03 | Knowledge about human papillomavirus and its vaccination and willingness to accept human papillomavirus vaccination in a population of students from the Local Health Authorities of Agrigento, Palermo and Trapani, Western Sicily

Background. Human papillomavirus (HPV) is one of the most common sexually transmitted infection and is associated with the development of several diseases, including malignancies such as cervical, anal, vulvar, vaginal penile, oropharyngeal cancers and benign lesions such as genital warts. HPV vaccination is a highly effective and safe primary prevention intervention; however, uptake of vaccination programs is strongly influenced by the level of knowledge and perceptions of the target population, particularly among adolescents. In this context, educational interventions at schools play a central role in promoting awareness and favorable attitudes toward preventive behaviors.

Materials and Methods. The study involved a sample of 2,146 students attending first and second grade secondary schools in the 3 Wester Sicily provinces of Agrigento, Palermo and Trapani. Participants were involved via the administration of a structured questionnaire designed to assess their knowledge, attitudes toward HPV and its vaccination, and willingness to receive vaccination. A second version of the questionnaire was re-administered following training sessions aimed to providing scientific information on the infection and prevention strategies. Responses were collected using Likert scales ranging from 1 to 5 to assess opinions and from 1 to 10 to measure vaccination willingness. Participation in the study required a written informed consent previously signed from the students' parents.

Results. Students showed a high level of agreement with the statement that the virus can cause serious illness, with an average score of 4.5 out of 5, and acknowledged the possibility of being exposed to the infection during their lifetime, with an average score of 3.9. A strong perception of the importance of communication on the topic also emerged, both within the family, school, and healthcare settings, with average scores of 4.23, 4.46, and 4.21, respectively. Regarding the Vaccination, participants expressed a high level of agreement regarding the vaccine's usefulness in preventing cervical cancer and genital warts (mean 4.5), its safety (mean 4.32), and the appropriateness of their peers getting vaccinated (mean 4.48). Vaccination willingness, measured on a scale of 1 to 10, reached a mean value of 8.94, an increase from the pre-intervention score of 8.62 (p-value <0.001). Furthermore, 93.6% stated that, if they were not vaccinated, they would be vaccinated, while 6.4% expressed refusal to be vaccinated, regardless of their vaccination status.

Conclusions. The study results suggest that school-based educational interventions are an effective tool for improving HPV knowledge and attitudes toward vaccination. The observed increase in vaccination willingness and the high percentage of students willing to be vaccinated indicate that targeted information strategies can significantly contribute to increasing adherence to prevention programs. Therefore, the systematic implementation of educational programs in schools should be considered a fundamental component of public health policies aimed at reducing the burden of HPV-related diseases.