Journal of Prevention

Cost–Benefit Analysis of Human Papillomavirus Vaccine in Iran

Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.

Knowledge, Attitude and Practices towards Cervical Cancer and its Screening Among Women from Tribal Population of Anuppur District

Cervical cancer poses a significant public health challenge, especially among tribal women who face barriers in accessing healthcare. This study aimed to evaluate the knowledge, attitudes, and practices of tribal women regarding cervical cancer and HPV screening in Anuppur, a rural district in Madhya Pradesh, India. Conducted between December 2020 and December 2022, the cross-sectional study included one tribal block (Pushprajgarh) and one urban block (Jaithari). The study involved females aged 10-59 years from randomly selected households, excluding those with a history of cancer and those not consenting. Healthcare professionals from local health centres were also included, except those on leave. The sample size was 384, determined using a 95% confidence interval and a 5% margin of error. Data were collected through a structured questionnaire covering sociodemographic characteristics, knowledge, attitudes, and practices related to cervical cancer screening. Knowledge was assessed with questions about risk factors, symptoms, and preventive measures, while attitudes were measured using a 7-point Likert scale. Practice-related questions focused on experiences with Pap smear testing. The study revealed a significant lack of awareness among tribal women about cervical cancer and its link to HPV infection. Many participants had limited understanding of the risk factors, symptoms, and preventive measures, leading to negative attitudes towards screening. Barriers such as financial constraints, cultural beliefs, and limited healthcare access further hindered screening practices. As a result, many women had never undergone cervical cancer screening. These findings highlight the urgent need for targeted interventions and educational programs to improve awareness and promote positive attitudes towards cervical cancer screening among tribal women. Emphasizing the importance of regular screening and addressing misconceptions can help bridge the knowledge gap and enhance preventive measures.

Lower Compliance with Cervical Cancer Screening Guidelines Among Vegetarians in North America

Cervical cancer is preventable and treatable through regular screening and follow-up. However, the utilization of cervical cancer screening may vary widely based on individual lifestyles. The purpose of this study was to examine the differences in the adherence to cervical cancer screening guidelines in various dietary groups. Our study included 21,376 women from the United States and Canada, aged 30-69 from the Adventist Health Study-2, a large population-based prospective cohort study. Modified Poisson regression with robust variance estimation was used to determine the prevalence ratios of cervical cancer screening behavior in participants following five different dietary patterns (non-vegetarians, semi-vegetarians, pesco-vegetarians, lacto-ovo-vegetarians, and vegans). All analyses were adjusted for age, race/ethnicity, marital status, education, personal income, body mass index, smoking, alcohol use, exercise, and family history of all female cancer. Vegetarians, in general, had similar screening prevalence as non-vegetarians. However, vegans were 16% less likely to have had a Pap test compared to non-vegetarians (prevalence ratio (PR) = 0.84, 95% confidence interval 0.81-0.86). Women who were younger, Black, married, more educated, had a family history of all female cancer, had a higher income, and exercise reported higher compliance to a Pap test. It remains to be seen whether vegan women in Adventist Health-2 experience a higher incidence of cervical cancer or are diagnosed at a later stage compared to non-vegetarians.