title: Behavior in early adolescence and risk of human papillomavirus infection as a young adult: results from a population-based study.
abstract: OBJECTIVE
  The goal of this study was to determine the utility of a risk factor-based approach to human papillomavirus catch-up vaccination.
  
  
  METHODS
  Data from waves I and III of the National Longitudinal Study of Adolescent Health were examined to determine the association between adolescent characteristics and future human papillomavirus infection. Analysis was restricted to 3181 female subjects who were >12 years of age when risk factors were assessed in wave I (1994-1995) and who underwent human papillomavirus testing as young adults in wave III (2001-2002). The main outcome of interest was a positive test result for >or=1 of 4 human papillomavirus types (human papillomavirus-6, -11, -16, or -18) targeted by the human papillomavirus vaccine currently available in the United States. Separate analyses were performed for sexually active and virginal adolescents. Poststratification sampling weights were used to generate nationally representative estimates.
  
  
  RESULTS
  Although nearly one half (43%) of the female adolescents were sexually active in wave I, adolescent sexual activity status was not associated with future detection of vaccine-specific human papillomavirus infection. Furthermore, for both virginal and sexually active adolescents, none of the assessed risk factors was associated with increased odds of future vaccine-specific human papillomavirus infection in multivariate models. Similar results were obtained when all high-risk human papillomavirus types were assessed as the outcome measure.
  
  
  CONCLUSIONS
  Behavioral risk factors assessed during adolescence are inadequate predictors of future infection with vaccine-type human papillomavirus. A risk factor-based approach to human papillomavirus catch-up vaccination is unlikely to be an effective implementation strategy.
authors.affiliation: Department of General Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, 300 North Ingalls Building, Room 6E08, Ann Arbor, MI 48109-0456, USA. adempsey@umich.edu
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Dempsey
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Laura
authors.initials: L
authors.lastname: Koutsky
authors.forename: Lisa
authors.initials: L
authors.lastname: Manhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D030361:Papillomavirus Infections / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior