Determinants for Participation in Human Papillomavirus Self-Sampling among Nonattenders to Cervical Cancer Screening in Denmark.

Background: Offering human papillomavirus-based self-sampling to nonparticipants in routine cervical cancer screening can increase screening participation. However, little is known about characteristics of women who accept self-sampling. In this population-based study, we investigated determinants for participation in self-sampling among Danish nonattenders to routine cervical cancer screening.Methods: During 2014 to 2015, a random sample of screening nonparticipants ages 27 to 65 years living in the Capital Region of Denmark were invited for self-sampling. Of 21,314 eligible women, 4,743 participated in self-sampling. Information on sociodemographic characteristics and mental and physical health of all the women was obtained from nationwide registries, and 3,707 women completed a questionnaire on lifestyle, sexual behavior, and reasons for nonparticipation in routine screening. We used logistic regression to estimate ORs for participation in self-sampling, crude, and adjusted for sociodemographic characteristics.Results: Basic education [ORadjusted = 0.79; 95% confidence interval (CI), 0.72-0.88], low income (ORadjusted = 0.66; 95% CI, 0.59-0.73), origin from a nonwestern country (ORadjusted = 0.43; 95% CI, 0.38-0.48), and being unmarried (ORadjusted = 0.66; 95% CI, 0.61-0.72) were associated with lower self-sampling participation. Long-term unscreened women (ORadjusted = 0.49; 95% CI, 0.45-0.53), women with prior schizophrenia or other psychoses (ORadjusted = 0.62; 95% CI, 0.48-0.80), women with poor self-perceived health (ORadjusted = 0.42; 95% CI, 0.25-0.69), and women who perceived screening as unnecessary (ORadjusted = 0.54; 95% CI, 0.37-0.80) or irrelevant (ORadjusted = 0.81; 95% CI, 0.78-0.96) were less likely to self-sample.Conclusions: Certain population groups, including women with low socioeconomic position or of nonwestern origin, were less likely to participate in self-sampling.Impact: Targeted approaches may be needed to increase screening participation in these groups. Cancer Epidemiol Biomarkers Prev; 27(11); 1342-51. ©2018 AACR.

Socioeconomic predictors of human papillomavirus vaccination among girls in the Danish childhood immunization program.

PURPOSE: In 2009, human papillomavirus (HPV) vaccination was introduced in the Danish national childhood immunization program targeting all 12-year-old girls. Previous findings suggest that 10%-13% of girls born in 1996-1997 have not initiated vaccination despite free access. This study aims to identify socioeconomic predictors of initiation and completion of HPV vaccination. METHODS: Girls born in 1996-1997 and their guardians were identified through the Danish Civil Registration System. Information on socioeconomic variables and HPV vaccination status was obtained by linkage to Statistics Denmark and the Danish National Health Insurance Service Register. Through logistic regression, we examined associations between socioeconomic variables and HPV vaccine initiation (N = 65,926) and completion (N = 61,162). RESULTS: Girls with immigrant ethnicity (odds ratio [OR] = .49; 95% confidence interval [CI], .42-.57) had lower HPV vaccine initiation than Danish girls. Girls of mothers with basic education (OR = .75; 95% CI, .69-.82) or low disposable income (OR = .67; 95% CI, .61-.73) had decreased initiation compared with girls of mothers with higher education/income. Girls of unemployed mothers (OR = .75; 95% CI, .69-.82) or mothers being unmarried (OR = .70; 95% CI, .65-.76) had lower initiation than girls of employed or married mothers. Finally, vaccine initiation varied depending on place of residence. The predictors of HPV vaccine completion were similar to those of initiation. CONCLUSIONS: We found social inequality in the initiation and completion of HPV vaccination despite free access. As socioeconomic risk factors identified for cervical cancer also are associated with decreased HPV vaccination, social inequalities in cervical cancer have the potential to increase.