Disparities of Perceptions and Practices Related to Cervical Cancer Prevention and the Acceptability of HPV Vaccination According to Educational Level in a French Cross-Sectional Survey of 18–65 Years Old Women

<div><p>Introduction</p><p>We aimed to study the relationships between educational level, women's knowledge about cervical cancer (CC), and acceptance of HPV vaccination for their daughters.</p><p>Methods</p><p>We analysed data from a quantitative (self-administrated questionnaire) and qualitative (semi-structured interviews) cross-sectional study performed in 2008 among 1,229 French 18–65-year-old women recruited by general practitioners. Women were categorized into three educational level groups: low (LEL: 43.9%), medium (MEL: 33.4%) and high (HEL: 22.6%).</p><p>Results</p><p>Knowledge about CC and its prevention was lower among LEL women. In the 180 mothers of 14–18-year-old daughters (99 LEL, 54 MEL, 45 HEL), acceptance of HPV vaccine was higher in LEL (60.4%) and MEL (68.6%) than in HEL mothers (46.8%). Among LEL mothers, those who were favourable to HPV vaccination were more likely to be young (OR = 8.44 [2.10–34.00]), to be vaccinated against hepatitis B (OR = 4.59 [1.14–18.52]), to have vaccinated their children against pneumococcus (OR = 3.52 [0.99–12.48]) and to present a history of abnormal Pap smear (OR = 6.71 [0.70–64.01]).</p><p>Conclusion</p><p>Although LEL women had poorer knowledge about CC and its prevention, they were more likely to accept HPV vaccination than HEL mothers.</p></div

Knowledge about cervical cancer, Pap-smear screening and HPV vaccination.

<p>LEL: Low education level, MEL: Medium education level, HEL: High education level.</p><p>Knowledge about cervical cancer, Pap-smear screening and HPV vaccination.</p

Sociodemographic characteristics and preventive health behaviours of survey participants according to educational level.

<p>LEL: Low education level, MEL: Medium education level, HEL: High education level, DTP: Diphtheria-tetanus-poliomyelitis.</p>1<p>Beneficiary of public free health insurance and/or minimal financial allocation for non workers.</p>2<p>N = 1,012 mothers: 467 LEL, 326 MEL and 219 HEL.</p><p>Sociodemographic characteristics and preventive health behaviours of survey participants according to educational level.</p

Multivariate analysis of factors associated with HPV vaccination acceptance among mothers with a low educational level (N = 91).

†<p>: first model, output threshold = 0.05, ‡: second model, output threshold = 0.10, <i>OR: Odd ratio, CI: confidence interval, NS not significant</i>.</p><p>Multivariate analysis of factors associated with HPV vaccination acceptance among mothers with a low educational level (N = 91).</p

Acceptability of HPV vaccination: options presented in the self-administered questionnaire, and the coding of responses.

<p>Acceptability of HPV vaccination: options presented in the self-administered questionnaire, and the coding of responses.</p

HPV vaccine acceptance among mothers of 14–18 year old daughters (N = 188).

<p>LEL: Low education level, MEL: Medium education level, HEL: High education level.</p><p>HPV vaccine acceptance among mothers of 14–18 year old daughters (N = 188).</p

Univariate analysis of factors associated with HPV vaccination acceptance among mothers with a low educational level (N = 91).

<p>Results are presented as N (%)/N(%) for number and percent for the tested category versus number and percent for the reference category.</p><p>OR: Odds ratio, CI: confidence interval, vs: versus, STI, Sexually transmitted infection.</p><p>Univariate analysis of factors associated with HPV vaccination acceptance among mothers with a low educational level (N = 91).</p

Description of variants predicted as deleterious by SIFT and as probably damaging by Polyphen.

<p>Ref.: Reference allele</p><p>Alt.: Alternative allele</p><p>Freq.: Minor allele frequency observed in our data</p><p>a. a. change: amino acid change</p><p>Description of variants predicted as deleterious by SIFT and as probably damaging by Polyphen.</p

Description of variants observed but unknown in MITOMAP.

<p>Pos.: position on mitochondrial genome</p><p>Ref.: Reference allele</p><p>Alt.: Alternative allele</p><p>Description of variants observed but unknown in MITOMAP.</p

Inclusion categories of selected index cases.

<p>Inclusion categories of selected index cases.</p