Reviewer ’s report  
 
Title: Attitudes of Undergraduate University Women towards HPV Vaccination: A Cross -
sectional  Study in Ottawa, Canada  
 
Version: 0 Date: 05 Dec 2017  
 
Reviewer: Robert Bednar czyk  
 
Reviewer's report:  
This was a very straightforward analysis of HPV vaccination status and barriers among college 
students in Ottawa Ontario.  
 
There are some key issues that need to be addressed.  
1. When discussing the different types of HPV vaccine us ed in Canada, there was no mention of 
9-valent HPV vaccine - is this being used? If so, it should be addressed.  
2. Background - line 104 - you indicate that only 8th grade girls were targeted for vaccination in 
2007. How long did this restriction occur and what could be the implications of this, now that we 
are about a decade out from that initial time?  
3. TPB for H PV vaccine studies may be difficult to fully operationalize because, as we have seen, 
HPV vaccine uptake is often more complicated than can be explained by regular theoretical 
models. Because of cost, multiple doses required, and perceptions of stigma arou nd HPV vaccine 
due to HPV being primarily sexually transmitted, intention to vaccinate may be a large predictor 
of actual vaccination, but may not be a great predictor.  I don't think there is more that can be done 
here from a study design and execution pe rspective, but I think these issues deserve at least a 
mention in the discussion.  
4. Methods and results were difficult to track. Overall, the results were not very clearly written, 
and there were times where a large amount of narrative was presented that could have been 
simplified into a figure (e.g. 3rd and 4th paragraph of Results) and other tables that did not seem 
to be very closely tied in to much of the rest of the discussion. I feel like this manuscript can be 
tightened up through a better use of fi gures/tables to reduce some of the narrative, and tie the 
findings together more clearly with regard to the methods.  
5. Discussion - many of the comparator studies presented in the 2nd paragraph were conducted in 
2008 -2010, but your study was conducted in 2013. Given increases in HPV vaccine coverage over 
time, are these the best comparators, and if they are all that are available, then mention should be 
made about these timing differences.  
6. Safety is a major concern, as documented in the 4th paragraph of  the discussion. However, how 
long is long enough to conduct safety studies? Are there any plans for future studies to find out 
how we can best communicate vaccine safety information to these individuals?  
7. It would have been helpful to see data collecti on about other recommended vaccines as a 
comparison - e.g. how many people vaccinated against meningococcal disease, if this is given prior 
to college attendance.  It could also help look at differences not only in prevalence of vaccination 
but also respon se bias.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Not suitable for publication unless extensively edited  
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