[SUS users' knowledge of and attitude to HPV virus and vaccines available in Brazil]

Eventos adversos após a vacina papilomavírus humano em adolescentes no estado de Minas Gerais

Objetivo: investigar as notificações dos eventos adversos pós-vacinação papilomavírus humano no Estado de Minas Gerais, segundo a localidade de notificação, causalidade, gravidade, bem como a evolução dos casos. Métodos: estudo epidemiológico realizado com os dados de 2015-2019, notificados no Sistema de Informação de Vigilância de Eventos Adversos. Os dados foram analisados e apresentadas em proporções, segundo as macrorregiões de saúde e os anos do estudo. Resultados: em 2015, foram notificados 26,41% eventos adversos, sendo o ano com maior notificação. Ao se analisar as macrorregiões de saúde, Vale do Jequitinhonha apresentou a menor prevalência de registro, com 0,43%, e a Centro a maior prevalência de notificação (30,95%). Os eventos adversos locais mais prevalentes foram: dor (56,48%) e edema (38,89%). Já quanto aos eventos sistêmicos a cefaleia (29,69%) e gastroenterite (29,69%) tiveram os maiores registros de casos. Os eventos classificados como eventos adversos não graves (59,82%) foram os mais prevalentes e, quanto a causa, 35,94% deles foram atribuídos aos erros de imunização. Conclusão: este estudo reforça que os eventos adversos pós-vacina de HPV foram, em sua maioria, eventos não graves, demonstrando, portanto, a segurança da vacina HPV para o público adolescente e contribuindo para o aumento das taxas de cobertura vacinal.

HPV vaccination in Latin America: Coverage status, implementation challenges and strategies to overcome it

Cervical cancer remains a leading cause of morbidity and mortality amongst females in Latin America (LATAM). Cervical cancer is a preventable disease and HPV vaccination is a main key strategy towards its elimination. This study analyzes HPV vaccine implementation current status and the main barriers to achieve adequate coverage in the region. Data from the nineteen sovereign states of LATAM (comprised of all Portuguese and Spanish-speaking nations located south of the United States) were collected, including year of HPV vaccine implementation, gender and age targets, the number of doses included in the public program and coverage by dose. Sixteen out of the 19 evaluated countries have already implemented HPV vaccination programs. However, despite its proven efficacy and safety, HPV vaccine uptake in LATAM has been lower than expected. There is an evident decline in adhesion, mainly regarding the second dose. Several reasons are probably involved, of note: limited knowledge of HPV and HPV vaccine, misguided safety concerns, high cost, cultural barriers, and the Covid19 pandemic. Proper strategies to overcome these barriers are needed to ensure successful uptake. Effective policies are: adopting the one dose schedule, delivering the vaccine on both health center and schools, and advising health professionals to recommend the vaccine. Further research regarding HPV vaccine hesitancy in Latin America is needed.

Knowledge, attitudes, and practices of adolescents regarding human papillomavirus

OBJECTIVE

To analyze knowledge, attitudes, and practices of adolescent students from public schools in the municipality of Teresina, state of Piauí, regarding human papillomavirus (HPV).

METHODS

Cross-sectional, analytical study carried out in 12 public schools in the municipality of Teresina, with a random sample of 472 15-year-old adolescents. All participants answered a validated questionnaire, which evaluated sociodemographic characteristics, level of knowledge about HPV, attitudes regarding vaccination and vaccination status. The levels of knowledge and attitude were classified by standardized scores and practice by the vaccination situation. The analyses were carried out using the SPSS software. In the bivariate analysis, simple logistic regression was used generating odds ratios to identify the associations of sociodemographic characteristics, knowledge, and attitude with HPV prevention practice. Variables that presented p-value ≤ 0.20 in the bivariate analysis were inserted in a multivariate logistic regression model. Statistical significance was set at p < 0.05.

RESULTS

Among the participants, 27.3% had sufficient knowledge, 34.1% had positive attitudes, and 74.6% had adequate practice. In the multivariate analysis, we observed a statistically significant association among females (ORa = 15.62; 95%CI: 9.08–26.9), satisfactory knowledge (ORa = 2.09; 95%CI: 1.15–3.81), and positive attitudes (ORa = 1.89; 95%CI: 1.10–3.23) with proper practice.

CONCLUSIONS

Being female, having a satisfactory level of knowledge about HPV and the vaccine, and having positive attitudes towards HPV vaccination reinforce the appropriate practice of vaccination. These findings demonstrate the need to expand the knowledge of adolescents, generating positive attitudes towards vaccination within an appropriate perspective.

Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital

BACKGROUND

Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater.

METHODS

A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy).

FINDINGS

Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83).

INTERPRETATION

Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics

Cervical cancer remains one of the top causes of cancer-related morbidity and mortality all over the world. Currently, however, there are no published studies to assess the knowledge of HPV and cervical cancer in Kazakhstan. This study aimed to assess the awareness of HPV, the knowledge of HPV as a cause of cervical cancer, and the awareness of HPV vaccination among Kazakhstani women visiting gynecological clinics across the country. In addition, the study aimed to identify the factors associated with the awareness of HPV and the HPV vaccine and knowledge of HPV as a major cause of cervical cancer. This was a cross-sectional survey-based study with 2,272 women aged between 18–70 years attending gynecological clinics, who were administered paper-based questionnaires. Data analysis included descriptive statistics consisting of mean values, standard deviations, and frequencies, where applicable. Differences in categorical variables between groups were analyzed using the Chi-square test with a significance value of <0.005. Crude odds ratio (OR) and adjusted odds ratio (AOR) with 95% corresponding confidence intervals were calculated in regression analysis using univariate and multivariable logistic regression models. The mean age of participants was 36.33±10.09 years. More than half (53%) of the participants had been screened for cervical cancer. Among those who were aware of HPV, 46% knew that HPV causes cervical cancer and 52% were aware of the HPV vaccine. The key factors related to outcome variables were age, ethnicity, education, family, number of deliveries, and menarche. From a subgroup analysis, results from the HPV test and Pap smear test were factors related to dependent variables such as awareness of HPV and awareness of HPV vaccination.

Human papillomavirus vaccine and risky sexual behavior: Regression discontinuity design evidence from Brazil

This study aims to analyze the hypothesis of moral hazard caused by vaccination against human papillomavirus (HPV), regarding girls' beginning of sex life and, once they have begun their sex life, to understand whether it reduces the probability of girls using a condom in their first sexual intercourse. The data are from the 2015 National Survey of School Health (PeNSE). The model used is the regression discontinuity, with the discontinuity in the age of the girls who were able to participate in the public vaccination campaign. The results of the so-called Fuzzy-RDD show that the campaign was effective in increasing the likelihood of vaccination by 26.7-27.6 percentage points. There is no observable effect on young women initiating their sex lives or refraining from using condoms. The results are tested by several robustness methods. This is the first work to use quasi-experimental models in a developing country with low vaccination coverage in Latin America and show that it is necessary to increase awareness campaigns with parents, so they will know that there is no effect of vaccination on the beginning of sex life and condom use.

Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians

BACKGROUND

Infections with Human Papillomavirus (HPV) are the main cause of cervical cancer. Since 2014, the HPV vaccine was introduced in the Brazilian National Vaccination Calendar. The purpose of this study was to assess the knowledge of adolescent girls and their mothers/guardians about HPV and HPV vaccine, identify the factors associated with this knowledge, and evaluate immunization dropout rate.

METHODS

This was a cross-sectional study involving adolescent girls and their mothers/guardians. Participants underwent an interview that addressed sociodemographic data, sexual and gynecological history, and knowledge about HPV, HPV vaccine and cervical cancer. The third quartile of the total score was established as a cutoff for assessing knowledge. Adolescents who correctly answered more than four questions and mothers/guardians who obtained more than five correct responses were categorized into high knowledge. Poisson regression analysis was performed to identify variables associated with low knowledge. Vaccination records were used to assess immunization dropout rates. Any adolescent who did not complete the two-dose vaccination schedule was considered dropout.

RESULTS

A total of 666 adolescent girls and 623 mothers/guardians were interviewed. Low knowledge was observed in 76.7% of adolescents and 79.8% of mothers/guardians. Most were unaware of the causal relationship between HPV and cervical cancer, signs and symptoms of HPV infection, and had limited knowledge about the HPV vaccine. Factors associated with low knowledge of adolescents were aged 12 years [IRR 1.2 (95% CI 1. 1-1.3)] or less [IRR 1.3 (95% CI (1. 2-1.4)]; household income lower than US$750 [IRR 1.7 (95% CI 1. 1-2.6)] and household income between US$751 and US$1500 [IRR 1.6 (95% CI 1.0-2.6)]. Among mothers/guardians, low knowledge was related to having completed elementary school or less [IRR 1.5 (95% CI 1. 2-2.0)]; and household income lower than US$750 [IRR 1.2 (95% CI 1.0-1.4)]. Knowledge of adolescents and mothers/guardians was not associated with vaccine uptake. HPV immunization dropout rate was considered high (32.3%).

CONCLUSION

Knowledge about HPV and cervical cancer as well as vaccine uptake was low. Results highlight the need for educational interventions about HPV and cervical cancer. These actions may contribute to improve adherence to HPV vaccination.

Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents

In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.

HPV Vaccination in Latin America: Global Challenges and Feasible Solutions

HPV vaccine programs in Latin America run the risk of repeating the problems associated with Papanicolaou (Pap) test programs, an efficient, life-saving tool that is unfortunately underutilized for cancer prevention, in low- and middle-income countries. There is a great need for vigilance in the ongoing implementation of the HPV vaccine in Latin America.

Vaccination access in Primary Care from the user's perspective: senses and feelings about healthcare services

Abstract Objective: To understand the feelings, senses, perceptions and perspectives of Users regarding access to vaccination in Primary Health Care. Method: This is a Holistic-Qualitative Multiple Case Study, based on Comprehensive Sociology of Everyday Life with 74 participants representing four microregions of health in the Western Extended Region of Minas Gerais. Data collection occurred between June 2016 and April 2017. In order to analyse the data, we used the Thematic Content Analysis, obeying the technique of cross-synthesis of the cases. Results: The results reveal the senses perceived by Users in the experience of vaccination and the feelings regarding care, showing that interpersonal relations between population and health professionals are determinant in the access to vaccination. The constant expansion of the official immunization schedule increased access, however, geographical and social aspects, the lack of knowledge about vaccination and the recurrent lack of immunobiological were referred to as barriers to immunization access. Final considerations: We emphasized the need to reinforce more equitable policies and effective communication as a means to promote the credibility of the services with Users.

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil?

The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

Human papillomavirus knowledge, beliefs, and behaviors: A questionnaire adaptation

OBJECTIVE

This study aims to adapt a questionnaire about the knowledge, beliefs and behaviors regarding HPV and related subjects into Brazilian Portuguese.

STUDY DESIGN

National Survey.

METHODS

The instrument was translated into Portuguese and retranslated into English separately. Experts assessed the validity of the content and cross-cultural adaptation of the instrument. The instrument was administered to 8580 male and female Brazilian adolescents and young adults (aged between 16 and 25 years) who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District.

RESULTS

The full questionnaire is composed of 30 questions, with a good absolute agreement between its two halves (61.16 ± 9.97). The preventive behavior section showed the lowest agreement. Men and women showed a difference concerning their knowledge about HPV (score for men 0.48 (± 8.93) vs. women 0.55 (± 4.51), p < 0.001).

CONCLUSION

The proposed questionnaire is the first instrument able to describe the knowledge, beliefs and behaviors regarding HPV and related subjects in Brazilian women and men. This questionnaire appears to be adequate for use in future studies that may produce evidence and knowledge on these specific topics.

[Knowledge and perception of HPV in the population over 18 years of age in the city of Ipatinga - State of Minas Gerais, Brazil]

Several studies have identified misconceptions about human papillomavirus (HPV), which can lead to negligent behavior and risk to the health of the population. This article aims to assess the knowledge of men and women about HPV in the city of Ipatinga, Minas Gerais, and evaluate socioeconomic factors and preventive measures associated with such knowledge. It involved a cross-sectional study with 591 subjects living in the city, by means of stratified sampling by quotas proportional to the number of individuals by sex and age in each of the eight administrative regions of the city. Pearson's chi-square test or the t-Student test and the binary logistic regression model were used to assess the factors associated with knowledge about HPV. Less than half (40.1%) of the respondents said they knew what HPV was. Factors associated with having knowledge about HPV were being female, having secondary or tertiary education, using the private health service, having heard about or seen a campaign about HPV and knowing of the existence of a vaccine against HPV. There is a great deficit of knowledge about HPV and vague information of what is known, favoring actions with a potential risk to personal health, including that of the partner.

Knowledge and attitudes about human papillomavirus and vaccination

Abstract Objective: Uncover knowledge and attitudes of girls, mothers, teachers and health professionals about human papillomavirus and vaccination. Method: A qualitative study carried out by means of focus groups in public elementary schools and health units of Sanitary District IV from Recife-PE, Brazil, between June and July 2015. The sample was six schoolchildren, ten adolescents, nine mothers, ten teachers, thirteen health professionals and seven community health agents. Speeches were analyzed with the technique of Discourse of Collective Subject (DSC), using the Qualiquantisoft, version 1.3c software. Results: Four categories emerged from the DSC: controversial understanding of HPV; transmissibility of HPV virus; adequate knowledge about the vaccine; and education in health. Final considerations: Different levels of knowledge - doubts and misconceptions - about the subject were unveiled. However, attitudes were favorable to adhesion to immunization. Realities that need to be problematized in the educational practice of nurses.

Factors related to non-compliance to HPV vaccination in Roraima-Brazil: a region with a high incidence of cervical cancer

Background

To evaluate the HPV vaccination coverage in Boa Vista, Roraima (Brazil) and to identify personal and socioeconomic factors related to non-compliance to HPV vaccination.

Methods

A school-based, cross-sectional study was conducted by distributing a self-administered questionnaire to the parents or guardians of pre-adolescent girls. The questionnaire addressed compliance to, knowledge about and perception of HPV and the HPV vaccine. Between July and November 2015, 13 private and public schools were visited based on a random cluster sampling method.

Results

A total of 1337 questionnaires were distributed to all female students in the target age group, and 797 were completed and returned (the participation rate was 59.6 %). The vaccination coverage rate was 82.7 % and was higher among public school students than among private school students (84.1 % vs 56.3 %; p = 0.003). Most parents (60 %) incorrectly answered more than half of the questions related to HPV knowledge, and limited knowledge about HPV and the HPV vaccine correlated with lower compliance to vaccination (adjusted OR = 1.42; 95 % CI: 1.01 to 2.76). In the perception analysis, the belief that the HPV vaccine is important for the daughter was an important protective factor (adjusted OR = 0.62; 95 % CI: 0.23 to 0.93), and concern about adverse effects of the HPV vaccine was a risk factor for non-compliance (adjusted OR = 1.66; 95 % CI: 1.01 to 2.71). Family income, religion and education level of the parents or guardians did not correlate with compliance to vaccination.

Conclusion

HPV vaccination coverage was high in Boa Vista, Brazil, but knowledge about the vaccine was deficient. This deficiency was associated with a distorted perception and was negatively associated with compliance to vaccination. Actions aimed at informing the public about the HPV vaccine, including its risks and benefits, are needed to attain higher vaccination coverage in Brazil.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1677-y) contains supplementary material, which is available to authorized users.

Knowledge, attitude and practice of the smear test and its relation with female age

OBJECTIVE

to verify the association among the knowledge attitude and practice of women in relation to the smear test and the age range.

METHOD

a cross-sectional research was undertaken, associated with the knowledge, attitude and practice survey at a Primary Health Care service. The sample consisted of 775 women, distributed in three age ranges: adolescent, young and elderly.

RESULTS

although high rates of inappropriate knowledge were found in all age ranges, it was significantly higher among the adolescents (p=0.000). A similar trend was found in the attitude component, with percentages of inappropriateness in adolescence that drop as age advances (p=0.000). Nevertheless, no statistical difference among the groups was found in terms of practice (p=0.852).

CONCLUSION

the study demonstrated a relation between the age range and knowledge, attitude and practice of the smear test.

OBJETIVO

verificar a associação entre o conhecimento, atitude e prática de mulheres em relação ao exame colpocitológico e a faixa etária.

MÉTODOS

trata-se de pesquisa de corte transversal associada ao inquérito conhecimento, atitude e prática, em uma Unidade de Atenção Primária à Saúde. A amostra foi composta por 775 mulheres, distribuídas em três faixas etárias: adolescentes, jovens e idosas.

RESULTADOS

embora o conhecimento inadequado tenha tido altas taxas em todas as faixas etárias, foi significativamente superior entre as adolescentes (p=0,000). Tendência semelhante no componente atitude por apresentar percentuais de inadequabilidade na adolescência e decair com o avançar da idade (p=0,000). Todavia, não houve diferença estatística entre os grupos quanto à prática (p=0,852).

CONCLUSÃO

o estudo demonstrou relação entre a faixa etária e o conhecimento, a atitude e a prática do exame colpocitológico.

OBJETIVO

verificar la asociación entre el conocimiento, la actitud y práctica de mujeres con relación a la prueba colpocitológica y el rango de edad.

MÉTODO

se trata de investigación trasversal asociada a la encuesta conocimiento, actitud y práctica, en una Unidad de Atención Primaria de Salud. La muestra abarcó a 775 mujeres, distribuidas en tres rangos de edad: adolescentes, jóvenes y ancianas.

RESULTADOS

aunque el conocimiento inadecuado tenga mostrada altas tasas en todos los rangos de edad, fue significativamente superior entre las adolescentes (p=0,000). Tendencia semejante en el componente actitud, debido a porcentajes de inadecuación en la adolescencia, disminuyendo con el avance de la edad (p=0,000). Sin embargo, no fue encontrada diferencia estadística entre los grupos respecto a la práctica (p=0,852).

CONCLUSIÓN

el estudio demostró relación entre el rango de edad y el conocimiento, la actitud y la práctica de la prueba colpocitológica.

Adaptação transcultural do Questionário sobre Conhecimento de Doenças Sexualmente Transmissíveis para o português brasileiro

Objetivo Adaptar o Questionário sobre Conhecimento de Doenças Sexualmente Transmissíveis (STD-KQ) para o português do Brasil. Métodos O instrumento foi traduzido para o português e retraduzido para o inglês de forma independente. Seis juízes avaliaram a validade aparente e a validade de conteúdo. A validade de conteúdo foi mensurada pelo Coeficiente de Validade de Conteúdo para cada item (CVCc) e para o questionário como um todo (CVCt). A discussão com a população foi realizada por meio de grupos focais com 15 usuários de centros comunitários e 15 universitários. A dimensão teórica do instrumento foi calculada pelo coeficiente Kappa. Resultados Um item foi retirado por apresentar baixa validade de conteúdo (CVCc < 0,80). Duas questões sobre sífilis foram acrescentadas. Para dimensão teórica, houve substancial concordância entre os juízes. Conclusão Os resultados mostraram que, para clareza da linguagem (CVCt = 0,89), pertinência prática (CVCt = 0,92) e relevância teórica (CVCt = 0,93), os itens propostos parecem adequados para a realização de futuras investigações sobre a validade de constructo e a fidedignidade, os quais produzirão evidências sobre a aplicabilidade desse questionário para avaliação do conhecimento no tema abordado.

Human papillomavirus vaccines and cervical cancer: awareness, knowledge, and risk perception among Turkish undergraduate students

The aim of this study was to evaluate awareness, knowledge, and risk perception about human papillomavirus (HPV), cervical cancer, and HPV vaccines among undergraduate students in Turkey. The convenience sample of this descriptive cross-sectional study consisted of 605 undergraduate students in Istanbul University during a semester. Demographic characteristics of students, their reproductive health and lifestyle behaviors, and knowledge of HPV and HPV vaccine were questioned using self-administered forms. The overall proportion of students who had heard about HPV infection was 48.8%, while the proportion of students who had heard of the HPV vaccine was 44.5%. Forty eight percent of females and 60% of males reported never having heard of the HPV. Only 45.7% of females had knowledge about HPV as a cause of genital warts, and 58.1% correctly indicated that HPV caused cervical cancer. The majority of students in both genders (>80%) knew that the infection is primarily transmitted through sexual intercourse. Females were more concerned than males about having cervical/penile cancer associated with HPV in the future. Only 46.4% of females and 39% of males reported having heard of the HPV vaccine. The majority of the female and male students did not know who should get the HPV vaccine and when to get vaccinated. Among males, 25.8% reported that they would consider getting vaccinated (if available) and 38.4% intended to vaccinate their children. Turkish undergraduate students had a low to moderate level of knowledge regarding HPV infection and HPV vaccine. In order to increase awareness about HPV and develop positive behaviors, young people should be provided with accurate information through educational activities in the community and health care services.