title: Vaccination against Human Papillomavirus in relation to Financial Crisis: The "Evaluation and Education of Greek Female Adolescents on Human Papillomaviruses' Prevention Strategies" ELEFTHERIA Study.
abstract: OBJECTIVE
  In this study we aimed to explore financial and other sociodemographic factors that affect nonvaccination against the human papillomavirus (HPV) in Greece, one of the first European Union countries to introduce the vaccination against HPV into its National Immunization Programme in 2008. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Six hundred thirty-two female adolescents (aged 11-16 years) from Greece completed a pilot cross-sectional questionnaire-based survey (ELEFTHERIA study) from 2008 to 2014.
  
  
  RESULTS
  Overall, only 8.9% (56 of 632) of the female adolescents reported that they had received all 3 doses of the HPV vaccination. The HPV vaccination uptake rates increased gradually from 3.2% (3 of 95) in 2008 to 17.1% (14 of 82) in 2011. However, it abruptly decreased to 2.1% (2 of 95) in 2012 and it reached 9.2% (8 of 87) in 2013 and 11.5% (11 of 96) in 2014. The most common factors for nonvaccination included fear of side effects, which decreased (Spearman ρ = -0.860; P = .024) and financial issues, which increased statistically significantly (Spearman ρ = 0.890; P = .012) during the years 2008 to 2014.
  
  
  CONCLUSIONS
  In our study we addressed the novel topic of the association of financial issues with HPV vaccination compliance and highlighted the urgent need to provide and maintain health insurance coverage to children in Greece, a country in financial crisis.
authors.affiliation: Department of Clinical Virology, School of Medicine, University of Crete, Heraklion, Heraklion, Greece. Electronic address: mammasjo@googlemail.com.
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Mammas
authors.affiliation: First Department of Paediatrics, 'Aghia Sophia' Children's Hospital, University of Athens School of Medicine, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Theodoridou
authors.affiliation: Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, Penteli, Greece.
authors.forename: Chryssie
authors.initials: C
authors.lastname: Koutsaftiki
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Bertsias
authors.affiliation: Department of Clinical Virology, School of Medicine, University of Crete, Heraklion, Heraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Sourvinos
authors.affiliation: Department of Clinical Virology, School of Medicine, University of Crete, Heraklion, Heraklion, Greece.
authors.forename: Demetrios A
authors.initials: DA
authors.lastname: Spandidos
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006115:Greece; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000523:psychology; D053918:Papillomavirus Vaccines / Q000191:economics*; D010349:Patient Compliance; D010865:Pilot Projects; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000191:economics* / Q000523:psychology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; Financial crisis; Greece; HPV; Human papillomavirus; Vaccination