Human papillomavirus (HPV) is one of the major causes of head and neck cancer (HNC). The incidence rate of newly diagnosed HPV-induced HNC cancer is on the rise, year-by-year; this is a problem of public health concern. This study aims to determine the prevalence and predictors of knowledge of senior secondary (high) school students in Nigeria on HPV and HPV vaccines.

This study was a cross-sectional survey of 2530 high school students from six states in Nigeria using a selfadministered structured questionnaire. Data collected were analyzed using the SPSS version 25 software.

The mean (±SD) age of the respondents was 16.4 (±2.0) years, 56.0% were male and 34.9% were from the Yoruba ethnic group. Only 23.0% and 18.3% of the respondents were aware of HPV and HPV vaccine, respectively. The majority (78.2%) of those who were aware of HPV had below-average knowledge score about HPV. Those respondents: in the highest class in high school (AOR=1.36; CI=1.00–1.84; p=0.048); attending girls-only schools (AOR=2.86; CI: 1.93–4.24; p<0.001); and schooling in Bauchi state (AOR=2.56; CI: 1.47–4.51; p=0.001) were most likely to be aware of HPV compared to those in the other categories. However, those: attending girls-only (AOR=2.80; CI: 1.84–4.27; p<0.001); schooling in Bauchi state (AOR=2.87; CI: 1.55–5.33; p=0.001); and belonging to the Hausa tribe (AOR=2.41; CI: 1.51–3.85; p<0.001) were most likely to be aware to HPV vaccine than those in other categories.

The level of knowledge of HPV and HPV vaccine among high school students in Nigeria is very poor. There is a need for health education programs on HPV and HPV vaccines in Nigerian secondary schools.

The authors are grateful to Cephas Health Research Initiative Inc for funding the study. Also, all participating schools and students are duly appreciated.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Study conceptualization: KKK, OFF; protocol design: KKK, OFF; data collection: all authors except SAO and PAK; data analysis: OFF, KKK; manuscript drafting: KKK, OFF; review of drafts: all authors; final draft review: all authors. Note: KKK and OFF contributed equally to the study.
Not commissioned; externally peer reviewed.
Mcmurray HR, Nguyen D, Westbrook TF, Mcance DJ. Biology of human papillomaviruses. Int J Exp Pathol. 2001;82(1):15-33. doi:10.1046/j.1365-2613.2001.00177.x
Lajer CB, von Buchwald C. The role of human papillomavirus in head and neck cancer. APMIS. 2010;118(6-7):510-519. doi:10.1111/j.1600-0463.2010.02624.x
Braaten KP, Laufer MR. Human papillomavirus (HPV), HPV-related disease, and the HPV vaccine. Rev Obstet Gynecol. 2008;1(1):2-10. PMID:18701931.
Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518-527. doi:10.1056/NEJMoa021641
Münger K, Howley PM. Human papillomavirus immortalization and transformation functions. Virus Res. 2002;89(2):213-228. doi:10.1016/s0168-1702(02)00190-9
Husain N, Neyaz A. Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts. J Oral Biol Craniofac Res. 2017;7(3):198-205. doi:10.1016/j.jobcr.2017.08.003
Westra WH. The morphologic profile of HPV-related head and neck squamous carcinoma: implications for diagnosis, prognosis, and clinical management. Head Neck Pathol. 2012;6(Suppl 1):48-54. doi:10.1007/s12105-012-0371-6
Bishop JA, Westra WH. Human papillomavirus-related small cell carcinoma of the oropharynx. Am J Surg Pathol. 2011;35(11):1679-1684. doi:10.1097/PAS.0b013e3182299cde
Bosch FX, Lorincz A, Muñoz N, Meijer CJLM, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55:244-265. doi:10.1136/jcp.55.4.244
Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 2009;199(6):805-814. doi:10.1086/597071
Somers GR, Tabrizi SN, Borg AJ, Garland SM, Chow CW. Juvenile laryngeal papillomatosis in a pediatric population: a clinicopathologic study. Pediatr Pathol Lab Med. 1997;17(1):53-64. PMID:9050060.
Lee LY, Garland SM. Human papillomavirus vaccination: the population impact. F1000Res. 2017;6:866. doi:10.12688/f1000research.10691.1
World Health Organization. Immunization, Vaccines and Biologicals: Research and development. Geneva, Switzerland: World Health Organization; 2017. Accessed July 16, 2020.
Kreimer AR, Alberg AJ, Daniel R, et al. Oral human papillomavirus infection in adults is associated with sexual behavior and HIV serostatus. J Infect Dis. 2004;189(4):686-698. doi:10.1086/381504
Kjaer SK, Chackerian B, van den Brule AJ, et al. High-risk human papillomavirus is sexually transmitted: evidence from a follow-up study of virgins starting sexual activity (intercourse). Cancer Epidemiol Biomarkers Prev. 2001;10(2):101-106. PMID:11219765.
Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003;157(3):218-226. doi:10.1093/aje/kwf180
Kashima H, Leventhal B, Mounts P, et al. Scoring system to assess severity and course in recurrent respiratory papillomatosis. In: Howley PM, Broker TR, eds. Papillomaviruses: Molecular and clinical aspects. New York, NY: Alan R. Liss Inc.; 1985:125-135.
Fredericks BD, Balkin A, Daniel HW, Schonrock J, Ward B, Frazer IH. Transmission of human papillomaviruses from mother to child. Aust N Z J Obstet Gynaecol. 1993;33(1):30-32. doi:10.1111/j.1479-828x.1993.tb02047.x
Austin DF, Reynolds P. Laryngeal cancer. In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention. 2nd Ed. Oxford, UK: Oxford University Press; 1996:619-636.
Rodríguez AC, Schiffman M, Herrero R, et al. Rapid clearance of human papillomavirus and implications for clinical focus on persistent infections. J Natl Cancer Inst. 2008;100(7):513-517. doi:10.1093/jnci/djn044
Patel C, Brotherton JML, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, Marshall H. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill. 2018;23(41):1700737. doi:10.2807/1560-7917.ES.2018.23.41.1700737
Lekoane KMB, Kuupiel D, Mashamba-Thompson TP, Ginindza TG. Evidence on the prevalence, incidence, mortality and trends of human papilloma virus-associated cancers in sub-Saharan Africa: systematic scoping review. BMC Cancer. 2019;19(1):563. doi:10.1186/s12885-019-5781-3
Vuyst HD, Alemany L, Lacey C, et al. The Burden of Human Papillomavirus Infections and Related Diseases in Sub-Saharan Africa. Vaccine. 2013;31(0_5):F32-F46. doi:10.1016/j.vaccine.2012.07.092
Ritchwood TD, Ford H, DeCoster J, Sutton M, Lochman JE. Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis. Child Youth Serv Rev. 2015;52:74-88. doi:10.1016/j.childyouth.2015.03.005
Moscicki AB. Impact of HPV infection in adolescent populations. J Adolesc Health. 2005;37(6 Suppl):S3-S9. doi:10.1016/j.jadohealth.2005.09.011
Panatto D, Amicizia D, Trucchi C, et al. Sexual behaviour and risk factors for the acquisition of human papillomavirus infections in young people in Italy: suggestions for future vaccination policies. BMC Public Health. 2012;12:623. doi:10.1186/1471-2458-12-623
Odeigah L, Rasaki SO, Ajibola AF, Hafsat AA, Sule AG, Musah Y. High risk sexual behavior among adolescent senior secondary school students in Nigeria. Afr Health Sci. 2019;19(1):1467-1477. doi:10.4314/ahs.v19i1.20
Chimah UC, Nnebue CC, Ilika AL, Lawoyin TO. Sexual behavioral pattern, consequences and adopted solutions among senior secondary schools students in a military barracks in Nigeria. Int J Adolesc Med Health. 2016;28(2):203-210. doi:10.1515/ijamh-2015-0012
Ajuwon AJ, Olaleye A, Faromoju B, Ladipo O. Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria. BMC Public Health. 2006;6:310. doi:10.1186/1471-2458-6-310
Slap GB, Lot L, Huang B, Daniyam CA, Zink TM, Succop PA. Sexual behaviour of adolescents in Nigeria: cross sectional survey of secondary school students. BMJ. 2003;326(7379):15. doi:10.1136/bmj.326.7379.15
Odimegwu C, Somefun OD. Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation. Reprod Health. 2017;14(1):16. doi:10.1186/s12978-017-0284-7
Folayan MO, Adebajo S, Adeyemi A, Ogungbemi KM. Differences in Sexual Practices, Sexual Behavior and HIV Risk Profile between Adolescents and Young Persons in Rural and Urban Nigeria. PLoS One. 2015;10(7):e0129106. doi:10.1371/journal.pone.0129106
Mohammed FA, Kanmodi KK, Fagbule OF, Adesina MA, Njideka NJ, Sadiq HA. Shisha smokers’ desire to quit shisha smoking habit: Findings from a Nigerian pilot survey. Global Psychiatry. 2019;2(1):37-42. doi:10.2478/gp-2019-0004
Kanmodi KK, Fagbule OF, Aladelusi TO. Prevalence of shisha (waterpipe) smoking and awareness of head and neck cancer among Nigerian secondary school students: A preliminary survey. Int Public Health J. 2018;10(2):209-214. Accessed July 16, 2020.
Adesina MA, Kanmodi KK, Fagbule OF, Ogunmuko T. Unfavorable family background is associated with smoking at youthful age. Int J Child Health Hum Dev. 2019;12(2):139-144.
Mohammed FA, Njideka NJ, Aliyu BM, Kanmodi KK, Fagbule OF, Ogbeide ME. Attitudes of a snowballed sample of Nigerian hookah (shisha) smokers toward tobacco ban: A short report. Int J Disabil Hum Dev. 2019;18(2):in press. Accessed July 16, 2020.
Badru AI, Kanmodi KK, Ogundipe PA, Owadokun AM, Adesina MA. Opinions of Nigerian religious leaders and seminarians on what causes cancer: A short report. J Altern Med Res. 2019;11(2):165-167.
Kanmodi KK, Mohammed FA, Nwafor NJ, Fagbule OF, Adesina MA, Aliyu BM, Ogundipe PA. Poor knowledge of the harmful effects of shisha among shisha smokers: Findings from a preliminary survey in Northwest Nigeria. Med Univ. 2019;2(2):49-56. doi:10.2478/medu-2019-0009
Kanmodi KK, Fagbule FO. Does head and neck cancer (HNC) education have impact on adolescents’ knowledge and attitude towards HNC and HNC peer education? An example from Nigeria. Int J Child Adolesc Health. 2018;11(3):343-347. Accessed July 16, 2020.
Fagbule OF, Kanmodi KK, Aladelusi TO. Secondhand tobacco smoke exposure and attitudes towards tobacco ban: A pilot survey of secondary school students in Ibokun Town, Nigeria. Int J Child Adolesc Health. 2018;11(3):349-353. Accessed July 16, 2020.
Kanmodi KK, Ogbeide ME, Fagbule OF, Omoleke SA, Isola TO, Ogundipe PA. Do college freshmen know about head and neck cancer and its risk factors? Experience from Gwadabawa, Nigeria. Int J Med Res Health Sci. 2019;8(9):111-116. Accessed July 16, 2020.
Kanmodi KK, Mohammed FA,Omoleke SA, et al. Head and neck cancer risk factors among a pilot sample of Nigerian shisha smokers: Focus on oral sex, tobacco, alcohol, and knowledge of head and neck cancer. J Dent Orofac Res. 2019;15(2):49-57. Accessed July 16, 2020.
Maness SB, Reitzel LR, Watkins KL, McNeill LH. HPV awareness, knowledge and vaccination attitudes among church-going African-American Women. Am J Health Behav. 2016;40(6):771-778. doi:10.5993/AJHB.40.6.9
Yu Y, Xu M, Sun J, et al. Human papillomavirus infection and vaccination: awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China. PLoS ONE. 2016;11(1): e0146741. doi:10.1371/journal.pone.0146741
Marlow LAV, Zimet GD, McCaffery KJ, Ostini R, Waller J. Knowledge of human papillomavirus (HPV) and HPV vaccination: An international comparison. Vaccine. 2013;31(5):763-769. doi:10.1016/j.vaccine.2012.11.083
Marek E, Dergez T, Rebek-Nagy G, et al. Adolescents’ awareness of HPV infections and attitudes towards HPV vaccination 3 years following the introduction of the HPV vaccine in Hungary. Vaccine. 2011;29(47):8591-8598. doi:10.1016/j.vaccine.2011.09.018
Bowyer HL, Marlow LAV, Hibbitts S, Pollock KG, Waller J. Knowledge and awareness of HPV and the HPV vaccine among young women in the first routinely vaccinated cohort in England. Vaccine. 2013;31(7):1051-1056. doi:10.1016/j.vaccine.2012.12.038
Lambert EC. College students’ knowledge of human papillomavirus and effectiveness of a brief educational intervention. J Am Board Fam Pract. 2001;14(3):178-183. PMID:11355049.
Blumenthal J, Frey MK, Worley Jr MJ, Tchabo NE, Soren K, Slomovitz BM. Adolescent understanding and acceptance of the HPV vaccination in an underserved population in New York City. J Oncol. 2012:1-8. doi:10.1155/2012/904034
Sampson IT. Religious violence in Nigeria: causal diagnoses and strategic recommendations to the state and religious communities. Afr J Conflict Resol. 2012;12(1):103-134. Accessed July 16, 2020.
Diorgu FC, Diorgu KN. Awareness of HPV infection and vaccination among teens in urban high school. ARCH Women Health Care. 2019;2(2):1-3. Accessed July 16, 2020.
Sadoh AE, Okonkwo C, Nwaneri DU, Ogboghodo BC, Eregie C, Oviawe O, Famuyiwa O. Effect of peer education on knowledge of human papilloma virus and cervical cancer among female adolescent students in Benin City, Nigeria. Ann Global Health. 2018;84(1):121-128. doi:10.29024/aogh.24
Ojimah C, Maduka O. Awareness and uptake of human papillomavirus vaccines among female undergraduate students: Implications for cervical cancer prevention in South-South, Nigeria. Port Harcourt Med J. 2017;11(3):134-140. doi:10.4103/phmj.phmj_14_17
Ramavath KK, Olyai R. Knowledge and awareness of HPV infection and vaccination among urban adolescents in india: a cross-sectional study. J Obstet Gynaecol India. 2013;63(6):399-404. doi:10.1007/s13224-013-0413-3
Liu CR, Liang H, Zhang X, et al. Effect of an educational intervention on HPV knowledge and attitudes towards HPV and its vaccines among junior middle school students in Chengdu, China. BMC Public Health. 2019;19(1):488. doi:10.1186/s12889-019-6823-0
Patel H, Pcolkina K, Stradzina K, et al. Awareness of HPV infection and attitudes toward HPV vaccination among Latvian adolescents. Int J Gynaecol Obstet. 2017;137(2):138-144. doi:10.1002/ijgo.12117
Patel H, Jeve YB, Sherman SM, Moss EL. Knowledge of human papillomavirus and the human papillomavirus vaccine in European adolescents: a systematic review. Sex Transm Infect. 2016;92(6):474-479. doi:10.1136/sextrans-2015-052341
Rosen BL, Shew ML, Zimet GD, Ding L, Mullins TLK, Kahn JA. Human Papillomavirus Vaccine Sources of Information and Adolescents’ Knowledge and Perceptions. Glob Pediatr Health. 2017;4:2333794X17743405. doi:10.1177/2333794X17743405
Kanmodi KK, Chidiebere O, Nwafor NJ, Amoo BA. Knowledge of HPV, HPV-induced cancers, and HPV vaccine among university students in medical laboratory science disciplines: Nigerian study. J Obstet Gynecol Investig. 2020;3:e10-e16. doi:10.5114/jogi.2020.94420
Kanmodi KK, Osunro KS, Nwafor NJ, Kanmodi PA. Impact of head and neck cancer (HNC) education on HNC knowledge and attitudes toward HNC peer and non-peer education: A school-based pilot study. Yen Med J. 2020;2(2):47-55. https://yenagoamedicaljournal..... Accessed July 16, 2020.
Ohareri B, Adefolaju AO, Onyeneho CA. Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. Eur J Midwifery. 2020;4(January). doi:10.18332/ejm/114886
Ojiyi CE, Dike EI, Okuedo C, Nzewuihe AC, Uzoma MJK. Human papilloma virus vaccine: Awareness and acceptability amongst female medical students and health workers in a university teaching hospital in Eastern Nigeria. Nig J Surg Sci. 2013;23(1):14-17. doi:10.4103/1116-5898.127102
Kanmodi KK, Adegbile OE, Ogidan IO, Kanmodi PA. What are we learning on social media about shisha? A case study of top 50 short English YouTube shisha videos. Yenagoa Medical Journal. 2020;2(4):38-47. https://yenagoamedicaljournal..... Accessed July 16, 2020.