HJAR Jan/Feb 2024

Introduction Human papillomavirus (HPV) infection is one of the most consequential sexually transmitted infections in the United States. Not only is it the most common, with a prevalence in 2018 of 42.5 million for dis- ease-associated HPV, 1 but it is also asso- ciated with several types of cancer. It was estimated that 79% of cervical, vaginal, vul- var, penile, anal, and oropharyngeal cancers each year from 2015 to 2019 were related to HPV. 2 In addition, the cost of HPV infection is high. One study estimated the direct life- time medical cost of diseases attributable to HPV infection for U.S. individuals aged 15 to 59 to be $774 million for those who acquired the infection in 2018, of which $407 million was accounted for by infections in adoles- cents and young adults aged 15 to 24. 3 Unfortunately, in the state of Arkansas, the rates of HPV-associated cancers are among the highest in the nation. Accord- ing to Centers for Disease Control (CDC), Arkansas ranked third highest for the rates of newHPV-associated cancers from 2016- 2020 with 15.1 cases per 100,000 individu- als (Figure 1). 4 This included 656 new cases of cervical carcinoma in women and 1,018 new cases of oropharyngeal squamous cell carcinoma in men diagnosed during this timeframe. Vaccination for HPV has been shown to be effective in preventing infection from the most common cancer-causing strains of the virus and it is estimated that 90% of cancers caused by HPV can be prevented by vaccination. 5 The vaccine is approved for both females and males aged 9 years and up and is recommended by the CDC for indi- viduals through the age of 26 who have not been previously vaccinated, as well as some individuals through the age of 45 based on shared clinical decision making. Because it is most effective when given at a younger age, the goal is to ensure all children receive the recommended doses of the vaccine by the 13th birthday. 6 Unfortunately, the per- centage of adolescents vaccinated for HPV is well below the Healthy People 2030 goal of 80%, with only 61.7% of U.S. adolescents aged 13 to 17 up-to-date for the HPV vac- cine as of 2021. 7 In Arkansas specifically, this number was only 56.8%, ranking 38th among all states. 8 In order to increase HPV vaccination rates, it is vital to determine why rates are low and to follow up with individuals who are not up to date. One specific population to consider is college-aged individuals. This group is relatively young, is still within the recommended age for vaccination, is able to make their own medical decisions, and is a somewhat “captive” population that could be targeted for education and vaccination campaigns. To successfully increase vac- cination rates in this group, it is important to understand their knowledge about HPV and the barriers they face to vaccination. In an effort to study the local college- age population, an anonymous survey was administered to students at a local uni- versity. The immediate goals were to learn about the knowledge and beliefs about HPV infection and vaccination in this group in order to identify gaps in knowledge and bar- riers to vaccination. Long-term goals are to utilize this information to increase HPV vaccination rates and ultimately decrease the burden of HPV-associated cancers. Methods Undergraduate students attending Arkansas State University in Jonesboro who were at least 18 years of age were invited to participate in the study, with no restriction specified for an upper age limit. A descrip- tion of the study and a link to the anony- mous survey were posted in the universi- ty’s online newsletter for three consecutive days. Students who clicked on the link were taken to the survey, which was designed to assess participants’ knowledge and beliefs about HPV infection and the HPV vaccine, as well as to gather information about HPV vaccination rates. As an incentive, the first Rate of all new HPV-associated cancers in males and female in the U.S., 2016 – 2020 Source: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2022 submission data (1999-2020): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Released June 2023. https://www.cdc.gov/cancer/dataviz FIGURE 1 HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2024 23