{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:50:15Z","timestamp":1792554615590,"version":"4.5.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:00:00Z","timestamp":1702425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is responsible for cancer of cervix uteri. Despite its safety and immunogenicity, HPV vaccine hesitancy is one of the most challenging topics that pediatricians face.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We aimed to describe the impact of knowledge, attitude, and practice towards vaccines in general, on practice related to HPV vaccination in Lebanon. A questionnaire addressed to parents of students (3\u201318 years of age) was distributed in 2 public and 2 private schools randomly selected from the greater Beirut area during the school year 2017\u20132018. Questionnaires covered knowledge, attitude, and practices of vaccination in general and HPV vaccine in particular.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 400 distributed questionnaires, 306 (76.5%) were returned. Of the 185 parents aware of HPV vaccine, 60% hadn\u2019t given or were not planning to give the HPV vaccine to their children. Of parents not in favor of HPV vaccine, 7.5 thought that vaccines aren\u2019t necessary versus none among those in favor of HPV vaccine(p = 0.02). Thirteen percent of those not in favor of HPV vaccine thought that vaccines are not safe versus 2.7% in the group in favor (p = 0.02). An effect of gender on vaccine acceptance was noted: mothers vs fathers and daughters vs sons. Lack of recommendation by pediatricians and the thought that too little is known about the vaccine were the most selected reasons for parents not wanting to vaccinate their children against HPV, whereas cost and religious and cultural beliefs seemed to have no impact.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Most parents in our study did not vaccinate or weren\u2019t willing to vaccinate their children against HPV even when they were in favor of vaccines in general. Physician recommendation was shown to be one of the most important predictors of vaccination. Effort should be put into educating parents about the importance of the vaccine and its well-established safety and efficacy regardless of gender. Lebanese physicians should also be educated and empowered to recommend HPV vaccine more strongly and consistently.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0295644","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T18:25:51Z","timestamp":1702491951000},"page":"e0295644","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Determinants of human papillomavirus vaccine hesitancy among Lebanese parents"],"prefix":"10.1371","volume":"18","author":[{"given":"Ramia","family":"Zakhour","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Tamim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Faytrouni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Makki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayan","family":"Hojeij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-497X","authenticated-orcid":true,"given":"Lama","family":"Charafeddine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,13]]},"reference":[{"key":"pone.0295644.ref001","unstructured":"National Cancer Institute. HPV and Cancer [Internet]. National Cancer Institute. Cancer.gov; 2019. https:\/\/www.cancer.gov\/about-cancer\/causes-prevention\/risk\/infectious-agents\/hpv-and-cancer"},{"key":"pone.0295644.ref002","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1016\/j.cmi.2016.12.017","article-title":"Vaccines against human papillomavirus infections: protection against cancer, genital warts or both?","volume":"22","author":"EA Joura","year":"2016","journal-title":"Clinical Microbiology and Infection"},{"issue":"5","key":"pone.0295644.ref003","doi-asserted-by":"crossref","first-page":"e206","DOI":"10.1016\/S1470-2045(14)70481-4","article-title":"Present status of human papillomavirus vaccine development and implementation","volume":"16","author":"R Herrero","year":"2015","journal-title":"The Lancet Oncology"},{"issue":"3","key":"pone.0295644.ref004","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1093\/infdis\/jit192","article-title":"Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003\u20132010","volume":"208","author":"LE Markowitz","year":"2013","journal-title":"The Journal of Infectious Diseases"},{"issue":"5","key":"pone.0295644.ref005","first-page":"375","article-title":"Human papillomavirus vaccination guideline update: American Cancer Society Guideline endorsement","volume":"66","author":"D Saslow","year":"2016","journal-title":"CA: A Cancer Journal for Clinicians"},{"issue":"9","key":"pone.0295644.ref006","doi-asserted-by":"crossref","first-page":"e052016","DOI":"10.1136\/bmjopen-2021-052016","article-title":"Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators","volume":"11","author":"J Spayne","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0295644.ref007","unstructured":"https:\/\/www.unicef.org\/supply\/stories\/closing-gap-unicef-bolsters-country-efforts-increase-hpv-vaccination, accessed July 15, 2023"},{"issue":"12","key":"pone.0295644.ref008","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1056\/NEJMc1801036","article-title":"The New HPV Vaccination Policy in France","volume":"378","author":"H Lef\u00e8vre","year":"2018","journal-title":"New England Journal of Medicine"},{"issue":"3","key":"pone.0295644.ref009","doi-asserted-by":"crossref","first-page":"e20164186","DOI":"10.1542\/peds.2016-4186","article-title":"The Need to Optimize Adolescent Immunization","volume":"139","author":"HH Bernstein","year":"2017","journal-title":"Pediatrics"},{"key":"pone.0295644.ref010","first-page":"100836","article-title":"Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis","volume":"34","author":"T Dorji","year":"2021","journal-title":"E Clinical Medicine"},{"issue":"4","key":"pone.0295644.ref011","doi-asserted-by":"crossref","first-page":"e0266081","DOI":"10.1371\/journal.pone.0266081","article-title":"Awareness, attitudes and acceptability of the HPV vaccine among female university students in Morocco","volume":"17","author":"A Yacouti","year":"2022","journal-title":"PLOS ONE"},{"issue":"1","key":"pone.0295644.ref012","doi-asserted-by":"crossref","first-page":"2194772","DOI":"10.1080\/21645515.2023.2194772","article-title":"Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs","volume":"19","author":"M Alsanafia","year":"2023","journal-title":"Human Vaccines & Immunotherapeutics"},{"key":"pone.0295644.ref013","doi-asserted-by":"crossref","unstructured":"Al Shdefat S., Al Awar S., Osman N., Khair H., Sallam G., and Elbiss H.; 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Human Papillomavirus and Related Cancers, Fact Sheet 2023 [Internet]. Lebanon: HPV information center; 2023 Mar. https:\/\/hpvcentre.net\/statistics\/reports\/LBN_FS.pdf"},{"key":"pone.0295644.ref021","doi-asserted-by":"crossref","first-page":"G58","DOI":"10.1016\/j.vaccine.2012.06.097","article-title":"Prospects and Challenges in the Introduction of Human Papillomavirus Vaccines in the Extended Middle East and North Africa Region","volume":"31","author":"AO Jumaan","year":"2013","journal-title":"Vaccine"},{"issue":"8","key":"pone.0295644.ref022","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.vaccine.2015.01.009","article-title":"Human papillomavirus vaccination: Assessing knowledge, attitudes, and intentions of college female students in Lebanon, a developing country","volume":"33","author":"M Dany","year":"2015","journal-title":"Vaccine"},{"key":"pone.0295644.ref023","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2147\/TCRM.S152737","article-title":"Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: Barriers to vaccination with a focus on Mothers&RSQUO; knowledge about available vaccines","volume":"14","author":"M Abou El Ola","year":"2018","journal-title":"Therapeutics and Clinical Risk Management"},{"issue":"49","key":"pone.0295644.ref024","doi-asserted-by":"crossref","first-page":"7562","DOI":"10.1016\/j.vaccine.2018.10.065","article-title":"Factors associated with human papilloma virus (HPV) vaccine recommendation by physicians in Lebanon, a cross-sectional study","volume":"36","author":"J Abi Jaoude","year":"2018","journal-title":"Vaccine"},{"issue":"6","key":"pone.0295644.ref025","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.4161\/hv.28608","article-title":"Public awareness regarding children vaccination in Jordan","volume":"10","author":"MM Masadeh","year":"2014","journal-title":"Human Vaccines & Immunotherapeutics"},{"issue":"6 Suppl 4","key":"pone.0295644.ref026","doi-asserted-by":"crossref","first-page":"S426","DOI":"10.1016\/j.amepre.2015.07.002","article-title":"Childhood Immunizations: First-Time Expectant Mothers\u2019 Knowledge, Beliefs, Intentions, and Behaviors","volume":"49","author":"JL Weiner","year":"2015","journal-title":"American journal of preventive medicine"},{"key":"pone.0295644.ref027","unstructured":"Survey of Parents on Key Issues Related to Immunization: Final Report | immunizecanada [Internet]. immunize.ca. https:\/\/immunize.ca\/resources\/survey-parents-key-issues-related-immunization-final-report"},{"key":"pone.0295644.ref028","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2014.18.157.1773","article-title":"Maternal satisfaction about childhood immunization in primary health care center, Egypt","volume":"18","author":"HAA Abdel Rahman El Gammal","year":"2014","journal-title":"Pan African Medical Journal"},{"issue":"01","key":"pone.0295644.ref029","doi-asserted-by":"crossref","DOI":"10.4172\/2157-7560.1000215","article-title":"Parents\u2032 Knowledge and Attitudes on Childhood Immunization, Taif, Saudi Arabia","volume":"05","author":"YM Ahmed Abdulrahman","year":"2014","journal-title":"Journal of Vaccines & Vaccination"},{"issue":"6","key":"pone.0295644.ref030","doi-asserted-by":"crossref","first-page":"538","DOI":"10.26719\/2018.24.6.538","article-title":"Knowledge, awareness and acceptability of anti-HPV vaccine in the Arab states of the Middle East and North Africa Region: A systematic review","volume":"24","author":"R Gamaoun","year":"2018","journal-title":"Eastern Mediterranean Health Journal"},{"issue":"3","key":"pone.0295644.ref031","doi-asserted-by":"crossref","first-page":"879","DOI":"10.7314\/APJCP.2012.13.3.879","article-title":"Knowledge towards HPV infection and HPV vaccines among Syrian mothers","volume":"13","author":"M. A. Alsaad","year":"2012","journal-title":"Asian Pacific Journal of Cancer Prevention"},{"issue":"7","key":"pone.0295644.ref032","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.31557\/APJCP.2019.20.7.1945","article-title":"Knowledge and attitude toward human papillomavirus and HPV vaccination in Iranian population: A systematic review","volume":"20","author":"M. Taebi","year":"2019","journal-title":"Asian Pacific Journal of Cancer Prevention"},{"key":"pone.0295644.ref033","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1186\/s12887-023-04177-w","article-title":"Human papillomavirus vaccine knowledge and conspiracy beliefs among secondary school students in Lebanon","volume":"23","author":"J. Khalil","year":"2023","journal-title":"BMC Pediatr"},{"issue":"5","key":"pone.0295644.ref034","doi-asserted-by":"crossref","first-page":"e1000270","DOI":"10.1371\/journal.pmed.1000270","article-title":"A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt","volume":"7","author":"G Ogilvie","year":"2010","journal-title":"PLoS Medicine"},{"issue":"2","key":"pone.0295644.ref035","doi-asserted-by":"crossref","first-page":"e0193054","DOI":"10.1371\/journal.pone.0193054","article-title":"Parents\u2019 knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand","volume":"13","author":"M Grandahl","year":"2018","journal-title":"PLOS ONE"},{"issue":"1","key":"pone.0295644.ref036","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-015-1863-6","article-title":"Parental attitudes towards male human papillomavirus vaccination: A pan-European cross-sectional survey","volume":"15","author":"G Lee Mortensen","year":"2015","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0295644.ref037","doi-asserted-by":"crossref","first-page":"e0195801","DOI":"10.1371\/journal.pone.0195801","article-title":"Attitudes towards and knowledge about Human Papillomavirus (HPV) and the HPV vaccination in parents of teenage boys in the UK","volume":"13","author":"SM Sherman","year":"2018","journal-title":"PLOS ONE"},{"issue":"1","key":"pone.0295644.ref038","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s10900-022-01141-0","article-title":"Knowledge and attitudes of physicians and nurses in Turkey regarding human papillomavirus vaccination of their children","volume":"48","author":"F. Tuba\u015f","year":"2022","journal-title":"Journal of Community Health"},{"issue":"4","key":"pone.0295644.ref039","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.jiph.2019.09.002","article-title":"Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine","volume":"13","author":"S. Almazrou","year":"2020","journal-title":"Journal of Infection and Public Health"},{"issue":"1","key":"pone.0295644.ref040","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/josh.12470","article-title":"To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden","volume":"87","author":"M Grandahl","year":"2017","journal-title":"The Journal of School Health"},{"issue":"4","key":"pone.0295644.ref041","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1007\/s10943-011-9553-x","article-title":"HPV Vaccine Decision-Making and Acceptance: Does Religion Play a Role?","volume":"52","author":"RC Shelton","year":"2011","journal-title":"Journal of Religion and Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295644","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T18:26:16Z","timestamp":1702491976000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295644"}},"subtitle":[],"editor":[{"given":"Ghada Abdrabo Abdellatif","family":"Elshaarawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,12,13]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0295644","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,13]]}}}