Association between Maternal Preventive Care Utilization and Adolescent Vaccination: It's Not Just About Pap Testing

Study ObjectiveTo examine the association between maternal preventive care utilization and human papillomavirus (HPV) vaccine uptake by their adolescent daughters.DesignA cross-sectional study using immunization records from administrative claims and the state health department's immunization information system from June 2006 through May 2011.ParticipantsCommercially-insured Michigan females aged 13-17 in May 2011 and their mothers. Mothers were identified using relationship information on the insurance contract.Main Outcome MeasuresUsing logistic regression, we investigated whether initiating and/or completing the HPV vaccine series were associated with maternal preventive care utilization (Papaniculou testing, mammograms, primary care office visits) independently and using a combined maternal preventive care utilization index.ResultsAmong 38,604 mother-daughter pairs, 36% of daughters initiated and 22% completed the HPV vaccine series. Maternal utilization of each recommended service was modestly associated with both daughter's initiation and completion of the HPV vaccine. Effect estimates for receipt of Papaniculou test on vaccine initiation (OR = 1.07, 95% CI = 1.06-1.08) were not any higher than for mammograms (OR = 1.10, 95% CI = 1.08-1.11) or primary care office visits (OR = 1.07, 95% CI = 1.06-1.09). Using a maternal preventive care utilization index, vaccine uptake increased with an increasing number of received services.ConclusionsMaternal receipt of recommended preventive care, which may reflect general attitudes toward prevention, is as or more predictive of daughter's vaccination status than cervical cancer screening alone. Engaging women in broad routine preventive care practices may have additional positive effects on adolescent HPV vaccination beyond those achieved through cervical cancer prevention efforts alone.     

Attitudes and Perceptions of the HPV Vaccine in Caribbean and African-American Adolescent Girls and their Parents

ObjectiveTo describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors.DesignQuestionnaire survey.SettingAn adolescent medicine clinic.ParticipantsA convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic.InterventionParticipants completed an anonymous confidential 10-minute questionnaire.Main outcome MeasuresData on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine.ResultsResponses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13–4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV (P < 0.001) and with interest in receiving HPV vaccination (P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents.There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC.ConclusionsAlthough controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.     

Adolescent Girls’ Attitudes on Human Papillomavirus Vaccination

Study ObjectiveThe objective of the study was to assess the attitudes of adolescent girls on Human papillomavirus (HPV) vaccination and the impact of an information pamphlet on their attitude. Other factors that may affect their attitude were also studied.DesignQuestionnaire survey.SettingPediatric and adolescent gynecology clinic.Participants250 adolescents aged 12 to 19 years.InterventionsParticipants completed a questionnaire regarding their knowledge and attitudes towards HPV vaccination. Immediately following this, they read an information pamphlet on HPV vaccination. They then completed the same questionnaire again.Main Outcome MeasuresThe attitude of the adolescents towards HPV vaccination.ResultsInitially, 35% intended to receive the vaccination but after reading the information pamphlet, it rose to 69%. Their intention was positively correlated with their knowledge (P = 0.003), health belief (P < 0.001) and belief in who should receive the vaccine (P < 0.001) but negatively correlated with their belief that other people would approve of their vaccination (normative belief) (P < 0.001). There was a significant increase in their knowledge score (P < 0.001) after reading the pamphlet. Their health belief and belief in who should receive vaccine became more positive (P < 0.001), but the normative belief was more negative (P = 0.002) after reading.Conclusion69% of adolescent girls intended to receive HPV vaccination and their intention was improved by reading an information pamphlet. It was positively correlated with their knowledge, health belief, and belief in who should receive the vaccine, but negatively correlated with their normative belief.     

Adolescent and Parent Willingness to Participate in Microbicide Safety Studies

Study ObjectiveTo understand adolescents' and parents' willingness to participate (WTP) in a hypothetical phase I prevention study of sexually transmitted infections, discordance within adolescent-parent dyads, and expectations of each other during decision-making.Design and SettingAdolescent-parent dyads were recruited to participate in a longitudinal study about research participation attitudes.ParticipantsAdolescents (14-17 years old) and their parents (n = 301 dyads) participated.InterventionsNone.Main Outcome MeasuresIndividual interviews at baseline assessed WTP on a 6-level Likert scale. WTP was dichotomized (willing/unwilling) to assess discordance.ResultsWTP was reported by 60% (182 of 301) of adolescents and 52% (156 of 300) of parents. In bivariate analyses, older adolescent age, sexual experience, and less involvement of parents in research processes were associated with higher level of WTP for adolescents; only sexual experience remained in the multivariable analysis. For parents, older adolescent age, perceived adolescent sexual experience, and conversations about sexual health were significant; only conversations remained. Dyadic discordance (44%, 132 of 300) was more likely in dyads in which the parent reported previous research experience, and less likely when parents reported higher family expressiveness. Adolescents (83%, 248 of 299) and parents (88%, 263 of 300) thought that the other would have similar views, influence their decision (adolescents 66%, 199 of 300; parents 75%, 224 of 300), and listen (adolescents 90%, 270 of 300; parents 96%, 287 of 300). There were no relationships between these perceptions and discordance.ConclusionInclusion of adolescents in phase I clinical trials is necessary to ensure that new methods are safe, effective, and acceptable for them. Because these trials currently require parental consent, strategies that manage adolescent-parent discordance and support adolescent independence and parental guidance are critically needed.     

HPV vaccine use among African American girls: Qualitative formative research using a participatory social marketing approach

ObjectiveTo generate recommendations for framing messages to promote HPV vaccination, specifically for African American adolescents and their parents who have not yet made a decision about the vaccine (the “Undecided” market segment).MethodsFocus groups and interviews were conducted with African American girls ages 11–18 (N = 34) and their mothers (N = 31), broken into market segments based on daughter's vaccination status and mother's intent to vaccinate.ResultsFindings suggested that the HPV vaccine should be presented to “Undecided” mothers and adolescents as a routine vaccine (just like other vaccines) that helps prevent cancer. Within the “Undecided” segment, we identified two sub-segments based on barriers to HPV vaccination and degree of reluctance. The “Undecided/Ready If Offered” segment would easily accept HPV vaccine if given the opportunity, with basic information and a healthcare provider recommendation. The “Undecided/Skeptical” segment would need more in-depth information to allay concerns about vaccine safety, mistrust of drug companies, and recommended age. Some mothers and girls had the erroneous perception that girls do not need the vaccine until they become sexually active. African American adolescents and their mothers overwhelmingly thought campaigns should target both girls and boys for HPV vaccination. In addition, campaigns and messages may need to be tailored for pre-teens (ages 9–12) versus teens (ages 13–18) and their parents.ConclusionsFindings pointed to the need to “normalize” the perception of HPV vaccine as just another routine vaccine (e.g., part of pre-teen vaccine package). Findings can inform social marketing campaigns targeting Undecided or ethnically diverse families.     

Parents’ and Adolescents’ Attitudes about Parental Involvement in Clinical Research

Study ObjectiveTo understand parent and adolescent attitudes toward parental involvement during clinical trials and factors related to those attitudes.DesignAs part of a study on willingness to participate in a hypothetical microbicide study, adolescents and their parents were interviewed separately.SettingAdolescent medicine clinics in New York City.ParticipantsThere were 301 dyads of adolescents (ages 14-17 years; 62% female; 72% Hispanic) and their parents.InterventionsNone.Main Outcome MeasuresThe interview included questions on demographic characteristics, sexual history, and family environment (subscales of the Family Environment Scale) that were associated with attitudes about parental involvement.ResultsFactor analysis of the parental involvement scale yielded 2 factors: LEARN, reflecting gaining knowledge about study test results and behaviors (4 items) and PROCEDURE, reflecting enrollment and permissions (4 items). Adolescents endorsed significantly fewer items on the LEARN scale and the PROCEDURE scale indicating that adolescents believed in less parental involvement. There was no significant concordance between adolescents and their own parents on the LEARN scale and the PROCEDURE scale. In final multivariate models predicting attitudes, adolescents who were female and had sexual contact beyond kissing, and non-Hispanic parents had lower LEARN scores. Adolescents who were older, had previous research experience, and reported less moral or religious emphasis in their family had lower PROCEDURE scores; there were no significant predictors for parents in the multivariate analyses.ConclusionParents wanted greater involvement in the research process than adolescents. Recruitment and retention might be enhanced by managing these differing expectations.     

Associations of Maternal Age,Education, and Marital Status with HPV Vaccine Uptake and Hesitancy among United States Youth: A Cross-Sectional Analysis of the 2020 National Immunization Survey

Study ObjectiveHuman papillomavirus (HPV) vaccination is proven to reduce the risk of HPV-associated cancers and lesions. Factors associated with HPV vaccine receipt or rejection have been studied, but specific maternal characteristics driving uptake among teens requires further investigation. The aim of this study was to examine maternal characteristics influencing teen vaccine uptake and intent to vaccinate.Study DesignCross-sectional analysisMethodsWe analyzed data on 27,320 teens aged 13-17 using the 2020 National Immunization Survey-Teen. We constructed regression models to determine the associations, via relative risk, between child vaccination status and maternal characteristics.ResultsCompared with mothers with less education, those with a college degree were significantly more likely to have their children receive HPV vaccination (RR = 1.18; 95% CI, 1.11-1.26). Compared to mothers under 35 years, those aged 35-44 (RR 1.07; 95% CI 1.01-1.14) and over 45 (RR = 1.13; 95% CI, 1.07-1.21) were more likely to provide HPV vaccination to their child. Among children not previously vaccinated (n = 12,098; N = 5,752,355), educated mothers were significantly less likely to report intent to vaccinate their child in the next year. There was no significant difference in vaccination rates in mothers who were married compared with never married (RR = 0.99; 95% CI, 0.97-1.02).ConclusionMaternal education was the strongest predictor of teens receiving the HPV vaccine. Among mothers with teens not previously vaccinated, intent to obtain the HPV vaccine for their child was higher among mothers with less education compared with college-level educated mothers. Understanding maternal characteristics driving HPV vaccine hesitancy can inform targeted approaches to improve vaccine uptake in children. Additionally, adequate and consistent health messaging on the safety, efficacy, and benefits of HPV vaccination from health providers and public health agencies could increase uptake among adolescents and teens of vaccine-hesitant mothers.     

Education about human papillomavirus and human papillomavirus vaccines in adolescents

PURPOSE OF REVIEW: The purpose of this article is to review recent literature that may help guide the development of effective, evidence-based strategies to educate adolescents about human papillomavirus (HPV) and HPV vaccines. Educational strategies are essential, given several new and highly effective technologies to prevent HPV and related diseases such as cervical cancer. RECENT FINDINGS: Although little has been published regarding adolescent knowledge about HPV and HPV vaccines, studies conducted primarily in adult women demonstrate that knowledge generally is poor. Studies of adolescent attitudes about HPV vaccines have identified several modifiable factors associated with intention and confidence in one's ability to receive the vaccine, including higher perceived severity of cervical cancer and fewer barriers to vaccination. Studies of clinician attitudes about HPV vaccines have demonstrated that although clinicians generally support vaccination, some report concerns; for example, adolescents may practice riskier sexual behaviors after vaccination. Studies also show that clinicians believe that educational materials developed specifically for adolescents are essential. SUMMARY: The recent literature on adolescent knowledge about HPV and attitudes about HPV vaccines supports the importance of designing developmentally appropriate educational materials for adolescents about HPV and HPV vaccines, and provides guidance for the development of key educational messages.     

Parental Attitudes Toward Fertility Preservation in Female Adolescent Cancer Patients in Lebanon

Study ObjectiveTo measure parental attitudes toward fertility preservation (FP) in female adolescent cancer patients in a Middle Eastern country to understand barriers to decision-making and decisional conflicts.Design and SettingA questionnaire was distributed to parents of all female adolescents at a tertiary care center from February 2018 to September 2018.ParticipantsA total of 70 families.InterventionsNone.Main Outcome MeasuresParental attitudes toward FP.ResultsThe educational level of parents was associated with the knowledge about the side effects of treatment (P < .001). FP options were not offered to parents in 60/70 (85.6%) of cases. Oocyte cryopreservation was an acceptable option for 23/70 (32.9%) of interviewed parents who agreed on collecting the oocytes using vaginal ultrasound. The fear of disrupting the hymen was the main reason for disapproval in 20/70 (28.6%) of cases. The religious preference of the family was a significant factor in the acceptance of vaginal ultrasound and vaginal oocyte retrieval. The educational level of parents, the monthly income, and the current employment status were not linearly associated with their acceptance to approve their daughters’ undergoing oocyte cryopreservation through the vaginal route (χ² = 100.651; P < .001).ConclusionParents are not aware of the effect of cancer treatment on future fertility of their daughters. Ethical, social, and religious barriers affect the decision-making for FP. However, a major interest exists among parents for FP, highlighting the importance of development of an oncofertility program, involving a multidisciplinary team to initiate proper counseling and guidance.     

Urban-Rural Inequities in the Parental Attitudes and Beliefs Towards Human Papillomavirus Infection,Cervical Cancer,and Human Papillomavirus Vaccine in Mysore,India

Study Objective

The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India.

Human Papillomavirus Vaccine: Continuation,Completion, and Missed Opportunities

Study ObjectiveTo examine human papillomavirus (HPV) series completion in older adolescents and assess vaccination completion opportunities missed by providers.Design, Setting, Participants, Interventions, and Main Outcome MeasuresElectronic medical records were queried for women 18-24 years old who initiated the HPV vaccine in the Adolescent Medicine, Young Mother's, or Family Planning clinics at Children's Hospital Colorado from January 1, 2010-December 31, 2012. Clinic visits during appropriate dosing intervals of HPV vaccine at which the second (4-14 weeks after first dose) or third (21-40 weeks after first dose and >12 weeks after second dose) doses were not administered were counted as “missed opportunities.”ResultsA total of 1072 female adolescents initiated the HPV series during the study period; 20.9% completed the series within 1 year. Of these, 33.7% who did not receive their second dose had at least 1 missed opportunity and 25.5% who received the second but not the third had a missed opportunity. Women who initiated the vaccine in the Family Planning clinic were less likely to have missed opportunities than those in other adolescent clinics (36.2% vs 56.4%; P < .001).ConclusionA significant number of female adolescents who initiated the HPV vaccine attended clinic visits at which opportunities for vaccine continuation and completion were missed. This emphasizes the importance of provider awareness of vaccine updates at every adolescent visit. Our overall completion rate is significantly lower than published rates and might reflect older adolescents' inexperience in managing their own preventive health care. Our results clearly identify the need for provider and patient interventions to improve vaccine series completion.     

Racial and Ethnic Differences in HPV Knowledge,Attitudes, and Vaccination Rates among Low-income African-American,Haitian, Latina,and Caucasian Young Adult Women

ObjectiveTo examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years.DesignUsing semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake.ParticipantsWe enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012.Main Outcome MeasuresIntent to vaccinate and actual vaccination rates.ResultsOf 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians.ConclusionDesire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.     

Understanding Human Papillomavirus Vaccination Intentions: Comparative Utility of the Theory of Reasoned Action and the Theory of Planned Behavior in Vaccine Target Age Women and Men

IntroductionHuman papillomavirus (HPV) is an exceedingly prevalent sexually transmitted infection with serious medical, sexual, and relationship consequences. HPV vaccine protection is available but vaccine uptake is very inconsistent.AimsThis research applies two major theories of health behavior uptake, the Theory of Reasoned Action and the Theory of Planned Behavior, in an effort to understand intentions to receive HPV vaccine among vaccine target age women and men. The Theory of Reasoned Action asserts that attitudes toward HPV vaccination and perceptions of social support for HPV vaccination are the determinants of intentions to be vaccinated, whereas the Theory of Planned Behavior holds that attitudes toward vaccination, perceptions of social support for vaccination, and perceived ability to get vaccinated are the determinants of intentions to be vaccinated.MethodsCanadian university men (N = 118) and women (N = 146) in the HPV vaccine target age range took part in this correlational study online.Main Outcome MeasuresParticipants completed standard measures of attitudes toward HPV vaccination, perceptions of social support for vaccination, perceived ability to get vaccinated, beliefs about vaccination, and intentions to be vaccinated in the coming semester.ResultsFindings confirmed the propositions of the Theory of Reasoned Action and indicated that attitudes toward undergoing HPV vaccination and perceptions of social support for undergoing HPV vaccination contributed uniquely to the prediction of women's (R² = 0.53) and men's (R² = 0.44) intentions to be vaccinated in the coming semester.ConclusionClinical and public health education should focus on strengthening attitudes and perceptions of social support for HPV vaccination, and on the basic beliefs that appear to underlie attitudes and perceptions of social support for HPV vaccination, in efforts to promote HPV vaccine uptake. Fisher WA, Kohut T, Salisbury CMA, and Salvadori MI. Understanding human papillomavirus vaccination intentions: Comparative utility of the Theory of Reasoned Action and the Theory of Planned Behavior in vaccine target age women and men. J Sex Med 2013;10:2455–2464.     

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

ObjectivesDespite 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.MethodsA 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).ResultsRespondents 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).ConclusionsDespite 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.     

Accuracy of Sexual and Reproductive Health Information among Adolescent Girls: A Cross-Sectional Study

BackgroundThe leading cause of death for girls aged 15-19 years globally is complications from pregnancy and childbirth. Girls have poor access to sexual and reproductive health (SRH) services, including information.Study ObjectiveTo describe the accuracy of SRH information (SRHI) and its associated factors among adolescent girls in UgandaMethodsWe conducted a cross-sectional study among girls aged 13-19 years in an urban district and a rural district. The accuracy of SRHI was assessed using a set of 13 questions covering “sex and reproduction,” “condom use,” and “HIV and other sexually transmitted diseases.” Accuracy was categorized as low (≤7 items correct), moderate (8-11 items correct), and high accuracy (≥12 items) according to the number of correct answers. Poisson regression analysis was used to determine factors associated with accurate SRHI using STATA version 14.ResultsOf the 600 girls (mean age: 16.9 years; SD = 3.84), 75.3% were in school. The mean SRHI knowledge score was 9.9. The SRHI accuracy score was low among 6.3% of adolescents, moderate among 80.7%, and high among 13%. Parents with permissive parenting styles had adolescents with low SRHI accuracy compared with disciplinarian/authoritarian parents (IRR = 0.93 [0.885-0.987]; P = .004), whereas parents talking about sex with their adolescents was associated with accurate SRHI (IRR = 1.1 [1.051-1.153]; P < .001). Adolescents who had ever been pregnant had low SRHI accuracy (0.98 [0.911-0.989]; P = .019). There was no difference in SRHI accuracy between the urban and rural districts (P = .45).ConclusionThe low accuracy of SRHI calls for interventions aimed at engaging and training parents, who are considered to be the first in line to provide accurate information to adolescents irrespective of their location. The interventions and training should be culturally appropriate, and parents need to be supported with skills aimed at demystifying SRHI.     

Genital HPV in Children and Adolescents: Does Sexual Activity Make a Difference?

Study ObjectiveTo compare the prevalence of human papillomavirus (HPV) genital infection among prepubertal children, sexually active and not sexually active adolescents, and assess potential risk factors for transmission.DesignProspective study.SettingOutpatient adolescent health clinic.ParticipantsNinety-five girls aged 2-21 years; 38 sexually active adolescents (group A), 28 not sexually active adolescents (group B), and 29 prepubertal children (group C).InterventionsParticipants' vaginal or cervical specimens were tested for HPV with the CLART HPV 2 assay (Clinical Array Technology, Genomica, Madrid, Spain) and for cytological abnormalities with liquid-based cytology.Main Outcome MeasuresDifferences in prevalence of low- and high-risk HPV infections among the 3 groups.ResultsGenital HPV was detected in 37.9% (36/95) of all participants; 47.4% (18/38) of group A, 28.6% (8/28) of group B, and 34.5% (10/29)of group C (P = .27). Multiple HPV infection was detected in 26.3% (10/38), 10.7% (3/28), and 13.8% (4/29) of groups A, B, and C, respectively (P = .21). High-risk genotypes were detected in 47.4% (18/38), 28.6% (8/28), and 24.1% (7/29) of groups A, B, and C, respectively (P = .10). Main high-risk genotypes were HPV 16 (27%, 10/37), HPV 31 (21.6%, 8/37 ), HPV 35 (13.5%, 5/37), HPV 53 (13.5%, 5/37), and low-risk HPV 6 (18.9%, 7/37). Sexual activity was associated with increased risk for genital high-risk HPV infection (odds ratio = 3.41; 95% confidence interval, 1.19-9.78); specifically with HPV 33 and HPV 51. Forty percent of sexually active adolescents with normal cervical cytology were infected with high-risk HPV types. Family history of skin HPV was positively associated with genital HPV in the sexually active group (odds ratio = 2.01; 95% confidence interval, 1.17-3.46).ConclusionTimeline and target population for HPV vaccination might need to be reappraised, in view of significant nonsexual transmission of genital HPV so early in childhood.