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Risk Level, Knowledge, and Preventive Behavior for Human Papillomaviruses among Sexually Active College Women a

Karen Vail-Smith MS, MPA & David M. White EdD

a

a

Department of Health, Physical Education, Recreation, and Safety , East Carolina University , Greenville, North Carolina, USA Published online: 09 Jul 2010.

To cite this article: Karen Vail-Smith MS, MPA & David M. White EdD (1992) Risk Level, Knowledge, and Preventive Behavior for Human Papillomaviruses among Sexually Active College Women, Journal of American College Health, 40:5, 227-230, DOI: 10.1080/07448481.1992.9936284 To link to this article: http://dx.doi.org/10.1080/07448481.1992.9936284

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Risk Level, Knowledge, and Preventive Behavior for Human Papillomaviruses Among Sexually Active College Women

Downloaded by [University of Alberta] at 22:54 31 December 2014

Karen Vail-Smith, MS, MPA; and David M. White, EdD

Abstract. During the past decade, there has been mounting scientific evidence linking human papillomavirus (HPV) with cervical cancer and, at the same time, a great increase in physician consultations for HPV infections. HPV infection risk factors include multiple sex partners, early age at first intercourse, history of sexually transmitted diseases (STDs), and smoking. This study surveyed 263 sexually active college women and concluded that (1) they are at considerable risk for contracting HPV, (2) they lack awareness of HPV, and (3) they are not practicing preventive behaviors that could reduce their risk of HPV and its serious consequences. Key Words. college women, condoms, condylomata acuminata, health education, human papillomavirus

H

uman papillomavirus (HPV) is one of the most common sexually transmitted diseases (STDs) in the United States."' It is highly contagious, with a 50% to 70% infection rate and possible longterm consequences that can be life threatening.' Yet, until recently, public education and research efforts to deal with HPV have been minimal in comparison with those related to other STDs. More than 50 types of HPV have been identified; the most common clinical manifestation of an HPV infection is genital warts.4 Evidence that certain HPV types, specifically types 16 and 18, are etiological agents in the development of cervical cancer has mounted during the last decade.5s9Recent studies have reported that HPV-16 or HPV-18 DNA sequences have been found in cervical biopsies in up to 90% of patients with invasive cervical cancer.sB9 This evidence, coupled with a 500% increase in physician consultations for genital warts between

Karen Vd-Smith k a lecturer, and David M. white an associate professor of health education; both are with the Department of Health, Physical Education, Recreation, and Sqfety at East Carolina University in Greenville, North Carolina. VOL 40, MARCH 1992

1966 and 1981, has caused increasing concern among health professionals.I Risk factors for HPV include early age of fmt coitus,'o history of sexually transmitted disease, multiple sex partners,2 and smoking." Preventive behaviors that address these risk factors are the best defense against contracting HPV infections. Because HPV is often asymptomatic, routine Papanicolaou (Pap) smears are an important secondary preventive measure for controlling the possible life-threatening consequences of an HPV infection. Because the level of sexual activity of a given population is a primary determinant of its STD infection rate, the university student population is a high-risk group for STDs, including HPV. This study sought to develop a profile of HPV infection risk among a sample of university women. Specifically, the study surveyed sexually active university-aged women to examine the extent of their risk for contracting HPV, their awareness of HPV, and their practice of HPV preventive behaviors.

METHOD We developed an instrument for this study that measured demographic factors (ethnicity and age), HPV risk and prevention behaviors, and awareness of HPV. HPV risk items focused on the primary risk factors associated with HPV infection, including history of STD, age at first intercourse, number of partners, and smoking status. The HPV prevention items asked about condom use and Pap test history. Items measuring awareness of HPV focused on risk factors, transmikion, signs and symptoms, and treatment. To assess content validity, we asked a panel of three university professors with substantial knowledge about STDs to review the questionnaire. It was also pilot tested with 30 students similar to those we studied. The professors and students suggested revisions regarding item clarity and format. 227

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COLLEGE HEALTH

We conducted the study at a public university in the southeast. Subjects were 20 randomly selected individuals from 49 different sections of 30 to 35 students enrolled in a personal health course required for graduation. Participation was voluntary, and we collected the data during the first class of the 1989 fall semester. Because the survey contained some sensitive questions regarding sexual activity and medical history, we took several measures to assure subject anonymity and encourage honest and accurate responses. The questionnaire was formatted so that all items were answered, regardless of the sexual activity status or disease history of the subject. The subjects recorded their answers on computer answer sheets with no identifiers. Also, because these data were collected during the first day of class, most subjects had had very limited interaction with each other and with the instructor. All 323 women in the selected sections chose to participate. This research focuses on those at risk for HPV, and therefore the following results apply to only the 263 (81.4% of the sample) participants who were sexually active. Because 70.8% of the group were first-semester students and the data were collected during the first class meeting of the fall semester, the results, for the most part, describe behaviors that took place before the participants entered college.

TABLE 1 Number of Partners and Age of First Intercourse as HPV Risk Factors for 263 Sexually Active College Women

I

First intercourse Age

n

Vo

13andyounger

13 83 128 39

4.8 31.4 48.8 14.9

I 1 2-4 5-10 > 10

82 94 63 24

31.2 35.7 24.0 9.1

14-15 16-17 18 or older

I

TABLE 2 Sexually Transmitted Diseases as Risk Factors for HPV of 263 Sexually Active College Women

I

I

Yes

Disease

n

AIDS

0 10 17 6 14 1 4 0 16

Chlamydia Pubic lice Genital herpes Genital warts

RESULTS

The sample consisted of 236 (89.7%) white, 21 (8.OOro) black, and 6 (2.3%) students classified as “other.” Although 181 (68.8%) subjects were 18 to 19 years of age, 38 (14.2%) were under 18, 20 (7.22%) were 20 to 21, 9 (3.42%) were 22 to 23, and 15 (5.7%) were over 23. The racial distribution of this sample is comparable to that of the overall university population, which is 88% white, 9% black, and 3% other. The percentage of sexually active subjects and their levels of sexual activity (Table 1) were virtually identical to the findings of previous research using subjects enrolled in this Thus, in terms of ethnicity, the sample appears to be representative of the younger university women at this institution, and the reported sexual activity levels are consistent with previous research.

Sex partners in lifetime n Vo Number

Gonorrhea PID Syphilis

Trichomoniasis

Vo 3.8 6.5 2.3 5.0 0.4 1.5 6.2

STD history No Not sure n Vo n Vo 255 235

244 254

246 260 252 259

244

%.9 89.3 92.7 %.5 93.8 98.8 95.8 98.5 92.7

8 18 2 3 3 2 7 4 3

3.1 6.9 0.8 1.2 1.2 0.8 2.7 1.5 1.2

I

As mentioned previously, risk factors for HPV infection include early age of first intercourse, history of STD, multiple sex partners, and smoking. Seventy-six women in the sample (29.5%) were smokers. The study’s findings relative to participants’ other HPV risk factors are shown in Tables 1 and 2.

warts, only 3 (23.68%) have ever heard of HPV before they became infected. Considering that only 34 respondents (13% of the sample) had ever heard of HPV, it is not surprising that so few exhibited awareness of the specific signs and symptoms of, or risk factors for, HPV. Of the 263 respondents, 17 (6.6%) correctly identified smoking, 21 (7.9%) identified early age of first intercourse, and 23 (8.8%) identified history of STD as HPV risk factors. Only 38 (14.5%) knew that a history of multiple sex partners increased the risk of infection. With regard to the general HPV knowledge items, only 13 subjects (4.8%) knew that HPV can cause genital warts, 21 (7.9%) knew that HPV is associated with cervical cancer, 25 (9.6%) were aware that HPV can be asymptomatic, and 52 (14.4%) that a Pap test can help detect genital warts.

Awareness of HPV

Practice of HPV Preventive Behaviors

Of the total sample, 229 (87%) respondents had either never heard of HPV (189, or 72%) or were not sure whether they had heard of it (40, or 15%). Of the 13 subjects who reported a previous infection of genital

Use of condoms has been noted as a means of preventing HPV infection, and Pap tests are a recommended means of detecting the condition early and preventing complications. Data in Table 3 describe the study’s

Extent of Risk

228

JACH

PAPILLOMAVIRUS AMONG WOMEN STUDENTS

TABLE 3 HPV Preventlon and Early Detectlon Behaviors (N = 263)

Number of respondents

n

Behaviors Condom use (Yo of time) Always

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67% -99% 34%-66% 1%-33 %

Never Pap test Never Had in past year Have had one, but not in last year

070

30 50 32 82 69

11.2 19.2 12.3 31.2 26.2

83 153 27

31.5 58.0 10.5

findings concerning the participants’ use of condoms and experience with Pap smears. Of those who had had a Pap test, 41 (22.8%) had been told the results were “abnormal.” Only 86 (32.7%) of the respondents knew that a woman under the age of 18 should have her first Pap test soon after having sexual intercourse for the first time. DISCUSSION

This research was designed to assess the extent of HPV risk among a group of university women. The results indicated that this group appeared to be at high risk for HPV infection. Forty-six (17.4%) of the respondents reported having had at least one STD; 181 (68.9Vo)have had more than one sex partner, with 87 (33.1%) having had more than four; 90 (34.1%) have had early sexual activity (defined as first sexual intercourse at age 15 or younger); and 76 (29.5%) were smokers. A multiple-risk factor profde revealed that among these sexually active women, 69 (26.1%) respondents had none of the identified risk factors; 65 (2.6%) had one risk factor; 79 (29.9%) had two risk factors; and 50 (19.1%) had three or more risk factors. Risk level is of particular concern because almost one third of the subjects had never had a Pap smear and three fourths reported they did not always use condoms. Both use of condoms and regular Pap tests are important in reducing the risk of HPV infections and their possible long-term consequences. The risk of HPV infection for these students is also enhanced by their apparent lack of knowledge about HPV. The use of self-report data regarding sensitive issues such as sexual activity levels among young adults could be considered a limitation of our study. Because we had taken steps to assure anonymity, however, we trust that any self-reporting error was minimized. VOL 40, MARCH 1992

Recommendations The evidence that HPV infection is linked to cervical cancer, combined with the level of risk apparent among these young women, indicates that college health educators need to intensify their efforts in STD-prevention education and must actively encourage behaviors that prevent HPV infection. Education curricula dealing with STDs should be examined and revised, if necessary, to include appropriate information about HPV infection. HPV-related literature should be available in clinic waiting areas. Most important, university health service personnel should take advantage of the “teachable moment” that the diagnosis of an STD provides. The results of this investigation suggest that similar studies should be conducted with larger, more diverse groups of college women and men. Because initial sexual activity often takes place before young people reach college age, we also recommend studies of younger subjects. In conclusion, it appears that the behaviors of this group of university women put them at risk for HPV infection and its potential consequences. This high risk is accompanied by low levels of preventive behavior and knowledge relative to HPV infection. University health professionals have the opportunity to have an impact on this problem by increasing the amount and quality of education and other HPV infection prevention efforts and by continuing to promote and participate in research on this important issue. REFERENCES 1. Condyloma acuminatum-United States 1966-1981. Current trends. MMWR. 1983;32:306-308. 2. Becker TM, Stone KM,Alexander ER. Genital human papillomavirus infection: A growing concern. Obstet Gynecol CIin North Am. 1987;14:389-3%. 3. Lucas VA. Human papillomavirus infection: A potentially carcinogenic sexually transmitted disease (condylomata acuminata, genital warts). Nurs Clin North Am. 1988;23: 917-935. 4. Jones HW. Cervical intraepithelial neoplasia: In: Jones

HW, Wentz AC, Burnett LS, eds. Novak’s Textbook of Gynecology, 11th ed. Baltimore: Williams & Wilkins; 1989: 643-679. 5. Zhang WH, Coppleson M, Rose BR, et al. Papilloma-

virus and cervical cancer: A clinical and laboratory study. J Med Virologv. 1988;26: 163-174. 6. Lancaster WD, Castellano C, Santos C, Delgado G , Kurman RJ, Jenson AB. Human papillomavirus deoxyribonucleic acid in cervical carcinoma from primary and metatastic sites. A m J Obstet Gynecol. 1986; 154: 115-1 19. 7. Durst M, Gissman L, Ikenberg H, zur Hausen H. A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions. Proc National Academy of Sciences. 1983;80: 3812-3815. 8. Reid R. Genital warts and cervical cancer. 11. Is human

papillomavirus infection the trigger to cervical carcinogenesis? Gynecol Oncol. 1983;15:239-252. 9. Gissman L, Schneider A. Human papillomavirus DNA in preneoplastic and neoplastic genital lesions. In: Pet0 R, zur 229

COLLEGE HEALTH

Hansen H, eds. Banbury Report 21. New York: Cold Spring Harbor; 1986:217-224. 10. Reeves WC, Caussy D, Brinton LA, et al. Case-control study of human papillomavirus and cervical cancer in Latin America. Znt J Cancer. 1987;40:450-454. 11. Daling JR, Sherman KJ, Weiss NS. Risk factors for condyloma acuminatum in women. Sex Transm Dis. 1986;13:

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16-18. 12. Glasscoff D, Glasscoff M, White DM. The impact of

questionnaire length and answer format on completion time: An experiment involving college students, condom use and information about AIDS. Theory and Practice for Marketing in the 90’s. Proceedings of the Atlantic Marketing Association. Orlando, October 1989;187-191, 13. Matthews MS. AIDS knowledge and attitudes among college underclassmen. Greenville, NC: East Carolina University, 1988. Thesis. 14. White DM, Glascoff M, Chenier T. University students’ awareness of the public health message “Understanding AIDS.” Arch Ctr Dis Control. 1989.

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Risk level, knowledge, and preventive behavior for human papillomaviruses among sexually active college women.

During the past decade, there has been mounting scientific evidence linking human papillomavirus (HPV) with cervical cancer and, at the same time, a g...
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