Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 1-7 (doi:10.1542/10.1542/peds.2007-2515)
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ARTICLE

Behavior in Early Adolescence and Risk of Human Papillomavirus Infection as a Young Adult: Results From a Population-Based Study

Amanda F. Dempsey, MD, PhD, MPHa, Achamyeleh Gebremariam, MSa, Laura Koutsky, PhDb and Lisa Manhart, PhDb

a Department of General Pediatrics, University of Michigan, Ann Arbor, Michigan
b Department of Epidemiology, University of Washington, Seattle, Washington

OBJECTIVE. The goal of this study was to determine the utility of a risk factor-based approach to human papillomavirus catch-up vaccination.

METHODS. Data from waves I and III of the National Longitudinal Study of Adolescent Health were examined to determine the association between adolescent characteristics and future human papillomavirus infection. Analysis was restricted to 3181 female subjects who were >12 years of age when risk factors were assessed in wave I (1994–1995) and who underwent human papillomavirus testing as young adults in wave III (2001–2002). The main outcome of interest was a positive test result for ≥1 of 4 human papillomavirus types (human papillomavirus-6, -11, -16, or -18) targeted by the human papillomavirus vaccine currently available in the United States. Separate analyses were performed for sexually active and virginal adolescents. Poststratification sampling weights were used to generate nationally representative estimates.

RESULTS. Although nearly one half (43%) of the female adolescents were sexually active in wave I, adolescent sexual activity status was not associated with future detection of vaccine-specific human papillomavirus infection. Furthermore, for both virginal and sexually active adolescents, none of the assessed risk factors was associated with increased odds of future vaccine-specific human papillomavirus infection in multivariate models. Similar results were obtained when all high-risk human papillomavirus types were assessed as the outcome measure.

CONCLUSIONS. Behavioral risk factors assessed during adolescence are inadequate predictors of future infection with vaccine-type human papillomavirus. A risk factor-based approach to human papillomavirus catch-up vaccination is unlikely to be an effective implementation strategy.

Key Words: human papillomavirus • vaccine • risk factors • adolescent

Abbreviations: HPV—human papillomavirus • CI—confidence interval • Add Health—National Longitudinal Study of Adolescent Health

Accepted Oct 16, 2007.


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