Factors associated with HPV-associated sexual risk behaviors among sexually active college students

High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors-number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural-urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases.

College Students' Awareness of the Link Between Human Papillomavirus (HPV) and HPV-Associated Cancers

We describe the level of awareness of the link between HPV and HPV-associated cancers and identify demographic and lifestyle factors associated with awareness. This was a cross-sectional study of college students (n = 862) at a public Midwestern university conducted between February and May 2021. The outcomes were student's awareness-accessed by asking students if they knew whether HPV was causally link with anal, cervical, vaginal, oropharyngeal, vulvar, and penile cancers. Logistic regression models estimated the association between sociodemographic and sexual behavior and awareness of the link between HPV and HPV-associated cancers. Approximately 70% were aware that HPV causes cervical, 53% were aware HPV causes vaginal, 40% were aware HPV causes vulvar cancers, 39% were aware HPV causes oropharyngeal, 38% were aware HPV causes penile, and 34% were aware HPV causes anal cancers. In multivariable analyses, men were less likely to be aware that HPV causes vaginal (aOR = 0.42, 95% CI 0.30-0.59) or vulvar cancers (aOR = 0.54, 95% CI 0.38-0.77) compared to women. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV causes anal (aOR = 1.98, 95% CI 1.17-3.34), penile (aOR = 1.82, 95% CI 1.11-2.97), vaginal (aOR = 1.81, 95% CI 1.14-2.88), or vulvar (aOR = 2.05, 95% CI 1.24-3.40) cancers. Awareness of the link between HPV and HPV-associated cancers was low, except cervical. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake.

Association between Sexual Activity and Human Papillomavirus (HPV) Vaccine Initiation and Completion among College Students

HPV vaccination is most effective if received before initiation of sexual activity. Previous studies suggested that young adult women who were not sexually active were not interested in receiving the vaccine because they did not think it was necessary. Whether this misperception is still prevalent today-and also shared by men-is unknown. This study examined whether sexual activity was associated with HPV vaccine uptake (initiation and completion) among university students. A cross-sectional study was conducted between February and May 2021 among students (n = 951) at a public Midwestern University. Sexual activity was categorized as "never" or "ever" had oral and/or vaginal sex. Outcome variables were HPV vaccine initiation, defined as receipt of ≥1 dose, and completion, defined as receipt of ≥3 doses. Multivariable logistic regression models estimated the association between sexual activity and HPV vaccine uptake, adjusting for sociodemographic factors. Approximately 18% of students reported never engaging in sexual activity. Overall, 45.5% initiated the HPV vaccine, and 16.5% completed the vaccine series. After adjusting for covariates, compared to students that reported never engaging in sexual activity, those that had ever engaged in sexual activity were more likely to have initiated the vaccine series (aOR = 2.06, 95% CI: 1.34-3.17); however, no difference was observed for completion. HPV vaccination was low; sexually naïve students were less likely to initiate the HPV vaccine. Since sexually naïve students may benefit from receiving the HPV vaccination, targeted interventions should be implemented towards this population to help increase vaccination rates and prevent HPV-associated diseases.

Abstract PO-244: Association between sexual naivety and human papillomavirus (HPV) vaccination initiation and completion

Background: Human papillomavirus (HPV) accounts for about 35,000 HPV-associated cancers per year. In the United States, a gender-neutral HPV vaccine was recommended by the Advisory Committee on Immunization Practices in 2011 with the primary goal of preventing HPV-associated cancers. Although the HPV vaccine is safe and effective, vaccine uptake is low especially in young adult population. College students comprise the age-group with the highest risk of HPV infection. The HPV vaccines are thought to be most effective before initiation of sexual activity. However, there is a dearth of information on the association between HPV vaccine uptake and sexual activity among college students. This study examined if sexual naivety was associated with HPV vaccination uptake (initiation and completion) among university students. Methods: A cross-sectional study was conducted between February and May 2021 among students at a Midwestern University. Sexual naivety was assessed with these questions: “Have you ever had vaginal sexual intercourse?”, and “Have you ever had oral sex?” Responses were categorized as “no oral or vaginal sex”, “had oral or vaginal sex”, or “had oral and vaginal sex”. The outcome variable was HPV vaccination uptake; initiation was defined as receipt of ≥1 dose, and completion as receipt of ≥3 doses. Multivariable logistic regression models estimated the association between sexual naivety and vaccine uptake, adjusting for age, gender, race, relationship status, academic level, and rural-urban status. Results: Approximately 18% of students reported being sexually naïve. Overall, 45.5% had initiated the HPV vaccination, and 16.5% had completed the vaccination. After adjusting for covariates, compared to students who reported being sexually naïve, those that had ever had oral and vaginal sex were more likely to have initiated (aOR=2.18, 95% CI: 1.41–3.39) the HPV vaccinations; however, no difference was observed for completion. Other factors associated with lower odds of HPV vaccination initiation included younger age (aOR=0.90, 95% CI: 0.85–0.95), male sex (aOR=0.33, 95% CI: 0.23–0.45), rural residence (aOR=0.67, 95% CI: 0.47–0.96), and freshman/sophomore academic level (aOR=0.55, 95% CI: 0.31–0.95). Only gender was associated with vaccination completion where male students were 74% less likely to have completed the series compared to female students. Conclusions: We show that 1-in-5 students were sexually naïve, and that 4-in-10 had initiated the HPV vaccination but only 16% had completed the series. Sexual naivety was an independent predictor of HPV vaccine initiation, with sexually naïve students less likely to have initiated the vaccination. Since sexually naïve students may benefit the most from receiving the HPV vaccination, targeted interventions should be implemented towards this population to help increase vaccination rates and prevent HPV-associated diseases.

Citation Format: Eric Adjei Boakye, Stacey L. McKinney, Maria C. Franca, Kelli D. Whittington, Valerie E. Boyer, Minjee Lee, Richard C. McKinnies, Sandra K. Collins. Association between sexual naivety and human papillomavirus (HPV) vaccination initiation and completion [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-244.

Abstract PO-269: Awareness of the link between human papillomavirus (HPV) and HPV-associated cancers among university students

Background: Human papillomavirus (HPV) is associated with virtually all cases of cervical, 90% of anal, 69% of vaginal, 60% of oropharyngeal, 51% of vulvar, and 40% of penile cancers. The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years, and catch-up vaccination is also recommended for both males and females aged 13-26 years. College students not only fall in the age group at high risk for HPV infection but are also of childbearing age; thus, their awareness not only affects current vaccination rates but also those of the next generation. Therefore, understanding college students' awareness of the causal link between HPV and HPV-associated cancers is of great significance for the promotion of HPV vaccine uptake. The objectives of the study were to 1) describe the level of awareness of the link between HPV and HPV-associated cancers; and 2) identify factors associated with awareness. Methods: This was a cross-sectional study at a public Midwestern university. A previously validated questionnaire was distributed online to all students at the university from February to May 2021. The outcomes of interest were student's awareness that HPV causes certain cancers (anal, vaginal, oropharyngeal, vulvar, and penile). Students were asked if they knew whether HPV was causally link with those cancers, with response options ‘yes', ‘no' and ‘don't know'. Students who answered yes were categorized as aware and those who answered ‘no' and ‘don't know' were categorized as unaware. Five multivariable logistic regression models estimated the association between age, gender, race, relationship status, academic level, rural-urban status, sexual naivety; and awareness of the link between HPV and HPV-associated cancers. Results: A total of 862 students were included in the study. Approximately 34% were aware HPV causes anal, 39% were aware HPV cause oral, 38% were aware HPV cause penile, 53% were aware HPV cause vaginal, and 40% were aware HPV cause vulvar cancers. In multivariable analyses, males were less likely to be aware that HPV cause vaginal (aOR=0.42, 95% CI: 0.30–0.59), or vulvar cancers (aOR=0.54, 95% CI: 0.38–0.77) compared to females. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV cause anal (aOR=1.98, 95% CI: 1.17–3.34), penile (aOR=1.82, 95% CI: 1.11–2.97), vaginal (aOR=1.81, 95% CI: 1.14–2.88), or vulvar (aOR=2.05, 95% CI: 1.24–3.40) cancers. Conclusion: Overall awareness of the link between HPV and HPV-associated cancers were low, with roughly 4-in-10 students having awareness, except vaginal where half of students had awareness of the link. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake.

Citation Format: Eric Adjei Boakye, Maria C. Franca, Valerie E. Boyer, Minjee Lee, Kelli D. Whittington, Stacey L. McKinney, Sandra K. Collins, Richard C. McKinnies. Awareness of the link between human papillomavirus (HPV) and HPV-associated cancers among university students [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-269.

MR Imaging in Spinocerebellar Ataxias: A Systematic Review

BACKGROUND AND PURPOSE

Polyglutamine expansion spinocerebellar ataxias are autosomal dominant slowly progressive neurodegenerative diseases with no current treatment. MR imaging is the best-studied surrogate biomarker candidate for polyglutamine expansion spinocerebellar ataxias, though with conflicting results. We aimed to review quantitative central nervous system MR imaging technique findings in patients with polyglutamine expansion spinocerebellar ataxias and correlations with well-established clinical and molecular disease markers.

MATERIALS AND METHODS

We searched MEDLINE, LILACS, and Cochrane data bases of clinical trials between January 1995 and January 2016, for quantitative MR imaging volumetric approaches, MR spectroscopy, diffusion tensor imaging, or other quantitative techniques, comparing patients with polyglutamine expansion spinocerebellar ataxias (SCAs) with controls. Pertinent details for each study regarding participants, imaging methods, and results were extracted.

RESULTS

After reviewing the 706 results, 18 studies were suitable for inclusion: 2 studies in SCA1, 1 in SCA2, 15 in SCA3, 1 in SCA7, 1 in SCA1 and SCA6 presymptomatic carriers, and none in SCA17 and dentatorubropallidoluysian atrophy. Cerebellar hemispheres and vermis, whole brain stem, midbrain, pons, medulla oblongata, cervical spine, striatum, and thalamus presented significant atrophy in SCA3. The caudate, putamen and whole brain stem presented similar sensitivity to change compared with ataxia scales after 2 years of follow-up in a single prospective study in SCA3. MR spectroscopy and DTI showed abnormalities only in cross-sectional studies in SCA3. Results from single studies in other polyglutamine expansion spinocerebellar ataxias should be replicated in different cohorts.

CONCLUSIONS

Additional cross-sectional and prospective volumetric analysis, MR spectroscopy, and DTI studies are necessary in polyglutamine expansion spinocerebellar ataxias. The properties of preclinical disease biomarkers (presymptomatic) of MR imaging should be targeted in future studies.