Sexually related behaviors as predictors of HPV vaccination among young rural women

Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia

OBJECTIVE

Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings.

DATA SOURCE

We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings.

DATA EXTRACTION

Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest.

DATA SYNTHESIS

Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework.

RESULTS

A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels.

CONCLUSIONS

Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.

Parental Refusal of the Human Papillomavirus Vaccine

INTRODUCTION

The purpose of this study was to explore reasons why parents may defer administration of the human papillomavirus (HPV) vaccine to their children. The literature suggests that parents choose to defer administration of this vaccine for several reasons. Data from this pilot study will contribute to our understanding of why parents defer administration of the vaccine.

METHOD

This mixed-methods study took place in a pediatric practice. After a health care visit in which the vaccine was deferred, a survey was provided to the parent in a private room. The survey was confidential and anonymous.

RESULTS

A total of 23 surveys were completed. Demographic data were reported. Data were analyzed for descriptive statistics and themes from open-ended questions. The majority of parents (75%) deferred administration of the HPV vaccine because they believed it was too new or required further research.

DISCUSSION

Nurse practitioners are in an excellent position to dispel myths and clarify information about HPV vaccination. The data are useful in communicating with parents and promoting best practices to facilitate good health in children.

Voluntary vaccination strategy and the spread of sexually transmitted diseases

In this work, we investigate the spread and control of sexually transmitted diseases when a game-theory based vaccination strategy is involved. An individual's decision on vaccination uptake may follow a cost-benefit analysis since the individual obtains immunity against the disease from the vaccination and, at the same time, may have some perceived side effects. Evolutionary game theory is integrated into the epidemic model to reveal the relationship between individuals' voluntary decisions on vaccination uptake and the spread and control of such diseases. We show that decreasing the perceived cost of taking vaccine or increasing the payoff from social obligation is beneficial to controlling the disease. It is also shown how the "degree of rationality" of males and females affects the disease spread through the net payoff of the game. In particular, individual awareness of the consequences of the disease on the infectives also contributes to slowing down the disease spread. By analyzing an asymmetric version of our evolutionary game, it is shown that the disease is better controlled when individuals are more sensitive to fitness differences when net payoff is positive than when it is negative.

Effective dual method contraceptive use and HPV vaccination among U.S. adolescent and young adult females

BACKGROUND

Problem Behavior Theory posits that risky behaviors cluster in individuals, implying that protective behaviors may follow a similar pattern. The purpose of this study was to determine whether the protective behavior of effective dual method contraception use at first and most recent sexual intercourse is associated with HPV vaccination among adolescent and young adult females.

METHODS

National Survey of Family Growth (2006-2010) data were used to examine the association between women's contraception use during first and most recent sexual intercourse and HPV vaccination. Women aged 15 to 24 years (n = 1,820) served as the study sample.

FINDINGS

At first and last sexual intercourse, effective dual method contraception use was reported by 15.3% and 16.8% women, respectively; 27.8% reported receiving at least one dose of the human papillomavirus (HPV) vaccine. Higher HPV vaccination rates were observed among dual method users at first and last sexual intercourse (36.4% and 48.2%, respectively). This trend was also observed across age groups (15-19 year olds vs. 20-24 year olds). In adjusted models, among all respondents, dual users at last sexual intercourse were significantly more likely to be vaccinated, whereas at first sexual intercourse only younger dual users were more likely to report HPV vaccination.

CONCLUSIONS

Findings suggest that the protective behavior of dual method contraceptive use at first and most recent sexual intercourse may serve as a predictor of another complementary health behavior, HPV vaccination, particularly among adolescent females. More research is needed to understand behavioral clustering to design related multi-focused women's health interventions.

Factors related to vaccine uptake by young adult women in the catch-up phase of the National HPV Vaccination Program in Australia: Results from an observational study

BACKGROUND

Australia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12-26 years.

OBJECTIVE

To identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase.

METHODS

1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008-2009 (age 20-29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors.

RESULTS

Overall, 880 (77%) women reported receiving ≥ 1 dose of the vaccine and 777 women (68%) reported receiving ≥ 2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥ 1 dose of the vaccine was significantly associated with being born in Australia (p < 0.01), being single (p = 0.02), being nulliparous (p < 0.01), living in a higher socioeconomic status area (p-trend = 0.03), living in more remote areas (p = 0.03), drinking alcohol (p < 0.01) and using hormonal contraceptives (p < 0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend = 0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p = 0.03). Similar factors were associated with receiving ≥ 2 doses.

CONCLUSIONS

In this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups.

Human papillomavirus vaccination and sexual behavior in young women

STUDY OBJECTIVE

To compare sexual attitudes and behaviors of young women who have received or declined the HPV vaccine.

DESIGN

Cross-sectional survey.

SETTING

Obstetrics and gynecology and pediatrics clinics at a large, Midwestern, academic health center.

PARTICIPANTS

223 young women (ages 13-24): 153 who had received HPV vaccination and 70 with no prior HPV vaccination.

MAIN OUTCOME MEASURES

Sexual behaviors; attitudes toward sexual activity.

RESULTS

Vaccinated young women were slightly but significantly younger than unvaccinated (mean age 19.2 vs 20.0). Both groups showed a large percentage of participants engaging in high-risk sexual behavior (75% vs 77%). The mean age at sexual debut was not significantly different between the groups (16.8 vs 17.0) nor was the average number of sexual partners (6.6 for both). Unvaccinated participants were more likely to have been pregnant (20% vs 8.6%, P = .016), although this difference was not significant in multivariate analysis CI [0.902-5.177]. Specific questions regarding high-risk sexual behaviors and attitudes revealed no significant differences between the groups.

CONCLUSION

We found that sexual behaviors, including high-risk behaviors, were similar between young women who had and had not received HPV vaccination. Our findings provide no support for suggestions that the vaccine is associated with increased sexual activity. Importantly, we found that young women in our population are sexually active at a young age and are engaged in high-risk behaviors, affirming the importance of early vaccination.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

BACKGROUND

Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge.

METHODS

Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women's Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement).

RESULTS

Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV.

CONCLUSIONS

Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

Background

Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge.

Methods

Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women’s Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement).

Results

Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV.

Conclusions

Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.

Geographic variability in human papillomavirus vaccination among U.S. young women

BACKGROUND

Little information is available on geographic disparity of human papillomavirus (HPV) vaccination among women aged 18-26 years in the U.S. Genital HPV is the most common sexually transmitted infection in the U.S. Persistent HPV infection with oncogenic types can cause cervical cancer.

PURPOSE

This study utilized data collected from the 2010 National Health Interview Survey (NHIS). It identified geographic variability and other factors contributing to the disparities in HPV vaccine series initiation in a nationally representative sample of women aged 18-26 years.

METHODS

The study utilized data collected from 1867 women who participated in the Cancer Control Module Supplement of the 2012 NHIS. A multivariable logistic regression model was used to assess characteristics associated with initiation of the HPV series. Analyses were performed in 2012.

RESULTS

After adjusting for other characteristics, women living in the West and North Central/Midwest had 54% and 20% greater odds of initiating the HPV series, respectively, compared with those living in the Northeast. Other factors associated with HPV series initiation were younger age, Hispanic background, being single/never married, childlessness, a history of HPV, and current alcohol use. Factors correlated with failure to initiate the HPV series were: not having insurance, living below the 200% poverty level, not being a high school graduate, not currently using hormone-based birth control, most recent Pap >1 year ago, no regular provider, last clinic visit ≥12 months ago, and never having received the hepatitis B vaccine.

CONCLUSIONS

Results demonstrate disparity in HPV vaccine uptake by region of residence in the U.S. among young women. Further research is needed to understand the factors contributing to this geographic disparity. Evaluation of vaccination policies and practices associated with higher coverage regions might help characterize effective methods to improve HPV vaccination among women aged 18-26 years.

"1-2-3 Pap" Intervention Improves HPV Vaccine Series Completion among Appalachian Women

Completion of the Human Papillomavirus (HPV) vaccine series is a national priority. This study not only identified correlates of intent to complete the vaccine series and actual series completion, but also tested the efficacy of a DVD intervention to promote series completion. Women's beliefs that all three doses reduced cancer risk predicted intent and completion. Intention predicted completion, as did the belief that having a friend accompany the woman would promote completion. Beyond these effects, women assigned to the intervention were 2.44 times more likely than women in the control group to complete the series. Thus, in controlled analyses, a theory-grounded DVD intervention successfully promoted HPV series completion in a community setting. This method of intervention has high translational potential.

Identifying knowledge-attitude-practice gaps to enhance HPV vaccine diffusion

To examine differences in knowledge, attitudes, and related practices among adopters and nonadopters of the human papillomavirus (HPV) vaccine, the researchers conducted 83 in-depth interviews with 18- to 26-year-old women. The study identified knowledge-attitude-practice gaps in the context of the HPV vaccine to explain why diffusion of a preventive innovation (such as the HPV vaccine) requires targeted risk communication strategies in order to increase demand. Salient findings included similarities between vaccinated and unvaccinated women's lack of knowledge and uncertainties about HPV and cervical cancer. Vaccinated women who had no knowledge of HPV or no-risk/low-risk perceptions of HPV reported receiving vaccination, indicating HPV risk protection behavior could precede knowledge acquisition for vaccinated women. These vaccinated women identified an interpersonal network supportive of vaccination and reported supportive social influences. Among unvaccinated women, unsupportive vaccination attitudes included low perceived personal risk of HPV. In contrast, unvaccinated women often cited erroneous beliefs that HPV could be avoided by abstinence, monogamy, and knowledge of their partners' sexual history as reasons that the vaccine was not personally relevant. Unvaccinated women cited interpersonal influences that activated short- and long-term vaccination safety and efficacy concerns. Different levels of fear regarding the HPV vaccine may underlie (a) attitudinal differences between vaccinated and unvaccinated women in perceived vaccination value and (b) attitude-practice gaps.