• Journal of the Korean Society of School Health
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• v.29 no.3
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• pp.123-131
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• 2016

Purpose: Human Papillomavirus(HPV) vaccination is the best prevention for cervical cancer. Therefore, this study was to examine the best predictors of HPV vaccination status in female nursing university students. Methods: Five hundred and forty junior and senior female nursing students from Seoul and provinces of Kyunggi, Chungcheong and Gyungsang completed paper and pencil questionnaires. Descriptive statistics, $x^2$ test, t-test, and multiple logistic regression with dummy variables were conducted using SAS 9.2. Results: Of the total students, 56.8% were vaccinated. As a result of the analysis of the bivariate relationships, family economic status, school type, perceived susceptibility, perceived benefit and perceived barriers (cost, time, distance from hospital and side effects) were significantly related to vaccination status. After controlling for the general characteristics and the HPV related knowledge score, higher family economic status (Adjusted Odds Ratio [AOR]: 3.78, 95% Confidence Interval [CI]: 1.21~11.76), private university (AOR: 1.69, 95% CI: 1.14~2.53), higher perceived benefit (AOR: 1.80, 95% CI: 1.47~2.20), lower perceived barrier (cost) (AOR: 0.86, 95% CI: 0.74~0.99), lower perceived barrier (time) (AOR: 0.71, 95% CI: 0.61~0.84), and lower perceived barrier (side effects) (AOR: 0.82, 95% CI: 0.72~0.94) were significantly related to HPV vaccination. Perceived benefit, perceived barrier (time) and perceived barrier (side effects) were the top 3 predictors of HPV vaccination status. Conclusion: This study suggests that vaccinated female nursing students were more likely to be from higher family economic status and private universities and have a higher perception of benefit and a lower perception of barriers (cost, time, and side effects). Thus, efforts to increase HPV vaccination rates of female nursing students should focus on improving their perception of benefit while lowering their perception of barriers, particularly cost, time and side effects.

• Journal of Korean Biological Nursing Science
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• v.15 no.1
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• pp.24-32
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• 2013

Purpose: The purpose of this study was to investigate and compare human papillomavirus (HPV) vaccination status associated with HPV health belief and knowledge between male and female highschool students. Methods: In the winter of 2012, 183 students responded to self-administered questionnaires, and t-test, ${\chi}^2$-test, and ANOVA were used for data analysis. Results: There were significant differences in the experiences of hearing about HPV vaccination, source of HPV information, experience of being vaccinated with HPV vaccination, reason for HPV unvaccination and vaccination intention by gender. The mean scores for health belief of HPV vaccination were 1.72 (total score: 4) in men and 2.31 in women. There were significant differences in HPV health belief (t=-5.14, p<.001). The mean scores for knowledge of HPV vaccination were 0.08 (total score: 1) in men and 0.12 in women, but there were no significant differences in HPV knowledge (t=-1.62, p=.108). There were positive associations between HPV health belief and knowledge in women (p=.02). Conclusion: This study showed different HPV vaccination status, health belief and knowledge in gender. The results indicate a need to consider levels of health belief and knowledge of HPV vaccination in target populations of highschool students when planning a HPV related education program.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.6
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• pp.2643-2646
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• 2012

Objectives: Human papillomavirus (HPV) is the major etiological agent of cervical cancer, a leading cause of morbidity and mortality in women worldwide. Screening strategies for reducing the burden of HPV-mediated carcinogenesis are emerging as an effective means for cervical cancer control and prevention in developing countries. Our study, therefore, aimed to identify HPV infection status in North Indian women during random population screening. Methodology: Cervical/vaginal exfoliated cells and/or Pap smear specimens were collected from 890 women of North Indian ethnicity residing in Lucknow and adjoining areas, during random population screening from June 2009-March 2012. HPV viral loads in clinical specimens were determined by the Hybrid Capture (hc)-2 HPV DNA assay, and subsequently, positive/negative/borderline HPV status was calculated. Results: The HPV incidence in the present study was 11.7%. 751 out of a total of 890 women (84.4%) participating in our HPV screening program were HPV negative (HPV -), 104 (11.7%) tested positive (HPV +) while 35 (3.9%) showed borderline (HPV $^*$) infection status. Furthermore, in the HPV + subjects (N=104), 18 (17.3%) showed strong positivity. We observed that HPV positivity tends to increase with age in North Indian women; the higher the viral load with increasing age, higher is the susceptibility to HPV-mediated cervical cancer. Conclusions: HPV viral load/genotyping may help in identifying women at risk of developing cervical cancer. However, cost-effective HPV screening protocols with a wider population coverage are warranted so as to reduce the burden of cervical cancer in women worldwide in the vaccine-era.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1837-1843
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• 2014

Background: No studies on male attitudes towards HPV and HPV vaccination have been conducted in Japan, and little is known globally whether attitudes of single fathers differ to those living with a female partner. This exploratory study assessed whether Japanese fathers were likely to have their daughter vaccinated against HPV in a publically funded program and whether any differences existed regarding attitudes and knowledge about HPV according to marital status. Materials and Methods: Subjects were 27 fathers (16 single; 11 married) who took part in a study on HPV vaccine acceptability aimed at primary caregivers of girls aged 11-14 yrs in three Japanese cities between July and December 2010. Results: Knowledge about HPV was extremely poor (mean score out of 13 being $2.74{\pm}3.22$) with only one (3.7%) participant believing he had been infected with HPV and most (81.4%) believing they had no or low future risk. No difference existed regarding knowledge or awareness of HPV according to marital status. Concerning perceived risk for daughters, single fathers were significantly more likely to believe their daughter was at risk for both HPV (87.5% versus 36.4%; p=0.01) and cervical cancer (75.0% versus 27.3%; p=0.02). Acceptability of free HPV vaccination was high at 92% with no difference according to marital status, however single fathers were significantly more likely (p=0.01) to pay when vaccination came at a cost. Concerns specific to single fathers included explaining the sexual nature of HPV and taking a daughter to a gynecologist to be vaccinated. Conclusions: Knowledge about HPV among Japanese fathers is poor, but HPV vaccine acceptability is high and does not differ by marital status. Providing sexual health education in schools that addresses lack of knowledge about HPV as well as information preferences expressed by single fathers, may not only increase HPV vaccine acceptance, but also actively involve men in cervical cancer prevention strategies. However, further large-scale quantitative studies are needed.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.6065-6068
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• 2013

Background: Primary aim of this study is to assess whether or not there is an increase at rate of HPV positive oropharyngeal cancers during 1996-2011 in Turkey, for comparison with prior reports from Western countries. Materials and Methods: A total of 138 newly diagnosed patients with oropharyngeal cancer were identified, 39 of which had no primary tumor specimen available and 18 patients with invalid HPV status, therefore HPV status for remaining 81 patients was evaluated. The presence and type of HPV DNA were determined with formalin-fixed paraffin embedded specimens, using an HPV DNA-based multiplex PCR assay. Associations between HPV status and clinicopathological characteristics were evaluated using a two-sample t-test for the continuous variables and the categorical variables were compared by chi-square test. Overall survival (OS) periods were calculated with Kaplan-Meier method. Results: The proportion of HPV-positive cancer has continued to increase during 2004-2011 as compared with 1996-2003. Notably, 33% (6/18) of the cases were HPV-positive in 1996-1999, 43% (9/21) in 2000-2003, 55% (11/20) in 2004-2007 and 70% (16/23) in 2008-2011. Thus, when we compared the results obtained during the 2004-2011with results of 1996-2003 period, we found that increase at HPV-positivity ratio was statistically significant (38% vs 64% p=0.012). Conclusions: This study demonstrated that HPV positive oropharyngeal cancers are increasing in Turkish patients as in the Western world.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2869-2873
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• 2014

Background: Human papillomavirus (HPV) integration within the E2 gene has been proposed as a critical event in cervical carcinogenesis. This study concerned whether HPV16 status and E2 gene intactness are predictive of radiation response in patients with cervical cancer. Materials and Methods: Biopsies of 44 patients with cervical cancer were collected before or after radiotherapy. The presence of HPV16 was assessed by polymerase chain reaction (PCR) using specific primers for the L1 region. E2 disruption was detected by amplifying the entire E2 gene. Results: HPV16 DNA was found in 54.5% of the clinical samples. Overall, 62.5% of the HPV16 positive tumors had integrated viral genome and 37.5% had episomal genome. There was a tendency of increase of HPV16 E2 negative tumors compared with HPV16 L1 ones in advanced stages (75% versus 20% in stage III respectively). Detection of E2 gene appeared influenced by the radiotherapy treatment, as the percentage of samples containing an intact HPV16 E2 was more frequent in pretreated patients compared to radiotherapy treated patients (66.6% versus 20%). The radiation therapy caused an eight-fold [OR= 8; CI=1.22-52.25; p=0.03] increase in the risk of HPV16 genome disruption. The integration status is influenced by the irradiation modalities, interestingly E2 disruption being found widely after radiotherapy treatment (75%) with a total fractioned dose of 50Gy. Conclusions: This study reveals that the status of the viral DNA may be used as a marker to optimize the radiation treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8351-8359
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• 2014

Background: Recent epidemiological data have implicated human papilloma virus (HPV) infection in the pathogenesis of head and neck cancers, especially oropharyngeal cancers. Although, HPV has been detected in varied amounts in persons with oral dysplasia, leukoplakias and malignancies, its involvement in oral tongue carcinogenesis remains ambiguous. Materials and Methods: HPV DNA prevalence was assessed by PCR with formalin fixed paraffin embedded sections (n=167) of oral tongue squamous cell carcinoma patients and the physical status of the HPV16 DNA was assessed by qPCR. Immunohistochemistry was conducted for p16 evaluation. Results: We found the HPV prevalence in tongue cancers to be 51.2%, HPV 16 being present in 85.2% of the positive cases. A notable finding was a very poor concordance between HPV 16 DNA and p16 IHC findings (kappa<0.2). Further molecular classification of patients based on HPV16 DNA prevalence and p16 overexpression showed that patients with tumours showing p16 overexpression had increased hazard of death (HR=2.395; p=0.005) and disease recurrence (HR=2.581; p=0.002) irrespective of their HPV 16 DNA status. Conclusions: Our study has brought out several key facets which can potentially redefine our understanding of tongue cancer tumorigenesis. It has emphatically shown p16 overexpression to be a single important prognostic variable in defining a high risk group and depicting a poorer prognosis, thus highlighting the need for its routine assessment in tongue cancers. Another significant finding was a very poor concordance between p16 expression and HPV infection suggesting that p16 expression should possibly not be used as a surrogate marker for HPV infection in tongue cancers. Interestingly, the prognostic significance of p16 overexpression is different from that reported in oropharyngeal cancers. The mechanism of HPV independent p16 over expression in oral tongue cancers is possibly a distinct entity and needs to be further studied.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.21-25
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• 2007

Background：Squamous cell carcinoma(SCC)of the palatine tonsils represents approximately 15-23% of all intraoral SCC. The most frequently reported risk factors for oropharyngeal cancer are smoking and alcohol. In a recent overview of HPV and tonsillar squamous cell carcinoma(TC), 51% contained HPV DNA, and HPV-16 being the most frequent type. We aimed to clarify whether HPV directly effects on the oncogenesis and biologic behavior of TC by comparison with infection prevalence, and physical status of virus. Material and Method：We used HPV genotyping DNA chip(Biocore, Korea, Seoul) arrayed by multiple oligonucleotide probes of L1 sequence of 26 types of HPV and HPV genotypes are identified by fluorescence scanner. The copy numbers of HPV E2 and E6 open reading frames(ORF) were assessed using a TaqMan-based 5'-exonuclease quantitative real-time PCR assay. The ratio of E2 to E6 copy numbers was calculated to determine the physical status of HPV-16 viral gene. Results：We observed a significant difference in HPV prevalence between 52 TCs and 69 CFTs(73.1% vs. 11.6%), and most of the HPVs were type 16(87.2%)and non-episomal(94.1%) state. Conclusions：This study regarding HPV infection prevalence and mechanism in the largest population of palatine tonsillar squamous cell carcinoma with chronic follicular tonsillitis revealed significant difference pf HPV prevalence between TC and CFT. Most of HPV were 16 type and integrated or mixed, HPV-16 integration could be directly related to tonsillar carcinogenesis.

• Journal of the Korean Society of School Health
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• v.33 no.1
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• pp.58-66
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• 2020

Purpose: HPV vaccination is important for the prevention of cervical cancer and genital warts and it is recommended that females be vaccinated against HPV before having sexual contact. Although the national HPV immunization has recently started in Korea, the vaccination rate is still not high. This is a relevant study attempting to investigate the factors affecting the vaccination status of female adolescents in the target age groups focusing on mothers' knowledge and health beliefs of HPV vaccines. Methods: Participants were 206 mothers who had daughters at the target age for the national HPV vaccination program living in a metropolitan city. Data were collected using a self-reported questionnaire about HPV knowledge and health beliefs of HPV vaccines, consisting of perceived susceptibility seriousness, benefits, barriers, and cues to action. Results: The participants' knowledge of HPV was significantly correlated with the overall health beliefs. The factors influencing mothers regarding the HPV vaccination status of their adolescent daughters were found to be perceived barriers, advice on vaccination from medical staff, and perceived benefits. Conclusion: There is a need to organize subject-specific education programs focusing on correcting misinformation about the side effects and benefits of HPV vaccines. When operating education programs, it is recommended that participants include both students and their parents, that various approaches be implemented such as formal health classes, home correspondence and online education, and that medical personnel be also involved as education providers.

• Women's Health Nursing
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• v.25 no.3
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• pp.285-298
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• 2019

Purpose: The purpose of this study was to identify the impacts of human papillomavirus (HPV) vaccination-related health belief, attitudes toward HPV vaccination, and subjective norms on HPV vaccination intent targeting mothers of elementary school daughters. Methods: The study use a correlative survey design. The subjects of the study were 121 mothers of elementary school daughters located in metropolitan city B. All subjects agreed to participate in the study. The data were collected from September 1 to October 18, 2018, and were analyzed using descriptive statistics, Independent t-test, ANOVA with a post hoc $Scheff{\acute{e}}$ test, Pearson's correlation coefficients, and stepwise multiple regression. Results: Attitude toward HPV vaccination, subjective norms, vaccination plans for their children, and mother's vaccination status were significant factors influencing HPV vaccination intention. These factors accounted for 72% of the HPV vaccination intention. Conclusions: This study showed that factors affecting the intention of mothers of elementary school daughters to vaccinate against HPV were HPV vaccination attitudes, subjective norms, vaccination plans for their children, and mother's vaccination status. The biggest influencing factor was HPV vaccination attitudes. Therefore, in order to encourage mothers of elementary school daughters to vaccinate against HPVs, national-level policies should be implemented to create a social atmosphere of positive attitudes toward HPV vaccinations that also emphasizes how easy it is to get vaccinated against HPV. Based on this, mothers of elementary school daughters should be encouraged to have them vaccinated against HPV, thus contributing to improving the HPV vaccination rates of elementary school girls.