Abstract
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.
Similar content being viewed by others
Data availability
The data generated and analyzed during the current study are not publicly available due to the possibility of compromising individual privacy but are available from the corresponding author upon reasonable request.
Code availability
Not applicable.
References
Adjei Boakye, E., Tobo, B. B., Osazuwa-Peters, N., Mohammed, K. A., Geneus, C. J., & Schootman, M. (2017). A comparison of parent- and provider-reported human papillomavirus vaccination of Adolescents. American Journal of Preventive Medicine., 52(6), 742–752. https://doi.org/10.1016/j.amepre.2016.10.016
Adjei Boakye, E., Lew, D., Muthukrishnan, M., et al. (2018). Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18–26 year olds in the United States. Human Vaccines and Immunotherapeutics., 14(8), 2016–2024. https://doi.org/10.1080/21645515.2018.1467203
Barnard, M., Cole, A. C., Ward, L., Gravlee, E., Cole, M. L., & Compretta, C. (2019). Interventions to increase uptake of the human papillomavirus vaccine in unvaccinated college students: A systematic literature review. Preventive Medicine Reports, 14, 100884. https://doi.org/10.1016/j.pmedr.2019.100884
Bendik, M. K., Mayo, R. M., & Parker, V. G. (2011). Knowledge, perceptions, and motivations related to HPV vaccination among college women. Journal of Cancer Education, 26(3), 459–464. https://doi.org/10.1007/s13187-011-0200-8
Brouwer, A. F., Delinger, R. L., Eisenberg, M. C., Campredon, L. P., Walline, H. M., Carey, T. E., & Meza, R. (2019). HPV vaccination has not increased sexual activity or accelerated sexual debut in a college-aged cohort of men and women. BMC Public Health, 19, 1–8.
Center for Disease Control and Prevention. (2020) Behavioral Risk Factor Surveillance System (BRFSS). https://www.cdc.gov/brfss/data_documentation/index.htm. Accessed 8 September 2020
Chesson, H. W., Dunne, E. F., Hariri, S., & Markowitz, L. E. (2014). The estimated lifetime probability of acquiring human papillomavirus in the United States. Sexually Transmitted Diseases, 41(11), 660–664. https://doi.org/10.1097/olq.0000000000000193
Chesson, H. W., Meites, E., Ekwueme, D. U., Saraiya, M., & Markowitz, L. E. (2019). Updated medical care cost estimates for HPV-associated cancers: Implications for cost-effectiveness analyses of HPV vaccination in the United States. Human Vaccines & Immunotherapeutics, 15(7–8), 1942–1948. https://doi.org/10.1080/21645515.2019.1603562
Daniels, V., Saxena, K., Roberts, C., et al. (2021). Impact of reduced human papillomavirus vaccination coverage rates due to COVID-19 in the United States: A model based analysis. Article Vaccine, 39(20), 2731–2735. https://doi.org/10.1016/j.vaccine.2021.04.003
Fontenot, H. B., Collins Fantasia, H., Charyk, A., & Sutherland, M. A. (2014). Human papillomavirus (HPV) risk factors, vaccination patterns, and vaccine perceptions among a sample of male college students. Journal of American College Health, 62(3), 186–192. https://doi.org/10.1080/07448481.2013.872649
Gerend, M. A., Shepherd, M. A., & Shepherd, J. E. (2013). The multidimensional nature of perceived barriers: Global versus practical barriers to HPV vaccination. Health Psychology, 32(4), 361–369. https://doi.org/10.1037/a0026248
Halkitis, P. N., LoSchiavo, C., Martino, R. J., De La Cruz, B. M., Stults, C. B., & Krause, K. D. (2021). Age of sexual debut among young gay-identified sexual minority men: The P18 cohort study. The Journal of Sex Research, 58(5), 573–580. https://doi.org/10.1080/00224499.2020.1783505
Kennedy, C., Gray Brunton, C., & Hogg, R. (2014). Just that little bit of doubt’: Scottish parents’, teenage girls’ and health professionals’ views of the MMR, H1N1 and HPV vaccines. International Journal of Behavioral Medicine, 21(1), 3–10. https://doi.org/10.1007/s12529-013-9356-4
Lei, J., Ploner, A., Elfstrom, K. M., et al. (2020). HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine, 383(14), 1340–1348. https://doi.org/10.1056/NEJMoa1917338
Liddon, N. C., Leichliter, J. S., & Markowitz, L. E. (2012). Human papillomavirus vaccine and sexual behavior among adolescent and young women. American Journal of Preventive Medicine, 42(1), 44–52. https://doi.org/10.1016/j.amepre.2011.09.024
Lieblong, B. J., Montgomery, B. E. E., Su, L. J., & Nakagawa, M. (2019). Natural history of human papillomavirus and vaccinations in men: A literature review. Health Sci Rep., 2(5), e118. https://doi.org/10.1002/hsr2.118
Magnusson, B. M., Nield, J. A., & Lapane, K. L. (2015). Age at first intercourse and subsequent sexual partnering among adult women in the United States, a cross-sectional study. BMC Public Health, 15, 1–9.
Marchand, E., Glenn, B. A., & Bastani, R. (2013). HPV vaccination and sexual behavior in a community college sample. Journal of Community Health, 38(6), 1010–1014. https://doi.org/10.1007/s10900-013-9710-0
Martinez, G. M., & Abma, J. C. (2015). Sexual activity, contraceptive use, and childbearing of teenagers aged 15–19 in the United States. NCHS Data Brief, 209, 1–8.
Martinez, G. M., & Abma, J. C. (2020). Sexual activity and contraceptive use among teenagers aged 15–19 in the United States, 2015–2017. NCHS Data Brief, 366, 1–8.
Martin-Gutierrez, G., Wallander, J. L., Song, A. V., Elliott, M. N., Tortolero, S. R., & Schuster, M. A. (2017). Health-related issues in Latina youth: Racial/ethnic, gender, and generational status differences. Journal of Adolescent Health, 61(4), 478–485. https://doi.org/10.1016/j.jadohealth.2017.04.007
National Cancer Institute. (2020) Health Information National Trends Survey, https://hints.cancer.gov/data/default.aspx. Accessed 8 August 2020.
National Center for Health Statistics. (2015). National Health Interview Survey (NHIS) Public Use Data Release. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf. Accessed 5 November 2017.
Osazuwa-Peters, N., Adjei Boakye, E., Rohde, R. L., Ganesh, R. N., Moiyadi, A. S., Hussaini, A. S., & Varvares, M. A. (2019). Understanding of risk factors for the human papillomavirus (HPV) infection based on gender and race. Scientific Reports, 9(1), 297. https://doi.org/10.1038/s41598-018-36638-z
Rohde, R. L., Adjei Boakye, E., Christopher, K. M., et al. (2018a). Assessing university students’ sexual risk behaviors as predictors of human papillomavirus (HPV) vaccine uptake behavior. Vaccine, 36(25), 3629–3634. https://doi.org/10.1016/j.vaccine.2018.05.022
Rohde, R. L., Adjei Boakye, E., Christopher, K. M., et al. (2018b). Assessing university students’ sexual risk behaviors as predictors of human papillomavirus (HPV) vaccine uptake behavior. Vaccine, 36(25), 3629–3634.
Rosenblum, H. G., Lewis, R. M., Gargano, J. W., Querec, T. D., Unger, E. R., & Markowitz, L. E. (2021). Declines in prevalence of human papillomavirus vaccine-type infection among females after introduction of vaccine—United States, 2003–2018. Morbidity and Mortality Weekly Report, 70(12), 415.
Saxena, K., Dawson, R. S., Cyhaniuk, A., Bello, T., & Janjan, N. (2022). Clinical and economic burden of HPV-related cancers in the US veteran population. Journal of Medical Economics, 25(1), 299–308. https://doi.org/10.1080/13696998.2022.2041855
Senkomago, V., Henley, S. J., Thomas, C. C., Mix, J. M., Markowitz, L. E., & Saraiya, M. (2019). Human papillomavirus-attributable cancers—United States, 2012–2016. MMWR. Morbidity and Mortality Weekly Report, 68(33), 724–728. https://doi.org/10.15585/mmwr.mm6833a3
Truong-Vu, K. P. (2021). On-time, late, or never: Incorporating intersectionality to predict age-specific probabilities of initiating the HPV vaccine series. Social Science and Medicine, 287, 114227. https://doi.org/10.1016/j.socscimed.2021.114227
Van Dyne, E. A., Henley, S. J., Saraiya, M., Thomas, C. C., Markowitz, L. E., & Benard, V. B. (2018). Trends in human papillomavirus-associated cancers—United States, 1999–2015. MMWR. Morbidity and Mortality Weekly Report, 67(33), 918–924. https://doi.org/10.15585/mmwr.mm6733a2
Winer, R. L., Hughes, J. P., Feng, Q., et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25), 2645–2654. https://doi.org/10.1056/NEJMoa053284
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Human and animal rights and Informed Consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lee, M., Gerend, M.A., Whittington, K.D. et al. Factors associated with HPV-associated sexual risk behaviors among sexually active college students. J Behav Med 47, 334–341 (2024). https://doi.org/10.1007/s10865-023-00463-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-023-00463-1