title: Romanian adolescents' knowledge and attitudes towards human papillomavirus infection and prophylactic vaccination.
abstract: OBJECTIVE
  Since licensure of HPV vaccine in 2006, HPV vaccine coverage among Romanian adolescents remains worryingly low. The objectives of the study were to assess the knowledge and attitudes towards HPV infection and vaccination among Romanian adolescents and to explore the barriers to HPV vaccination with a view to developing strategies for expanding primary HPV infection prevention.
  
  
  METHODS
  This study was conducted in Bucharest between April and June 2015. A total of 524 adolescents aged 16-18 years old were recruited from the first two general highschools in Bucharest (according to the admission grade) and completed a self-administered questionnaire including demographics, HPV related and Papanicolau smear test knowledge. Odds ratio and 95% confidence intervals were used to identify the strength of association. Logistic regression analysis was used to identify the effect of demographic characteristics on the level of knowledge and HPV vaccination rate. Associations were considered statistically significant at p<0.05.
  
  
  RESULTS
  Of the adolescents interviewed, a very small proportion had heard of HPV infection, HPV vaccine and Papanicolau smear test, that is, 20.22%, 67.92% and 22.9%, respectively. The overall vaccination rate for this group was 2.3%. The most common reason for not receiving the HPV vaccine was the lack of information (80.6%) followed by parents' concerns regarding safety (11%), fear of pain (5.59%) and not being sexually active (2.7%). However, 97.7% of the respondents declared interest in receiving more information about HPV. According to demographic characteristics, age at first sexual intercourse over 16 years old, monthly household income over one thousand euros and self-perceived good relationship with family members were statistically associated on a multivariate logistic regression analysis with a high HPV knowledge score and rate of vaccination.
  
  
  CONCLUSIONS
  This study shows a low level of knowledge about HPV infection and prophylactic vaccination among Romanian adolescents which may be one of the most important factors for the alarmingly low HPV vaccination rate. We specifically call for HPV knowledge and awareness programs; the implication of health professionals, Romanian media and family members should be included as a centrepiece in the effort to inform this vulnerable population group.
authors.affiliation: University Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sârbu", Department of Obstetrics and Gynecology IV, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. Electronic address: calinamaier@yahoo.com.
authors.forename: Călina
authors.initials: C
authors.lastname: Maier
authors.affiliation: University Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sârbu", Department of Obstetrics and Gynecology IV, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Traian
authors.initials: T
authors.lastname: Maier
authors.affiliation: University Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sârbu", Department of Obstetrics and Gynecology IV, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Cristina E
authors.initials: CE
authors.lastname: Neagu
authors.affiliation: Elias University Emergency Hospital, Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Vlădăreanu
mesh_terms: D000293:Adolescent; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D012383:Romania; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; HPV infection and vaccination; Health education; Knowledge