Vaccine 29 (2011) 8060–8065 Contents lists available at ScienceDirect Vaccine j ourna l ho me pag e: www.elsevier.com/locate/vaccine Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States Christopher W. Wheldon a,* , Ellen M. Daley a , Eric R. Buhi a , Alan G. Nyitray b , Anna R. Giuliano b a Department of Community & Family Health, College of Public Health, University of South Florida, 13210 Bruce B. Downs Blvd., MDC56, Tampa, FL 33612-3805, USA b H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA a r t i c l e i n f o Article history: Received 27 May 2011 Received in revised form 8 August 2011 Accepted 8 August 2011 Available online 22 August 2011 Keywords: HPV Vaccine Gay Bisexual Psychosocial a b s t r a c t Gay and bisexual men are at increased risk of anal cancer as a result of human papillomavirus (HPV) infection. Prophylactic vaccination is a potentially effective strategy for preventing anal cancer in this population. The purpose of this study was to identify factors associated with gay and bisexual men’s intention to receive HPV vaccine. In the fall of 2010, 179 self-identified gay and bisexual men (mean age 22 years) completed an Internet-based questionnaire assessing beliefs and attitudes toward HPV vaccination. Men were recruited from college-based and Internet venues throughout the southeastern United States. The probability of intent to receive HPV vaccine was modeled using logistic regression. A majority of men (93%) had heard of HPV prior to participation but were generally unaware of the association of HPV with anal, penile, and oral cancers. Only 26% were aware of an HPV vaccine for males. Of the 179 participants, 64 (36%) were likely to be vaccinated. Men most likely to receive HPV vaccine perceived stronger physical and psychological benefits from vaccination and had more positive attitudes toward the vaccine. Conversely, intent to be vaccinated was negatively associated with concern over the financial cost of vaccination. Findings from this study can inform college-based health education programs aimed at increasing vaccine uptake among gay and bisexual men. © 2011 Elsevier Ltd. All rights reserved. 1. Introduction Infection with oncogenic types of human papillomavirus (HPV) is a primary causal factor in the etiology of anal cancer [1–4], and is also associated with other cancers affecting males such as penile and oropharyngeal cancers [5–7]. Men who have sex with men (MSM) are at increased risk for these cancers given a high prevalence of HPV infection. For example, in a recent study of HIV- seronegative MSM, prevalence of anogenital HPV infection was 48% [8]. Compared to men who have sex with women (MSW), MSM are also more likely to have oncogenic HPV types and multiple HPV types present in the anal canal [9] and thus have a higher risk for anal cancer [10]. In fact, the risk for anal cancer among MSM is comparable to women’s risk for cervical cancer prior to widespread implementation of cytological screening [11,12]. Recent efforts to prevent HPV infection, particularly in females, involve prophylactic vaccination as a primary prevention strategy [13]. A quadrivalent HPV (qHPV) vaccine has been shown to have high efficacy for preventing not only infection of HPV types -6, -11, -16, and -18 [14], but also clinical diseases such as ano-genital warts and precancerous lesions [15]. In October 2009, the U.S. Food and * Corresponding author. Tel.: +1 813 974 4867; fax: +1 813 974 5172. E-mail address: cwheldon@health.usf.edu (C.W. Wheldon). Drug Administration approved Gardasil for the prevention of gen- ital warts in males, and in November 2010, Gardasil was approved for the prevention of anal cancer and anal intraepithelial neopla- sia in both males and females [16]. Recent analyses indicate that prophylactic vaccination may be a cost-effective strategy for the prevention of genital warts and anal cancer among MSM in the U.S. [17]. In order for such a strategy to be effective, widespread acceptance and uptake of the vaccine among young MSM is essen- tial. Maximizing vaccine uptake within the MSM population will require public health interventions to address factors influencing vaccine acceptability, intentions, and subsequent behavior. Health behavior theories are useful in guiding research to iden- tify correlates of vaccine intentions, as well as for developing effective health communication messages [18]. Currently, there is limited theory-based research on HPV vaccine acceptability and intention among men in general [19], and even fewer studies focus- ing on MSM [20,21]. According to the existing literature MSM have limited knowledge about the direct health effects of HPV infection on males [20–23]. Despite this low level of knowledge, vaccine acceptability has been relatively high among this group [21,24]; however, data were collected with regard to a hypothetical HPV vaccine since, at the time, no vaccine had been approved for the prevention of HPV in males. Furthermore, participants in these studies were, on average, much older than males who are in the licensed age range of 9–26 years for HPV vaccination. Consequently, 0264-410X/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2011.08.045