HPV Vaccination among Teens

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) in the United States. HPV has a prevalence of 29.5% in sexually experienced girls 14 to 19 years of age. Sequelae of HPV infection may include genital warts, cervical dysplasia, and, with long-term viral persistence, cervical cancer. In 2006, the US Food and Drug Administration licensed the first prophylactic HPV vaccine. This quadrivalent vaccine, which induces immunity to 2 HPV types associated with genital warts (HPV-6 and -11) and 2 HPV types associated with cervical cancer (HPV-16 and -18), is recommended for girls aged 11 to 12 years, with catch-up immunization to 26 years of age. A bivalent prophylactic HPV vaccine, which induces immunity to HPV-16 and -18, was licensed in 2009. Since vaccines for HPV have been widely available, there has been no study examining whether the vaccine has any impact on adolescent perceptions of risk, which may affect sexual behavior as a result. The objectives of this study [Arch Pediatr Adolesc Med. 2012;166(1):82-88] were to examine perceptions of risk of HPV and other STIs, to examine perceived need for safer sexual behaviors, and to determine factors associated with less perceived need for safer sexual behaviors, all in the context of receiving the first HPV vaccination. The study reported baseline findings from an ongoing longitudinal cohort study examining the long-term attitudinal and behavioral impact of HPV vaccination in adolescent girls. Participants were consecutively recruited from a hospital-based adolescent primary care office in urban Cincinnati, Ohio. Eligible participants were aged 13 to 21 years, had received their first voluntary HPV vaccination within 2 days of study enrollment, and were willing to participate in a 30-month study. Mothers or female legal guardians of participants were invited to enroll. A total of 406 girls were approached for enrollment; 339 (83.5%) girls and their mothers (n=253) agreed to participate. Girls who enrolled did not differ from girls who declined enrollment with respect to age, race, and ethnicity. However, girls who declined enrollment were more likely to lack health insurance than girls who enrolled (8.6% vs 0%) and were less likely to have public insurance (62.1% vs 74.9%). Mean age of the enrolled girls was 16.8 years, and 259 (76.4%) were black; 57.5% of the girls were sexually experienced. Main outcome measures were girls’ perceived risk of HPV after HPV vaccination, girls’ perceived risk of other STIs after vaccination, girls’ perceived need for continued safer sexual behaviors after vaccination, and factors associated with girls’ perception of less need for safer sexual behaviors. Slightly more than half of the girls (50.7%) had a mean scale score ≥9 for perceived need for safer sexual behaviors, which correlates with the highest 10% of possible scores for that scale. For perceived need for safer sexual behaviors, only 3.8% of girls had a mean scale score <5. For perceived risk of STIs, 23.6% of girls had a mean scale score <5. Overall, girls perceived themselves to be at less risk for HPV than for other STIs after HPV vaccination (paired t test; P<.001). Although most girls reported continued need for safer sexual behaviors, factors independently associated with perception of less need for safer sexual behaviors included adolescent factors (lower HPV and HPV vaccine knowledge and less concern about HPV) and maternal factors (lower HPV and HPV vaccine knowledge, physician as a source of HPV vaccine information, and lack of maternal communication about the HPV vaccine). A total of 235 mothers participated in the study. Univariable logistic regression models demonstrated that several maternal factors were associated with girls’ perception of less need for safer sexual behaviors (P<.05), including knowledge, educational attainment, attitudes, and source of HPV vaccine information. Contrary to the authors’ original hypothesis, maternal history of an abnormal Papanicolaou test result and maternal communication regarding Papanicolaou testing and sexual behavior were not associated with girls’ perception of need for safer sexual behaviors.