High-Risk Human Papillomavirus (HPV) Infection and Cervical Cancer Prevention in Britain: Evidence of Differential Uptake of Interventions from a Probability Survey.
BACKGROUND
The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) provides an opportunity to explore high-risk human papillomavirus (HR-HPV) and uptake of cervical screening and HPV vaccination in the general population.


METHODS
Natsal-3, a probability sample survey of men and women ages 16 to 74, resident in Britain, interviewed 8,869 women in 2010 to 2012. We explored risk factors for HR-HPV (in urine from 2,569 sexually experienced women ages 16 to 44), nonattendance for cervical screening in the past 5 years, and noncompletion of HPV catch-up vaccination.


RESULTS
HR-HPV was associated with increasing numbers of lifetime partners, younger age, increasing area-level deprivation, and smoking. Screening nonattendance was associated with younger and older age, increasing area-level deprivation (age-adjusted OR 1.91, 95% confidence interval, 1.48-2.47 for living in most vs. least deprived two quintiles), Asian/Asian British ethnicity (1.96, 1.32-2.90), smoking (1.97, 1.57-2.47), and reporting no partner in the past 5 years (2.45, 1.67-3.61 vs. 1 partner) but not with HR-HPV (1.35, 0.79-2.31). Lower uptake of HPV catch-up vaccination was associated with increasing area-level deprivation, non-white ethnicity, smoking, and increasing lifetime partners.


CONCLUSIONS
Socioeconomic markers and smoking were associated with HR-HPV positivity, nonattendance for cervical screening, and noncompletion of catch-up HPV vaccination.


CONCLUSIONS
The cervical screening program needs to engage those missing HPV catch-up vaccination to avoid a potential widening of cervical cancer disparities in these cohorts. As some screening nonattenders are at low risk for HR-HPV, tailored approaches may be appropriate to increase screening among higher-risk women.
Research Department of Infection and Population Health, University College London, London, United Kingdom. c.tanton@ucl.ac.uk.
Clare
C
Tanton
Centre for Infectious Disease Surveillance & Control (CIDSC), Public Health England, London, United Kingdom.
Kate
K
Soldan
Virus Reference Department, Public Health England, London, United Kingdom.
Simon
S
Beddows
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Catherine H
CH
Mercer
Cancer Research UK Health Behaviour Research Centre, Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
Jo
J
Waller
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Nigel
N
Field
Research Department of Infection and Population Health, University College London, London, United Kingdom. NatCen Social Research, London, United Kingdom.
Soazig
S
Clifton
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Andrew J
AJ
Copas
Virus Reference Department, Public Health England, London, United Kingdom.
Kavita
K
Panwar
Virus Reference Department, Public Health England, London, United Kingdom.
Precious
P
Manyenga
Virus Reference Department, Public Health England, London, United Kingdom.
Filomeno
F
da Silva
Centre for Sexual and Reproductive Health Research, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Kaye
K
Wellings
Sexually Transmitted Bacteria Reference Unit, Public Health England, London, United Kingdom.
Catherine A
CA
Ison
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Anne M
AM
Johnson
Research Department of Infection and Population Health, University College London, London, United Kingdom.
Pam
P
Sonnenberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011336:Probability; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
D053918:Papillomavirus Vaccines