The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18-26 year old young adults.

OBJECTIVES: Despite the Advisory Committee on Immunization Practices (ACIP) recommendations for young adult females and males to receive the three-dose human papillomavirus (HPV) vaccine, most recent findings show that only 30% of the U.S. females aged 19-26, 2.8% of males aged 19-21, and only 1.7% of males aged 22-26 are initiating vaccination. This study evaluates the effects of a brief (5-10 min) group HPV educational intervention on knowledge and intent to vaccinate among young adults. METHODS: A sample of 131 18-26 year old females and males was recruited from the 2012 INShape Black and Minority Health Fair in Indiana. We randomized participants into one of two groups: (1) survey completion prior to education (control group) or (2) survey completion following education (intervention group). Written surveys assessed HPV knowledge, vaccination history, and vaccination intent (for unvaccinated participants). RESULTS: Respondents were primarily female (70%), single (85%), and the majority self-identified as non-Hispanic Black (77%). Thirty-seven percent had initiated HPV vaccination (≥1 dose) and 19% had completed the series. The intervention group had higher HPV knowledge scores (M=9.1; SD=1.8) than the control group (M=7.0; SD=2.9; F=22.53). Among unvaccinated individuals (n=79), the intervention group had higher HPV vaccination intent (86%) compared to the control group (67%) (OR=3.09; 95%CI=1.02-9.36). CONCLUSIONS: Despite ACIP recommendations, young adults continue to have low awareness of vaccine benefits and low vaccination rates. This study suggests that educational interventions to increase HPV awareness and vaccination may help to boost vaccination rates.

Association of Chlamydia trachomatis infection with redetection of human papillomavirus after apparent clearance.

BACKGROUND: Persistent infection with oncogenic human papillomavirus (HPV) is associated with an increased risk of cervical malignancy. Redetection of type-specific HPV after a period of nondetection may be caused by reactivation of a low-level persistent infection. Little is known about factors associated with type-specific HPV redetection. METHODS: For a longitudinal cohort of adolescent women with frequent behavioral and sexually transmitted infection (STI) information (every 3 months), Cox proportional hazard models were used to assess the influence of sexual behaviors and STIs on the redetection of oncogenic or high-risk HPV infections. RESULTS: A total of 210 type-specific high-risk HPV detection episode periods were identified in this longitudinal cohort; 71 (33.8%) were characterized by a period of nondetection followed by redetection. Chlamydia trachomatis (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.44-6.86) was associated with redetection; redetection was >2 times more likely with each additional self-reported sex partner in the past 3 months (HR, 2.26; 95% CI, 1.35-3.78). CONCLUSIONS: This study demonstrates the role of C. trachomatis and number of recent sexual partners in type-specific HPV redetection. Given that persistent oncogenic HPV infections are associated with cancer-related outcomes, understanding the potential role of such factors in the pathogenesis of HPV-related outcomes is important.

A national study of HPV vaccination of adolescent girls: rates, predictors, and reasons for non-vaccination.

Despite recommendations in the U.S. for routine HPV vaccination of adolescent girls since 2006, rates of vaccination continue to be low. This study reports vaccination uptake, factors associated with vaccine uptake and reasons for non-vaccination within a national sample of adolescent females during 2010. Using a computer administered survey of a national sample of 501 mothers of daughters 14-17 years old we assessed maternal reports of HPV vaccination as well as socio-demographical factors, maternal HPV exposures and reasons chosen for non-vaccination. Reported HPV vaccination rates were slightly over 50 % (51.1 %), with 38.3 % reporting completion of all 3 doses. Socioeconomic and demographic factors were not associated with vaccination initiation; however, Blacks and Hispanics were less likely to complete vaccination. The most common reasons for non-vaccination were concerns about vaccine safety, danger to daughter, and provider non-recommendation. Relatively poor HPV vaccine initiation and only modest 3-dose completion continues to be a major public health concern that requires continued efforts to address identified predictors and reasons for non-vaccination.

Using hemoglobin A1c for prediabetes and diabetes diagnosis in adolescents: can adult recommendations be upheld for pediatric use?

The obesity epidemic has resulted in more young people having high-risk profiles for the development of type 2 diabetes. Screening to promote earlier diagnosis and treatment of type 2 diabetes is of significant importance, as untreated disease leads to metabolic, microvascular, and macrovascular complications. However, the choice of screening methodology in adolescents is controversial, and implementation of screening protocols is not uniform. Expert panels have recommended the use of glycated hemoglobin (A1c) for the diagnosis of prediabetes and diabetes, based on the facts that the A1c assay has technical advantages and correlates well with the risk of microvascular diabetes. However, these recommendations are based strictly on data from adult studies and lack any input based on pediatric research. The pediatric research that has been published on the topic indicates that using adult cutoff points for A1c values to predict prediabetes or diabetes significantly underestimates the prevalence of these conditions in the pediatric and adolescent population. Therefore, we call for further investigation of the role of A1c for the diagnosis of prediabetes and diabetes in adolescents before its adoption as a principal diagnostic method in pediatric populations. We contend that a more comprehensive diabetes evaluation, along with A1c, remains necessary for screening adolescents at high risk for prediabetes and type 2 diabetes. Collaborative multicentered studies of prediabetes and type 2 diabetes in the obese pediatric population are especially needed to determine the A1c cutoff points, as well as other diagnostic measures, that best predict diabetes-related comorbid conditions later in life.