Journal of American College Health

ISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20

Knowledge And Perception Of Female Nursing

Students About Human Papilloma Virus (Hpv),
Cervical Cancer And Attitudes Towards Hpv
Vaccination

Sevgül Dönmez , Ruşen Öztürk , Sezer Kısa , Banu Karaoz Weller & Simge
Zeyneloğlu

To cite this article: Sevgül Dönmez , Ruşen Öztürk , Sezer Kısa , Banu Karaoz Weller & Simge
Zeyneloğlu (2018): Knowledge And Perception Of Female Nursing Students About Human
Papilloma Virus (Hpv), Cervical Cancer And Attitudes Towards Hpv Vaccination, Journal of
American College Health, DOI: 10.1080/07448481.2018.1484364

To link to this article: https://doi.org/10.1080/07448481.2018.1484364

Accepted author version posted online: 06

Jul 2018.

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PUBLISHER: TAYLOR & FRANCIS

JOURNAL: JOURNAL OF AMERICAN COLLEGE HEALTH

DOI: HTTPS://DOI.ORG/10.1080/07448481.2018.1484364

NURSING STUDENTS AND HUMAN PAPILLOMAVIRUS

KNOWLEDGE AND PERCEPTION OF FEMALE NURSING STUDENTS ABOUT
HUMAN PAPILLOMA VIRUS (HPV), CERVICAL CANCER AND ATTITUDES
TOWARDS HPV VACCINATION

Sevgül Dönmez, MSN,PhD, Research Assistanta, Ruşen Öztürk,MSN, PhD, Research

assistantb, Sezer Kısa MSN, PhD, Associate Professorc,*, Banu Karaoz Weller, MSN, PhD,
Assistant Professord, Simge Zeyneloğlu MSN, PhD, Associate Professore
a
Gaziantep University, Faculty of Health Sciences, Department of Nursing, Şahinbey,
Gaziantep-Turkey
b
Ege University, Faculty of Nursing, İzmir-Turkey
c
Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health
Promotion, Kjeller, Oslo-Norway
d
Izmir University, Faculty of Health Sciences, Department of Nursing
e
Gaziantep University, Faculty of Health Sciences, Department of Nursing, Şahinbey,
Gaziantep-Turkey
*
CONTACT Sezer Kısa MSN, PhD, Associate Professor, Oslo Metropolitan University,
Faculty of Health Sciences, Department of Nursing and Health Promotion Kjeller, Oslo-
Norway E-mail:sezerkisa@hotmail.com

Received 29 Jan 2018

Revised 09 Apr 2018

Accepted 30 May 2018

ABSTRACT

Objective: The researchers aimed to evaluate the knowledge and perceptions of first year

female nursing students about human papillomavirus (HPV), cervical cancer (CC) and HPV

vaccination. Participants: The sample included 690 female nursing students from sampled
universities between April and June 2015. Methods: Students were surveyed by using a

pretested HPV and CC awareness questionnaire. Results: More than half of the students

(65.1%) answered questions incorrectly with a mean HPV knowledge score of 6.085 ± 3.38.

The majority of students (82.6%) did not hear HPV vaccine. Only, 2.8% of the students had

been vaccinated. A statistically significant relationship was found between HPV knowledge

score and hearing about HPV vaccine (U = 28280,500, p = 0.015), and believing HPV

vaccine protectiveness (x2 = 14.153, p = 0.001). Conclusions: This study highlights the lack

of knowledge and low level of awareness about HPV, CC and HPV vaccination among first

year nursing college students.

KEYWORDS

Awareness; Cervical cancer; Human papillomavirus; Knowledge; Nursing; Perception

Introduction

Cervical cancer (CC) is the fourth most prevalent cancer among women worldwide, the

second among women living in developing and less developed countries, and ranks second in

deaths from female cancer in women aged 15-44 years in the world 1. Every year,

approximately 527,624 women get diagnoses of CC and 265,672 die from the disease and the
1,2
majority of cervical cancer deaths are seen in low -and middle- income countries . The

incidence rates of CC are highest in sub-Saharan Africa, Latin America and the Caribbean,

and lowest in Western Asia, Australia/New Zealand, and Northern America 2. The reported

age standardized incidence rates of CC cases per 100.000 women were 75.9 in Malawi, 47.7

in Bolivia, 28.6 in Romania, 2.3 in Egypt, 6.3 in Canada, and 3.6 in Switzerland 2. In Turkey,

CC is the 5th most common cancers in women aged 15-44 years. Each year, 1686 women get

the diagnosis of cervical cancer and of those 663 lose their lives from CC. The age

standardized incidence rate of CC cases was 4.3 per 100.0000 women in Turkey 2.

Background

2
CC is a disease that emerges with abnormal growth of cervical cells, is seen in all ages and

has a poor prognosis when diagnosed late 3. It can be prevented by early diagnosis, treatment,

and vaccination for human papilloma virus (HPV) infection at an early age. However, a recent

study showed that the rates of incidence and mortality increase due to the changes in the

sexual behaviors that increase the risk of HPV infection 3,4. HPV is the most common cause of

urogenital infections with more than 120 known types 5. Most HPV infections do not cause

any symptoms and can resolve spontaneously, but some (types 16 and 18) - if they are not

treated- cause precancerous lesions which can progress to cervical cancer 6. About 40 types of

HPV were identified to be related to cervical cancer or genital cancer 5. Studies in recent years

have found a strong association between HPV and vulvar, vaginal, penile, anal, oral, lung, and
7-9
skin cancer . Most HPV infections are asymptomatic and the majority of the people are

unaware that they are infected with the virus. Therefore, HPV is seen as one of the biggest
10
threats to public health in the world . HPV prevalence ranged from 1.6% to 25.6% among
5,10 2,11
women worldwide and 13.2% to 20% in Turkey . The reported HPV prevalence rates

were 21.1% in Africa, 14.2% in Europe, 11.5% in the Americas, and 9.4% in Asia 3.

In 2006, the Food and Drug Administration (FDA) approved the first HPV vaccine for

females to prevent the occurrence of HPV-induced cervical changes, then two more vaccines

with different HPV types were accepted in year 2009 and 2014. Today, World Health
12
Organization (WHO) classifies HPV vaccine as an essential medicine . However, so far,

only 71 countries with high rate of HPV vaccine uptake, such as U.S.A, Canada, Australia,

India, and Mexico have been included HPV vaccine in their national immunization program
12
. The HPV vaccine uptake rates vary from 82% in Poland, 84% in Iceland, 86.7% in
13,14
Ukraine to about 88% in Hungary, and 91.4% in Great Britain . In Turkey, HPV vaccine

is not in the national immunization program, however, it has been available in the pharmacies

since December, 2007 1. Turkey has approximately 18 million people between the ages of 9-

3
29 years old, and about eight hundred thousand girls are born each year. If the country adopts

the HPV vaccine eighteen million people in the first year, and eight hundred thousand girls

each year should be vaccinated in order to prevent cervical cancer in Turkey. The Turkish

Ministry of Health stated that the benefits and side effects of the HPV vaccine to prevent

cervical cancer had not well documented so that the Social Security Administration would not

include the HPV vaccine in the national immunization program due to its low cost-
15
effectiveness and doubts about the vaccine . Although HPV prevalence in Turkey is higher

than most of the European countries, the local studies show that the HPV vaccination rates

vary between 1.4 and 3.9 % 16-18. The low HPV vaccination uptake postulates a higher level of

ignorance of people who are at risk regarding the consequences of HPV infection and benefits

of HPV vaccination. In Turkey, women between 30 and 65 years of age are advised to have a
19
smear test and HPV testing every five years for early diagnosis of CC . CC screening

programs are offered free of charge by the public hospitals in Turkey but they are not

nationwide, well organized, and population-based. National studies reported that the rate of
20,21
Pap smear testing varies between 20% and 64.5% . Despite all the efforts, problems

persist in cervical cancer prevention programs due to the lack of health appropriate policies

based on evidence, social and personal beliefs such as women’s reluctance to gynecological

examination, having incorrect information regarding the smear test, lack of resources and

technical infrastructure.

Turkey has not been employed health professionals for the health education and promotion

programs, including sex education, at the primary and secondary education institutions, and

not formed any school health divisions in these facilities for many years. In addition, there has

been an increase in risky sexual behaviors such as early first sexual intercourse, multiple

sexual partners, early sexual activity outside of marriage, and unprotected sexual intercourse

for last two decades 22. Adolescents, because of their age, in developing and developed world,

4
including Turkey have been facing the risk of having sexually transmitted diseases, and HPV
22,23
due to display of more risky sexual behaviors . With the lack of knowledge about HPV

infection, it is not possible to increase the HPV vaccine uptake and reduce the mortality from

CC. In developed countries, College Student Health Centers are responsible to provide health

education and promotion services for the students by organizing conferences, distributing

brochures to increase students’ knowledge, and create awareness as well as recommending all
24,25
students to receive preventive immunization including the HPV vaccination . However,

despite the laws and rules for student health centers to provide these services in Turkey, many

services are not available due to lack of human and financial resources in the Turkish

Universities 24. After an exhaustive literature search, two local studies were found that were

focusing to determine the awareness and knowledge about HPV, and HPV vaccination among

university students in Turkey. A study specifically focusing on the first year female nursing

students with a large sample size, and including the biggest geographic regions of the country

could not be found. It is essential that nursing students receive adequate education about

adolescent and women’s health starting from their first day at the college, and practice it

efficiently. In addition, they could transfer this information to their family members, peers,

and other women in the community, thus contributing to public health. Therefore, we carried

out the present study in order to determine the awareness and perceptions of first year nursing

students about HPV, CC and attitudes towards HPV vaccination.

Methods

The purpose of the study is to determine the awareness and knowledge about HPV and

cervical cancer and attitudes toward HPV vaccination among first year female nursing

students.

Sample

5
The study employed a cross-sectional design to recruit a convenience sample of all female

nursing (n = 779) students of the five biggest state universities located in the western, middle,

south, and southeastern regions of Turkey. Students were recruited using the universities’

School of Nursing’s registration lists, and eligibility was limited to female students who were

in the second semesters of the first years. The survey was administered over a 3-month period

from April to June 2016. In addition, prior to beginning the research, a written permission and

ethical approval were obtained from the nursing schools of the sampled universities. Although

it is not directly related to the purpose of the study, the sampled students took anatomy (I and

II), physiology (I and II), basic concepts in nursing, biochemistry, health informatics,

fundamentals of nursing, clinical pharmacology, and health communication as health related

undergraduate courses in their first year.

Data collection

The objectives of the study were explained to the students, and a written consent was obtained

from each of the participants. The implementation of the data collection tools took about 20-

25 minutes for each participant. A self-administered close-ended questionnaire consisting of

two parts was used in the study. The questionnaire included two sections: the first section

comprises socio-demographic data such as age, residential place, information on parents, and

income status, etc. The second section included the Turkish version of the Cervical Cancer

and HPV Awareness Questionnaire composed of 36 items. The Cervical Cancer and HPV

Awareness Questionnaire developed in 2004 by Ingledue and colleagues consists of 36 items

26
. The validity and reliability of the Turkish version were tested by Ozdemir & Kısa in 2016
27
. The first part included 15 multiple-choice questions, which measure the knowledge level of

women about CC and HPV. Each question had one correct response. The possible range of

scores was from zero to 15; higher scores indicate a higher level of knowledge about HPV

and CC. The Kuder-Richardson Formula (KR) 21 reliability coefficient was .78 for the first

6
part of the questionnaire. The second part of the Cervical Cancer and HPV Awareness

Questionnaire included 15 questions (5-point Likert type) (completely agree = 5, agree = 4,

relatively appropriate = 3, not agree = 2, never agree = 1) which were based on the Health

Belief Model. Nine out of 15 questions were for perceived sensitivity (maximum score = 45,

minimum score = 9); six questions were for perceived seriousness (minimum score = 6,

maximum score = 30). The highest score in this section indicates a high level of perceived

threat for HPV infection. The last part of the scale included six multiple-choice questions

related to the individual’s sexual behavior, risk factors, and history of Pap smear test. The

second part of the questionnaire was found to be reliable (36 items; α = .79).

Statistical Analysis

In the original study, a total of 779 questionnaires was distributed, and 711 (response rate

91.27%) was returned and only 690 eligible questionnaires used for the analysis. Data was

analyzed using statistical software SPSS (IBM SPSS Statistics version 22.0). All variables

were analyzed using frequencies, means, proportions, standard deviations, and percentages. A

variety of statistical analyses were applied to the data, including Chi-square, and Mann–

Whitney U tests. Characteristics of female nursing students and groups of students were

described while inferential statistics were utilized to test the research questions on comparing

groups. Statistical significance was defined with a p value of ≤ 0.05 through all the statistical

analyses conducted in the current study.

Ethical Consideration

The study was reviewed and approved (No 68) by Ege University, Nursing Faculty Ethics

Committee. Each participant was clearly informed that participation in the study was

confidential and voluntary. We also obtained written consent from all the students before

beginning the data collection.

Results

7
This study included 690 first year female nursing students. The mean age of the students was

20.43 ± 2.97 (min = 18, max =25), 56.5% of the students were in the 18-19 age groups,

almost all the students (99.4%) were unmarried, and 43% stated their income level as

sufficient.

Only 11 students (1.6%) had sexual experience, of those 10% had more than five sexual

partners, 54.6% never used condoms and 45.4% never had a pap smear. A majority (78.2)

stated that they had never had a family history of cervical cancer (Table 1).

About one-fifth (17.4%) of the students heard of HPV vaccine, of those 71.6% were not sure

about protectiveness of HPV vaccine. A significant proportion (97.2%) did not receive the

HPV vaccine, and among the unvaccinated students, only 25.4% had an intention to receive

the HPV vaccination (Table 2).

The mean score for knowledge was 6.08 ± 3.38 (min = 0; max = 15), the percentage of

incorrect answers to knowledge questions for HPV and CC were 59.1%. The mean score of

general perceived threat for HPV was determined as 44.76 ± 7.89 (min = 15.00, max = 75.00).

The mean score for perceived susceptibility and seriousness were 26.46 ± 5.49 (min = 9, max

= 45) and 18.29 ± 3.49 (min = 6, max = 30), respectively (Table 3).

A significant proportion (71.6%) of the students worried about getting CC and 64.4% were

concerned about HPV. More than half of the students (59.4%) did not believe to be at risk of

developing cervical cancer. Only, 12.2% believed to be at risk of developing CC, 6.5%

believed was at high risk of catching HPV and 35.1% stated having a low risk of being an

HPV carrier. Students believed that they had the ability to prevent CC (34.0%) and avoid

HPV infection (37.1%). Almost 17% thought that CC is the most serious diseases that one

could ever get and 63.3% believed to be curable if diagnosed early. More than half of the

students (51.3%) believed that HPV is life threatening and 41.2% incorrectly believed that

HPV can be treated (Table 4).

8
As shown in table 5, variables such as having a recent pap smear test (x2 = 6.642, p = 0.036),

hearing about HPV vaccine (U = 28280,500, p = 0.015), and believing HPV vaccine

protectiveness (x2 = 14.153, p = 0.001) were statistically associated with the mean knowledge

score of HPV. Students who have had a recent pap smear test, who had heard HPV vaccine

and who believed HPV vaccine protectiveness had higher scores of knowledge about HPV.

The perceived threat score of HPV and CC was higher among students who regularly used

condoms and had a family history of CC compared to others (p > 0.001) (Table 5).

Discussion

The level of knowledge and awareness are the key factors in health promotion. Individuals

with higher knowledge and perceived threat are more likely to engage in healthy behaviors. In

this study, we aimed to determine the awareness and knowledge level of first year female

nursing students about HPV, CC and HPV vaccination. We found that the majority of the

students had a low level of knowledge and awareness about HPV, CC and HPV vaccine.
16,18,28-30
Similar findings were observed among nursing students in other countries . This

important finding clearly demonstrates inadequate campaign about HPV and HPV vaccination

in Turkey together with some cultural issues. We need to emphasize that very few students

stated having sexual experience and talking sexually related issues with parents in this study.

Premarital sex is still a taboo in the Turkish community as it is in many Muslim countries and

the majority of the families concern about the risk of early sexual experience of their children

after having sex education 22. The general approach of the Turkish health care providers such

as nurses or family physicians is not to talk to adolescents about sexually related issues if they

are not sexually active. Thus, these are the biggest concerns related to awareness about HPV

infection and HPV vaccination in Turkey.

The perceived threat for HPV infection and CC was to be low in this study. The majority of

the students worried about getting CC and being infected with HPV, but did not perceive

9
themselves at risk of developing CC and see CC as a serious disease. The results of this study
26,31
were consistent with prior studies . Studies reported that the perceived threat of HPV and

CC was increased among sexually active women, women with multiple sexual partners,

women who felt vulnerable to HPV infection, who attend a cervical cancer screening program

and have a history of recent Pap test 32,33.

As expected, HPV vaccine uptake was found to be very low among female nursing students

compared to other international studies, which also found low rates of HPV vaccine uptake
18,29,30,34,35
. A study from the Greece indicated that 47.7% of the nursing students had obtained
36
the HPV vaccine . Another study from Lebanon found HPV vaccination rate to be 16.5%
37
among female students . This study found that the students with low level of knowledge

about HPV had not believed in the protective nature of HPV vaccine. As mentioned in other

studies, lack of knowledge about HPV vaccination and perceived HPV vaccine effectiveness

are the important determinants of the HPV vaccine uptake 36,38.

This study showed an association between being sexually active, having smear test and

hearing HPV vaccine and knowledge about HPV and CC. Our results were consistent with the
32,39,40
previous studies done among various populations . Studies showed that students, who

had sexual experience, had a Pap smear history and heard of HPV vaccine, had a higher

knowledge level of HPV. Ingledue et al., (2004) indicated that women with higher HPV and
26
CC knowledge levels were more likely to obtain Pap smear tests . Another study declared

that the perceived seriousness of CC was more frequent among women ever having had a Pap
41
smear test . Studies reported that women with better knowledge of HPV related CC were

more likely to accept HPV vaccine 42,43

Conclusion

In this study, first year female nursing students had a low level of knowledge and awareness

about HPV, CC and HPV vaccination. Although the majority of the nursing students were

10
worried about getting CC and infected with HPV, they were not aware of HPV vaccination.

Student’s attitude towards HPV vaccination was inadequate. More than half of the students

were not sure about receiving HPV vaccine and HPV vaccine protectiveness that shows the

need to serve nursing students in this respect. Students who have had sexual experience, had a

Pap smear history and heard of HPV vaccine had highest knowledge level of HPV.

The findings refer that nursing students are not being educated or guided about HPV and HPV

vaccination during their early school years. A great responsibility falls to student health

centers which provide preventive health services to the students especially in developing

countries.

The college health centers should encourage students to take responsibility for their own

health by providing health information to increase the awareness about HPV and HPV

vaccine among all female university students in the early years of their education.

Considering that the majority of the students were not sure about HPV vaccine protectiveness,

the acquisition of more evidence-based knowledge about vaccine protectiveness should be

emphasized and education programs should focus more on the safety of the vaccination. Since

a vast majority of the students stated that they did not talk to their parents about sexually

related issues, it would be more culturally appropriate to inform parents about the HPV

vaccine to bring this topic up with their adolescents and establish a national school-based

sexual health education program to improve the knowledge of the adolescents about sex

related diseases in their early school years. HPV vaccines are very expensive for parents to

afford in Turkey. Therefore, we recommend policy makers to include the vaccine in the

national immunization program (free of charge) for the suggested age group as it is in many

western countries. We recommend further research to determine potential barriers for HPV

vaccine uptake and the role of school nurses and family physicians in providing knowledge to

adolescents about HPV related CC and vaccination in Turkey.

11
 Strengths and Limitations of the Study

The strengths of our study include the use of a culturally appropriate and validated

questionnaire for the knowledge and awareness about HPV and CC. Most importantly, a

sufficiently large sample size from five different nursing schools is more representative of the

female nursing students. There are also several limitations in this study. First, we used a

convenience sampling method to include students from five different universities, thus the

results may not be generalizable to other population groups in various settings. Second,

selecting convenience samples of females from one major area in a university setting might

not accurately represent the female college students. However, it is expected that nursing

students have had enough health-related courses to develop behaviors to protect and improve

their health status, and gained this level of knowledge to focus more on their own health at the

end of the second semester of their studies. Third, the self-report measures are subject to

reporting biases.

Conflicts of Interest

None

Acknowledgement:

The authors would like to thank the students who voluntarily participated and are grateful to

all the staff of the nursing schools for their support in the study.

Funding

This research did not receive any specific grant from funding agencies in the public,

commercial, or not-for-profit sectors.

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Table 1. Characteristics of Sexual and Reproductive Health (n = 690)
n %

Sexual experience
Never had 679 98.4
Sexually active 11 1.6
Number of sexual partner (n = 11)
10 90.0
Less than 5
1 10.0
5 and more
Talk sexually related issues with parents
Yes 157 22.8
No 509 73.7
Some issues* 24 3.5
Smoking status
Yes 62 9.0
No 628 91.0
Family history of cervical cancer
Yes 8 1.2
No 540 78.2
Do not know 142 20.6
HPV: Human Papilloma Virus
CC: Cervical Cancer
*Menstrual problems, hirsutism.
Table 2. Knowledge of HPV vaccine (n = 690)
n %

Heard HPV vaccine

Yes 120 17.4
No 570 82.6
Believing HPV vaccine protectiveness (n = 120)
Yes 20 16.7
No 14 11.7
Not sure 86 71.6
Received HPV vaccine
Yes 16 2.8
No 674 97.2
Willingness to receive HPV vaccine (n = 674)
Yes 171 25.4
No 67 9.9
Not sure 436 64.7
Table 3. Mean Scores of Knowledge and Perceived Threat about HPV and CC

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 Min. Max.
n Mean ± SD
Score Score

Knowledge 690 6.085 ± 3.38 0 15

Perceived threat (overall) 690 44.76 ± 7.89 15 75
Perceived Sensitivity Subscale 690 26.46 ± 5.49 9 45
Perceived Seriousness Subscale 690 18.29 ± 3.49 6 30
HPV: Human Papillomavirus; CC: Cervical Cancer
Table 4. Frequencies of Responses related to CC and HPV Perceived threat (n = 690)

Do not agree Not sure Agree

n % n % n %
Responses for Susceptibility
I am worried about getting CC 76 11.0 120 17.4 494 71.6
I am concerned about being infected with HPV 83 12.0 163 23,6 444 64.4
I believe I am at risk of developing CC 410 59.4 196 28,4 84 12.2
I believe I am at risk of being HPV carrier 451 65.4 186 27.0 53 7.6
Everybody has the same risk for CC, this is out of
298 43.2 252 36.5 140 20.3
my control
I have a high risk of acquiring HPV 401 58.1 244 35.4 45 6.5
I have a low risk of being HPV carrier 163 23.6 285 41.3 242 35.1
I have the ability to prevent CC 160 23.2 295 42.8 235 34.0
I have the ability to prevent HPV infection 134 19.4 300 43.5 256 37.1
Responses for Seriousness
All women with CC should have hysterectomy 353 51.2 273 39.6 64 9.2
I thought CC is the most serious diseases that I
265 38.4 310 44.9 115 16.6
could ever get
I believe HPV can be treated 96 13.9 310 44.9 284 41.2
I believe CC can be cured with early diagnosis 67 9.7 186 27.0 437 63.3
HPV is a life-threatening illness 67 9.7 269 39.0 354 51.3
Nobody dies of CC anymore 251 36.4 381 55.2 58 8.4
HPV: Human Papillomavirus; CC: Cervical Cancer
Table 5. Comparison of Students Knowledge and Perceived Threat Mean Scores with
Some Risky Behaviors

Knowledge Perceived Threat

n X SD p X SD p

Sexually active
Yes 679 5.80 3.41 44.06 7.60
U = 3.856 0.145
No 11 6.45 3.01 U = 3.294 0.193 44.95 0.09

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Condom Use*
All the time
1 8.00 1.82 50.75 11.5
Usually
2 6.33 2.51 2 48.66 3.78
Sometimes x = 4.239 0.237 x2 = 3.800 0.284
2 4.66 4.50 45.33 1.52
Never
6 5.00 4.24 44.39 7.96
Smoking
Yes 62 5.87 3.22 45.48 7.52
U = 16466.00 0.518 U =16315.00 0.449
No 628 6.13 3.36 44.44 7.93
Smear Test*
Never had 5 3.80 2.28 47.40 4.21
x2 = 6.642 0.036 x2 = 2.244 0.326
Had last year 4 6.39 3.31 44.96 7.93
Had once before 2 5.82 3.42 44.15 7.87
Family History of
CC
Yes 8 8.25 2.91 48.87 10.0
No 540 6.06 3.38 x2 =3.778 0.151 44.44 7,93 x2 = 1.168 0.558
Do not know 142 6.23 3.26 44.94 7.48
Heard of HPV
vaccine
Yes U=
120 6.85 3.52 U = 28280.500 0.015 45.45 7.48 0.928
No 32767.500
570 5.91 3.35 44.61 8.02
HPV vaccine
Protectiveness
Believe 113 7.20 3.29 45.62 7.82
x2 = 1.068 0.586
Do not believe 79 5.39 3.43 x2 =14.153 0.001 44.07 7.57
Not sure 498 5.94 3.59 44.67 8.92

Received HPV
vaccine
Yes 16 6.43 3.89 45.12 4.61
U = 4327.500 0.676 U = 4420.500 0.781
No 674 6.08 3.38 44.81 7.89
*Only students who had sexual experience answered this question
HPV: Human Papillomavirus
CC: Cervical Cancer

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