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

Hansen, Bo T.; Kjær, Susanne K.; Arnheim-Dahlström, Lisen; Liaw, Kai Li; Jensen, Kirsten Egebjerg; Thomsen, Louise T.; Munk, Christian; Nygård, Mari

doi:10.1016/j.vaccine.2014.07.025

Cited by 50 publications

(48 citation statements)

References 28 publications

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“…In a prior study, nearly half of mothers who had talked to their daughters about the HPV vaccine reported that the vaccine discussion led to a discussion about sex. 35 The results of this study, combined with those of previous studies, 13–16,36 suggest that clinicians can reassure parents that HPV vaccination does not lead to riskier sexual attitudes and that in fact the vaccination visit can be utilized by clinicians to promote healthier sexual behaviors.…”

Section: Discussionsupporting

confidence: 59%

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls

Mullins

Widdice

Rosenthal

et al. 2015

Vaccine

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Objectives Among 11–12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: 1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; 2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; and 3) whether mothers, clinicians, and media influenced girls’ risk perceptions, attitudes, and behavior. Methods Girls and mothers (n=25 dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls’ 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis. Results Girls’ baseline knowledge was poor but often improved with time. Most girls (n=18) developed accurate risk perceptions about HPV but only half (n=12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions. Conclusions Higher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.

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Section: Discussionsupporting

confidence: 59%

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls

Mullins

Widdice

Rosenthal

et al. 2015

Vaccine

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“…A UK-based study by Bowyer et al 74 demonstrated that there was no association between HPV vaccine uptake and age of sexual debut or sexual activity in adolescent girls, and a Scandinavian study found that women who were vaccinated before or at the same age as sexual debut did not subsequently engage more in sexual risk-taking behaviour than those who did not receive the HPV vaccine. 75 Several studies reported significantly greater levels of HPV disease-related knowledge in individuals who had received the HPV vaccine versus unvaccinated peers. However, the general level of knowledge was reported to be low, and misconceptions were commonplace, with some individuals even confusing HPV and HIV.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…The study population in the postvaccination survey has been described previously (Hansen et al, 2014). Briefly, in the Scandinavian countries, all residents are registered in nationwide population registries with a unique personal identification number.…”

Section: Study Populationmentioning

confidence: 99%

Awareness of human papillomavirus after introduction of HPV vaccination: a large population-based survey of Scandinavian women

Thomsen

Nygård

Stensen

et al. 2017

European Journal of Cancer Prevention

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Using a large, population-based survey, we assessed the levels and correlates of human papillomavirus (HPV) awareness among Scandinavian women after introduction of HPV vaccination. In 2011-2012, a random sample of women aged between 18 and 45 years from Denmark, Sweden and Norway received a questionnaire on lifestyle, health and HPV awareness. We included 47 895 women (response rate 60.6%) in our study. Country-specific and age-specific proportions of women who had heard of HPV in 2011-2012 (postvaccination survey) were compared with corresponding proportions in an identical survey from 2004-2005 (prevaccination survey, n=54 079, response rate 71.3%). Correlates of HPV awareness in the postvaccination survey were assessed by logistic regression. In all countries and age groups, awareness of HPV increased from the prevaccination to the postvaccination survey. In the postvaccination survey, HPV awareness was higher in Denmark (75.8%) and Sweden (74.8%) compared with Norway (62.4%), with greatest discrepancy among women aged between 18 and 19 years (Denmark: 74.9%, Sweden: 70.4%, Norway: 39.6%). Variables associated with low HPV awareness included the following: low education [≤12 vs. >16 years of schooling: odds ratio (OR)=0.45, 95% confidence interval (CI): 0.42-0.48], being a virgin (vs. nonvirgins: OR=0.74, 95% CI: 0.66-0.83), never having used condoms (vs. ever: OR=0.62, 95% CI: 0.56-0.67), nonuse of contraception at first intercourse (vs. use: OR=0.83, 95% CI: 0.79-0.88) and daily smoking (vs. never: OR=0.86, 95% CI: 0.80-0.92). HPV awareness in Scandinavia has increased since the introduction of HPV vaccination. However, 24-38% of Scandinavian women still have never heard of HPV. Future information efforts should target groups with low HPV awareness.

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

Abstract: 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.

Cited by 50 publications

References 28 publications

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls

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

Awareness of human papillomavirus after introduction of HPV vaccination: a large population-based survey of Scandinavian women

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