O-54: Comparison of sexual risk behavior in adolescent women before and after human papilloma virus education

Abstract

Human Papilloma Virus (HPV) is a sexually transmitted disease that has been causally linked to the development of cervical cancer. Given the high rate of HPV in young women, it is important for adolescents to be aware of HPV and its link to cervical cancer, as well as methods for prevention. Information about the virus can be imparted in a relatively short time during routine office visits, but it is unknown whether an improvement in HPV knowledge would have any effect on high-risk sexual behavior. The objective of this study was to examine associations between HPV knowledge and high-risk sexual behavior before and after HPV and sexual risk education. Our secondary objective was to document any statistical correlation between changes in HPV knowledge and high-risk sexual behavior after education. This is a prospective cohort study. Women aged 14-18 who attended a hospital-based teen clinic were asked to participate in this IRB-approved study. Willing participants filled out a questionnaire designed to assess knowledge about HPV and to self-report their high-risk sexual behavior based on previously published scales. Two separate risk scores were calculated to quantify behavior with casual partners and with long-term partners. Participants then participated in a brief HPV educational session which addressed the etiology, transmission, and effects of HPV, then the purpose of pap smears, and concluded with a condom demonstration. Participants completed a follow-up survey six to 12 months post-participation which re-evaluated HPV knowledge and recomputed both sexual risk scores. HPV knowledge and risk scores, and changes in each, were compared using t-tests and correlations were computed using Pearson correlation. Seventy women participated in this study, with 51% (36/70) completing the final survey. The sample was ethnically diverse, with the majority (56%, 37/66 who reported ethnicity) reporting more than one ethnicity. Ages ranged from 14 to 18, with a mean of 16.7 years. Individual improvements in knowledge score were significantly correlated with individual improvements (i.e. pre-participation versus follow-up) in sexual risk scores with casual partners (r = -.467, p = .002), but only marginally significantly with improvements in long-term partner risk scores (p = .095). Overall mean HPV knowledge scores did not change significantly from pre-participation through the time of follow-up. Although mean sexual risk scores for casual partners or long-term partners improved for pre-participation versus follow-up surveys, the change was not statistically significant. Four questions designed to assess participant attitudes towards their health were not associated with risk scores or change in behavior. Improving the knowledge about HPV and sexual risk had a significantly favorable effect on young women’s behavior with casual partners, even though knowledge regarding HPV was poor in this study sample. Education had only a marginal effect on behavior with long-term partners, and no significant effect on attitude towards health care, or overall knowledge scores. Poor follow-up of our participants underscores the obstacles faced in caring for this population. New and innovative programs should be designed to provide tools in addition to education to diminish risk-taking behavior.