title: Changes in knowledge of cervical cancer following introduction of human papillomavirus vaccine among women at high risk for cervical cancer.
abstract: OBJECTIVE
  To describe changes in knowledge of cervical cancer prevention, human papillomavirus (HPV), and HPV vaccination among women at high risk for cervical cancer in the first five years after introduction of HPV vaccination.
  
  
  METHODS
  In 2007, 2008-9, and 2011, women in a multicenter U.S. cohort study completed 44-item self-report questionnaires assessing knowledge of cervical cancer prevention, HPV, and HPV vaccination. Results across time were assessed for individuals, and three study enrollment cohorts were compared. Knowledge scores were correlated with demographic variables, measures of education and attention, and medical factors. Associations were assessed in multivariable models.
  
  
  RESULTS
  In all, 974 women completed three serial questionnaires; most were minority, low income, and current or former smokers. The group included 652 (67%) HIV infected and 322 (33%) uninfected. Summary knowledge scores (possible range 0-24) increased from 2007 (12.8, S.D. 5.8) to 2008-9 (13.9, S.D. 5.3, P < 0.001) and to 2011 (14.3, S.D 5.2, P < 0.0001 vs 2007 and <0.04 vs 2008-9). Higher knowledge scores at first and follow-up administration of questionnaires, higher income, and higher education level were associated with improved knowledge score at third administration. Women not previously surveyed had scores similar to those of the longitudinal group at baseline.
  
  
  CONCLUSIONS
  Substantial gaps in understanding of HPV and cervical cancer prevention exist despite years of health education. While more effective educational interventions may help, optimal cancer prevention may require opt-out vaccination programs that do not require nuanced understanding.
authors: Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO.
authors: L Stewart
authors: LS
authors: Massad
authors: Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL and Department of Veterans Affairs Hines Jr. VA Hospital, Hines, IL.
authors: Charlesnika T
authors: CT
authors: Evans
authors: The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL.
authors: Kathleen M
authors: KM
authors: Weber
authors: Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Gypsyamber
authors: G
authors: D'Souza
authors: Departments of Clinical Pharmacy and Medicine, University of California, San Francisco, CA.
authors: Nancy A
authors: NA
authors: Hessol
authors: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
authors: Rodney L
authors: RL
authors: Wright
authors: Department of Obstetrics & Gynecology, Georgetown University School of Medicine, Washington, DC.
authors: Christine
authors: C
authors: Colie
authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors: Howard D
authors: HD
authors: Strickler
authors: Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY.
authors: Tracey E
authors: TE
authors: Wilson
keywords: Human papillomavirus; Pap test; cervical cancer prevention; health education; human immunodeficiency virus in women