Awareness of and attitude towards human papillomavirus infection and vaccination for cervical cancer prevention among adult males and females in Korea: A nationwide interview survey

Abstract

We assessed adult male and female awareness and acceptance of human papillomavirus (HPV) infection and vaccination for cervical cancer prevention, as well as factors associated with willingness to be administered the HPV vaccine. A nationwide population-based interview survey was conducted in Korea. One thousand male and female adults were included with random sampling. Despite the fact that awareness of HPV infection (13.3%) and the preventive effect of HPV vaccination (8.6%) were low, willingness to vaccinate against HPV (55.0%) was relatively high, especially with regard to participants’ daughters (77.0%). Those who were informed about HPV infection (adjusted odds ratio, aOR = 2.5 and 95% confidence interval, CI = 1.1–5.3 in males; aOR = 2.5 and 95% CI = 1.5–4.2 in females) or vaccination (aOR = 2.9 and 95% CI = 1.1–7.6 in males; aOR = 2.9 and 95% CI = 1.6–5.4 in females), or who perceived a susceptibility to HPV infection (aOR = 3.6 and 95% CI = 1.9–6.8 in males; aOR = 2.8 and 95% CI = 1.6–5.0 in females) were more accepting of vaccination than those who did not.

Appropriate knowledge transfer, guidance from a health professional, and reductions in the cost of the vaccine are key issues in promoting awareness of HPV infection and vaccination for cervical cancer prevention.

Introduction

Following its rapid development, the prophylactic vaccine for human papillomavirus (HPV) is promising as a key component of future cervical cancer control programs; accordingly, an international effort to disseminate the vaccine has been implemented [1]. The HPV vaccine has been used in some communities or nations with or without national guidelines for vaccination, although cost-effectiveness analyses and efficacy trials in men are still ongoing.

However, the successful introduction and acceptance of the vaccine will depend on a range of factors including awareness of HPV infection as an important problem related to cervical cancer, the affordability and acceptability of the vaccine among the groups who will influence uptake, and political interest. Furthermore, in the absence of legally mandated and enforced HPV immunization, at-risk persons must voluntarily agree to receive the vaccine, a decision that is affected by individual knowledge, beliefs about susceptibility, perception of vaccine effectiveness, family and physician perspectives, sexual and cultural practices, and cost for vaccination.

For this reason, studies on awareness regarding HPV infections and attitudes towards HPV vaccinations have been conducted in many countries from the perspective of physicians [2], [3], [4], [5], [6], [7], parents [8], [9], [10], adolescents [11], [12], [13], [14], and Asians [15], [16], [17]. These study results differed in the characteristics of the study population, country, and socio-cultural background.

In Korea, HPV is suggested to be one of the most common sexually transmitted infection, with a 10% prevalence in sexually active women aged 20–74 years olds [18], [19]. The prevalence in young adults is also high, as reported in a recent epidemiologic study (15.2% and 8.7% in female and male university students, respectively) [20]. Corresponding to the high prevalence of HPV, uterine cervical cancer is still a major cancer affecting Korean women despite the fact that a national cervical cancer screening program using the Pap test has contributed to a decrease in cervical cancer incidence and mortality [21], [22], [23].

Recently two HPV vaccines were approved by the Korean Food and Drug Administration (KFDA), immunization of adolescent girls against HPV before having their first sexual contact was highly recommended by the Committee on Infectious Diseases of the Korean Pediatric Society [24] and the Korean Society of Gynecologic Oncology and Colposcopy [25]. However, national guidelines for HPV vaccination have not yet been established due to a lack of epidemiologic data, economic evaluations and many practical issues regarding its application.

Currently, although adolescents and young adults have been investigated for future HPV vaccine acceptance in a few studies [20], [26], little is known about adult males and females. However, this information is important in the debate regarding the necessity of mandated vaccination against HPV and for decisions on how the HPV vaccination should be applied to an overall cervical cancer control program.

Therefore, in this study, overall awareness of HPV infection as a necessary cause of cervical cancer and attitudes toward HPV vaccination were investigated among the general adult population, including males.