HPV Vaccination Knowledge and Decision-Making Among Adults 27 to 45 Years: A Large Online Survey

Abstract

Objective: Understand knowledge and barriers to human papillomavirus (HPV) vaccination among United States (US) adults, comparing adults in the original age cohort of 18-26 years to those in the expanded 27-45-yearyear-old cohort.

Methods: A cross-sectional survey was administered to US adults recruited through social media. Descriptive statistics characterized the data. Multivariate logistic regression identified factors associated with vaccination.

Results: Among 1735 respondents, the majority were in the 27-45 age group (936, 53.94%). The 27-45-year group exhibited more knowledge of HPV's link to head and neck cancer and vaccine protection but expressed less concern about HPV infection (all p < 0.05). Key motivators for the history of vaccination in the 27-45 year cohort included vaccine effectiveness (48.65%) and prior knowledge (42.44%). Self-vaccination rates were comparable across age groups (18-26: 70.62% vs. 27-45: 68.07%, p = 0.256). Older adults were less likely to vaccinate dependents (68.57% vs. 75.00%, p < 0.001) despite higher interest (p < 0.001). Main barriers for unvaccinated 27-45 year old adults included scheduling issues, insurance coverage, and lack of concern for HPV infection (all p < 0.05). Among individuals aged 27 to 45, multivariate logistic regression analysis revealed significantly higher odds of vaccination in those from the Western US (compared to Northeast/Midwest) (OR 3.15, 95% CI: [1.84, 5.39]) and personal history of head and neck cancer (3.01, [1.78-5.09]).

Conclusion: Most respondents understand HPV risks and are vaccinated. Interventions directed towards education about vaccine safety, the hazards of HPV, and improving access may increase vaccination.

Level of evidence: IV.

Keywords: Gardasil; HPV; HPV vaccination; patient knowledge; treatment decision making.

FIGURE 1

Respondent knowledge about HPV and HPV vaccination, with stratification by age cohort (18–26 years vs. 27–45 years vs. total cohort). An asterisk signifies a statistically significant difference between groups (p < 0.05).

FIGURE 2

Adult HPV vaccine treatment decision‐making with stratification by Age (n = 2293). Reasons why adults received (A) or did not receive HPV vaccination (B). An asterisk signifies a statistically significant difference between groups (p < 0.05).

FIGURE 3

Pediatric HPV vaccine treatment decision‐making (n = 1290). Reasons why parents vaccinated (A) or did not vaccinate their children (B). An asterisk signifies a statistically significant difference between groups (p < 0.05).