Family Vaccination Context Predicts HPV Vaccine Uptake Among Medical Students

Background/Objectives: Human papillomavirus (HPV) vaccination is an important cancer prevention strategy, yet uptake remains incomplete. Although provider recommendation is a key driver of HPV vaccination, less is known about how future physicians' own vaccination behaviors are shaped. This study examined whether family vaccination context was associated with HPV vaccine uptake among medical students, with attention to implications for future vaccine counseling and prevention training. Materials and Methods: We conducted a cross-sectional analysis of survey data from 230 medical students at Wayne State University School of Medicine. The primary outcome was self-reported HPV vaccination status, dichotomized as fully vaccinated versus not fully vaccinated or unsure. Predictors included family vaccination context, gender, religious affiliation, age, year in medical school, prior HPV education, HPV knowledge, and HPV stigma. Family vaccination context was modeled as an ordinal predictor based on agreement that family members of age were vaccinated. HPV knowledge was modeled using a 22-item baseline pre-survey composite score. HPV stigma was modeled as a 2-item composite assessing perceived stigma associated with HPV and disclosure. Analyses included univariate and bivariate tests, followed by complete-case multivariable logistic regression. A sensitivity analysis restricted the outcome to vaccinated versus unvaccinated students, excluding those who were unsure. Results: Of 230 students, 189 (82.2%) reported being fully vaccinated against HPV. In bivariate analyses, family vaccination context, gender, and HPV knowledge were associated with vaccination status, whereas religion, age, year in medical school, prior HPV education, and HPV stigma were not. In the adjusted model (n = 165), family vaccination context remained the strongest independent correlate of HPV vaccination status (OR, 3.95; 95% CI, 2.11-7.42; p < 0.001). Female gender was also associated with higher odds of vaccination (OR, 3.80; 95% CI, 1.01-14.29; p = 0.048), as was higher HPV knowledge (OR, 1.26; 95% CI, 1.03-1.53; p = 0.024). HPV stigma showed a borderline inverse association with vaccination status (OR, 0.53; 95% CI, 0.26-1.07; p = 0.076). Religion, age, year in medical school, and prior HPV education were not statistically significant after adjustment. The family vaccination association remained robust in the vaccinated-versus-unvaccinated sensitivity analysis (OR, 7.70; 95% CI, 2.45-24.26; p < 0.001). Exploratory secondary analyses suggested that family vaccination context may also be associated with stronger intention to recommend HPV vaccination to future patients and greater intent to vaccinate among students who were not fully vaccinated or unsure, although these findings should be interpreted cautiously. Conclusions: Perceived family vaccination context was the strongest and most consistent correlate of self-reported HPV vaccine completion among medical students in this cross-sectional study. Gender and HPV knowledge were also associated with vaccination status in the primary adjusted model, although these estimates were less precise and less consistent across model specifications. Findings should be interpreted as associations rather than causal effects. HPV prevention training may benefit from addressing not only factual knowledge, but also trainees' vaccination histories, perceived family and social norms, HPV-related stigma, and comfort discussing vaccination as part of preparation for future cancer prevention counseling.