title: Equity in human papilloma virus vaccination uptake?: sexual behaviour, knowledge and demographics in a cross-sectional study in (un)vaccinated girls in the Netherlands.
abstract: BACKGROUND
  In the Netherlands, human papillomavirus (HPV) vaccination is part of a national program equally accessible for all girls invited for vaccination. To assess possible inequalities in vaccine uptake, we investigated differences between vaccinated and unvaccinated girls with regard to various characteristics, including education and ethnicity, (both associated with non-attendance to the national cervical screening program), sexual behaviour and knowledge of HPV.
  
  
  METHODS
  In 2010, 19,939 nationwide randomly-selected 16-17 year-old girls (2009 vaccination campaign) were invited to fill out an online questionnaire. A knowledge scale score and multivariable analyses identified variables associated with vaccination status.
  
  
  RESULTS
  2989 (15%) of the selected girls participated (65% vaccinated, 35% unvaccinated). The participants were comparable with regard to education, ethnicity, most sexual risk behaviour and had similar knowledge scores on HPV transmission and vaccination. However, unvaccinated girls lived in more urbanised areas and were more likely to have a religious background. Irrespective of vaccination status, 81% of the girls were aware of the causal relationship between HPV and cervical cancer, but the awareness of the necessity of cervical screening despite being vaccinated was limited.
  
  
  CONCLUSIONS
  HPV vaccine uptake was not associated with knowledge of HPV and with factors that are known to be associated with non-attendance to the cervical cancer screening program in the Netherlands. Furthermore, most sexual behaviour was not related to vaccination status meaning that teenage unvaccinated girls were not at a disproportionally higher risk of being exposed to HPV. Routine HPV vaccination may reduce the social inequity of prevention of cervical cancer.
authors.forename: Madelief
authors.initials: M
authors.lastname: Mollers
authors.forename: Karin
authors.initials: K
authors.lastname: Lubbers
authors.forename: Symen K
authors.initials: SK
authors.lastname: Spoelstra
authors.forename: Willibrord C M
authors.initials: WC
authors.lastname: Weijmar-Schultz
authors.forename: Toos
authors.initials: T
authors.lastname: Daemen
authors.forename: Tjalke A
authors.initials: TA
authors.lastname: Westra
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Hans W
authors.initials: HW
authors.lastname: Nijman
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
authors.affiliation: Department of Medical Microbiology, Molecular Virology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. a.tami@umcg.nl.
authors.forename: Adriana
authors.initials: A
authors.lastname: Tami
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines