Age, sex, and other demographic trends in sexual behavior in the United States: Initial findings of the sexual behaviors, internet use, and psychological adjustment survey

Factors Associated with HPV Vaccination Among Middle-Aged Adults in the United States

OBJECTIVE

To examine prevalence of partial and complete HPV vaccination among middle-aged adults and factors associated with vaccination status.

STUDY DESIGN

Nationally representative cross-sectional survey.

SETTING

United States.

METHODS

Cohort includes adults aged 30 to 44 years from 2018 to 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey who completed questions about HPV vaccination status. Survey-weighted multivariable logistic regression was utilized to explore factors associated with partial and complete HPV vaccination status.

RESULTS

In this nationally representative cohort of 26,470 US middle-aged adults, 15.8% [95% confidence interval [CI]: 15.1%-16.6%] reported any HPV vaccination, and 6.5% [95% CI: 6.0%-7.0%] reported complete HPV vaccination. On multivariable regression, younger age, female sex, residence in the West or Northeast, higher educational attainment, unmarried status, having a personal healthcare provider, and gay or lesbian sexual orientation were associated with increased likelihood of vaccination. Race was variably associated with vaccination status. Annual income, insurance status, cancer history, head and neck cancer history, and time of last physician checkup were not associated with HPV vaccination status.

CONCLUSION

HPV vaccination among middle-aged adults who were not previously vaccinated should be based on risk for new HPV infection and possible benefits of vaccination. While our analysis shows that consideration of personal factors likely plays a role in HPV vaccination in this cohort, we also find that gaps in vaccination may exist due to other socioeconomic disparities between sexes, educational attainment levels, racial/ethnic groups, geographic regions, and access to a personal healthcare provider. These factors' influence suggests potential room for improved public health measures.

Young Adult Women and Sexual Awareness in the Digital Age: Examining Pathways Linking Online Dating Debut and Mindfulness with Sexual and Mental Health

Sexual awareness is an understudied phenomenon, despite its known effects on mental health. Little is known about the predictors of sexual awareness, including how early sexual debut and early engagement with online dating and hookup apps might impact the development of sexual mindfulness. Given the conceptual overlap between mindfulness and sexual awareness, this study tested a model that hypothesized that general mindfulness and early sexual and online dating debuts may be associated with mental health outcomes and sexual behavior through pathways involving sexual awareness (assertiveness, consciousness, appeal, and monitoring). A sample of 2,379 heterosexually active young adult women completed an online survey. Path models indicated that both early sexual debut (prior to age 15) and early online dating debut (prior to age 18) had significant, positive direct associations with anxiety and depression scores. Early online dating was also associated with condomless sex with casual male partners. However, both early sexual debut and early online dating debut were indirectly linked to greater sexual risk through greater appeal, and to lower sexual risk through sexual assertiveness. Additionally, greater monitoring contributed to more depression for those with an earlier sexual debut. These findings point to potential risks associated with early online dating. They also highlight benefits of studying sexual awareness as a multi-dimensional construct, especially as it helps to clarify divergent findings in the existing literature on the long-term consequences associated with early sexual debut. While some domains were associated with risk (monitoring and appeal), others were indicative of resilience (assertiveness).

Orogenital Human Papillomavirus Infection and Vaccines: A Survey of High- and Low-Risk Genotypes Not Included in Vaccines

Knowledge of human papillomavirus transmission from the genital tract to the oral mucosa remains unsatisfactory, with poor and often inconsistent literature results. The increase in HPV-associated oral malignancies prompts further analysis of the simultaneous detection of the virus in the two anatomical areas and on the identification of genotypes to be included in future vaccines. Therefore, in this retrospective study, we evaluated orogenital HPV concurrence, hrHPV, lrHPV and type-concordance in 337 samples, as well as the prevalence of the most common genotypes not included in HPV vaccines. Concurrence was found in 12.5% (31/248) of cases, hr-concordance in 61.3% (19/31) and lr-concordance in 12.9% (4/31). Finally, type-concordance was found in 32.3% (10/31) of concurrent infections. Regarding the identification of non-vaccine genotypes, the significantly prevalent genotypes in the anogenital area were HPV66 (12.6%, p < 0.0001), HPV53 (11.1%, p < 0.0001), HPV51 (8.7%, p < 0.0001), HPV42 (8.2%, p < 0.0001) and HPV68 (5.6%, p = 0.0034) in women and HPV66 (14.6%, p = 0.0058), HPV42 (12.2%, p = 0.0428), HPV51 (12.2%, p = 0.0428), HPV53 (12.2%, p = 0.0428), HPV70 (12.2%, p = 0.0428) and HPV73 (12.2%, p = 0.0428) in men. Considering the results of our study, we recommend including the high-risk genotypes HPV51, HPV68, HPV53 and HPV66 in future HPV vaccine formulations.

Age-Specific Prevalence of Anal and Cervical Human Papillomavirus Infection and High-Grade Lesions in 11 177 Women by Human Immunodeficiency Virus Status: A Collaborative Pooled Analysis of 26 Studies

BACKGROUND

Age-specific data on anal, and corresponding cervical, human papillomavirus (HPV) infection are needed to inform female anal cancer prevention.

METHODS

We centrally reanalyzed individual-level data from 26 studies reporting HPV prevalence in paired anal and cervical samples by human immunodeficiency virus (HIV) status and age. For women with HIV (WWH) with anal high-grade squamous intraepithelial lesions or worse (HSIL+), we also investigated concurrent cervical cytopathology.

RESULTS

In HIV-negative women, HPV16 prevalence decreased significantly with age, both at anus (4.3% at 15-24 years to 1.0% at ≥55 years; ptrend = 0.0026) and cervix (7.4% to 1.7%; ptrend < 0.0001). In WWH, HPV16 prevalence decreased with age at cervix (18.3% to 7.2%; ptrend = 0.0035) but not anus (11.5% to 13.9%; ptrend = 0.5412). Given anal HPV16 positivity, concurrent cervical HPV16 positivity also decreased with age, both in HIV-negative women (ptrend = 0.0005) and WWH (ptrend = 0.0166). Among 48 WWH with HPV16-positive anal HSIL+, 27 (56%) were cervical high-risk HPV-positive, including 8 with cervical HPV16, and 5 were cervical HSIL+.

CONCLUSIONS

Age-specific shifts in HPV16 prevalence from cervix to anus suggest that HPV infections in the anus persist longer, or occur later in life, than in the cervix, particularly in WWH. This is an important consideration when assessing the utility of cervical screening results to stratify anal cancer risk.