title: Sexually related behaviors as predictors of HPV vaccination among young rural women.
abstract: OBJECTIVE
  To explore whether sexually related behaviors predict refusal of the human papillomavirus (HPV) vaccine among a sample of women aged 18-26 in Appalachian Kentucky.
  
  
  METHODS
  Using a convenience sample, young women attending health clinics and a community college in southeastern Kentucky were recruited to participate in a Women's Health Study. After completing a questionnaire, women received a free voucher for the three-dose HPV vaccine series. Completion of dose one served as the outcome variable.
  
  
  RESULTS
  Women with a history of an abnormal Pap test were almost two times more likely to decline the HPV vaccine (adjusted odds ratio [AOR] 1.91, 95% confidence interval [CI] 1.14-3.20, p=0.015), and women who reported they had never had a Pap test were four times more likely to decline the vaccine (AOR 4.02, 95% CI 1.13-14.32, p=0.032). Women engaging in mutual masturbation were nearly two times more likely to decline the free vaccine (AOR 1.91, 95% CI 1.17-3.10, p=0.009). Use of hormonal birth control showed a protective effect against refusal of the free HPV vaccine (AOR 0.593, 95% CI 0.44-0.80, p=0.001).
  
  
  CONCLUSIONS
  Among this sample of Appalachian women, those engaging in behaviors that increase their risk for HPV infection were more likely to refuse the vaccine. Conversely, those women engaging in protective health behaviors were more likely to accept the vaccine. These findings suggest that those women not being vaccinated may be the very group most likely to benefit from vaccination. Cervical cancer prevention programs need to be creative in efforts to reach young women most in need of the vaccine based on a higher profile of sexually related behaviors and the proxy measure of this risk (having an abnormal Pap test result).
authors.affiliation: University of Kentucky College of Public Health, Department of Health Behavior, Lexington, Kentucky 40504, USA. lami223@kcr.uky.edu
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Mills
authors.forename: Robin C
authors.initials: RC
authors.lastname: Vanderpool
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
mesh_terms: D000328:Adult; D001061:Appalachian Region; D001294:Attitude to Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000523:psychology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000523:psychology; D016387:Women's Health; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines