An Exploratory Study of Japanese Fathers' Knowledge of and Attitudes towards HPV and HPV Vaccination: Does Marital Status Matter?

  • Hanley, Sharon Janet Bruce (Department of Reproductive Endocrinology and Oncology, Hokkaido University) ;
  • Yoshioka, Eiji (Department of Public Health, Graduate School of Medicine, Hokkaido University) ;
  • Ito, Yoshiya (Department of Clinical Medicine, Faculty of Nursing, Japanese Red Cross Hokkaido Red Cross College of Nursing) ;
  • Konno, Ryo (Department of Obstetrics and Gynecology, Faculty of Medicine, Jichi Medical University) ;
  • Sasaki, Yuri (Department of Obstetrics and Gynecology, Faculty of Medicine, Jichi Medical University) ;
  • Kishi, Reiko (Department of Public Health, Graduate School of Medicine, Hokkaido University) ;
  • Sakuragi, Noriaki (Department of Reproductive Endocrinology and Oncology, Hokkaido University)
  • Published : 2014.02.28


Background: No studies on male attitudes towards HPV and HPV vaccination have been conducted in Japan, and little is known globally whether attitudes of single fathers differ to those living with a female partner. This exploratory study assessed whether Japanese fathers were likely to have their daughter vaccinated against HPV in a publically funded program and whether any differences existed regarding attitudes and knowledge about HPV according to marital status. Materials and Methods: Subjects were 27 fathers (16 single; 11 married) who took part in a study on HPV vaccine acceptability aimed at primary caregivers of girls aged 11-14 yrs in three Japanese cities between July and December 2010. Results: Knowledge about HPV was extremely poor (mean score out of 13 being $2.74{\pm}3.22$) with only one (3.7%) participant believing he had been infected with HPV and most (81.4%) believing they had no or low future risk. No difference existed regarding knowledge or awareness of HPV according to marital status. Concerning perceived risk for daughters, single fathers were significantly more likely to believe their daughter was at risk for both HPV (87.5% versus 36.4%; p=0.01) and cervical cancer (75.0% versus 27.3%; p=0.02). Acceptability of free HPV vaccination was high at 92% with no difference according to marital status, however single fathers were significantly more likely (p=0.01) to pay when vaccination came at a cost. Concerns specific to single fathers included explaining the sexual nature of HPV and taking a daughter to a gynecologist to be vaccinated. Conclusions: Knowledge about HPV among Japanese fathers is poor, but HPV vaccine acceptability is high and does not differ by marital status. Providing sexual health education in schools that addresses lack of knowledge about HPV as well as information preferences expressed by single fathers, may not only increase HPV vaccine acceptance, but also actively involve men in cervical cancer prevention strategies. However, further large-scale quantitative studies are needed.


  1. Liddon N, Pulley L, Cockerham WC, et al (2005). Parents'/ guardians' willingness to vaccinate their children against genital herpes. J Adolesc Health, 37, 187-93.
  2. Kuznetsov L, Zippel SA, Ruzicka T, Kuznetsov AV (2012). Fathers' knowledge of and attitude towards human papillomavirus infection, genitoanal warts, cervical cancer and HPV vaccine. Int J Public Health, 57, 651-3.
  3. Lefevere E, Hens N, Theeten H, et al (2011). Like mother, like daughter? Mother's history of cervical cancer screening and daughter's Human Papillomavirus vaccine uptake in Flanders (Belgium). Vaccine, 29, 8390-6.
  4. Li N, Franceschi S, Howell-Jones R, et al (2011). Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication. Int J Cancer, 128, 927-35.
  5. Maiman LA, Becker MH, Kirscht JP, et al (1977). Scales for measuring health belief model dimensions: a test of predictive value, internal consistency, and relationships among beliefs. Health Educ Monogr, 5, 215-30.
  6. Marlow LA, Wardle J, Waller J (2009). Attitudes to HPV vaccination among ethnic minority mothers in the UK: an exploratory qualitative study. Hum Vaccin, 5, 105-10.
  7. McPartland TS, Weaver BA, Lee SK, Koutsky LA (2005). Men's perceptions and knowledge of human papillomavirus (HPV) infection and cervical cancer. J Am Coll Health, 53, 225-30.
  8. NHK (2002). Sexual behavior, sexual awareness of data book NHK Japanese, Tokyo: Japan Broadcasting Publishers Association
  9. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-17
  10. De Vuyst H, Clifford GM, Nascimento MC, et al (2009). Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer, 124, 1626-36.
  11. Dempsey AF, Zimet GD, Davis RL, Koutsky L (2006). Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV. Pediatrics, 117, 1486-93.
  12. Fazekas KI, Brewer NT, Smith JS (2008). HPV vaccine acceptability in a rural Southern area. J Womens Health (Larchmt), 17, 539-48.
  13. Garland SM, Hernandez-Avila M, Wheeler CM, et al (2007). Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med, 356, 1928-43.
  14. Gunasekaran B, Jayasinghe Y, Fenner Y, et al (2012). Knowledge of human papillomavirus and cervical cancer among young women recruited using a social networking site. Sex Transm Infect, 89, 327-9
  15. Hanley SJ, Yoshioka E, Ito Y, et al (2012). Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls. Vaccine, 30, 5740-7.
  16. Infectious Disease Surveillance Center. (2011), Immunization Schedule, Japan, available at: dschedule/Imm11EN.pdf. Accessed: February 10th, 2013.
  17. Kreimer AR, Clifford GM, Boyle P, Franceschi S (2005). Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev, 14, 467-75.
  18. Agarwal SS, Sehgal A, Sardana S, et al (1993). Role of male behavior in cervical carcinogenesis among women with one lifetime sexual partner. Cancer, 72, 1666-9.<1666::AID-CNCR2820720528>3.0.CO;2-M
  19. Arbyn M, de Sanjose S, Saraiya M, et al (2012). EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease. Int J Cancer, 131, 1969-82.
  20. Ault KA, Future IISG (2007). Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet, 369, 1861-8.
  21. Bosch FX, Castellsague X, Munoz N, et al (1996). Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain. J Natl Cancer Inst, 88, 1060-7.
  22. Burk RD, Ho GY, Beardsley L, et al (1996). Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis, 174, 679-89.
  23. Chao C, Slezak JM, Coleman KJ, Jacobsen SJ (2009). Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls. Am J Public Health, 99, 1137-42.
  24. de Martel C, Ferlay J, Franceschi S, et al (2012). Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol, 13, 607-15.
  25. de Sanjose S, Quint WG, Alemany L, et al (2010). Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol, 11, 1048-56.
  26. Perkins RB, Mehta PK, Langrish SM (2012). Fathers' intentions to accept human papillomavirus vaccination for sons and daughters: exploratory findings from rural Honduras. Int J Public Health, 57, 143-8.
  27. Oh JK, Lim MK, Yun EH, et al (2010). Awareness of and attitude towards human papillomavirus infection and vaccination for cervical cancer prevention among adult males and females in Korea: a nationwide interview survey. Vaccine, 28, 1854-60.
  28. Paavonen J, Naud P, Salmeron J, et al (2009). Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet, 374, 301-14.
  29. Pelucchi C, Esposito S, Galeone C, et al (2010). Knowledge of human papillomavirus infection and its prevention among adolescents and parents in the greater Milan area, Northern Italy. BMC Public Health, 10, 378.
  30. Verhoeven V, Baay M, Colliers A, et al (2006). The male factor in cervical carcinogenesis: a questionnaire study of men's awareness in primary care. Prev Med, 43, 389-93.
  31. Waller J, McCaffery K, Forrest S, et al (2003). Awareness of human papillomavirus among women attending a well woman clinic. Sex Transm Infect, 79, 320-2.
  32. Zunzunegui MV, King MC, Coria CF, Charlet J (1986). Male influences on cervical cancer risk. Am J Epidemiol, 123, 302-7.

Cited by

  1. Expression of Toll-like Receptor 9 Increases with Progression of Cervical Neoplasia in Tunisian Women - A Comparative Analysis of Condyloma, Cervical Intraepithelial Neoplasia and Invasive Carcinoma vol.15, pp.15, 2014,
  2. Knowledge, Attitudes and Beliefs about Cervical Cancer and Human Papilloma Virus Vaccination with Related Factors in Turkish University Students vol.15, pp.8, 2014,
  3. Challenges of Providing Cervical Cancer Prevention Programs In Iran: A Qualitative Study vol.15, pp.23, 2015,
  4. Personal and Socio-Cultural Barriers to Cervical Cancer Screening in Iran, Patient and Provider Perceptions: a Qualitative Study vol.16, pp.9, 2015,
  5. Parents’ preferences and willingness-to-pay for human papilloma virus vaccines in Thailand vol.8, pp.1, 2015,