Factors associated with HPV vaccination coverage before pregnancy: a cross-sectional study in a cohort of Pregnant Women

Background. Human papillomavirus (HPV) infection is a major cause of cervical and other anogenital cancers. Despite the availability of effective vaccines, HPV vaccination coverage remains suboptimal in Italy, particularly among women of childbearing age. Pregnant women represent a key population for investigating vaccine hesitancy and its determinants. This study aimed to explore socio-demographic, behavioural, and perceptual factors associated with HPV vaccination coverage prior to pregnancy, using data from the NEHO cohort in Southern Italy. Methods. A cross-sectional analysis was conducted on 567 pregnant women enrolled between 2018 and 2020 in the Priolo National Priority Site. HPV vaccination status was obtained from local immunization databases. Risk perception indices (HPI, EHPI, HRPI, RPI), and information sources were assessed via structured questionnaires. Logistic regression and Bayesian Weighted Quantile Sum (bWQS) models were used to identify associations between vaccination status and independent variables. Results. Only 7.4% of participants had HPV vaccination coverage prior to pregnancy. Vaccinated women were significantly younger, unmarried, and more likely to have lower educational levels. Higher scores on environmental and exposure hazard perception indices (HPI and EHPI) were positively associated with vaccination uptake. Vaccinated individuals were more likely to attribute health protection responsibility to national institutions and industry leadership. bWQS regression confirmed the relevance of risk perception in shaping vaccination behaviour, with EHPI contributing most to the overall effect. Conclusion. The results of this study suggest that tailored public health strategies that address risk perception, institutional trust, and population-specific dynamics are essential to increase HPV vaccination coverage and reduce health inequalities.