Differences in knowledge, attitudes and intentions towards HPV vaccination among young adults from diverse socio-cultural groups in Israel: A cross-sectional study

In Israel, The Human Papilloma Virus (HPV) vaccine is recommended to both genders up to age 26. Many 18-26 olds missed their opportunity for vaccination during school. Our study described HPV knowledge, attitudes and vaccination intentions among unvaccinated 18-26 Israeli adults across various demographics, aiming to inform future catch-up vaccination strategies. We recruited participants through an anonymous survey and collected information about demographics and HPV knowledge, attitudes and intentions using questions from validated questionnaires adapted to the Israeli context, distributed between December 2023-February 2024. We calculated weighted mean knowledge and attitude scores according to age, gender, ethnicity and sexual orientation. We determined factors associated with vaccination knowledge, attitudes and intentions using multivariate linear regressions. Of 4324 respondents, 36 % were vaccinated. Of 1994 unvaccinated individuals included in the final analysis, <50 % reported being familiar with HPV. The overall mean weighted HPV knowledge score was 9.5/14 (95 % CI 9.3-9.7). Older participants, Jewish non-Ultra-Orthodox, and those with higher education levels reported higher knowledge scores. Attitudes towards HPV vaccination were generally neutral but tended towards the positive, with an overall mean weighted score of 2.9/5 (95 %CI 2.88-2.95). Variation in attitudes across different demographic groups was minimal. Intention to vaccinate within 12 months was low, with <15 % of respondents overall expressing an intention to do so. Factors significantly associated with higher vaccination intention included being Arab, older, female, having multiple sexual partners, and being a student. There was no association between sexual orientation and vaccination intention. Arab participants showed the highest intention to vaccinate despite having the lowest knowledge levels. Young adults in Israel demonstrate low HPV awareness and vaccination intention, with minor variations in attitudes across different demographics. Providing more information may be insufficient to increase vaccine uptake in all groups. Future catch-up campaigns should be tailored to barriers specific to different groups.