Clinical study
Correlates of hepatitis B vaccination in a high-risk population: an internet sample

https://doi.org/10.1016/S0002-9343(01)00706-9Get rights and content

Abstract

PURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men.

SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month.

RESULTS: The mean (± SD) age of the 336 respondents was 38 ± 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001).

CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.

Section snippets

Methods

After securing approval from the Institutional Review Board of the University of Alabama at Birmingham, we established an Internet data collection site. Results from Internet searches for homosexually oriented web sites were used to identify webmasters who were solicited to establish linkages from their web sites to our data collection site. We also posted notices in “guest books” of homosexually oriented web sites. We announced the anonymous study via electronic mailing lists, targeting lists

Results

Of the 628 respondents who completed the survey, 565 (90%) reported living in the United States, of whom 123 (22%) were women and 62 (11%) were heterosexual men. Of the 381 US men who reported same-sex sexual behavior, 328 identified themselves as “gay,” “having sex with members of the same sex,” and 53 identified themselves as “bisexual,” “having sex with both men and women.” The 336 (88%) of these 381 men who reported knowing their vaccination status comprise the sample.

The mean (± SD) age

Discussion

There is an urgent need to enhance awareness and facilitate vaccination among populations at risk for hepatitis B virus infection. Although more than 40% of respondents reported in this study reported vaccination, more than 20% reported no source of information about hepatitis. Furthermore, many respondents reported engaging in behaviors that put them and their sexual partners at risk for hepatitis B virus infection. Given that hepatitis B virus transmission can result from mucous membrane

Acknowledgements

We wish to thank Erin Smith, MPH, of the University of Alabama at Birmingham, School of Public Health, the survey respondents, and the various webmasters and listserv owners who established links to our web site and distributed our web address.

References (37)

  • G.M. McQuillan et al.

    Prevalence of hepatitis B virus infection in the United Statesthe National Health and Nutrition Examination Surveys, 1976 through 1994

    Am J Public Health

    (1999)
  • P.J. Coleman et al.

    Incidence of hepatitis B virus infection in the United States, 1976-1994estimates from the National Health and Nutrition Examination Surveys

    J Infect Dis

    (1998)
  • W.M. Lee

    Hepatitis B virus infection

    N Engl J Med

    (1997)
  • D.J. van Leeuwen et al.

    Viral hepatitis and its imitators

  • A. Meheus

    Risk of hepatitis B in adolescence and young adulthood

    Vaccine

    (1995)
  • D.F. Schafer et al.

    Hepatocellular carcinoma

    Lancet

    (1999)
  • R.S. Koff

    Advances in the treatment of chronic hepatitis

    JAMA

    (1999)
  • Prevention of transmission of hepatitis B. Can Med Assoc J....
  • Hepatitis Ba comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. Recommendation of the Immunization Practices Advisory Committee (ACIP)

    MMWR

    (1991)
  • A. Dufour et al.

    Factors associated with hepatitis B vaccination among men having sexual relations with men in Montreal, Quebec, Canada

    Omega Study Group. Sex Transm Dis.

    (1999)
  • L.A. Kingsley et al.

    Sexual transmission efficiency of hepatitis B virus and human immunodeficiency virus among homosexual men

    JAMA

    (1990)
  • M.G. Brook

    Sexual transmission and prevention of the hepatitis viruses A-E and G

    Sex Transm Infect

    (1998)
  • L.A. Juarez-Figueroa et al.

    Hepatitis B markers in men seeking human immunodeficiency virus antibody testing in Mexico City

    Sex Transm Dis

    (1997)
  • G.R. Seage et al.

    HIV and hepatitis B infection and risk behavior in young gay and bisexual men

    Public Health Rep

    (1997)
  • L. Yuan et al.

    Hepatitis B vaccination and screening for markers at a sexually transmitted disease clinic for men

    Can J Public Health

    (1994)
  • K. Neighbors et al.

    Awareness and utilization of the hepatitis B vaccine among young men in the Ann Arbor area who have sex with men

    J Am Coll Health

    (1999)
  • J. McCusker et al.

    Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center

    Public Health Rep

    (1990)
  • M. Katz

    Undervaccination for hepatitis B among young men who have sex with menSan Francisco and Berkeley, California

    MMWR

    (1996)
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