STIs), cervical cancer, and human papillomavirus virus (HPV) vaccine-related awareness and knowledge among married Bhutanese refugee and Nepali women living in eastern Nepal. Participants were recruited from a women's health camp in Jhapa District in eastern Nepal. A demographic and health survey with questions on STIs, cervical cancer and HPV vaccine was administered to consenting participants. Women who were born in Bhutan or living in the United Nations administered refugee camps were classified as Bhutanese. Of the 630 participants, 14.3% of participants were Bhutanese and the mean age was 38.8 ± 8.2 years. A higher proportion of Bhutanese than Nepali women reported a lack of cervical cancer awareness (42.0% vs. 30.7%; p = 0.036). Only 21.5% of the participants knew HPV as the cause of cervical cancer; 13.9% were aware of an HPV vaccine; and 96% reported that they would have their children vaccinated against HPV if the vaccine was available free of cost to them. In multivariable analyses, the lack of awareness about STIs was directly associated with the lack of cervical cancer awareness [odds ratio (OR) 4.50; 95% confidence interval (CI) 2.99-6.77] and inversely associated with HPV-vaccine awareness [OR 0.53; 95% CI 0.29-0.97]. Low cervical cancer and HPV vaccine awareness and knowledge among Nepali and Bhutanese women in eastern Nepal highlight the need for increasing awareness and knowledge in the context of STIs and reproductive health education. Increasing awareness and knowledge of HPV, its role in cervical cancer, and prevention modalities is a first critical step for implementing successful targeted primary cervical cancer prevention measures focused on behavior modification and vaccine administration.