This investigation was uniquely poised to examine vaccine intentions among 2 different groups of males: a sample of adult men who had extensive exposure to information about HPV and HPV vaccination among males, and a sample of University men who had little exposure to information about HPV or vaccination among males. Receptiveness to HPV vaccination varied substantially between the 2 groups: 94% of males who had significant exposure to HPV-related information through a clinical study intended to vaccinate against HPV whether a safe and effective vaccine was available, compared to 62% of University males who were willing to consider HPV vaccination. As expected, most males in the University sample had not even heard of an HPV vaccine—even a vaccine for women. Currently, through pharmaceutical companies’ advertisements, the general public has been exposed to messages regarding the importance of HPV vaccination for young women, but men may disregard those messages because they do not pertain directly to them. Little information has been widely circulated regarding HPV and HPV vaccination among males—even in the wake of the recent CDC approval of the HPV vaccine for males 9 to 26 for prevention of genital warts. In the absence of information about HPV vaccination, and specifically information about HPV and HPV vaccination among males, males may be skeptical of receiving HPV vaccination. In fact, men in our University sample who had higher HPV-related knowledge and had heard of the HPV vaccine (vs. not) were less likely to be willing to consider HPV vaccination. Men who have only heard of HPV and HPV vaccination pertaining to women may fail to see the relevance of HPV vaccination to themselves. However, our CER sample shows that after repeated exposure to medically accurate information about HPV among males and females, including information emphasizing the high prevalence of HPV infection among males and the potential benefits of HPV vaccination for their health, most males report intent to vaccinate against HPV when the vaccine becomes available. Thus, these results suggest a tremendous potential for educational/awareness campaigns to successfully promote HPV vaccination for males.
Whereas public service announcements and other media campaigns are important and may be effective, these findings suggest that healthcare providers will have a critical role in promoting HPV vaccination among males. In both samples, most males thought a healthcare providers’ recommendation would be important in their decision about HPV vaccination. Other research has demonstrated the important role that providers play in patients’ healthcare decisions.18,19
Unfortunately, many young males who would be eligible for HPV vaccination may have few interactions with healthcare providers,27
and thus few opportunities to receive such recommendations. Thus, now that HPV vaccination has received permissive approval for young males, healthcare providers must take advantage of every encounter to inform young males about the vaccine. Such discussions should be sure to address perceived susceptibility to HPV, as University men in this investigation who believed they were not at risk for HPV were significantly less likely to be willing to consider vaccination.
Several critical windows of opportunity for HPV-related education exist and should be maximized, including: (a
) sports-related and camp-related physicals; (b
) medical visits for sports-related injuries; and (c
) precollege physicals, which are required for all males who are college bound. Outreach workers or community-based patient navigators28,29
may also be used to create linkages between males and healthcare providers as well as to provide males with information regarding the HPV vaccine. Popular opinion leader interventions may also be successful at encouraging vaccination among men.30,31
Additionally, friends, families, and partners may play a significant role in reaching out to men about the HPV vaccine and encouraging them to do their part to protect their families and loved ones.
Reducing perceived barriers to vaccination may be important for ensuring that men who desire vaccination actually receive the vaccine. Recent studies found that several barriers, such as cost, hassle of receiving a 3-shot series, safety, and side effects were associated with vaccine acceptability in males.15–19
In our sample of men enrolled in a longitudinal study of HPV infection, these barriers were not significantly associated with intent to vaccinate. However, more than half of the men who had been exposed to extensive information about HPV and HPV vaccination and who intended to vaccinate still expressed concerns about the potential high cost of vaccination as well as possible side effects. Other studies have demonstrated discordance between intention and behavior, and barriers such as high costs or potential side effects could prevent men who intend to get vaccinated from actually receiving the vaccine. Future research should explore whether concerns about costs and side effects moderate the relationship between intent to vaccinate and vaccination behavior. Moreover, “other” barrier remained significant and requires further exploration. Whereas “other” barrier does not specifically identify which barrier(s) to target in future interventions, the response does suggest that participants in the study who had additional concerns about vaccination (those not provided in the existing barrier list) are less likely to vaccinate. This finding indicates that more formative work may be needed to more fully understand the factors that may prevent men from receiving vaccination.
Results of these studies should be interpreted in light of several limitations. Data for the CER study were collected as part of a natural history study of HPV in males, and those enrolled in the study may differ in some ways from the overall population of the community from which they were drawn. For example, enrolled males were relatively young (M
= 28 years). Males enrolled in a study of HPV may also differ from the broader community in their willingness to discuss and be examined for STIs. University males were recruited from a single university and are not representative of the broader community, or of all University males throughout the United States. In addition, the small number of University males who reported intent to vaccinate (N = 8, 4.5%) precluded an analysis focusing on whether these men intended to vaccinate, and instead necessitated exploration of men’s willingness to consider vaccination. Finally, a small comparison study was designed to assess knowledge among “unexposed” men, in order to report differences in the 2 groups. Motivations regarding HPV vaccination were assessed with 1 item assessing susceptibility and 1 item assessing severity of genital warts. Vaccine intentions were also added to the comparison survey (University sample), but because this was a post hoc decision, the measures/questions do differ between the 2 samples. Single item measures are less ideal than assessment with multiple items. Additionally, genital warts are not the only potential manifestations of HPV—recent research has linked HPV among men to penile, anal, and oropharyngeal cancers,2–9
and concerns about such cancers should be studied in relation to HPV vaccination among men. Subsequently, these items have been added to the CER instrument, and will be reported at a later date. Nevertheless, findings from the current study are important. This is the first known study to suggest that when exposed to substantial information about HPV, a substantial proportion of males may be willing to vaccinate against HPV. Moreover, this study adds to the literature by identifying factors that may account for differences in HPV vaccine intentions.
In conclusion, the current study suggests that repeated exposure to information about HPV more generally and about HPV vaccination in males more specifically may result in high rates of vaccination among men. Moreover, men value the recommendations of healthcare providers, and thus, healthcare providers should be part of HPV vaccination promotion activities that target males. Data from our University sample suggest there is a substantial need for educational campaigns to disseminate knowledge about HPV among men. Recent studies on the relationship between HPV and oral, penile, and anal cancers suggest that the personal consequences of HPV infection for men may be more significant than previously thought.2
Other studies suggest that the quadrivalent HPV vaccine may be effective in preventing oral, penile, and anal cancers.32
These scientific advances may substantially change the way we educate men about HPV vaccination. It will be important to understand how men’s changing knowledge about the relationship between HPV and male cancers affects their willingness to receive HPV vaccination themselves and to encourage the women in their lives to be vaccinated as well.