Elsevier

Vaccine

Volume 28, Issue 3, 8 January 2010, Pages 811-816
Vaccine

Attitudes toward and intention to receive the human papilloma virus (HPV) vaccination and intention to use condoms among female Korean college students

https://doi.org/10.1016/j.vaccine.2009.10.052Get rights and content

Abstract

This study examined the relationships between attitudes toward and intention to receive the human papilloma virus (HPV) vaccination and intention to use condoms in a sample of female Korean college students. The data were collected in 2008 using a survey administered to a convenience sample of 1359 female Korean college students. Despite the availability of the HPV vaccine in South Korea, many college-age females are not being vaccinated. Attitudes towards the HPV vaccine appear to be an important contributing factor in vaccination, underscoring the need to make information widely available, to promote HPV vaccination, and to help women make informed decisions.

Introduction

The rates of human papilloma virus (HPV) infection are increasing in South Korea and worldwide [1]. HPV is a common sexually transmitted infection that is usually transient, asymptomatic, and resolved naturally without treatment. However, some cases of HPV infection persist chronically, with the subsequent development of cervical cancer [2]. HPV vaccines such as Gardasil and Cervarix have been developed to prevent HPV infection. HPV vaccines are now widely available in many countries, including Europe, Australia, America, and England [3], [4]. In South Korea, Gardasil has been available since 2007 and Cervarix since 2008.

HPV infection is now a major health concern among women. Although cervical cancer screening remains an important component of women's health prevention programs, HPV vaccination has been added as a primary prevention strategy. The HPV vaccines are approved for use in 9–26-year-old females, and in several countries/territories vaccination is routinely recommended for females as young as 9–11 years old. Because HPV infection occurs through sexual intercourse, vaccination before one's first experience of sexual intercourse is now recommended [3].

Unfortunately, there are a number of issues that affect the acceptance and use of the vaccine. The age of first sexual intercourse varies across individuals and populations, causing disagreement regarding the proper age to administer the HPV vaccine. For the vaccine to be most effective, many are now recommending that it be administered to females at age 12. Evidence provided by previous studies [5] indicates that vaccination at age 12 increases the chance of preventing cervical cancer to 61.8%, as compared to only 50.9% when the vaccine is administered at age 18. However, some parents are reluctant to have their daughters vaccinated so young and believe that the proper time for vaccination is when their daughters are old enough to make the decision to get vaccinated independently [6], [7]. In South Korea, the average age of a woman's first experience of sexual intercourse is around 20 years, or college age [8]. Although South Korean women are generally older than Western women at the onset of sexual intercourse, their rate of HPV infection rapidly catches up to that of American college students or young Danish women [9]. Therefore, college-aged women are a potential high-risk group for HPV infection, particularly in South Korea [10].

There are a number of behavioral factors that influence the acceptance and use of the HPV vaccine, including knowledge about HPV and the vaccine, attitudes toward the vaccine, and the intention to get vaccinated. Only a few studies have examined the link between knowledge of HPV and the HPV vaccine and intention to receive the HPV vaccination, and the findings of these studies are equivocal [11], [12]. Attitude towards the HPV vaccine has been shown to be related to acceptance of the HPV vaccine [13]. Because attitude is a determinant of intention and behavior [14], it is important to investigate attitudes toward the HPV vaccine as a prerequisite for changing behavior or increasing the intention to receive the vaccine. When targeting adolescent females for the HPV vaccine, attention must also be given to the attitudes of clinicians and parents who will make decisions about the vaccine for adolescent females. Two issues that may make clinicians and parents reluctant to administer the vaccine are concerns about possible long-term negative side effects [15], [16] and the possibility of the vaccine leading young females to initiate sexual intercourse earlier or to engage in risky sexual behavior [7], [17], [18]. Parents who consider their children to be at low risk of getting HPV infection did not show a positive attitude towards HPV vaccination [3].

Likewise, there are concerns that women who receive the HPV vaccine will neglect condom use, mistakenly believing that they are safe from sexually transmitted diseases because they have received the HPV vaccine [18]. However, the link between HPV vaccination and condom use has not been investigated, making it difficult to assess the validity of this concern.

Although studies investigating HPV acceptance have been increasing, most studies focus on parents’ willingness to vaccinate their children. As a result, studies about young women's attitudes toward and intention to receive HPV vaccination are scarce [19]. Such research is warranted to inform educational and national policy regarding the HPV vaccine.

To address current gaps in HPV research, we investigated the relationships between attitudes towards and intention to receive HPV vaccination and the intention to use condoms. The findings of this study may promote a better understanding of the relationship between HPV vaccination and condom use and may help to inform the development of strategies to promote HPV vaccination.

The purpose of this study was to evaluate the attitudes toward and intention to receive HPV vaccination and intention of condom use among college-aged women in South Korea and to investigate the relationships among these variables.

Section snippets

Design

A cross-sectional, descriptive design was used to examine the relationship between attitudes towards and intention to receive HPV vaccination and the intention to use condoms.

Sample and data collection

The research plan was reviewed and approved by the Institutional Review Board of the College of Medicine, Chung-Ang University, Seoul, Korea. Data were collected from April to June 2008, from 16 colleges located in 16 regions across the nation, using self-administered questionnaires. The questionnaires were administered

Sample characteristics

Participants’ demographic characteristics and scores on measures of HPV-related variables are shown in Table 1. The ages of the participants ranged from 18 to 32 years, with an average age of 20.96 (±1.80) years. Two hundred forty-two participants were freshmen (17.9%), 442 were sophomores (32.7%), 370 were juniors (27.3%), and 299 were seniors (22.1%). In terms of religion, 26.3% were Christian, 14.4% were Buddhist, 12.7% were Catholic, and 46.6% indicated no religious affiliation.

A large

Discussion

The main objectives were to investigate the relationships between attitudes towards the HPV vaccine, intention to get vaccinated, and intention to use condoms among Korean college women. The results showed that the intention to receive HPV vaccination increased when one's attitude towards the HPV vaccine was more positive. The rate of vaccination among the study participants was low, with only 1.3% of the participants having been vaccinated at the time of the study. This rate of vaccination is

Study limitations

The use of convenience sampling limits the generalizability of the study findings. Although a convenience sample was used, the participants were recruited from 16 colleges in 16 regions to increase the representativeness of the sample. However, college-age women not enrolled in college may have different attitudes and intentions. Thus, research including these populations is needed.

No information about cervical cancer screening was collected. Thus, one cannot conclude that college students

Conclusions

In this study, the great majority of women had not been vaccinated with the HPV vaccine, and their intention to get vaccinated was not high; however, willingness to get vaccinated was highest when the vaccine was recommended by clinicians. Therefore, in order to increase the acceptance of HPV vaccination, it will be helpful to educate women as well as clinicians. Since the intention to get vaccinated was lower when attitude towards the HPV vaccine was negative due to perceptions that the HPV

Acknowledgments

This work was supported by National Research Foundation of Korea Grant funded by the Korean government (MOEHRD) (KRF-2007-531-E00084). We would like to thank the participants for their participation and support.

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