Original studies
Adolescents' Knowledge of Human Papillomavirus and Cervical Dysplasia

Presented at the Great Lakes Regional Conference on Child Health Psychology, May 14–16, 1998, Louisville, KY.
https://doi.org/10.1016/S1083-3188(99)00031-5Get rights and content

Abstract

Study Objective

This study examined adolescents' knowledge of human papillomavirus (HPV) and cervical dysplasia (CD). Factors associated with knowledge and self-reported change in health-related behaviors were identified.

Design

Interviews were conducted at an average of 2.5 years following the diagnosis of HPV/CD. Medical charts were reviewed.

Setting

The study was conducted at a university-based adolescent dysplasia clinic.

Participants

Fifty females, ages 15–23 participated in the study: 88% African-American, 12% Caucasian.

Results

On average, participants responded correctly to 86% of the questions regarding HPV/CD. However, the following key points were routinely missed: 52% did not know cigarette smoking increased the risk for cervical cancer; 42% believed that HPV/CD was always symptomatic; and 22% did not know condoms decreased the transmission of HPV. According to participants, their health care provider explained the diagnosis and treatment of HPV/CD using words they understood “some” or “most of the time.” Higher academic skills significantly correlated with greater knowledge of HPV/CD. Forty-one percent of participants with a smoking history reportedly increased their smoking since the diagnosis, and only 40% used condoms “most of the time.” However, 90% had maintained or increased their frequency of Pap tests.

Conclusions

Adolescent girls had knowledge of most factors related to HPV/CD, but many did not understand the risks of cigarette smoking and failure to use condoms. To improve understanding and compliance, health care providers should tailor educational strategies to the functional level of adolescents.

Introduction

Sexually transmitted diseases (STDs) are a major public health concern, particularly for adolescents.1 One of the most common infections, human papillomavirus (HPV), has estimated prevalence rates of 24%–60% based on DNA detection.2, 3, 4 Although rates of HPV cytological abnormalities range from 12%–16%,2, 5 the occurrence of cervical dysplasia (CD) has increased significantly over the past decade.6 Several types of HPV have been linked to the pathogenesis of cervical cancer.7, 8, 9 Moscicki et al. found that 60% of HPV-positive females, ages 13–19, had at least one of the cancer-related HPV types (i.e., 16, 18, 31, 33, or 35).3 In fact, the risk for carcinoma in situ more than doubles if women are under age 25 when first diagnosed with HPV.10 Factors which increase adolescents' vulnerability to HPV/CD and cervical cancer include being single, involvement with multiple sexual partners, lack of condom use, history of prior infections, cigarette smoking, and biological immaturity of the cervix.3, 4, 11, 12, 13

Fortunately, with appropriate evaluation, treatment, and follow-up, invasive cervical carcinomas are largely preventable.14, 15, 16 However, 20%–39% of adolescents fail to comply with follow-up appointments and treatment recommendations following abnormal Pap tests.5, 17 Research has demonstrated that adolescent women often have a poor understanding of Pap test results and HPV/CD, which may account for their noncompliance.18, 19, 20 Recent efforts have focused on improving women's understanding of and adherence to medical recommendations to prevent the progression of HPV/CD to cancer. Adult women who received a brochure,21, 22 reminder letter,21, 23 clinic-based intervention,24 transportation incentive,25 slide/tape program on Pap tests,25 or telephone counseling26 showed an improved understanding of HPV/CD and follow-up recommendations. However, little is known about the factors related to knowledge of HPV/CD and treatment compliance among adolescents.

The goal of this study is to clarify, among adolescents who have been diagnosed with HPV/CD, their current understanding of the disease and recommendations for treatment. This information will be used to plan more effective educational strategies to improve adolescents' adherence to treatment recommendations and follow-up. Four specific aims will be addressed: (1) to identify the degree to which adolescents rely on their social network following the diagnosis of HPV/CD and find it helpful; (2) to identify the level of knowledge attained by adolescent females about HPV/CD and treatment recommendations; (3) to determine if specific factors, such as participant characteristics and academic skills are associated with level of knowledge; and (4) to document self-reported change in behavior and adherence to treatment recommendations following the diagnosis of HPV/CD.

Section snippets

Participants

Fifty females, 15 to 23 years of age (M = 19, SD = 1.76), were recruited to participate in a study of adolescents' knowledge of HPV/CD. Data collection occurred at an average of 2.5 years (range = 0.25–5.25 years) following the participant's first abnormal Pap test (n = 46) or diagnosis of external HPV (n = 23). At that time, the participants received initial education regarding HPV/CD, and they received ongoing education at follow-up clinic visits. The majority of females (n = 44, 88%) were

Participant Characteristics

The average age of sexual debut for the 50 participants was 14.6 years (SD = 1.63). Participants had an average of 10.3 (SD = 19) lifetime sexual partners. Thirty-four (68%) females were involved with a partner at the time of the interview, with an average relationship length of 2 years (SD = 1.72). Of the females with current boyfriends, most (n = 31, 91.2%) were sexually involved with their partner. Seventy-two percent (n = 36) of participants reported that they used a condom “some” or “most

Discussion

Adolescents are at a vulnerable level of cognitive and psychosexual development, and they exhibit considerable individual variability during this period.31 The conceptualization of disease etiologies begins to change from concrete to abstract causes , but adolescents continue to have difficulty understanding the link between sexual intercourse and cancer risk.32 This suggests that intervention methods should not be simply extrapolated from adult research, but that programs should be tailored

Acknowledgements

The authors gratefully acknowledge Lynn McDermott for assistance with manuscript preparation. This study was supported, in part, by the Ohio Chapter of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), and Maternal and Child Health Bureau Grant #MCJ-964.

References (39)

  • S.L Rosenthal et al.

    Family involvement in the gynecological care of adolescents

    J Pediatr Adolesc Gynecol

    (1996)
  • F.M Biro et al.

    Self-reported health concerns and sexual behaviors in adolescents with cervical dysplasia

    J Adolesc Health

    (1991)
  • The Hidden EpidemicConfronting Sexually Transmitted Diseases

    (1997)
  • N.B Kiviat et al.

    Prevalence and cytologic manifestations of human papillomavirus types among 500 consecutive women

    Int J Gynecol Pathol

    (1992)
  • A.B Moscicki et al.

    Human papillomavirus infection in sexually active adolescent femalesPrevalence and risk factors

    Pediatr Res

    (1990)
  • W.D Rosenfeld et al.

    High prevalence rate of human papillomavirus infection and association with abnormal Papanicolaou smears in sexually active adolescents

    Am J Dis Child

    (1989)
  • S.A Mangan et al.

    Increased prevalence of abnormal Papanicolaou smears in urban adolescents

    Arch Pediatr Adolesc Med

    (1997)
  • L Gissmann

    Linking HPV to cancer

    Clin Obstet Gynecol

    (1989)
  • L.A Koutsky et al.

    Epidemiology of genital human papillomavirus infections

    Epidemiol Rev

    (1988)
  • Cited by (61)

    • Development and validation of measures to evaluate adolescents' knowledge about human papillomavirus (HPV), involvement in HPV vaccine decision-making, self-efficacy to receive the vaccine and fear and anxiety

      2017, Public Health
      Citation Excerpt :

      The HAVIQ has been used to assess the efficacy of a school-based intervention aiming to maximise uptake of HPV vaccination,20,23 with the separate measures having specific research applications in the evaluation of adolescents' knowledge and experiences of the process of HPV vaccination in a school-based vaccination programme. An understanding about the transmission of HPV as well as the development of anogenital warts, and HPV-related cancers is particularly pertinent to adolescents, given that they are vulnerable to HPV infection and subsequently at risk for cervical, anal, penile, vulvar, vaginal, oropharyngeal cancers and anogenital warts.43–45 Knowledge about the HPV vaccine, HPV virus and its relationship with these cancers and anogenital warts is considered fundamental in ensuring informed vaccination decision-making.46–48

    • Knowledge of Human Papillomavirus and Acceptability to Vaccinate in Adolescents and Young Adults of the Moroccan Population

      2016, Journal of Pediatric and Adolescent Gynecology
      Citation Excerpt :

      In general, Moroccan students with a high level of education presented a higher level of knowledge of HPV compared with those with a low education level. The same findings were found by Gerhardt et al, who reported that a higher academic level was significantly associated with better knowledge of HPV.24 Several other studies worldwide revealed a poor level of HPV knowledge among participants with a low education level and vice versa.21,25,26

    • Examining attitudes and knowledge about HPV and cervical cancer risk among female clinic attendees in Johannesburg, South Africa

      2010, Vaccine
      Citation Excerpt :

      The survey took between 15 and 30 min to complete and participants received US$ 5 (ZAR 50, South Africa currency) for their participation. The brief, paper based survey was developed by the principal investigator (Francis) following a review of the literature on HPV, cervical cancer in developed and developing countries [6,13–19]. Participants’ cultural context and their reading and comprehension level were also considered.

    View all citing articles on Scopus
    View full text