Christian Kindt and Dr. Wendy Birmingham, Psychology Department
Most religions promote abstinence of sexual intimacy prior to marriage. This ideology may discount the use of vaccinations that religious individuals consider only applicable to those who are sexually active. These individuals may not take the time to investigate the benefits of such vaccinations and indeed may not even be aware of the risks associated with the infections these vaccinations protect against. Specifically, this study examined how religious beliefs impact knowledge about, and attitudes and intention towards human papillomavirus (HPV) and HPV vaccination adherence. HPV vaccination is recommended for youth between ages 9 and 13 but not to be administered later than 26 years of age. Most college-age students should have obtained the vaccination if adherent to recommendations. HPV puts women at a heightened risk for oral, anal, and vaginal cancers and is the highest predictor for the onset of cervical cancer. Although men are less affected physiologically, both genders are capable of carrying and transmitting the virus to future partners. The Centers for Disease Control and Prevention report that the national averages for completing HPV vaccination in girls and boys are 41.9% and 28.1%, respectively. In Idaho and Utah, rates drop below the national average: 24.6% for girls, and 19.9% for boys. The same lower rates are seen in the Evangelical South where rates hover around 40% compliance. Religious attitudes and behavior may be potential factors.
Religiosity encourages the belief that abstinence before marriage offers the most effective safe-guard against contracting sexually transmitted infections (STIs) such as HPV which indeed it does. Because religious youth and young adults believe that they are not at risk, they may not be aware of the association between HPV infection, cervical cancer, and the possibility of becoming infected without violating their own chastity values (i.e., an unfaithful spouse, sexual assault, marrying a divorced individual who may have been exposed despite faithfulness). Our study collected information on general knowledge of HPV infection, cervical cancer and HPV vaccination in young college age adults across several universities. Further, we measured participants’ attitudes toward their own risk and behavioral intentions regarding HPV vaccination, and general religious attitudes and behavior.
We administered an on-line survey to two colleges: Brigham Young University and San Diego State University. A multi-collegiate analysis accomplished three important aims: 1) that we gathered a large sample size from a large population; 2) that we minimized bias that would otherwise stem from single student bodies (i.e. generalizing all groups from one group’s behavior); and 3) that we collected data from multiple religions. The on-line survey consisted of three sections. Section one prefaced overall objectives, informed of inherent concerns, and gathered consent. In section two, subjects answered demographic questions and religious attitudes and behavior. The third section assessed knowledge, attitude, and intentions both past and future. Surveys were streamed using Qualtrics on-line software and completion took an average of 15 minutes. As an incentive to participate, students were given 4-5 SONA research credit hours. No personal monetary incentive was offered, but students could choose to be entered into a drawing for a $50 gift card.
Descriptive analyses were performed using SPSS software version 25, establishing demographic frequencies, percentages, as well as measures of central tendency and linear regressions. In order to ascertain statistically significant outputs, weekly data exports were conducted. This fulfilled two important aims: 1) that viable data was filtered from incomplete or disqualified participants, and 2) that English and Spanish items were aligned to ensure a more comprehensive analysis.
A total of 1143 young adults, all between ages 18 and 26 were surveyed. Most were female (72.2%), White (78.4%), single (81.1%), from Utah (73.3) and CA (22%), with 24.7% from other states across the nation. Most were LDS (76.1%) and attended church weekly (44.4%) or more than weekly (32.6%), and most were insured (92.1%). Most indicated that their religious beliefs lie behind their whole approach to life (74.4%), and religious beliefs influence all their dealings in life (78.5%). Most had knowledge of HPV (74.5%), but only 37.7% and 44.8% knew HPV infection was not rare in men and women respectively and less than half knew HPV is associated with cervical cancer (49.9%). Over one-third did not know or had no knowledge of HPV vaccination (38.2%), and only slightly more than one-quarter have been vaccinated (29.8%). Weekly church attendance was associated with vaccination uptake (p=<.001) such that greater church attendance was associated with lower vaccination uptake. Insurance status was not associated with uptake (p=.084). Women were more likely than men to have vaccinated (p=<.001). Having knowledge of HPV infection was positively associated with vaccination uptake (p=<.001) such that less knowledge indicated less uptake. Life approaches to religion were predictive of vaccination uptake (p=<.001) such that higher levels of life approaches were associated with lower vaccination uptake.
Discussion and Conclusion
Our findings indicate a significant negative relationship between church attendance, religious life approaches, and HPV vaccination uptake. In other words, a person scoring higher in religious attitudes and behavior is less likely to seek out the HPV vaccination. These results suggest the need for additional research to examine ways to influence vaccination uptake in a highly religious population.