Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States, with an infection rate highest among women age 20-24 (Baseman & Koutsky, 2005; Centers for Disease Control and Prevention, 2012; Dunne et al., 2007; Gerend & Magloire, 2012; Weinstock, Berman, & Cates, 2000). Individuals acquire HPV through genital skin-to-skin contact during sex. HPV can lead to genital warts and cervical cancer, as well as less frequently occurring cancers, such as cancer of the anus, penis, vulva, and throat (Bosch, Lorincz, & Munoz, 2002; Centers for Disease Control and Prevention, 2012; Christian, Christian, & Hopenhayn, 2009; Walboomers et al., 1999). In June 2006, the HPV vaccine, Gardasil® (Merck), was approved and released by the U.S. FDA. This vaccine protects against types of HPV responsible for 70% of cervical cancer cases, and types responsible for 90% of genital warts (Centers for Disease Control and Prevention, 2012).
In the United States, the HPV vaccine is recommended at age 11 to 12 (Committee on Infectious Diseases, 2012). Now that the vaccination has been available for several years, many adolescents will get vaccinated in middle school or high school while still living with their parents. Why, then, is it an emerging adulthood issue? Despite availability of the vaccination, some individuals will reach emerging adulthood without yet receiving vaccination. Several factors might determine lack of vaccination –cost/access being an important one. But another factor might be that some adolescents’ parents may not want to vaccinate them due to perceived health risks or religious or moral reasons. For example, as recently as 2010 only 1/3 of adolescent girls in the United States had received at least one HPV vaccination (Committee on Infectious Diseases, 2012; Laz, Rahman, & Berenson, 2012). Thus, an interesting question with this next generation will be what determines whether previously unvaccinated young people choose to get the HPV vaccination after leaving their parents’ home and/or reaching age 18.
We recently published a paper on HPV vaccination: among female college students. Our primary findings were:
· Almost half of female students had received the HPV vaccination by their sophomore year. We collected these data very soon after Gardasil became available, so it was relatively quick uptake for half the sample.
· Vaccination was more likely among students:
° whose mothers were more educated
° who were not African American/Black
° who reported stronger adherence to their religion’s teachings about sex-related principles
° who recently engaged in penetrative sex
The most surprising finding was the positive association between adherence to religion’s teaching and HPV vaccination. Past research suggests that parents who attend religious services more frequently are less likely to intend to vaccinate their children (Barnack, Reddy, & Swain, 2010). Researchers have interpreted this finding to mean that more religious families hesitate to provide their offspring with a vaccination that protects against an STI, given the implication that it might provide more sexual freedom or a license to have sex. However, our reverse findings in emerging adulthood suggest that young women may not only see HPV vaccination as an avenue toward safer sex, but as a more general health issue. It is also possible that more religious women were more concerned than other women about the stigma of STIs, and therefore were more likely to protect themselves.
Overall, the findings provide university health clinics, health care providers who work with emerging adults, and prevention scientists information about groups to target for intervention. Vaccination rates were lower among sexually inexperienced young women. Given that vaccination is more effective if received before the initiation of sexual activity (Centers for Disease Control and Prevention, 2012), sexually inexperienced women should be targeted for intervention. Our findings also suggest that African American/Black young women are particularly important to consider for vaccine education and access. Providing HPV education, access to vaccination, and, when possible, free vaccination programs to young women from lower SES backgrounds is of particular importance.
Although I don’t currently have the data to address it, if I were to follow up this line of research, I would want to examine the following:
o Sexual behaviors subsequent to getting vaccinated (for instance, does vaccination decrease likelihood of using condoms, because students feel less at risk?)
o Now that vaccination has been available for longer, differences between students who enter college already vaccinated, those who choose to get vaccinated after starting college, and those who do not get vaccinated.
o HPV vaccination among young men, comparing rates and correlates for men vs. women
What do you think? Do you think that emerging adults will approach HPV vaccination the way they approach other vaccines? Do you think young men will be as likely to get vaccinated as young women? Share your thoughts in the comments.
The post “Why predictors of HPV vaccination matter beyond early adolescence,” first appeared on the Society for the Study of Emerging Adulthood Sexuality Topic Network blog on September 24, 2014.