Knowledge of the HPV vaccine among South Asian and South Asian-American young adults

Objectives: To determine cultural barriers and investigate knowledge of HPV vaccination and uptake among South Asian and South Asian-Americans young adults in the United States as this population exhibits one of the lowest HPV vaccination rates. Methods: Participants 18-26 years old, South Asian descent (Indian, Pakistani, Bengali, Nepalese, or Sri Lankan) and English speaking were recruited to complete an online survey. Data collected was analyzed in Stata 16.0. Bivariate analyses were performed to confirm associations between outcomes and predictors of interest. Three scales were computed using survey responses: Knowledge of HPV, Attitudes and Beliefs, and Efficacy of Vaccine. Multivariate linear regressions were conducted to ascertain associations between scores from scales with participant characteristics and predictors. Results: Recruitment yielded a total of 253 participants (calculated sampled size of 121). The mean age was 23.3 years. 97.2% of the population was female, 84.2% was of Indian ethnicity, 55.4% were Hindu, and 92.9% completed higher education. A total of 194 participants received at least one dose of HPV vaccine, and 83.9% of these participants received it at their primary care office. A total of 59 participants had not received the vaccine, and 48.2% stated that they would like to get the vaccine. Regarding attitudes and beliefs, 76.6% strongly disagreed with the statement that the HPV vaccine was unsafe. 25.4% strongly agreed that the vaccine lasts a person's entire life and only 5.3% believed they did not have enough information about the vaccine. 81.4% disagreed with the belief that receiving the vaccine will make girls more likely to have sex. When stratifying for vaccine coverage, there were statistically significant differences in knowledge of efficacy and attitudes/beliefs towards HPV vaccination where those who were vaccinated had more knowledge and positive attitudes. In multivariate linear regressions, compared to participants not vaccinated, those who were vaccinated had a 0.508 point increase in knowledge scores (CI: 0.021-0.996). In addition, every one year increase in age was associated with a 0.25 point increase in knowledge score (CI: 0.133-0.366). When comparing knowledge on vaccine efficacy, participants who completed college and/or graduate school had a 1.03 point increase on these scores compared to those who had not completed higher education (CI: 0.213-1.84). Participants who were vaccinated were more likely to have higher (more positive) scores on the attitude scale (3.35, CI: 2.06-4.08). Conclusions: Vaccinated young adults of South Asian descent had more knowledge regarding efficacy and positive attitudes towards HPV vaccination compared to those not vaccinated. Age and education level influence knowledge and attitude towards receiving the HPV vaccine. Availability of the vaccine was not a significant barrier as the majority of vaccinated participants received at least one injection at their primary care office.