Knowledge About HPV and the HPV Vaccine
Observational Study on a Convenience Sample of Adolescents from Select Schools in Three Regions in Italy
Bridging Knowledge Gaps: HPV Awareness and Vaccination Efforts in Italian Schools
About This Study
I want to share our recent publication in the journal Vaccines! This study explores the awareness, knowledge, and vaccination practices of Italian adolescents regarding the Human Papillomavirus (HPV) and its vaccine. As a contributor to the methodology and formal analysis sections, I helped reveal crucial insights into the existing gaps in knowledge and vaccination coverage.
Our research, conducted across three regions in Italy, highlights significant misunderstandings among adolescents about HPV transmission and the diseases it causes. The study emphasizes the urgent need for better educational efforts and coordinated national strategies to enhance awareness and increase vaccination rates.
For those interested in public health and adolescent education, I invite you to read the full article here. Your thoughts and feedback would be greatly appreciated!
Abstract
Background/Objectives: HPV is the most common sexually transmitted infectious agent worldwide and adolescents are at high risk of contracting HPV. The aim of our study was to find out how much adolescents know about the virus and its effects, and to obtain information on attitudes and behaviors regarding HPV vaccination to close these gaps. Methods: As part of the ESPRIT project, 598 lower secondary (11–14 years) and upper secondary (14–19 years) school students from three Italian regions were surveyed between December 2023 and March 2024 using a seven-question online questionnaire on awareness, knowledge, and attitudes about HPV and the HPV vaccine. Count and zero-inflation models were used to determine correlations between sexes, urban/suburban, province of residence, and school type with knowledge. Results: Lower secondary students believed that HPV causes HIV/AIDS (8.9%) or hepatitis C (3.0%) and rarely mentioned anal (21%) and oral sex (9.6%) as ways of transmission. Among upper secondary students, misconceptions were similar, with worrying rates of students stating that HPV only causes cancer in females (18%) or males (2.4%), and low rates of identifying transmission risk through anal (41%) and oral (34%) sex and genital contact (38%). The HPV vaccination rate was quite low (47% in lower secondary students, 61% in upper secondary students). In the regressions, sex, urban/suburban area, and province were the variables associated with higher levels of knowledge for lower secondary students; for upper secondary students, level of knowledge was associated with sex, urban/suburban area, school type, and province of residence. Conclusions: Awareness and knowledge of HPV and the HPV vaccine are low among Italian students in this study and reported vaccination coverage is below the national target. Coordinated efforts at the national level are needed to address this public health issue. (Brunelli et al. 2025)
My contributions
Data Anlaysis
Sociodemographic data such as school characteristics (e.g., urban/suburban, lower/upper secondary school, northern/central/southern Italy, type of upper secondary school) and participant characteristics (e.g., gender) were included as predictors in the model, while the total score was set as the dependent variable. The types of upper secondary schools considered reflect the three main types of schools that exist in Italy: academic schools (in which the education is mainly theoretical, with a specialization in a specific field, e.g., humanities and antiquity, mathematics and natural sciences, foreign languages, psychology and pedagogy, social sciences, fine arts), technical schools (in which the education provides both a broad theoretical training and a specialization in a specific field (e.g., economics, administration, technology, tourism, agronomy), often in combination with a three-/six-month internship in a company, association, or college), and vocational schools (this type of school provides secondary education with a focus on practical subjects (e.g., engineering, agriculture, gastronomy, technical assistance, crafts) and allows students to start looking for a job immediately after completing their education). None of these types of schools are likely to be single-sex schools in the national public system.
There were several possible answers to each question. If an answer was marked correctly, the student received +1, otherwise 0. If the answer was “I don’t know”, the score for the entire question was set to 0, as the student did not know the correct answer, even if they had not marked the wrong answer. The answers given by the students as strings (i.e., “Other”) were not considered when calculating the points. The total score was calculated as the sum of the scores for each valuable question, including Q1, Q2, and Q4. For every question, the frequency and probability of responses for every socio-demographic characteristic were calculated. In addition, the p-value and significance of the proportion test were calculated for each pair of sociodemographic characteristics. The minimum p-value was set at 0.05 and the test power had to be at least 0.8. For the analysis of the overall scores, each observation was weighted to obtain an inverse propensity weighting (IPW) for each linear combination of sociodemographic characteristics. However, for some linear combinations, there were no observations, because there were no schools for these combinations, which made an IPW impossible. Therefore, the data for these groups were generated using a generalized linear model (family quasipoisson) to minimize bias, and then the IPW was calculated. For each socio-demographic characteristic, the weighted Kruskal–Wallis test was calculated to demonstrate stochastic superiority. A t-test or ANOVA test was not used as the assumptions were not met. Finally, a weighted Poisson model with zero-inflation was calculated. First, the probability of receiving 0 points in the survey was assessed using a binomial model and then a Poisson model was calculated.(Brunelli et al. 2025)