Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Pre- and Post-Intervention Questionnaires
2.3. Educational Intervention and On-Site HPV Vaccination Offer
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- De Villiers, E.M.; Fauquet, C.; Broker, T.R.; Bernard, H.U.; zurHausen, H. Classification of papillomaviruses. Virology 2004, 324, 17–27. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ault, K.A. Epidemiology and natural history of human papillomavirus infections in the female genital tract. Infect. Dis. Obstet. Gynecol. 2006, 2006, 40470. [Google Scholar] [CrossRef]
- Pierce Campbell, C.M.; Lin, H.Y.; Fulp, W.; Papenfuss, M.R.; Salmeron, J.; Lazcano-Ponce, E.; Giuliano, A.R.; Quiterio, M.; Villa, L.L. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: The HPV infection in men study. J. Infect. Dis. 2013, 208, 373–384. [Google Scholar] [CrossRef] [PubMed]
- Italian Ministry of Health. Vaccinazione Contro il Papillomavirus (HPV)-Coperture Vaccinali. Available online: www.salute.gov.it/portale/documentazione (accessed on 3 June 2020).
- Sheikh, S.; Biundo, E.; Courcier, S.; Damm, O.; Launay, O.; Maes, E.; Marcos, C.; Matthews, S.; Meijer, C.; Poscia, A.; et al. A report on the status of vaccination in Europe. Vaccine 2018, 36, 4979–4992. [Google Scholar] [CrossRef] [PubMed]
- Italian Ministry of Health. Direzione Generale Della Prevenzione Sanitaria. Coperture Vaccinali al 31/12/2017 per HPV. Available online: www.salute.gov.it/imgs/C_17_tavole_27_allegati_iitemAllegati_0_fileAllegati_itemFile_1_file.pdf (accessed on 3 June 2020).
- Italian Ministry of Health. Commento Alle Coperture Vaccinali al 31/12/2017 per HPV. Available online: http://www.salute.gov.it/imgs/C_17_tavole_27_allegati_iitemAllegati_1_fileAllegati_itemFile_1_file.pdf (accessed on 3 June 2020).
- Italian National Institute of Health-ISS. Coperturavaccinale in Italia. Available online: https://www.epicentro.iss.it/vaccini/dati_Ita#hpv (accessed on 3 June 2020).
- Restivo, V.; Costantino, C.; Fazio, T.F.; Casuccio, N.; D’Angelo, C.; Vitale, F.; Casuccio, A. Factors Associated with HPV Vaccine Refusal among Young Adult Women after Ten Years of Vaccine Implementation. Int. J. Environ. Res. Public Health 2018, 15, 770. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Palmeri, S.; Costantino, C.; D’Angelo, C.; Casuccio, N.; Ventura, G.; Vitale, F.; Pojero, F.; Casuccio, A. HPV vaccine hesitancy among parents of female adolescents: A pre-post interventional study. Public Health 2017, 150, 84–86. [Google Scholar] [CrossRef] [PubMed]
- Napolitano, F.; Navaro, M.; Vezzosi, L.; Santagati, G.; Angelillo, I.F. Primary care pediatricians’ attitudes and practice towards HPV vaccination: A nationwide survey in Italy. PLoS ONE 2018, 13, e0194920. [Google Scholar] [CrossRef]
- Liuccio, M.; Borgia, C.; Cannistrà, L.; Martino, B. HPV information campaigns in Italy since 2004. Ann. Ig. 2016, 28, 218–226. [Google Scholar]
- Trucchi, C.; Costantino, C.; Restivo, V.; Bertoncello, C.; Fortunato, F.; Tafuri, S.; Amicizia, D.; Martinelli, D.; Paganino, C.; Piazza, M.F.; et al. Immunization Campaigns and Strategies against Human Papillomavirus in Italy: The Results of a Survey to Regional and Local Health Units Representatives. Biomed. Res. Int. 2019, 4, 6764154. [Google Scholar] [CrossRef] [Green Version]
- Icardi, G.; Costantino, C.; Guido, M.; Zizza, A.; Restivo, V.; Amicizia, D.; Tassinari, F.; Piazza, M.F.; Paganino, C.; Casuccio, A.; et al. Burden and Prevention of HPV. Knowledge, Practices and Attitude Assessment Among Pre-Adolescents and their Parents in Italy. Curr. Pharm. Des. 2020, 26, 326–342. [Google Scholar] [CrossRef]
- Trucchi, C.; Amicizia, D.; Tafuri, S.; Sticchi, L.; Durando, P.; Costantino, C.; Varlese, F.; Silverio, B.D.; Bagnasco, A.M.; Ansaldi, F.; et al. Assessment of Knowledge, Attitudes, and Propensity towards HPV Vaccine of Young Adult Students in Italy. Vaccines (Basel.) 2020, 8, 74. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Demo ISTAT. Dati Popolazione Italiana 2019. Available online: http://demo.istat.it/pop2019/index.html (accessed on 3 June 2020).
- Caranci, N.; Biggeri, A.; Grisotto, L.; Pacelli, B.; Spadea, T.; Costa, G. [The Italian Deprivation Index at Census Block Level: Definition, Description and Association with General Mortality]. Epidemiol. Prev. 2010, 34, 167–176. [Google Scholar] [PubMed]
- Giambi, C.; D’Ancona, F.; Del Manso, M.; De Mei, B.; Giovannelli, I.; Cattaneo, C.; Possenti, V.; Declich, S. Local Representatives for VALORE. Exploring reasons for non-vaccination against human papillomavirus in Italy. BMC Infect. Dis. 2014, 14, 545. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Firenze, A.; Marsala, M.G.; Bonanno, V.; Maranto, M.; Ferrara, C.; Giovannelli, L.; Restivo, V. Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation. Hum. Vaccines Immunother. 2015, 11, 240–244. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Niccolai, L.M.; Hansen, C.E. Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review. JAMA Pediatr. 2015, 169, 686–692. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Marlow, L.A.; Forster, A.S.; Wardle, J.; Waller, J. Mothers’ and adolescents’ beliefs about risk compensation following HPV vaccination. J. Adolesc. Health 2009, 44, 446–451. [Google Scholar] [CrossRef]
- Remschmidt, C.; Walter, D.; Schmich, P.; Wetzstein, M.; Deleré, Y.; Wichmann, O. Knowledge, attitude, and uptake related to human papillomavirus vaccination among young women in Germany recruited via a social media site. Hum. Vaccines Immunother. 2014, 10, 2527–2535. [Google Scholar] [CrossRef] [Green Version]
- Roberts, S.A.; Brabin, L.; Stretch, R.; Baxter, D.; Elton, P.; Kitchener, H.; McCann, R. Human papillomavirus vaccination and social inequality: Results from a prospective cohort study. Epidemiol. Infect. 2011, 139, 400–405. [Google Scholar] [CrossRef] [Green Version]
- Schülein, S.; Taylor, K.J.; König, J.; Claus, M.; Blettner, M.; Klug, S.J. Factors influencing uptake of HPV vaccination among girls in Germany. BMC Public Health 2016, 16, 995. [Google Scholar] [CrossRef] [Green Version]
- Restivo, V.; Costantino, C.; Marras, A.; Napoli, G.; Scelfo, S.; Scuderi, T.; Casuccio, A.; Cernigliaro, A.; Giusti, A.; Alegiani, S.S. Pap testing high-income country with suboptimal compliance levels: A survey on acceptance factors among Sicilian women. Int. J. Environ. Res. Public Health 2018, 15, 1804. [Google Scholar] [CrossRef] [Green Version]
- Lee, A.; Wong, M.C.; Chanm, T.T.; Chan, P.K. A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine. BMC Public Health 2015, 15, 935. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shah, M.D.; Glenn, B.A.; Chang, L.C.; Chung, P.J.; Valderrama, R.; Uyeda, K.; Szilagyi, P.G. Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention. Acad. Pediatr. 2020. [Google Scholar] [CrossRef] [PubMed]
- Lindley, M.C.; Boyer-Chu, L.; Fishbein, D.B.; Kolasa, M.; Middleman, A.B.; Wilson, T.; Wolicki, J.; Wooley, S. The role of schools in strengthening delivery of new adolescent vaccinations. Pediatrics 2008, 121, S46–S54. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Waller, J.; Forster, A.; Ryan, M.; Richards, R.; Bedford, H.; Marlow, L. Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales. Vaccine 2020, 38, 1040–1047. [Google Scholar] [CrossRef] [PubMed]
- Slattelid Schreiber, S.M.; Juul, K.E.; Dehlendorff, C.; Kjær, S.K. Socioeconomic predictors of human papillomavirus vaccination among girls in the Danish childhood immunization program. J. Adolesc. Health 2015, 56, 402–407. [Google Scholar] [CrossRef] [PubMed]
- Bianco, A.; Pileggi, C.; Iozzo, F.; Nobile, C.G.A.; Pavia, M. Vaccination against human papilloma virus infection in male adolescents: Knowledge, attitudes, and acceptability among parents in Italy. Hum. Vaccines Immunother. 2014, 10, 2536–2542. [Google Scholar] [CrossRef] [Green Version]
- Spencer, A.M.; Roberts, S.A.; Brabin, L.; Patnick, J.; Verma, A. Sociodemographic factors predicting mother’s cervical screening and daughter’s HPV vaccination uptake. J. Epidemiol. Community Health 2014, 68, 571–577. [Google Scholar] [CrossRef]
- McCabe, S.E.; Boyd, C.J.; Young, A.; Crawford, S. Feasibility Study for Collecting Alcohol and Other Drug Use Data Among Secondary School Students: A Web-Based Survey Approach. J. Drug Educ. 2004, 34, 373–383. [Google Scholar] [CrossRef]
- Shah, P.D.; Gilkey, M.B.; Pepper, J.K.; Gottlieb, S.L.; Brewer, N.T. Promising alternative settings for HPV vaccination of US adolescents. Expert. Rev. Vaccines 2014, 13, 235–246. [Google Scholar] [CrossRef] [Green Version]
Variables | n (%) |
---|---|
Gender | |
Male | 802 (48) |
Female | 869 (52) |
School year | |
first class | 390 (22.9) |
second class | 497 (29.2) |
third class | 815 (47.9) |
School neighborhood deprivation index | |
A (high level) | 437 (25.7) |
B (intermediate level) | 858 (50.4) |
C (low level) | 407 (23.9) |
Residency | |
Palermo municipality | 1092 (64.2) |
Province of Palermo | 610 (35.8) |
Nationality | |
Italian | 1622 (98.1) |
Other | 31 (1.9) |
Deprivation index | |
Deprived | 1138 (67.1) |
Not Deprived | 559 (32.9) |
Variables | n (%) |
---|---|
Talking about STDs at home | |
Yes | 551 (32.4) |
No | 1151 (67.6) |
Talking about STDs at school | |
Yes | 1131 (66.5) |
No | 571 (33.5) |
Talking about STDs with physician | |
Yes | 370 (21.7) |
No | 1332 (78.3) |
Have you ever heard about HPV infection or vaccine | |
Yes | 1214 (71.3) |
No | 488 (28.7) |
Principal way of transmission of HPV infection | |
Sexual intercourse | 1497 (88) |
Airborne | 147 (8.6) |
Oro-fecal | 58 (3.4) |
HPV infection is common | |
Yes | 703 (39) |
No | 1098 (61) |
HPV infection can cause cancer among both sexes | |
Yes | 905 (50.2) |
No | 896 (49.8) |
HPV infection can cause genital warts | |
Yes | 319 (17.7) |
No | 1482 (82.3) |
HPV vaccination is actively and free of charge offered to | |
Female preadolescents | 299 (16.6) |
Both Sexes | 1502 (83.4) |
Variables | Crude OR | CI 95% | p-Value | Adj OR | CI 95% | p-Value | |
---|---|---|---|---|---|---|---|
Gender | Male | ref | 0.14 | ref | 0.36 | ||
Female | 1.16 | 0.95–1.42 | 1.11 | 0.89–1.37 | |||
School year | First | ref | <0.001 | ref | 0.01 | ||
Second | 1.95 | 1.49–2.54 | 1.09 | 0.98–1.95 | |||
Third | 2.11 | 1.68–2.66 | 1.18 | 1.03–1.36 | |||
School Deprivation Index | A | ref | 0.04 | ref | 0.75 | ||
B | 1.01 | 0.76–1.18 | 1.03 | 0.87–1.21 | |||
C | 0.66 | 0.53–0.91 | 0.89 | 0.72–1.06 | |||
Residency | Province | ref | 0.48 | ||||
Municipality | 0.95 | 0.89–1.27 | |||||
Nationality | Italian | ref | 0.92 | ||||
Other | 1.04 | 0.49–2.18 | |||||
Deprivation Index | Deprived | ref | <0.001 | ref | 0.02 | ||
Not Deprived | 1.60 | 1.29–2.00 | 1.35 | 1.05–1.73 | |||
Talking about STDs at home | No | ref | <0.001 | ref | <0.001 | ||
Yes | 2.13 | 1.70−2.67 | 1.62 | 1.27–2.07 | |||
Talking about STDs at school | No | ref | <0.001 | ref | <0.001 | ||
Yes | 2.65 | 2.15–3.27 | 2.15 | 1.70–2.71 | |||
Talking about STDs with physician | No | ref | 0.38 | ||||
Yes | 1.11 | 0.87–1.42 | |||||
Have you ever heard about HPV infection or vaccine | No | ref | <0.001 | ref | <0.001 | ||
Yes | 2.34 | 1.88–2.90 | 1.80 | 1.42–2.29 |
Questions | Correct Answer | Uncorrect Answer |
---|---|---|
n (%) | ||
HPV infection can cause severe diseases (such as cancers) | 1504 (93.7) | 101 (6.3) |
HPV vaccination can prevent cervical cancer, ano-genital cancers and genital warts | 1445 (90.2) | 157 (9.8) |
HPV vaccination is effective and safe | 1379 (85.9) | 226 (14.1) |
Preadolescent boys and girls should be vaccinated against HPV | 1450 (90.5) | 153 (9.5) |
Variables | Crude OR | CI 95% | p-Value | Adj OR | CI 95% | p-Value | |
---|---|---|---|---|---|---|---|
Gender | Male | ref | <0.001 | ref | <0.01 | ||
Female | 1.69 | 1.23–2.55 | 1.66 | 1.20–2.31 | |||
Nationality | Italian | ref | 0.63 | ||||
Other | 1.13 | 0.86–1.69 | |||||
School year | First | ref | 0.81 | ||||
Second | 0.87 | 0.64–1.26 | |||||
Third | 1.17 | 0.89–1.67 | |||||
School Deprivation Index | A | ref | <0.05 | ref | 0.10 | ||
B | 1.16 | 0.76–1.18 | 1.02 | 0.89–1.12 | |||
C | 1.34 | 1.09–1.72 | 1.20 | 0.96–1.49 | |||
Residency | Province | ref | <0.05 | ref | <0.05 | ||
Municipality | 1.54 | 1.09–2.19 | 1.55 | 1.09–2.22 | |||
DeprivationIndex | Deprived | ref | 0.36 | ||||
Not Deprived | 0.93 | 0.67–1.29 | |||||
Have you ever heard about HPV infection or vaccine | No | ref | <0.01 | ref | 0.07 | ||
Yes | 1.89 | 1.23–2.19 | 1.36 | 0.97–1.95 | |||
Knowledge score at preintervention questionnaire | Not adequate | ref | 0.09 | ref | 0.14 | ||
Adequate | 1.45 | 0.96–1.93 | 1.28 | 0.92–1.79 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Costantino, C.; Amodio, E.; Vitale, F.; Trucchi, C.; Maida, C.M.; Bono, S.E.; Caracci, F.; Sannasardo, C.E.; Scarpitta, F.; Vella, C.; et al. Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily. Int. J. Environ. Res. Public Health 2020, 17, 5362. https://doi.org/10.3390/ijerph17155362
Costantino C, Amodio E, Vitale F, Trucchi C, Maida CM, Bono SE, Caracci F, Sannasardo CE, Scarpitta F, Vella C, et al. Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily. International Journal of Environmental Research and Public Health. 2020; 17(15):5362. https://doi.org/10.3390/ijerph17155362
Chicago/Turabian StyleCostantino, Claudio, Emanuele Amodio, Francesco Vitale, Cecilia Trucchi, Carmelo Massimo Maida, Stefania Enza Bono, Francesca Caracci, Claudia Emilia Sannasardo, Francesco Scarpitta, Carlotta Vella, and et al. 2020. "Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily" International Journal of Environmental Research and Public Health 17, no. 15: 5362. https://doi.org/10.3390/ijerph17155362