published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 33-35).

published_or_final_version / Public Health / Master / Master of Public Health

Introduction: Cervical cancer is the second most prevalent cancer among female and one of the top causes of cancer death worldwide. Human Papillomavirus (HPV) infection is the primary factor of cervical cancer. HPV vaccine has potential to contribute greatly by curbing the development of cervical disease and to optimize public health outcomes. Chinese populations were disproportionally affected by cervical cancer and the cultural backgrounds of Chinese are distinctively different from other races. In near future, there is possibility that China may introduce the vaccine. Little is known about Chinese’s perceptions on HPV vaccine and the situation in Chinese community may be different. To achieve an effective prevention of cervical cancer in China, a comprehensive understanding of Chinese women’s knowledge, attitudes and practices on HPV vaccination is crucial before introduction of HPV vaccine to ensure high uptake and coverage among Chinese women. Objectives: To investigate the knowledge, attitudes and the associated factors on HPV vaccination among Chinese women. Methods: Published studies on knowledge and attitudes of HPV vaccination in preventing cervical cancer in Chinese population were identified by using the major databases: Global Health, Medline, Pubmed, CINAHL, PsycINFO and CKNI from 2005 to 2012. 15 articles were included after reviewing for eligibility. Results: The overall awareness of HPV and HPV vaccine among Chinese women was low. Chinese women generally showed knowledge deficit about HPV and HPV vaccine. Despite inadequate knowledge, level of acceptance of HPV vaccination among Chinese women was high. Several major reasons influencing the attitudes of HPV vaccination among Chinese were cost, concerns on efficacy and safety of HPV vaccine, social influences, perceived likelihood of being infected with HPV, and recommendations and endorsements from others. Different level of parental acceptance was resulted in different studies. They concerned the safety of HPV vaccine and worried that HPV vaccination may promote unsafe sex of daughters. Discussion: Policy makers should seriously consider implementation of HPV program for low-resource setting after balancing the cost and benefit of HPV vaccine program. Raising the awareness and knowledge level concerning HPV vaccine among Chinese population should be set as the urgent priority. To improve the public awareness and acceptance of HPV vaccination, education interventions should be targeted at both recipients and parents. Factors influencing the acceptability of HPV vaccination must be considered in constructing public health strategies for advocating HPV vaccination. Vaccination promotion campaign should be carefully framed for culturally sensitive setting. Healthcare professionals have important roles in recommending vaccination. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination. / published_or_final_version / Public Health / Master / Master of Public Health

Introductions: Cervical cancer has been the second most frequent cancer among females worldwide. Over 85% of women’s deaths from the disease are living in developing countries in 2008. Human papillomavirus (HPV) vaccination may provide a feasible strategy for cervical cancer prevention so as to reduce the disease burden. However the uptake of HPV vaccination is low. To promote HPV vaccination, the design of message frame, may be important. However, little research has been conducted to provide a clear interpretation of the effectiveness of health message frame on uptake of HPV vaccination. Objectives: To evaluate the effects of gain- and loss-framing message on HPV vaccination acceptability and explore the factors that might influence the acceptability of HPV vaccination. Methods: Literature search on the studies investigating gain- and loss-framed message on HPV vaccination. PubMed and Google Scholar during 2006 to 2013. Results: Ten articles, seven from U.S.A, two from Canada, and one from Ireland, were included in the systematic review. The effectiveness between message framing and the context of HPV vaccination were different by studies; the different effect of message framing may be due to in the studies population. Age, sex, culture and individuals’ risk perceiving level might have influence on the effect of gain- and loss-message framing. Four of five articles, which targeted at young population, showed that loss-farmed message is more effective to increase individual’s positive attitude and response to HPV vaccination. Participants with a greater number of sexual partner with higher avoidance-oriented attitudes, or are less likely to use protection; loss-framed message is more effective. In turn, when young people, particularly female with a lower number of sexual partner, with approach-oriented attitudes, or are more likely to use protection, both gain-and loss-framed message have no effect on their intention to vaccinate. However, another five articles in this review targeted at parents with young children found inconsistent results of framing effects on HPV vaccine acceptability. Discussion: The effect of gain- or loss-framed tends to be different, depending on types of health behavior promoted. Loss- and gain-framed messages might have different effect to different audience. Framing message selection is matching on individuals’ motivational orientation may help in prompting HPV vaccine acceptability. However, there is a lack of studies on the association between message framing effects and HPV vaccine acceptability, especially for Chinese population. Further investigations of message framing effects on acceptance of HPV vaccination in Chines population are necessary. / published_or_final_version / Medicine / Master / Master of Public Health

Objective: Toanalyze the clinical efficacy of quadrivalent human papillomavirus vaccine (QHPV)in preventing human papillomavirus (HPV) related diseases in males and to evaluate the potential epidemiological impact of the vaccine in males. Methods: All published studies were searched using specified keywords via EMBASE, PubMed, Cochrane Library and ClinicalTrials.gov to review systematically the efficacy of QHPV in males. Studies that modeled the impact of QHPV in males were also searched using specified keywords from PubMed, EMBASE and Cochrane Library to evaluate the vaccine impact on males. Results: A total of 5 studies were selected for the systematic review of QHPV efficacy in males. Observed efficacy of QHPV in preventing genital warts(GW)due to HPV types 6 and 11 in males is found to be statistically significant. Efficacies of QHPV in preventing anal intraepithelial neoplasia (AIN), HPV-related cancers in males are yet to be confirmed. A total of 9 studies were selected for the review of modeled impact of QHPV vaccination in males. QHPV vaccination in girls is predicted to reduce the incidence of HPV infections and GW in males. Inclusion of males in the vaccination program could only produce limited additional benefit if vaccination coverage of girls is high. Discussion: Analysis and implications of clinical efficacy of QHPV in males are discussed. The approved indications of QHPV vaccine in various countries were not fully substantiated by clinical evidence. Factors affecting the epidemiological impact of QHPV in males were also discussed. Questionable efficacy of QHPV in males casts doubt on the vaccine’s impact. Conclusion: Clinical efficacy of QHPV in males is basically unclear, except against GW. Impact of the vaccine in males is greatly limited by its efficacy. More research should be conducted in order to obtain a clearer picture on the efficacy and impact of QHPV in males. / published_or_final_version / Public Health / Master / Master of Public Health

Human papillomavirus (HPV) has a high prevalence among the population, and brings an enormous health impact and burden to the public. Vaccines have been developed in recent years, and their efficacy has been noted in many studies. Although there is much theoretical research conducted worldwide on the indirect protective effect of HPV vaccines to the unvaccinated population, convincing evidence on real world settings is still to be found. This systematic review recruits studies from two databases, PubMed and MEDLINE ovidSP and is intended to examine herd protection on community levels. 5 studies are included and the conclusion suggests that the herd protection is most significant among the sexually active young population, whereas it doesn’t seem to benefit people of older age. Therefore, follow up studies in the future are still needed to evaluate the herd immunity among the old age groups. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 52-57).

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 60-69).

published_or_final_version / Community Medicine / Master / Master of Public Health