Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Department of Pathology, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands.
BMC Public Health. 2018 Jul 5;18(1):837. doi: 10.1186/s12889-018-5745-6.
Implementation of human papillomavirus (HPV) vaccination raised concerns that vaccination could lead to riskier sexual behavior. This study explored how possible differences in sexual behavior and HPV knowledge developed over time between HPV-vaccinated and unvaccinated girls.
A random sample of 19,939 girls (16-17 year olds) eligible for the catch-up HPV vaccination campaign in the Netherlands was invited for a longitudinal study with questionnaires every 6 months over a two-year follow-up period. Possible differences over time between vaccinated and unvaccinated participants were studied using generalized equations estimation (GEE).
A total of 2989 girls participated in round one, of which 1574 participated (52.7%) in the final 5th round. Vaccinated girls were more likely to live in more urban areas (OR 1.28, 95%CI 1.10-1.47) and to use alcohol (OR 1.46, 95%CI 1.24-1.70) and contraceptives (OR 1.69, 95%CI 1.45-1.97). Vaccinated and unvaccinated girls showed comparable knowledge on HPV, HPV vaccination, and transmission. Vaccinated girls were more likely to be sexually active (OR 1.19, 95%CI 1.02-1.39), and this difference increased over time (OR for interaction 1.06, 95%CI 1.00-1.12). However, they had a slightly lower number of lifetime sexual partners (mean difference - 0.20, 95%CI -0.41-0.00). Vaccinated girls were less likely to use a condom with a steady partner (aOR 0.71, 95%CI 0.56-0.89). However, the difference between vaccinated and unvaccinated girls with regard to condom use with casual or steady partner(s) did not significantly change over time.
Overall, we did not find indications that vaccination influenced sexual behavior in girls during 2 years of follow-up. The few differences found may be related to existing disparities in the socio-demographic characteristics of the young population pointing to the importance and improvement of education with regard to safe sex practices. Our findings do not suggest that vaccination status is associated with changes in sexual risk behavior and thus it is unlikely that this might influence the effectiveness of the vaccination program.
人乳头瘤病毒（HPV）疫苗的接种引发了人们的担忧，即疫苗接种可能会导致性行为风险增加。本研究旨在探究 HPV 疫苗接种女孩和未接种女孩的性行为和 HPV 相关知识是否随时间推移而产生差异。
本研究对 19939 名（16-17 岁）有资格参加荷兰 HPV 疫苗补种活动的女孩进行了一项随机抽样，邀请她们参加一项纵向研究，在两年的随访期间每六个月进行一次问卷调查。采用广义方程估计（GEE）比较接种组和未接种组随时间变化的差异。
共有 2989 名女孩参加了第一轮调查，其中 1574 名（52.7%）参加了最终的第 5 轮调查。接种组女孩更可能居住在城市地区（OR 1.28，95%CI 1.10-1.47），更可能使用酒精（OR 1.46，95%CI 1.24-1.70）和避孕药具（OR 1.69，95%CI 1.45-1.97）。接种组和未接种组女孩对 HPV、HPV 疫苗接种和传播的相关知识无显著差异。接种组女孩更有可能发生性行为（OR 1.19，95%CI 1.02-1.39），且这一差异随时间推移而增加（交互作用 OR 1.06，95%CI 1.00-1.12）。然而，她们的终生性伴侣数量略少（平均差值-0.20，95%CI -0.41-0.00）。与稳定伴侣发生性行为时，接种组女孩使用避孕套的可能性更低（aOR 0.71，95%CI 0.56-0.89）。然而，接种组和未接种组女孩与偶然或稳定伴侣发生性行为时使用避孕套的差异并未随时间显著改变。
在 2 年的随访期间，总体而言，我们未发现疫苗接种会影响女孩的性行为。我们发现的少数差异可能与年轻人群在社会人口统计学特征方面存在的现有差异有关，这表明安全性行为教育的重要性和改进。我们的研究结果并未表明疫苗接种状况与性行为风险的变化相关，因此不太可能影响疫苗接种计划的效果。
