title: Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11-12 year-old girls.
abstract: OBJECTIVE
  Among 11-12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls' risk perceptions, attitudes, and behavior.
  
  
  METHODS
  Girls and mothers (n=25dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls' 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis.
  
  
  RESULTS
  Girls' baseline knowledge was poor but often improved with time. Most girls (n=18) developed accurate risk perceptions about HPV but only half (n=12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions.
  
  
  CONCLUSIONS
  Higher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.
authors.affiliation: Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, MLC 4000, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 3235 Eden Avenue, P.O. Box 670555, Cincinnati, OH 45267, USA. Electronic address: Tanya.mullins@cchmc.org.
authors.forename: Tanya L Kowalczyk
authors.initials: TL
authors.lastname: Mullins
authors.affiliation: Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, MLC 4000, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 3235 Eden Avenue, P.O. Box 670555, Cincinnati, OH 45267, USA.
authors.forename: Lea E
authors.initials: LE
authors.lastname: Widdice
authors.affiliation: Departments of Pediatrics and Psychiatry, Columbia University and New York Presbyterian Morgan Stanley Children's Hospital, 622 West 168 Street, Vanderbilt Clinic 4th Floor, Room 402, New York, NY 10032, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenthal
authors.affiliation: Division of Adolescent Medicine, Indiana University, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Zimet
authors.affiliation: Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, MLC 4000, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 3235 Eden Avenue, P.O. Box 670555, Cincinnati, OH 45267, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Kahn
mesh_terms: D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D009035:Mothers; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012725:Sexual Behavior; D014611:Vaccination / Q000523:psychology*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; Clinicians; Human papillomavirus (HPV) vaccine; Knowledge; Mothers; Sexual attitudes