title: Impact of human papilloma virus vaccination on adolescent knowledge, perception of sexual risk and need for safer sexual behaviors in Bali, Indonesia.
abstract: OBJECTIVE
  To determine the impact of human papilloma virus (HPV) vaccination on knowledge, perception of sexual risk and need for continued safe sexual behavior among Indonesian girls.
  
  
  METHODS
  A comparative cross-sectional study was carried on in Denpasar, the capital city of Bali, Indonesia, during September 2015-February 2016. A total of 828 adolescent girls (12-16 years) were recruited to assess their knowledge on HPV/HPV vaccine, perception of sexual risks and need for continued safe sexual behavior.
  
  
  RESULTS
  A total of 419 girls (50.7%) had received HPV vaccination prior to the study, 76.4% of whom (320/419) had sufficient knowledge about HPV. HPV vaccination was a strong and independent predictor of higher HPV/HPV vaccine knowledge (adjusted OR [AOR], 9.358; 95%CI: 6.816-12.849, P < 0.001). HPV vaccination (AOR, 0.107; 95%CI: 0.074-0.155, P < 0.001) and higher knowledge level (AOR, 0.667; 95%CI: 0.464-0.958, P = 0.028) were associated with lower perceived HPV risk. Despite the low risk perception, most of the vaccinated girls (408/419, 97.4%) continued to perceive higher need for safe sexual behaviors. On multivariate analysis, higher knowledge was the independent predictor for higher perceived need for safe sexual behaviors (AOR, 4.260; 95%CI: 2.016-9.001, P < 0.001).
  
  
  CONCLUSIONS
  The HPV vaccination was associated with higher knowledge and appropriately lower perception of HPV risk. Despite the vaccination, most of the adolescents continued to perceive a need for safer sexual behavior. All adolescent girls should receive HPV vaccination in order to reduce cervical cancer burden in the future.
authors.affiliation: Department of Obstetrics and Gynecology, Sanglah General Hospital/Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
authors.forename: Pande Kadek Aditya
authors.identifier: http://orcid.org/0000-0002-1976-2043
authors.initials: PK
authors.lastname: Prayudi
authors.affiliation: Department of Obstetrics and Gynecology, Sanglah General Hospital/Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
authors.forename: Anak Agung Istri Yulan
authors.initials: AA
authors.lastname: Permatasari
authors.affiliation: Department of Obstetrics and Gynecology, Sanglah General Hospital/Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
authors.forename: I Gde Sastra
authors.initials: IG
authors.lastname: Winata
authors.affiliation: Department of Obstetrics and Gynecology, Sanglah General Hospital/Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
authors.forename: Ketut
authors.initials: K
authors.lastname: Suwiyoga
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007214:Indonesia; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D012307:Risk Factors; D021841:Safe Sex; D014611:Vaccination / Q000523:psychology*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Indonesia; adolescent; human papilloma virus vaccine; need perception; sexual risk perception