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Thomas R, Dillard M, Xu J, Zimet GD, Kahn JA. Risk perceptions after human papillomavirus vaccination are not subsequently associated with riskier behaviors or sexually transmitted infections in HIV-infected young women. Hum Vaccin Immunother 2019; 15:1732-1736. [PMID: 30785355 DOI: 10.1080/21645515.2019.1582401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Concerns have been raised that risk perceptions after human papillomavirus (HPV) vaccination may lead to riskier sexual behaviors or sexually transmitted infection (STI) diagnosis. The aims of this study were to determine whether risk perceptions immediately after HPV vaccination (perceived risk of HPV, perceived risk of STIs other than HPV, and perceived need for safer sexual behaviors, measured using 5-item scales) were associated with number of sexual partners, condom use at last sexual intercourse, or STI diagnosis over the subsequent 48 weeks in HIV-infected young women (N = 99, 17-24 years of age) participating in an HPV vaccine clinical trial. Generalized estimating equation models demonstrated that lower perceived need for safer sexual behaviors was associated subsequently with lower total number of sexual partners (adjusted odds ratio (AOR) = 1.05, 95% confidence interval (CI) = 1.01-1.09) and lower perceived risk of HPV was associated with subsequent report of having used condoms at last sex (AOR = 0.36, AOR = 0.14-0.92). Lower perceived risk of other STIs was not associated with subsequent sexual behaviors. None of the three risk perceptions was associated with subsequent risk of STIs. The findings suggest that inappropriate risk perceptions after HPV vaccination such as lower perceived need for safer sexual behaviors and lower perceived risk of HPV or other STIs were not subsequently associated with risky behaviors or STI diagnosis in HIV-infected young women.
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Affiliation(s)
- Rachel Thomas
- a Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA.,b Ohio University College Heritage College of Medicine , Athens , Ohio
| | - Mary Dillard
- c Department of Infectious Diseases, St. Jude Children's Research Hospital , Memphis , Tennessee , Tennessee
| | | | - Gregory D Zimet
- e Department of Pediatrics, Indiana University School of Medicine , Indianapolis , IN
| | - Jessica A Kahn
- a Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA.,f Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA
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Ogilvie GS, Phan F, Pedersen HN, Dobson SR, Naus M, Saewyc EM. Population-level sexual behaviours in adolescent girls before and after introduction of the human papillomavirus vaccine (2003-2013). CMAJ 2018; 190:E1221-E1226. [PMID: 30322986 PMCID: PMC6188947 DOI: 10.1503/cmaj.180628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The human papillomavirus (HPV) vaccine is delivered widely through school-based immunization programs. Some groups have expressed concern that HPV vaccination programs will result in an increase in sexual risk-taking behaviours among adolescents. We aimed to evaluate population-level changes in sexual behaviours before and after implementation of the school-based HPV vaccination program in British Columbia. METHODS In 2008, a school-based HPV vaccination program for girls was introduced in British Columbia. Using data from the BC Adolescent Health Survey - a longitudinal provincial survey administered in schools to capture adolescent physical and emotional health indicators, we conducted a linear trend analysis on sexual health behaviours and risk factors in adolescent girls before and after the implementation of vaccination for HPV (2003, 2008 and 2013). RESULTS We analyzed data for 298 265 girls who self-identified as heterosexual. The proportion of girls reporting ever having sexual intercourse decreased from 21.3% (2003) to 18.3% (2013; adjusted odds ratio [OR] 0.79). Self-report of sexual intercourse before the age of 14 years decreased significantly from 2008 to 2013 (adjusted OR 0.76), as did reported substance use before intercourse (adjusted OR for 2003-2013 0.69). There was no significant change in the number of sexual partners reported (2003-2013). Between 2003 and 2013, girls' reported use of contraception and condoms increased, while pregnancy rates decreased. INTERPRETATION Since the implementation of school-based HPV vaccination program in BC, sexual risk behaviours reported by adolescent girls either reduced or stayed the same. These findings contribute evidence against any association between HPV vaccination and risky sexual behaviours.
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Affiliation(s)
- Gina S Ogilvie
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
| | - Felicia Phan
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
| | - Heather N Pedersen
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
| | - Simon R Dobson
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
| | - Monika Naus
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
| | - Elizabeth M Saewyc
- School of Population and Public Health (Ogilvie, Phan, Pedersen), Faculty of Medicine; School of Nursing (Saewyc), The University of British Columbia; Women's Health Research Institute (Ogilvie, Phan, Pedersen), BC Women's Hospital; Vaccine Evaluation Center (Dobson), BC Children's Hospital Research Centre; BC Centre for Disease Control (Naus), Vancouver, BC
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HIV-Infected Young Men Demonstrate Appropriate Risk Perceptions and Beliefs about Safer Sexual Behaviors after Human Papillomavirus Vaccination. AIDS Behav 2018; 22:1826-1834. [PMID: 28220313 DOI: 10.1007/s10461-017-1710-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to identify risk perceptions after human papillomavirus (HPV) vaccination among HIV-infected young men who have sex with men. On average, participants appropriately perceived themselves to be at lower than neutral risk for HPV (mean subscale score 4.2/10), at higher than neutral risk for other sexually transmitted infections (7.0/10), and that safer sexual behaviors were still important (8.5/10). Higher perceived risk of HPV was associated with African-American race (p = .03); higher perceived risk of other sexually transmitted infections with White race (p = .01) and higher knowledge about HPV (p = .001); and higher perceived need for safer sexual behaviors with consistent condom use (p = .02). The study provides reassuring data that HIV-infected young men who have sex with men generally have appropriate risk perceptions and believe that safer sexual behaviors after vaccination are still important. These findings mirror the results of studies in HIV-infected young women and HIV-uninfected adolescents.
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Abstract
The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.
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Affiliation(s)
- Aria C Attia
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Judith Wolf
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Ana E Núñez
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
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Kasting ML, Shapiro GK, Rosberger Z, Kahn JA, Zimet GD. Tempest in a teapot: A systematic review of HPV vaccination and risk compensation research. Hum Vaccin Immunother 2016; 12:1435-50. [PMID: 26864126 PMCID: PMC4964724 DOI: 10.1080/21645515.2016.1141158] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/21/2015] [Accepted: 01/07/2016] [Indexed: 10/24/2022] Open
Abstract
There has been some concern among parents and in the media that vaccinating children against human papillomavirus could be seen as giving children permission to engage in risky sexual behaviors (also known as sexual disinhibition). Several studies have found this concern to be unfounded but there have been no attempts to synthesize the relevant studies in order to assess if there is evidence of sexual disinhibition. The aim of this study was to synthesize recent literature examining sexual behaviors and biological outcomes (e.g., sexually transmitted infections) post-HPV vaccination. We reviewed literature from January 1, 2008-June 30, 2015 using PubMed, CINAHL, and Embase with the following search terms: [(sex behavior OR sex behavior OR sexual) AND (human papillomavirus OR HPV) AND (vaccines OR vaccine OR vaccination)] followed by a cited reference search. We included studies that examined biological outcomes and reported behaviors post-vaccination in both males and females. Studies were reviewed by title and abstract and relevant studies were examined as full-text articles. We identified 2,503 articles and 20 were eventually included in the review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors or higher rates of STIs after HPV vaccination. Instead, the studies found that vaccinated compared to unvaccinated individuals were less likely to report vaginal intercourse without a condom (OR = 0.5; 95%CI = 0.4-0.6) and non-use of contraception (OR = 0.27; 95%CI = 0.15-0.48) and unvaccinated participants had higher rates of Chlamydia (OR = 2.3; 95%CI = 1.06-5.00). These results should be reassuring to parents and health care providers.
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Affiliation(s)
- Monica L. Kasting
- Indiana University School of Public Health, Department of Epidemiology, Indianapolis, IN, USA
| | - Gilla K. Shapiro
- Department of Psychology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research & Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, Montreal, QC, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research & Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, Montreal, QC, Canada
| | - Jessica A. Kahn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gregory D. Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, Indianapolis, IN, USA
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Turiho AK, Muhwezi WW, Okello ES, Tumwesigye NM, Banura C, Katahoire AR. Human Papillomavirus (HPV) Vaccination and Adolescent Girls' Knowledge and Sexuality in Western Uganda: A Comparative Cross-Sectional Study. PLoS One 2015; 10:e0137094. [PMID: 26327322 PMCID: PMC4556485 DOI: 10.1371/journal.pone.0137094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022] Open
Abstract
The purpose of the study was to investigate the influence of human papillomavirus (HPV) vaccination on adolescent girls' knowledge of HPV and HPV vaccine, perception of sexual risk and intentions for sexual debut. This cross-sectional comparative study was conducted in Ibanda and Mbarara districts. Data was collected using a standardized self-administered questionnaire and analyzed using the Statistical Package for the Social Sciences computer software. Univariate, bivariate, and logistic regression analyses were conducted with significance level set at p < .05. Results showed that HPV vaccination was associated with being knowledgeable (Crude OR: 5.26, CI: 2.32-11.93; p = 0.000). Vaccination against HPV did not predict perception of sexual risk. Knowledge was low (only 87/385 or 22.6% of vaccinated girls were knowledgeable), but predicted perception of a high sexual risk (Adjusted OR: 3.12, CI: 1.37-3.63; p = 0.008). HPV vaccination, knowledge and perceived sexual risk did not predict sexual behaviour intentions. High parental communication was associated with adolescent attitudes that support postponement of sexual debut in both bivariate and multiple regression analyses. In conclusion, findings of this study suggest that HPV vaccination is not likely to encourage adolescent sexual activity. Influence of knowledge on sexual behaviour intentions was not definitively explained. Prospective cohort studies were proposed to address the emerging questions.
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Affiliation(s)
| | | | | | | | - Cecil Banura
- Child Health and Development Center, Makerere University, Kampala, Uganda
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Krawczyk A, Perez S, King L, Vivion M, Dubé E, Rosberger Z. Parents' decision-making about the human papillomavirus vaccine for their daughters: II. Qualitative results. Hum Vaccin Immunother 2015; 11:330-6. [PMID: 25692507 PMCID: PMC4514412 DOI: 10.4161/21645515.2014.980708] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/08/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
The goal of the study was to examine the reasons given by parents who accepted or refused the HPV vaccine for their daughters in the context of a free provincial school-based vaccination program. A random sample of parents of 9-10 y old girls completed a mail-in questionnaire. Parents' responses to 2 open-ended questions were assessed using content analysis. Coding themes were derived from the Health Belief Model. 806 parents returned and answered the relevant items. 88% of these parents decided to vaccinate their daughter. The primary reasons for parents' acceptance was the perceived benefits (e.g., health protection, cancer/HPV prevention) and cues to action (e.g., physician recommendation, trusting the school vaccine program). Reasons for parental refusal included barriers (e.g., fear of side effects) and low susceptibility (e.g., their daughter is not at risk). Both groups of parents had unanswered questions, doubts and often inaccurate information. This study provides unique insight into parents' perspectives concerning the decision making process for their daughter. There appears to be a need for accurate and complete information to assure informed HPV vaccine decision-making by parents and to increase HPV vaccine uptake.
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Affiliation(s)
- Andrea Krawczyk
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
| | - Samara Perez
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
| | - Leonora King
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
- Department of Psychiatry; McGill University; Montreal, QC, Canada
| | - Maryline Vivion
- Institut national de santé publique du Québec; Québec City, QC, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec; Québec City, QC, Canada
| | - Zeev Rosberger
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
- Department of Psychiatry; McGill University; Montreal, QC, Canada
- Louise Granofsky Psychosocial Oncology Program; Segal Cancer Center; Jewish General Hospital; Montreal, QC, Canada
- Department of Oncology; McGill University; Montreal, QC, Canada
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8
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Mayhew A, Mullins TLK, Ding L, Rosenthal SL, Zimet GD, Morrow C, Kahn JA. Risk perceptions and subsequent sexual behaviors after HPV vaccination in adolescents. Pediatrics 2014; 133:404-11. [PMID: 24488747 PMCID: PMC3934341 DOI: 10.1542/peds.2013-2822] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Concerns have been raised that human papillomavirus (HPV) vaccination could lead to altered risk perceptions and an increase in risky sexual behaviors among adolescents. The aim of this study was to assess whether adolescent risk perceptions after the first vaccine dose predicted subsequent sexual behaviors. METHODS Young women 13 to 21 years of age (N = 339) completed questionnaires immediately after HPV vaccination, and 2 and 6 months later, assessing demographic characteristics, knowledge/attitudes about HPV vaccination, risk perceptions, and sexual behaviors. Risk perceptions were measured by using 2 5-item scales assessing: (1) perceived risk of sexually transmitted infections (STI) other than HPV, and (2) perceived need for safer sexual behaviors after HPV vaccination. We assessed associations between risk perceptions at baseline and sexual behaviors over the next 6 months by using logistic regression, stratifying participants by sexual experience at baseline and age (13-15 vs. 16-21 years). RESULTS Among all sexually inexperienced participants (42.5%), baseline risk perceptions were not associated with subsequent sexual initiation; in age-stratified analyses, girls 16 to 21 years of age who reported lower perceived risk for other STI (an inappropriate perception) were less likely to initiate sex (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.03-0.69). Among all sexually experienced participants (57.5%) and in age-stratified analyses, baseline risk perceptions were not associated with subsequent number of sexual partners or condom use. CONCLUSIONS Risk perceptions after HPV vaccination were not associated with riskier sexual behaviors over the subsequent 6 months in this study sample.
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Affiliation(s)
- Allison Mayhew
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tanya L. Kowalczyk Mullins
- University of Cincinnati College of Medicine, Cincinnati, Ohio;,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lili Ding
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Susan L. Rosenthal
- Department of Pediatrics, Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York; and
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Charlene Morrow
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A. Kahn
- University of Cincinnati College of Medicine, Cincinnati, Ohio;,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Bynum SA, Staras SAS, Malo TL, Giuliano AR, Shenkman E, Vadaparampil ST. Factors associated With Medicaid providers' recommendation of the HPV vaccine to low-income adolescent girls. J Adolesc Health 2014; 54:190-6. [PMID: 24064282 PMCID: PMC3946969 DOI: 10.1016/j.jadohealth.2013.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination in the United States remains a public health challenge with vaccine rates of 50%. Although health care providers can facilitate HPV vaccination, several factors may impede their ability to universally recommend the vaccine. To maximize the potential of HPV vaccines, it is important to understand challenges providers face in the clinical environment. The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early (9-10), target (11-12), early adolescent catch-up (13-14), and late adolescent catch-up (15-17) vaccination groups. METHODS Surveys were mailed between October 2009 and April 2010 to a random sample of Florida-based physicians serving Medicaid-enrolled adolescents. Data were analyzed in 2013. RESULTS Among early adolescents, discomfort discussing sexually transmitted infections (STIs) with teens (odds ratio [OR] = 1.75), difficulty ensuring vaccine completion (OR = .73), and discomfort discussing STIs with parents (OR = .44) were associated with recommendation. For target adolescents, discomfort discussing STIs with teens (OR = 2.45), time constraints (OR = .70), vaccine efficacy concerns (OR = .65), discomfort discussing STIs with parents (OR = .33), obstetrics/gynecology (OR = .25) and family medicine (OR = .24) specialty, and non-Hispanic black patient (OR = .15) were associated with recommendation. In early catch-up adolescents, concerns that teens will practice riskier behaviors (OR = .57), discomfort discussing STIs with parents (OR = .47), and family medicine specialty (OR = .20) were associated with recommendation. For late catch-up adolescents, family medicine specialty (OR = .13) was associated with recommendation. CONCLUSIONS Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention. Overall, findings suggest that efforts should focus on sexuality communication and family medicine specialty.
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Affiliation(s)
- Shalanda A. Bynum
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Stephanie A. S. Staras
- Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, FL
| | - Teri L. Malo
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL
| | - Anna R. Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL,Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa
| | - Elizabeth Shenkman
- Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, FL
| | - Susan T. Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL,Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa
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Zimet GD, Rosberger Z, Fisher WA, Perez S, Stupiansky NW. Beliefs, behaviors and HPV vaccine: correcting the myths and the misinformation. Prev Med 2013; 57:414-8. [PMID: 23732252 DOI: 10.1016/j.ypmed.2013.05.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/13/2013] [Accepted: 05/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived "newness" of HPV vaccines. METHODS Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake. RESULTS There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered "new". Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination. CONCLUSION Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination.
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Affiliation(s)
- Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410W. 10th St., HS1001, Indianapolis, IN 46260, USA.
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La Torre G, De Vito E, Ficarra M, Firenze A, Gregorio P, Boccia A, Miccoli S, Giraldi G, Saulle R, Semyonov L, Unim B, Ferrara M, Langiano E, De Belvis G, Capizzi S, Nardella R, Marsala M, Bonanno V, Ferrara C, Guidi E, Bergamini M, Lupi S. Is there a lack of information on HPV vaccination given by health professionals to young women? Vaccine 2013; 31:4710-3. [DOI: 10.1016/j.vaccine.2013.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/23/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
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Kahn JA, Xu J, Kapogiannis BG, Rudy B, Gonin R, Liu N, Wilson CM, Worrell C, Squires KE. Immunogenicity and safety of the human papillomavirus 6, 11, 16, 18 vaccine in HIV-infected young women. Clin Infect Dis 2013; 57:735-44. [PMID: 23667266 DOI: 10.1093/cid/cit319] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The objective of this study was to determine whether the 3-dose quadrivalent human papillomavirus (HPV) vaccine series (HPV-6, -11, -16, -18) is immunogenic and safe in young women infected with human immunodeficiency virus (HIV). METHODS We enrolled 99 women aged 16-23 years in a phase 2, open-label, multicenter trial, conducted from 2008 to 2011 by the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Outcome measures were immunogenicity 4 weeks after dose 3, measured by (1) geometric mean titers (GMTs) and (2) seroconversion rates for HPV-6, -11, -16, and -18, among those seronegative and HPV DNA negative for each type. Immune responses were compared to those of a historical comparison group of HIV-negative women (n = 267) using univariate methods. Clinical and laboratory adverse events were assessed after each dose. RESULTS The mean age of subjects was 21.4 years; 80% were non-Hispanic black, 69 were not taking antiretroviral therapy (ART), and 30 were taking ART. No differences in GMTs were noted among participants taking ART vs the comparison group, but GMTs were lower in participants not taking ART vs the comparison group for HPV-16 (2393 vs 3892 milli-Merck units per milliliter [mMU/mL], P = .012) and HPV-18 (463 vs 801 mMU/mL, P = .003). Seroconversion rates were 100% for HPV-6, -11, -16, and -18 among participants taking ART. Rates ranged from 92.3% (for HPV-18) to 100.0% (for HPV-6) among participants not taking ART. One severe adverse event (fatigue) was noted. CONCLUSIONS In a sample of HIV-infected women who were HPV DNA and HPV seronegative, immune responses to HPV vaccination were generally robust and the vaccine was well tolerated.
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Affiliation(s)
- Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio 45229, USA.
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Prevalence and risk factors for HPV in HIV-positive young women receiving their first HPV vaccination. J Acquir Immune Defic Syndr 2013; 61:390-9. [PMID: 22820809 DOI: 10.1097/qai.0b013e3182676fe3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The objectives of this study were to describe the prevalence and risk factors for HPV infection among HIV-infected young women receiving their first quadrivalent HPV (HPV-6, -11, -16, and -18) vaccine dose. METHODS We recruited 16- to 23-year-old women from 14 sites for an HPV vaccine trial. At the first visit, they completed a questionnaire and were tested for cervicovaginal HPV DNA (41 types) and HPV serology (4 vaccine types). Factors associated with any HPV, type-specific HPV, and high-risk (cancer-associated) HPV infections were identified using univariate and multivariable logistic regression. RESULTS The mean age of participants (N = 99) was 21.4 years, 30.3% were on antiretroviral therapy, 74.7% were positive for ≥1 HPV DNA type, 53.5% for ≥1 high-risk type, 12.1% for HPV-16, and 5.1% for HPV-18. Most were HPV DNA negative and seronegative for HPV-16 (55.6%) and HPV-18 (73.7%); 45.5% were HPV DNA negative and seronegative for both HPV-16 and -18. Three variables were associated with high-risk HPV DNA in multivariable analysis: non-Hispanic black versus Hispanic ethnicity (adjusted odds ratio [AOR]: 7.06, 95% CI: 1.63 to 30.5), HIV viral load ≥ 400 versus <400 copies/mL (AOR: 3.47, 95% CI: 1.28 to 9.43), and frequency of vaginal sex in the past 90 days (AOR: 5.82, 95% CI: 1.30 to 26.11 for ≥6 vs 0 times). CONCLUSIONS The prevalence of ≥1 HPV type was high in these young women, demonstrating the importance of vaccinating before sexual initiation. However, most women were HPV DNA negative and seronegative for high-risk vaccine-type HPV infection, supporting vaccination of sexually experienced HIV-positive young women.
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Abstract
PURPOSE OF REVIEW Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents with the human papillomavirus (HPV) vaccine, U.S. coverage among women remains less than 50%, with that of adolescent men below 2%. RECENT FINDINGS Ongoing studies document the efficacy and safety of the HPV vaccine. Nevertheless, misconceptions and negative attitudes persist and serve as barriers to vaccine uptake. Additionally, other factors such as age, insurance status, poverty status, and racial or ethnic background have been associated with diminished vaccine uptake and poor completion rates. Internationally, HPV vaccination programs and school-based programs have achieved increased rates of uptake and series completion. HPV vaccination coverage may also be facilitated by improving communication between physicians, parents, and adolescents as well as by addressing common misconceptions about the vaccine. SUMMARY This review highlights significant findings of recent literature on HPV vaccination of adolescent women with a special focus on uptake, series completion, communication, disparities in vaccine coverage, and other health outcomes associated with HPV vaccination.
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