The Relationship Between Knowledge and Beliefs About Human Papillomavirus, Acceptance of the Human Papillomavirus Vaccine, and Intentions to Practice Safer Sex Behaviors Among Female College Students Theresa Scorcia-Wilson, Ph.D., Karen Perrin, Ph.D., Ellen Daley, Ph.D., Jeffrey Kromrey, Ph.D., & Robert McDermott, Ph.D.

Human Papillomavirus (HPV) Common public health issue among college-aged women Common public health issue among college-aged women Low-risk types linked to genital warts and high-risk types linked to anogenital cancers Low-risk types linked to genital warts and high-risk types linked to anogenital cancers HPV vaccine is effective in preventing low and high risk types HPV vaccine is effective in preventing low and high risk types Sources: Centers for Disease Control and Prevention (CDC), 2001; National Cancer Institute, 2003; Partridge & Koutsky, 2006; Weaver, 2004

Statement of the Problem HPV vaccine acceptability studies have not examined if a relationship exists among: HPV vaccine acceptability studies have not examined if a relationship exists among: HPV knowledge HPV knowledge Health beliefs about HPV Health beliefs about HPV Acceptance of the HPV vaccine Acceptance of the HPV vaccine Intentions to practice safer sex behaviors Intentions to practice safer sex behaviors

Purpose of the Study To determine if women attending college who have high acceptance of the HPV vaccine and are likely to become vaccinated against HPV, also intend to practice other safer sex behaviors To determine if women attending college who have high acceptance of the HPV vaccine and are likely to become vaccinated against HPV, also intend to practice other safer sex behaviors

Research Questions What is the relationship between HPV knowledge and intentions to practice safer sex behaviors among women attending college? What is the relationship between HPV knowledge and intentions to practice safer sex behaviors among women attending college? What is the relationship between knowledge of the HPV vaccine and acceptance of the HPV vaccine among women attending college? What is the relationship between knowledge of the HPV vaccine and acceptance of the HPV vaccine among women attending college? What is the relationship between health beliefs about HPV and acceptance of the HPV vaccine among women attending college? What is the relationship between health beliefs about HPV and acceptance of the HPV vaccine among women attending college? What is the relationship between acceptance of the HPV vaccine and intentions to practice other safer sex behaviors among women attending college? What is the relationship between acceptance of the HPV vaccine and intentions to practice other safer sex behaviors among women attending college?

Perceived Susceptibility to HPV Perceived Severity of HPV Individual Perceptions Modifying Factors Demographics Sociopsychological Variables Structural Variables - Knowledge Perceived Threat of Disease Self-efficacy (perceived behavioral control) Benefits to acquiring the HPV vaccine Barriers to acquiring the HPV vaccine Likelihood of becoming vaccinated Intentions to practice safer sex behaviors Likelihood of Action Normative Beliefs Control Beliefs Theoretical Application Behavioral Beliefs Cues to Action Advice from others Illness of family member or friend Health Belief Model & Theory of Planned Behavior

Methods Study Sample (N = 2,706) Study Sample (N = 2,706) Convenience sample of female, undergraduate students, ages Convenience sample of female, undergraduate students, ages Central Michigan University (CMU) Central Michigan University (CMU) University of South Florida (USF) University of South Florida (USF) Western Michigan University (WMU) Western Michigan University (WMU) Recruitment Recruitment University student health centers University student health centers to students to students Instrument Instrument Online survey Online survey

Predictors of Intentions to Practice Safer Sex Behaviors Intentions R =.730, p <.001 Attitudes (β =.666) 95% C.I. [.649,.711] Control Beliefs (β =.082) 95% C.I. [.062,.132] Normative Beliefs (β =.076) 95% C.I. [.062,.129]

Results

Results Attitudes regarding practicing safer sex behaviors Attitudes regarding practicing safer sex behaviors “Refusing to have sex with a partner who will not use a condom” (Most favorable) 51.8% 26.0% 14.9% 5.8% 1.6% 51.8% 26.0% 14.9% 5.8% 1.6%______|______|______|______|______|______ Strongly agree Agree Somewhat agree Disagree Strongly disagree Strongly agree Agree Somewhat agree Disagree Strongly disagree “Telling a partner that I will not be sexually active with them until they have been tested for STIs”(Least favorable) 25.7% 26.3% 26.6% 19.0% 2.5% 25.7% 26.3% 26.6% 19.0% 2.5%______|______|______|______|______|______ Strongly agree Agree Somewhat agree Disagree Strongly disagree Strongly agree Agree Somewhat agree Disagree Strongly disagree

Results Perceived Susceptibility to HPV Perceived Severity of HPV

Results Vaccine Acceptance and Intentions General vaccine acceptance, r =.087, p <.001 General vaccine acceptance, r =.087, p <.001 Importance of vaccinations, r =.081, p <.001 Importance of vaccinations, r =.081, p <.001 Likelihood of becoming vaccinated, r =.098, p <.001 Likelihood of becoming vaccinated, r =.098, p <.001 Influential factors, R =.244, p <.001 Influential factors, R =.244, p <.001 “Whether I practice safe sex” (β =.191) “Whether I practice safe sex” (β =.191) “If someone in my family has cancer” (β =.062) “If someone in my family has cancer” (β =.062) “If my friends think I should get it” (β =.056) “If my friends think I should get it” (β =.056) “If my health insurance covers it” (β = -.183) “If my health insurance covers it” (β = -.183) Barriers, R =.128, p <.001 Barriers, R =.128, p <.001 “Cost of the vaccine” (β = -.101) “Cost of the vaccine” (β = -.101) “Not knowing where to get the vaccine” (β = -.055) “Not knowing where to get the vaccine” (β = -.055)

Discussion Findings from this study confirm the need for university student health centers to include HPV vaccination as part of a broader sexually transmitted infection (STI) educational campaign Findings from this study confirm the need for university student health centers to include HPV vaccination as part of a broader sexually transmitted infection (STI) educational campaign How to practice safer sex behaviors How to practice safer sex behaviors Communication with partners about how to get tested for STIs Communication with partners about how to get tested for STIs Localized information on where to get the vaccine Localized information on where to get the vaccine Determine eligibility for low-cost or free vaccination Determine eligibility for low-cost or free vaccination