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Author Notes:

Wendy Landier, PhD, CRNP, FAAN, Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, 1600 7th Ave. S., Lowder 500, Birmingham, AL; Phone: 205-638-2120. Email: wlandier@peds.uab.edu

Conception and Design: Brooke Cherven, James L. Klosky, Karen Heaton, Gwendolyn Childs, Smita Bhatia, Wendy Landier. Financial Support: James L. Klosky, Wendy Landier, Brooke Cherven Administrative Support: James L. Klosky, Smita Bhatia, Leslie L. Robison, Wendy Landier Provision of Study Materials or Patients: James L. Klosky, Jocelyn M. York, Jessica S. Flynn, James A. Connelly, Karen Wasilewski-Masker, Leslie L. Robison, Melissa M. Hudson, Smita Bhatia, Wendy Landier Collection and Assembly of Data: James L. Klosky, Jocelyn M. York, Jessica S. Flynn, James A. Connelly, Karen Wasilewski-Masker, Wendy Landier Data Analysis and Interpretation: Brooke Cherven, James L. Klosky, Yanjun Chen, Karen Heaton, Gwendolyn Childs, F. Lennie Wong, Smita Bhatia, Wendy Landier Manuscript Writing: All authors; Final Approval of Manuscript: All authors

This work was supported by the National Cancer Institute (R01CA166559 – MPIs-Landier & Klosky) and supported in part by the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP #40083; PI-Landier), and the American Lebanese Syrian Associated Charities (ALSAC) support of the Consortium for Pediatric Intervention Research. Dr. Cherven received support from the Robert Wood Johnson Future of Nursing Scholars (RWJF 72509) program and the American Cancer Society Doctoral Scholarship in Cancer Nursing (17–078-01-SCN). The opinions expressed in this paper are those of the authors and do not necessarily represent those of the study sponsors.

Disclosures: None



  • Science & Technology
  • Social Sciences
  • Life Sciences & Biomedicine
  • Oncology
  • Social Sciences, Biomedical
  • Biomedical Social Sciences
  • Cancer survivor
  • Human papillomavirus
  • HPV vaccine
  • Sexual behavior

Sexual behaviors and human papillomavirus vaccine non-initiation among young adult cancer survivors

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Journal Title:



Volume 15, Number 6


, Pages 942-950

Type of Work:

Article | Post-print: After Peer Review


Background: Young adult cancer survivors are at risk for subsequent human papillomavirus (HPV)-related malignancies. High-risk sexual behavior increases risk for HPV acquisition; HPV vaccination protects against infection. We aimed to determine the prevalence of sexual behaviors, factors related to high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among survivors. Methods: Survivors at comprehensive cancer centers, aged 18–26 years and 1–5 years post-treatment, reported sexual behaviors and HPV vaccine initiation (i.e., ≥ 1 dose). Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with high-risk sexual behaviors (age at first intercourse < 16 years, ≥ 3 lifetime sexual partners, or condom use ≤ 50% of the time) and to explore the relationship between sexual behaviors and vaccine non-initiation. Results: Of the 312 participants (48.1% female, median age at cancer diagnosis 17.2 years and at survey 20.9 years), sexual intercourse was reported by 63.1%. Of those reporting intercourse, 74.6% reported high-risk sexual behavior. Factors related to high-risk sexual behavior included currently dating/partnered (OR = 4.39, 95%CI 2.5–7.7, P < 0.001) and perceived susceptibility to HPV (OR = 1.76, 95%CI 1.3-2.5, P < 0.001). Most survivors (75.3%) reported HPV vaccine non-initiation; sexual behaviors were not associated with vaccine non-initiation (P = 0.4). Conclusions: Many survivors participate in high-risk sexual behaviors, yet HPV vaccine initiation rates are low. Factors related to high-risk sexual behaviors can inform interventions to reduce risk for HPV acquisition among survivors. Implications for Cancer Survivors: Cancer survivors participate in sexual behaviors that increase risk for HPV acquisition and would benefit from vaccination.
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