Adolescents' intention and self-efficacy to follow Pap testing recommendations after receiving the HPV vaccine

Figures & data

Table 1. Results of descriptive analyses: participant intention and self-efficacy to get a Pap test after HPV vaccination; demographic characteristics; medical history; communication about Pap testing; HPV knowledge; and behaviors.

	N (%)	Mean (SD^1)
Intention and Self-Efficacy to Get a Pap test after HPV Vaccination
Intention^2
Extremely likely	168 (49.6)
Somewhat likely/neither/somewhat unlikely/extremely unlikely	171 (50.4)
Self-efficacy^3
Completely sure	199 (58.7)
Not at all sure/somewhat sure	140 (41.3)
Demographic Characteristics
Age (years)^4		16.8 (2.4)
Race
White, Asian/Pacific Islander, Native American/Alaskan Native	59 (17.4)
African American	259 (76.4)
Multiracial, other	21 (6.2)
Ethnicity
Appalachian	13 (3.8)
Hispanic	11 (3.2)
Insurance Status
Have insurance
Yes	286 (84.4)
No/not sure	53 (15.6)
Insurance plan
Medicaid/Caresource	193 (56.9)
Private/self pay/other	68 (20.1)
No insurance or missing	78 (23.0)
Medical History
Ever had a Pap test	151 (44.5)
Pap test in past year	123 (36.3)
Ever had abnormal Pap test	46 (13.6)
Ever had colposcopy	13 (3.8)
Family history of cervical cancer	44 (13.0)
Communication about Pap Testing
Frequency mother talked about getting a Pap test
Never/once	248 (73.2)
Several times/ frequently	91 (26.8)
Today doctor/nurse talked about needing Pap test after HPV vaccination	169 (49.8)
Today doctor/nurse gave written information about HPV/HPV vaccines	268 (79.1)
HPV and HPV vaccine knowledge^5
Scale score (mean)		5.3 (2.5)
Relevant individual items
Women with HPV need Pap tests more often (% correct responses)	204 (60.2)
Women who have received the HPV vaccine still need Pap testing (% correct responses)	235 (69.3)
Perceived risk of HPV
Scale score (mean)		5.0 (2.2)
Dichotomized^6
Low perceived risk	116 (34.2)
High perceived risk	223 (65.8)
Behaviors
Sexual History
Age at first sexual contact		14.5 (1.6)
Age at first sexual intercourse		14.6 (1.5)
Number of lifetime male partners		5.6 (7.3)
0	144 (43.2)
1	42 (12.6)
2-4	72 (21.6)
5 or more	75 (22.5)
Number of lifetime female partners		0.3 (2.8)
0	319 (94.7)
1 or more	18 (5.3)
Substance Use
Cigarettes: smoked at least 5 packs in lifetime	34 (10.0)
Cigarettes: number of days smoked in past 30 d
0	299 (88.2)
1 or more d	40 (11.8)
Marijuana: used past year	69 (20.4)
Alcohol: drank in past year	112 (33.0)
Alcohol: number of drinks consumed at one time
0	225 (66.8)
1 or more	112 (33.2)

¹SD = standard deviation

²Measured using the following item: If you knew you were supposed to get a Pap test done within the next six months, how likely or unlikely is it that you would get a Pap test within that time frame?

³Measured using the following item: How sure are you that you will get a Pap test when your doctor or nurse recommends that you get one?

⁴Measured as a continuous variable

⁵13-item scale measuring knowledge about HPV and HPV vaccines

⁶Scale score dichotomized into upper and lower 2 tertiles: upper tertile represents low and lower two tertiles represent high perceived risk

Table 2. Variables associated with intention and self-efficacy to get a Pap test after HPV vaccination among all participants: results of unadjusted logistic regression models.

		Intention		Self-efficacy
Variables		OR^1 (95% CI^2)	P-value	OR (95% CI)	P-value
Demographics
Age (years)^3		1.3 (1.2-1.4)^4	<0.0001	1.4 (1.3-1.6)	<0.0001
Perceived Risk of HPV	Low vs. high perceived risk	1.6 (1.0-2.5)	0.05	1.2 (0.8-2.0)	0.36
Insurance
Has insurance	Yes vs.no	1.2 (0.7-2.2)	0.5	2.8 (1.5-5.1)	0.001
Insurance plan	Medicaid vs. none/unsure	1.6 (1.0-2.8)	0.07	3.0 (1.7-5.1)	<0.0001
Medical History
Ever had a Pap test	Yes vs. no/not sure	4.6 (2.9-7.2)	<0.0001	6.9 (4.2-11.6)	<0.0001
Pap test in past year	Yes vs. no/not sure	4.3 (2.7-6.9)	<0.0001	7.6 (4.3-13.5)	<0.0001
Ever had abnormal Pap test	Yes vs. no/not sure	4.4 (2.1-9.3)	<0.0001	7.0 (2.7-18.5)	<0.0001
HPV and HPV Vaccine Knowledge
Scale HPV and vaccine knowledge	Scale score	1.2 (1.1-1.4)	<0.0001	1.2 (1.1-1.3)	0.0002
Individual items
Women with HPV need Pap tests more often	Correct vs. Incorrect	1.6 (1.0-2.4)	0.05	1.6 (1.0-2.5)	0.04
Women who have received HPV vaccine still need Pap tests	Correct vs. Incorrect	3.5 (2.1-5.8)	<0.0001	3.0 (1.8-4.8)	<0.0001
Communication
Today doctor or nurse talked about needing a Pap test after HPV vaccine	Yes vs. no/not sure	2.2 (1.4-3.4)	0.0005	3.0 (1.9-4.7)	<0.0001
Frequency with which mother talked about getting a Pap test	Frequently/several times vs. once/never	1.4 (0.9-2.3)	0.2	2.1 (1.3-3.6)	0.004
Sexual History
Number of lifetime male partners	≥ 5 vs. 0	4.3 (2.3-7.7)	<0.0001	7.5 (3.9-14.6)	<0.0001
	2-4 vs. 0	3.5 (2.0-6.4)	<0.0001	7.1 (3.7-13.9)	<0.0001
	1 vs. 0	0.9 (0.5-2.0)	0.87	3.1 (1.5-6.2)	0.002
Substance Use
Cigarettes, number of days smoked in past 30 days	≥ 1 vs. 0	2.1 (1.0-4.1)	0.04	5.8 (2.2-15.1)	0.0004
Marijuana, used in past year	Yes vs. no	2.4 (1.4-4.2)	0.002	3.8 (2.0-7.3)	<0.0001
Beer, wine or liquor average times drank in past year	≥ 1 vs. 0	2.1 (1.3-3.3)	0.002	2.7 (1.7-4.5)	<0.0001
Alcohol, amount consumed when drinking	≥ 1 vs. 0	2.1 (1.3-3.3)	0.002	2.6 (1.6-4.2)	0.0002

¹OR = odds ratio.

²CI = confidence interval.

³Age measured as a continuous variable.

⁴Independent variables associated with the outcome variables at P < .10 (included in multivariable models) are bolded.

Table 3. Variables associated with intention to follow recommendations for Pap testing after HPV vaccination, among all participants and stratified by sexual experience and age: results of adjusted logistic regression models.¹

Variables		AOR^2 (95% CI^3)
		All	Sexually experienced	Sexually inexperienced	≥ 18 years	< 18 years
Medical History
Ever had a Pap test	Yes vs. no/not sure	3.8 (2.4-6.2)	2.4 (1.1-5.2)	5.5 (1.2-24.4)		3.4 (1.8-6.3)
Had a Pap test in past year	Yes vs. no/not sure				3.9 (1.4-10.9)
HPV and HPV Vaccine Knowledge
HPV and vaccine knowledge	Mean scale score	1.2 (1.1-1.3)	1.2 (1.0-1.3)	1.3 (1.1-1.5)		1.2 (1.1-1.4)
Sexual History
Number of lifetime male partners	≥ 5 vs. 1		2.9 (1.2-7.2)
	2-4 vs. 1		3.1 (1.3-7.2)

¹Variables included in the multivariable models were all variables associated with each outcome variable at p < .10 in the univariable models, and variables associated with the outcomes at p < .05 in the final models are shown in the table. For the model predicting intention among all participants, the following variables were included: age, perceived risk of HPV, insurance plan, history of Pap testing (ever, in the past year), history of an abnormal Pap test, HPV and HPV vaccine knowledge (scale score), communication with doctor/nurse about Pap testing after vaccination, number of lifetime male sex partners, cigarette use, marijuana use, and alcohol use and consumption. Variables excluded were those shown in Table 1 that were not associated with the outcome variables at p < .10. For stratified models, there were differences in the variables included in the multivariable models due to differences in the results of the univariate models; only those variables associated with the outcome variable at p < .10 in the stratified univariable models were included.

²AOR = adjusted odds ratio

³CI = confidence interval

Table 4. Variables associated with self-efficacy to follow recommendations for Pap testing after HPV vaccination, among all participants and stratified by sexual experience and age: results of adjusted logistic regression models.¹

Variables		AOR^2 (95% CI^3)
		All	Sexually experienced	Sexually inexperienced	≥ 18 years	< 18 years
Insurance Coverage
Insurance Plan	Medicaid vs. none/unsure	3.1 (1.6-5.9)		4.1 (1.4-11.9)		4.2 (1.9-9.3)
Have insurance	Yes vs. no/not sure		2.9 (1.1-6.1)
Medical History
Ever had a Pap test	Yes vs. no/not sure				5.7 (1.6-20.0)	2.8 (1.4-5.8)
Had a Pap test in past year	Yes vs. no/not sure	3.6 (1.6-8.0)	2.9 (1.4-6.0)
Communication
From clinician: Pap needed  after HPV vaccination	Yes vs. no/not sure	2.2 (1.3-3.7)	2.1 (1.0-4.3)			2.9 (1.6-5.3)
From mother: need for  Pap testing	Several times/frequently vs. never/once			3.1 (1.3-7.7)
Sexual History
Number of lifetime male partners	≥ 5 vs. 0	2.2 (0.9-5.5)
	2-4 vs. 0	3.4 (1.6-7.4)
	1 vs. 0	1.7 (0.8-3.7)
Substance Use
Cigarette smoking previous 30 days	≥ 1 vs. 0 days	3.5 (1.0-11.9)	5.0 (1.1-22.8)
Marijuana use previous year	Yes vs. no					4.5 (1.7-12.0)

¹Variables included in the multivariable models were all variables associated with each outcome variable at p < .10 in the univariable models, and variables associated with the outcomes at p < .05 in the final models are shown in the table. For the model predicting self-efficacy among all participants, the following variables were included: age, insurance status, insurance plan, history of Pap testing (ever, in the past year), history of an abnormal Pap test, HPV and HPV vaccine knowledge (scale score), communication with doctor/nurse about Pap testing after vaccination, communication with mother about Pap testing, number of lifetime male sex partners, cigarette use, marijuana use, and alcohol use and consumption. Variables excluded were those shown in Table 1 that were not associated with the outcome variables at p < .10. For stratified models, there were differences in the variables included in the multivariable models due to differences in the results of the univariate models; only those variables associated with the outcomes at p < .10 in the stratified univariable models were included.

²AOR = adjusted odds ratio

³CI = confidence interval