Adolescents' beliefs about their parents' human papillomavirus vaccination decisions

Human papilloma virus vaccination and attitudes towards contraception: a cross-sectional study

Objective: Human papilloma virus (HPV) vaccination may result in misconceptions that encourage young women to adopt risky contraceptive practices. The purpose of this article was to investigate whether HPV vaccination status was associated with choice of contraceptive method and adoption of risky sexual behaviour. Methods: Vaccinated and non-vaccinated visitors to a university department paediatric and adolescent gynaecology clinic were asked to anonymously fill in a survey comprising questions on sociodemographic characteristics, sexual history, opinions on contraception and attitudes towards contraception. Results: A total of 191 women were studied, 75 (39.3%) of whom had received the HPV vaccination and 116 (60.7%) of whom had not. The main contraceptive methods used in both groups were male condom (46%), emergency contraception (14%) and coitus interruptus (12%). The vaccinated group was less religious and had better educated mothers compared with the non-vaccinated group (relative risk [RR] 0.64; 95% confidence interval [CI] 0.45, 0.93; p = .016 vs RR 1.91; 95% CI 1.01, 3.63; p = .027, respectively). They also had an earlier sexual debut (RR 1.94; 95% CI 1.06, 3.55; p = .015), agreed that vaccination increased the safety of sex (RR 1.45; 95% CI 1.02, 2.05; p = .039) and considered the HPV vaccine a prerequisite to initiation of a sexual relationship (RR 1.87; 95% CI 1.34, 2.63; p < .001). Conclusion: HPV vaccination did not affect sexual behaviour, attitudes to condom use or choice of contraceptive method.

The association of human papillomavirus vaccination with sexual behaviours and human papillomavirus knowledge: a systematic review

Since the 2008 introduction of the human papillomavirus (HPV) vaccination programme for adolescent girls in the UK, parents and other groups have expressed fears that immunisation condones sexual activity, promotes promiscuity and encourages risky sexual behaviour. This study aimed to explore whether HPV vaccination programmes have increased knowledge surrounding HPV and associated disease and whether uptake has influenced sexual behaviour. MEDLINE, Embase, Cochrane Library and PsycINFO electronic databases were interrogated. Studies of behaviour, attitudes and knowledge associated with HPV vaccination (or vaccination intent) in subjects of any age and gender in programmes reflective of UK practice were included in the review (n = 58). The evidence regarding the association of HPV vaccination with high-risk sexual behaviour was varied, primarily due to the heterogeneous nature of the included studies. Young females typically exhibited better knowledge than males, and vaccinated respondents (or those with vaccination intent) had higher levels of knowledge than the unvaccinated. However, knowledge surrounding HPV and genital warts was generally poor. This review highlights the need to provide effective education regarding the HPV vaccine and HPV-associated disease to adolescents of vaccination age, nurses, teachers, parents and guardians to ultimately allow informed decisions to be made regarding receipt of the HPV vaccine.

Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: evidence from a large survey of Nordic women

OBJECTIVE

To assess whether recipients and non-recipients of the human papillomavirus (HPV) vaccine subsequently differ in terms of sexual risk taking behaviour.

DESIGN

Cross-sectional survey. Sequential analyses constructed from self-reported age at vaccination, age at first intercourse and age at response.

SETTING

A random selection of women aged 18-46 years living in Denmark, Norway and Sweden in 2011-2012, eligible for opportunistic or organized catch-up HPV vaccination.

PARTICIPANTS

A total of 3805 women reported to have received the HPV vaccine and 40,247 reported not to have received it. Among vaccinees, 1539 received the HPV vaccine before or at the same age as sexual debut, of which 476 and 1063 were eligible for organized catch-up and opportunistic vaccination, respectively.

MAIN OUTCOME MEASURES

Self-reported sexual behaviour, compared by hazard ratios and odds ratios for women who received the HPV vaccine before or at the same age as sexual debut versus women who did not receive the HPV vaccine.

RESULTS

HPV vaccination did not result in younger age at first intercourse. Women who received the HPV vaccine before or at the same age as sexual debut did not have more sexual partners than did non-vaccinees. Non-use of contraception during first intercourse was more common among non-vaccinees than among HPV vaccinees. The results were similar for organized catch-up and opportunistic vaccinees.

CONCLUSION

Women who received the HPV vaccine before or at the same age as sexual debut did not subsequently engage more in sexual risk taking behaviour than women who did not receive the HPV vaccine.

Human papillomavirus vaccination and sexual behaviour: cross-sectional and longitudinal surveys conducted in England

OBJECTIVE

To examine whether HPV vaccination influences sexual behaviour in adolescent girls, either by giving them a 'green light' to have sex, or because perceived protection afforded by the vaccine permits compensatory risky sexual behaviour.

DESIGN

Cross-sectional and longitudinal surveys.

SETTING

Seven English schools.

MAIN OUTCOME MEASURES

Self-reported sexual behaviour.

PARTICIPANTS

The cross-sectional survey included 1053 girls (mean age 17.1 years) who had (n=433 recruited in March 2010) or had not (n=620 recruited in March 2009) been offered the HPV vaccine. The longitudinal survey included 407 girls (mean age 17.5 years) who had been offered HPV vaccination and had either received at least one dose (n=148) or had not received any doses (n=259).

RESULTS

In the cross-sectional survey, the group of girls who had been offered the HPV vaccine were no more likely to be sexually active than the group of girls who had not been offered the HPV vaccine. In the longitudinal survey, the vaccinated group were no more likely to have changed their condom use or increased their total number of sexual partners than the unvaccinated group.

CONCLUSIONS

Neither being offered the HPV vaccine nor receiving it affected sexual behaviour.

HPV vaccination among ethnic minorities in the UK: knowledge, acceptability and attitudes

BACKGROUND

Human papillomavirus (HPV) vaccination offers a unique opportunity for the primary prevention of cervical cancer. Studies suggest that knowledge and attitudes about the vaccine are likely to influence uptake. One limitation of most studies assessing HPV vaccine knowledge, attitudes and acceptability is their under representation of ethnic minorities. It is important to ensure that our understanding of HPV knowledge and attitudes include all ethnic groups in the UK. This article reviews research that has considered knowledge, acceptability and attitudes about HPV and the HPV vaccine among ethnic minorities in the UK.

METHODS

Articles in Medline, CINAHL and PsycINFO (January 2000-March 2010) were searched.

RESULTS

A total of 17 UK-based papers examined knowledge, attitudes or acceptability related to HPV vaccination in the 'lay' population (parents, adolescents or the general population as opposed to health professionals) and reported findings by ethnicity.

CONCLUSION

Findings seem to suggest lower awareness of HPV and lower acceptability of the vaccination, which could be important if they are reflected in uptake. More research is needed with ethnic minority groups, particularly in the context of the vaccination programme.

The importance of social norms for uptake of catch-up human papillomavirus vaccination in young women

Background Human papillomavirus (HPV) is the cause of almost all cases of cervical cancer. The current UK government immunisation program includes free routine HPV vaccination of girls aged 12–13, with a catch-up vaccination program for 13–18-year-old girls. The aim of this study was to identify correlates of intended and actual uptake of catch-up HPV vaccination. Methods: An online questionnaire was completed by 591 young women aged 16–20. Results: Of the 350 women who had been offered catch-up HPV vaccination, 90.6% had accepted. In multivariate analyses, vaccine uptake was significantly correlated with subjective norms more supportive of HPV vaccination, and greater uptake of other childhood vaccinations (χ2(3) = 39.34, P < 0.01; 91.1% correctly classified; Nagelkerke pseudo-r2 = 0.23). Among the 241 women aged 16–20 who had not been offered HPV vaccination, the average intention was 3.70 on a five-point scale. Multivariate analyses revealed four significant independent predictors of stronger intentions to accept vaccination: subjective norms more supportive of HPV vaccination, greater worry about sexually transmissible infections, greater support for young people’s sexual health services and greater support for childhood vaccination (F(4,236) = 18.67, P < 0.01; adjusted r2 = 0.23). Young women rated television advertisements, educational programs and television soaps as the most effective ways to encourage uptake of HPV vaccination. Conclusions: Uptake of HPV vaccination may be increased if interventions use appropriate media to promote social norms supportive of HPV vaccination.