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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Changes in (risk) behavior and HPV knowledge among Dutch girls eligible for HPV vaccination: an observational cohort study

Authors: Robine Donken, Adriana Tami, Mirjam J. Knol, Karin Lubbers, Marianne A. B. van der Sande, Hans W. Nijman, Toos Daemen, Willibrord C. M. Weijmar Schultz, Hester E. de Melker

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Implementation of human papillomavirus (HPV) vaccination raised concerns that vaccination could lead to riskier sexual behavior. This study explored how possible differences in sexual behavior and HPV knowledge developed over time between HPV-vaccinated and unvaccinated girls.

Methods

A random sample of 19,939 girls (16–17 year olds) eligible for the catch-up HPV vaccination campaign in the Netherlands was invited for a longitudinal study with questionnaires every 6 months over a two-year follow-up period. Possible differences over time between vaccinated and unvaccinated participants were studied using generalized equations estimation (GEE).

Results

A total of 2989 girls participated in round one, of which 1574 participated (52.7%) in the final 5th round. Vaccinated girls were more likely to live in more urban areas (OR 1.28, 95%CI 1.10–1.47) and to use alcohol (OR 1.46, 95%CI 1.24–1.70) and contraceptives (OR 1.69, 95%CI 1.45–1.97). Vaccinated and unvaccinated girls showed comparable knowledge on HPV, HPV vaccination, and transmission. Vaccinated girls were more likely to be sexually active (OR 1.19, 95%CI 1.02–1.39), and this difference increased over time (OR for interaction 1.06, 95%CI 1.00–1.12). However, they had a slightly lower number of lifetime sexual partners (mean difference − 0.20, 95%CI -0.41-0.00). Vaccinated girls were less likely to use a condom with a steady partner (aOR 0.71, 95%CI 0.56–0.89). However, the difference between vaccinated and unvaccinated girls with regard to condom use with casual or steady partner(s) did not significantly change over time.

Conclusion

Overall, we did not find indications that vaccination influenced sexual behavior in girls during 2 years of follow-up. The few differences found may be related to existing disparities in the socio-demographic characteristics of the young population pointing to the importance and improvement of education with regard to safe sex practices. Our findings do not suggest that vaccination status is associated with changes in sexual risk behavior and thus it is unlikely that this might influence the effectiveness of the vaccination program.
Literature
1.
zur Hausen H, Gissmann L, Steiner W, Dippold W, Dreger I. Human papilloma viruses and cancer. Bibl Haematol. 1975;(43):569–71. PMID:183728.
2.
Syrjanen K, Hakama M, Saarikoski S, Vayrynen M, Yliskoski M, Syrjanen S, Kataja V, Castren O. Prevalence, incidence, and estimated life-time risk of cervical human papillomavirus infections in a nonselected Finnish female population. Sex Transm Dis. 1990;17(1):15–9.CrossRefPubMed
3.
de Melker HE, Conyn-van Spaendonck MAE, Coutinho RA, Boot HJ. Introductie van vaccinatie tegen baarmoederhalskanker [Introduction to vaccination against cervical cancer]. Ned Tijdschr Geneeskd. 2009;153(14):658-61.
4.
van Lier A: Vaccinatiegraad Rijksvaccinatieprogramma Nederland, Verslagjaar 2011; 2012.
5.
Forster AS, Marlow LA, Stephenson J, Wardle J, Waller J. Human papillomavirus vaccination and sexual behaviour: cross-sectional and longitudinal surveys conducted in England. Vaccine. 2012;30(33):4939–44.CrossRefPubMed
6.
Brabin L, Roberts SA, Stretch R, Baxter D, Chambers G, Kitchener H, McCann R. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ. 2008;336(7652):1056–8.CrossRefPubMedPubMedCentral
7.
Etter DJ, Zimet GD, Rickert VI. Human papillomavirus vaccine in adolescent women: a 2012 update. Curr Opin Obstet Gynecol. 2012;24(5):305–10.CrossRefPubMed
8.
Marlow LA, Forster AS, Wardle J, Waller J. Mothers’ and adolescents’ beliefs about risk compensation following HPV vaccination. J Adolesc Health. 2009;44(5):446–51.CrossRefPubMed
9.
Mayer MK, Reiter PL, Zucker RA, Brewer NT. Parents’ and sons’ beliefs in sexual disinhibition after human papillomavirus vaccination. Sex Transm Dis. 2013;40(10):822–8.CrossRefPubMedPubMedCentral
10.
Ogilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielak KL, Ehlen TG, Dobson SR, Money DM, Patrick DM. Parental intention to have daughters receive the human papillomavirus vaccine. CMAJ. 2007;177(12):1506–12.CrossRefPubMedPubMedCentral
11.
12.
Kasting ML, Shapiro GK, Rosberger Z, Kahn JA, Zimet GD. Tempest in a teapot: a systematic review of HPV vaccination and risk compensation research. Hum Vaccine Immunother. 2016;12(6):1435–50.CrossRef
13.
14.
Mullins TL, Widdice LE, Rosenthal SL, Zimet GD, Kahn JA. Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11-12 year-old girls. Vaccine. 2015;33(32):3907–12.CrossRefPubMedPubMedCentral
15.
Mullins TL, Zimet GD, Rosenthal SL, Morrow C, Ding L, Shew M, Fortenberry JD, Bernstein DI, Kahn JA. Adolescent perceptions of risk and need for safer sexual behaviors after first human papillomavirus vaccination. Arch Pediatr Adolesc Med. 2012;166(1):82–8.CrossRefPubMedPubMedCentral
16.
Montgomery MP, Dune T, Shetty PK, Shetty AK. Knowledge and acceptability of human papillomavirus vaccination and cervical cancer screening among women in Karnataka, India. J Cancer Educ. 2015;30(1):130–7.CrossRefPubMed
17.
Liddon NC, Leichliter JS, Markowitz LE. Human papillomavirus vaccine and sexual behavior among adolescent and young women. Am J Prev Med. 2012;42(1):44–52.CrossRefPubMed
18.
Rysavy MB, Kresowik JD, Liu D, Mains L, Lessard M, Ryan GL. Human papillomavirus vaccination and sexual behavior in young women. J Pediatr Adolesc Gynecol. 2014;27(2):67–71.CrossRefPubMed
19.
Smith LM, Kaufman JS, Strumpf EC, Levesque LE. Effect of human papillomavirus (HPV) vaccination on clinical indicators of sexual behaviour among adolescent girls: the Ontario grade 8 HPV vaccine cohort study. CMAJ. 2015;187(2):E74–81.CrossRefPubMedPubMedCentral
20.
Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012;130(5):798–805.CrossRefPubMed
21.
Sadler L, Roberts SA, Hampal G, McManus D, Mandal D, Brabin L. Comparing risk behaviours of human papillomavirus-vaccinated and non-vaccinated women. J Fam Plann Reprod Health Care. 2015;41(4):255–8.CrossRefPubMed
22.
Cummings T, Zimet GD, Brown D, Tu W, Yang Z, Fortenberry JD, Shew ML. Reduction of HPV infections through vaccination among at-risk urban adolescents. Vaccine. 2012;30(37):5496–9.CrossRefPubMedPubMedCentral
23.
Ratanasiripong NT. Human papillomavirus vaccine increases high-risk sexual behaviors: a myth or valid concern. J Sch Nurs. 2014;30(6):456–63.CrossRefPubMed
24.
Mollers M, Lubbers K, Spoelstra SK, Weijmar-Schultz WC, Daemen T, Westra TA, van der Sande MA, Nijman HW, de Melker HE, Tami A. Equity in human papilloma virus vaccination uptake?: sexual behaviour, knowledge and demographics in a cross-sectional study in (un)vaccinated girls in the Netherlands. BMC Public Health. 2014;14:288.CrossRefPubMedPubMedCentral
25.
26.
van Lier A, Oomen P, de Hoogh P, Drijfhout I, Elsinghorst B, Kemmeren J, Conyn-van Spaendonck M, de Melker H. Præventis, the immunisation register of the Netherlands: a tool to evaluate the National Immunisation Programme. Euro surveill. 2012;17(17). PMID: 22551495.
27.
Mattebo M, Grun N, Rosenblad A, Larsson M, Haggstrom-Nordin E, Dalianis T, Tyden T. Sexual experiences in relation to HPV vaccination status in female high school students in Sweden. Eur J Contracept Reprod Health Care. 2014;19(2):86–92.CrossRefPubMed
28.
Marchand E, Glenn BA, Bastani R. HPV vaccination and sexual behavior in a community college sample. J Community Health. 2013;38(6):1010–4.CrossRefPubMed
29.
Lutringer-Magnin D, Kalecinski J, Cropet C, Barone G, Ronin V, Regnier V, Leocmach Y, Jacquard AC, Vanhems P, Chauvin F, et al. Prevention of sexually transmitted infections among girls and young women in relation to their HPV vaccination status. Eur J Pub Health. 2013;23(6):1046–53.CrossRef
30.
Ruiz-Sternberg AM, Pinzon-Rondon AM. Risk perception and sexual behavior in HPV-vaccinated and unvaccinated young Colombian women. Int J Gynaecol Obstet. 2014;126(3):205–8.CrossRefPubMed
31.
Hansen BT, Kjaer SK, Arnheim-Dahlstrom L, Liaw KL, Jensen KE, Thomsen LT, Munk C, Nygard M. Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: evidence from a large survey of Nordic women. Vaccine. 2014;32(39):4945–53.CrossRefPubMed
32.
Madhivanan P, Pierre-Victor D, Mukherjee S, Bhoite P, Powell B, Jean-Baptiste N, Clarke R, Avent T, Krupp K. Human papillomavirus vaccination and sexual Disinhibition in females: a systematic review. Am J Prev Med. 2016;51(3):373–83.CrossRefPubMed
33.
Jena AB, Goldman DP, Seabury SA. Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females. JAMA Intern Med. 2015;175(4):617–23.CrossRefPubMedPubMedCentral
34.
de Graaf H. et al.: Seks onder je 25e; 2012.
35.
de Graaf H. et al.: Seks onder je 25e; 2005.
36.
Brown B, Blas MM, Heidari O, Carcamo C, Halsey NA. Reported changes in sexual behaviour and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial. Int J STD AIDS. 2013;24(7):531–5.CrossRefPubMed
37.
Romaih WRASA, Shahahmasebi S, Omar HA. No significant change in sexual behavior in association with human papilloma virus vaccination in young girls. Int J Child Adolesc Health. 2011;4(4):351–5.
38.
Rondy M, van Lier A, van de Kassteele J, Rust L, de Melker H. Determinants for HPV vaccine uptake in the Netherlands: a multilevel study. Vaccine. 2010;28(9):2070–5.CrossRefPubMed
39.
Sopracordevole F, Cigolot F, Mancioli F, Agarossi A, Boselli F, Ciavattini A. Knowledge of HPV infection and vaccination among vaccinated and unvaccinated teenaged girls. Int J Gynaecol Obstet. 2013;122(1):48–51.CrossRefPubMed
40.
Lenselink CH, Schmeink CE, Melchers WJ, Massuger LF, Hendriks JC, van Hamont D, Bekkers RL. Young adults and acceptance of the human papillomavirus vaccine. Public Health. 2008;122(12):1295–301.CrossRefPubMed
Metadata
Title
Changes in (risk) behavior and HPV knowledge among Dutch girls eligible for HPV vaccination: an observational cohort study
Authors
Robine Donken
Adriana Tami
Mirjam J. Knol
Karin Lubbers
Marianne A. B. van der Sande
Hans W. Nijman
Toos Daemen
Willibrord C. M. Weijmar Schultz
Hester E. de Melker
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5745-6

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