Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.
Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
BMC Public Health. 2023 Feb 15;23(1):340. doi: 10.1186/s12889-022-14908-w.
While health risk behaviours are likely to co-occur, there is dearth of studies exploring the clustering of cervical cancer and HPV infection risk factors among adolescents. This study aimed to determine: 1) the prevalence of modifiable risk factors for cervical cancer and HPV infection, 2) the clustering of modifiable risk factors for cervical cancer and HPV infection, and 3) factors associated with the identified clusters.
Female students (aged 16-24 years, N = 2400) recruited from 17 randomly selected senior high schools in the Ashanti Region, Ghana completed a questionnaire assessing modifiable risk factors for cervical cancer and HPV infection including sexual experience, early sexual intercourse (< 18 years), unprotected sex, smoking, sexually transmitted infections (STIs); multiple sexual partners (MSP) and smoking. Latent class analysis explored separate classes of students according to their risk factor profiles for cervical cancer and HPV infection. Latent class regression analysis explored factors associated with latent class memberships.
Approximately one in three students (34%, 95%CI: 32%-36%) reported exposure to at least one risk factor. Two separate classes emerged: high-risk and low-risk (cervical cancer: 24% and 76% of students, respectively; HPV infection: 26% and 74% of students, respectively). Compared to participants in the low-risk classes i) the cervical cancer high-risk class were more likely to report exposure to oral contraceptives; early sexual intercourse (< 18 years); STIs; MSP and smoking; and ii) the HPV infection high risk class were more likely to report exposure to sexual intercourse; unprotected sex and MSP. Participants with higher risk factor knowledge had significantly higher odds of belonging to cervical cancer and HPV infection high-risk classes. Participants with greater perceived susceptibility to cervical cancer and HPV infection were more likely to belong to the high-risk HPV infection class. Sociodemographic characteristics and greater perceived seriousness about cervical cancer and HPV infection had significantly lower odds of belonging to both high-risk classes.
The co-occurrence of cervical cancer and HPV infection risk factors suggests that a single school-based multi-component risk reduction intervention could concurrently target multiple risk behaviours. However, students in the high risk class may benefit from more complex risk reduction interventions.
虽然健康风险行为可能同时发生，但目前缺乏研究探讨青少年中宫颈癌和 HPV 感染风险因素的聚类情况。本研究旨在确定：1）宫颈癌和 HPV 感染的可改变风险因素的流行率，2）宫颈癌和 HPV 感染的可改变风险因素的聚类情况，3）与确定的聚类相关的因素。
从加纳阿散蒂地区 17 所随机选择的高中招募了 2400 名年龄在 16-24 岁的女学生，完成了一份问卷，评估了宫颈癌和 HPV 感染的可改变风险因素，包括性经历、性早期 (<18 岁)、无保护性行为、吸烟、性传播感染 (STI)；多个性伴侣 (MSP) 和吸烟。潜在类别分析根据学生的宫颈癌和 HPV 感染风险因素概况，将学生分为不同的类别。潜在类别回归分析探讨了与潜在类别成员资格相关的因素。
大约三分之一的学生 (34%，95%CI：32%-36%) 报告至少接触过一种风险因素。出现了两个单独的类别：高风险和低风险 (宫颈癌：分别为 24%和 76%的学生；HPV 感染：分别为 26%和 74%的学生)。与低风险类别参与者相比，i）宫颈癌高风险类别的参与者更有可能报告接触口服避孕药；性早期 (<18 岁)；STI；MSP 和吸烟；ii）HPV 感染高风险类别的参与者更有可能报告性接触；无保护性行为和 MSP。风险因素知识较高的参与者属于宫颈癌和 HPV 感染高风险类别的可能性显著增加。对宫颈癌和 HPV 感染的感知易感性较高的参与者更有可能属于高危 HPV 感染类别。社会人口统计学特征和对宫颈癌和 HPV 感染的感知严重性较低的参与者，属于两个高风险类别的可能性显著降低。
宫颈癌和 HPV 感染风险因素的同时发生表明，单一的基于学校的多成分风险降低干预措施可以同时针对多种风险行为。然而，高风险类别的学生可能受益于更复杂的风险降低干预措施。
