Uptake of free HPV vaccination among young women: a comparison of rural versus urban rates.

PURPOSE: To contrast rates of initial HPV vaccine uptake, offered at no cost, between a rural clinic, a rural community college, and an urban college clinic and to identify rural versus urban differences in uptake of free booster doses. METHODS: Young rural women attending rural clinics (n = 246), young women attending a rural community college (n = 251) and young women attending an urban university health clinic (n = 209) were recruited in Kentucky. After completing a brief questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for the initial dose of vaccine served as the study outcome variable. FINDINGS: In controlled analyses, the contrast in initial uptake between urban clinic women (reference category) and rural college women was significant (P < .0001). However, the contrast in initial uptake between urban clinic women (reference category) and rural clinic women was not significant (P = .42). The model predicting uptake of subsequent doses among those with initial uptake (n = 235) also indicated significant differences as a function of recruitment location, with rural clinic women being about 7 times more likely than urban clinic women (P < .0001) to not return for at least 1 follow-up dose. The contrast between urban clinic women and rural college women was also significant (P = .014). CONCLUSION: Initial uptake of free HPV vaccination among young rural college women may be problematic. Moreover, uptake of subsequent free doses among rural women may be problematic regardless of whether contact is made in a clinic or through college recruitment.

Low rates of free human papillomavirus vaccine uptake among young women.

OBJECTIVE: To determine uptake of quadrivalent human papillomavirus recombinant vaccine (quadrivalent; Gardasil((R)), Merck, New Jersey, USA) offered under optimal conditions to women 18 to 24 years of age, and to identify predictors of uptake. METHODS: Young women (n = 209) were recruited from a university health clinic. After completing a self-administered questionnaire, women received a free voucher for the entire vaccine series. RESULTS: Only 59 women (28.2%) who were offered this free service completed the series. Just over half (50.7%) received the first dose. Of those, 78.3% returned to receive the second and 55.7% returned for the third. Young women who felt their mothers might not want them to be vaccinated were much less likely to complete the series compared with those who felt their mothers would 'definitely' want them to be vaccinated (P = 0.0002). Also, young women who indicated that they would take the time to return to the clinic for doses two and three were far more likely to complete the series (P = 0.0004). Several measures failed to achieve even bivariate significance with vaccine uptake, including being sexually active in the past 12 months, ever having a Pap test or an abnormal Pap test result, and ever having a sexually transmissible infection. CONCLUSIONS: Even under ideal conditions, uptake of Gardasil among women 18-24 years of age may be quite low. Maternal endorsement and young women's perceptions about the time needed to return for subsequent doses are important determinants of vaccine uptake. Fortunately, these two determinants lend themselves to intervention efforts.

Pap smear knowledge among young women following the introduction of the HPV vaccine.

STUDY OBJECTIVE: Investigate sexually active young women's knowledge of the term Pap smear since development of the HPV vaccine. DESIGN: Cross-sectional study conducted January-May 2007. SETTING: University health services clinic at a university in southern United States. PARTICIPANTS: Sexually active women, age 18-24, presenting for a Pap smear or STD testing (N=145). MAIN OUTCOME MEASURES: Pap smear knowledge was assessed by participants' written definition of the term Pap smear and by multiple choice responses indicating Pap smear as a test for cervical cancer/ HPV and not a pelvic exam, STD test, or pregnancy test. RESULTS: 9.7% provided accurate definitions; 12.4% checked appropriate Pap smear synonyms. 68.5% incorrectly responded that Pap smear was the same as "pelvic exam"; 42.5% indicated "STD test"; 11.7% indicated "pregnancy test." Indicators of HPV risk (age of sexual debut, previous abnormal Pap smear, previous STD diagnosis) were not associated with knowledge. Never using condoms, increasing age, and lower depression scores predicted accurate Pap smear definition rating (R2=0.08). Never using condoms, Caucasian race, and decreased lifetime number of sex partners predicted accurate identification of Pap smear synonyms (R2=0.15). RESULTS: Few participants understood the meaning of the term Pap smear; there does not appear to be improvement in women's knowledge after development of the HPV vaccine. Poor Pap smear knowledge may affect young women's understanding of their overall sexual health.

Young women's misperceptions about sexually transmissible infection testing: a 'clean and clear' misunderstanding.

BACKGROUND: This exploratory study investigated young women's perceptions of sexually transmissible infection (STI) testing received during gynaecological care. Correlates of the incorrect perception that STI testing occurred were assessed. METHODS: Cross-sectional study of sexually active young women, age 18-24 years, attending a university healthcare setting for gynaecological care (n = 109). Two hundred and four women were approached and 87 were ineligible; of the remaining 117, 93.2% chose to enrol. RESULTS: Of the women enrolled, 25.7% falsely perceived that they were STI tested (labelled 'clean and clear'). Only approximately one in seven (14.7%) accurately understood the STI for which they were tested. In multivariate analyses, controlling for race, STI symptoms, depression, number of lifetime visits to the gynaecologist, and suspicion of current STI, three variables were significant: minority race (adjusted odds ratio (AOR) = 4.84, confidence interval (CI) = 1.38-16.96, P = 0.01), earlier age at sexual debut (AOR = 4.67, CI = 1.73-12.57, P = 0.002), and previous STI diagnosis (AOR = 3.38, CI = 1.07-10.66, P = 0.04). COMMENT: The findings suggest that many young women may have an inaccurate understanding of the STI testing they undergo during gynaecological care and may operate under the misperception they are 'clean and clear' of STI. Women with said misperception were more likely to be of minority race and report relatively earlier age of sexual debut and previous STI diagnosis. Further investigation is warranted to determine whether the 'clean and clear' misperception influences young women's sexual risk behaviour.