European Journal of Obstetrics & Gynecology and Reproductive Biology
Ethnically diverse female university students’ knowledge and attitudes toward human papillomavirus (HPV), HPV vaccination and cervical cancer
Introduction
Cervical cancer is one of the most common cancers in women worldwide. There are an estimated 470,000 new cases of cervical cancer that result in 233,000 deaths per year [1]. Eighty-three percent of cases occur in the developing world, where cervical cancer accounts for 15% of female cancers, as compared to just 3.6% in developed countries [1]. The Asia Pacific region alone contributes half of the world's total cervical cancer cases (51.6%) and cervical cancer deaths (50.3%) [2]. Cervical cancer rates appear to be higher in less-developed relative to more-developed Asian Pacific countries. In Malaysia, the cervical cancer age-standardized incidence rate (ASR) of 15.7 per 100,000 women is comparatively higher than in China (6.8), Japan (8.0), and Singapore (13.2) but is much lower than those of Thailand (19.8), Cambodia (38.7) and India (30.7) [2].
While cervical screening has the potential to greatly reduce deaths from cervical cancer, it is a great challenge for developing countries, where lack of resources limits coverage of cervical screening [3]. The HPV prevalence among women in these countries was also relatively higher than in developed regions [4]. The HPV prevalence of the general Malaysian population is not available but high prevalence of high-risk HPV types was found in women attending Pap smear clinics [5], [6].
Studies have indicated that an estimated 30–60% of all sexually active adults acquire HPV at some point in their lives [7], [8]. Young women, especially those of college age, are at risk as they tend to be sexually active and have higher numbers of sexual partners [9], [10]. In Malaysia, studies consistently indicated that sexually transmitted infection (STI) rates were particularly high among young compared to older women [11], [12].
Despite the high prevalence of HPV infection among young women, studies in Western countries have shown that most adolescent and young women [13], [14], even the highly educated [15], [16], know very little about HPV infection. Little has been written about young women's knowledge of HPV in the South-East Asia region. The purpose of this study was to evaluate the knowledge and attitudes toward HPV, HPV vaccination and cervical cancer of a sample of female university students. The health impact of college or university students’ sexual behavior has been a primary concern due to their higher levels of sexual experimentation and unsafe sexual practices [17], [18]. The findings will provide insight into provision of appropriate educational intervention for risk reduction and effective HPV immunization uptake among youths in institutions of higher learning.
Section snippets
Sample
A cross-sectional survey using a convenience sample of 1083 ethnically diverse Malaysian female students attending a public university located in Kuala Lumpur, Malaysia. The sample was randomly recruited from people attending common areas of the campus during academic semesters between April and December 2007.
Instrument
All interviews were conducted face-to-face by trained enumerators. The first part of the questionnaire elicited socio-demographic details of the participants. In the second part,
Participants’ background
A total of 650 students responded in the interview survey (60% response rate). The mean age of respondents was 21.47 years (S.D. ±2.0). The majority of respondents were Malay (63.7%) followed by Chinese (25.1%), Indian (8.8%), and other ethnic groups (indigenous groups in Sabah and Sarawak) (2.5%) (Table 1).
Knowledge and awareness
For many respondents, this was their first exposure to information about HPV and HPV infection. Of the total participants, 21.7% (95% CI 17.9–24.1%) had heard of HPV, and only 10.3% (95% CI
Discussion
Published literature on studies assessing university students’ knowledge of hypothetical HPV vaccine indicated a general lack of knowledge. A European study reported that only 17.7% of university students had heard of HPV [22]. Slightly higher rates of awareness of HPV, approximately one-third, were reported from university students in the United States [14], [21]. Awareness of HPV was reported to be higher after the release of the vaccine. In a recent study of female university students in
Conclusion
In conclusion, there is an urgent need for provision of HPV education to women in institutions of higher learning. The data from this study suggest that in order to enhance HPV immunization uptake, provision of information about HPV infection and its link to cervical cancer and genital warts is essential, with emphasis on high HPV infection rates, provision of assurance on safety and efficacy of the new vaccine, and eliminating stigma associated with STI prevention. Future research to test the
Conflict of interest
The authors declare no competing interests.
Acknowledgement
The study was not funded in whole or in parts by any research grant or funding body.
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