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Vaccination against Human Papillomavirus in relation to Financial Crisis: The “Evaluation and Education of Greek Female Adolescents on Human Papillomaviruses’ Prevention Strategies” ELEFTHERIA Study

Published:December 24, 2015DOI:https://doi.org/10.1016/j.jpag.2015.12.007

      Abstract

      Study Objective

      In this study we aimed to explore financial and other sociodemographic factors that affect nonvaccination against the human papillomavirus (HPV) in Greece, one of the first European Union countries to introduce the vaccination against HPV into its National Immunization Programme in 2008.

      Design, Setting, Participants, Interventions, and Main Outcome Measures

      Six hundred thirty-two female adolescents (aged 11-16 years) from Greece completed a pilot cross-sectional questionnaire-based survey (ELEFTHERIA study) from 2008 to 2014.

      Results

      Overall, only 8.9% (56 of 632) of the female adolescents reported that they had received all 3 doses of the HPV vaccination. The HPV vaccination uptake rates increased gradually from 3.2% (3 of 95) in 2008 to 17.1% (14 of 82) in 2011. However, it abruptly decreased to 2.1% (2 of 95) in 2012 and it reached 9.2% (8 of 87) in 2013 and 11.5% (11 of 96) in 2014. The most common factors for nonvaccination included fear of side effects, which decreased (Spearman ρ = −0.860; P = .024) and financial issues, which increased statistically significantly (Spearman ρ = 0.890; P = .012) during the years 2008 to 2014.

      Conclusion

      In our study we addressed the novel topic of the association of financial issues with HPV vaccination compliance and highlighted the urgent need to provide and maintain health insurance coverage to children in Greece, a country in financial crisis.

      Key Words

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      References

        • zur Hausen H.
        Papillomaviruses and cancer: from basic studies to clinical application.
        Nat Rev Cancer. 2002; 2: 342
        • Mammas I.N.
        • Sourvinos G.
        • Spandidos D.A.
        Human papilloma virus (HPV) infection in children and adolescents.
        Eur J Pediatr. 2009; 168: 267
        • zur Hausen H.
        Papillomaviruses in the causation of human cancers – a brief historical account.
        Virology. 2009; 384: 260
        • Einstein M.H.
        • Schiller J.T.
        • Viscidi R.P.
        • et al.
        Clinician's guide to human papillomavirus immunology: knowns and unknowns.
        Lancet Infect Dis. 2009; 9: 347
        • Mammas I.N.
        • Spandidos D.A.
        • George N.
        Papanicolaou (1883-1962): fifty years after the death of a great doctor, scientist and humanitarian.
        J BUON. 2012; 17: 180
        • Tota J.E.
        • Chevarie-Davis M.
        • Richardson L.A.
        • et al.
        Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies.
        Prev Med. 2011; 53: S12
        • Mammas I.N.
        • Sourvinos G.
        • Zaravinos A.
        • et al.
        Vaccination against human papilloma virus (HPV): epidemiological evidence of HPV in non-genital cancers.
        Pathol Oncol Res. 2011; 17: 103
        • Kahn J.A.
        HPV vaccination for the prevention of cervical intraepithelial neoplasia.
        N Engl J Med. 2009; 361: 271
        • Kim J.J.
        • Goldie S.J.
        Health and economic implications of HPV vaccination in the United States.
        N Engl J Med. 2008; 359: 821
        • Raffle A.E.
        Challenges of implementing human papillomavirus (HPV) vaccination policy.
        BMJ. 2007; 335: 375
        • Fisher H.
        • Audrey S.
        • Mytton J.A.
        • et al.
        Examining inequalities in the uptake of the school-based HPV vaccination programme in England: a retrospective cohort study.
        J Public Health (Oxf). 2014; 36: 36
        • Stöcker P.
        • Dehnert M.
        • Schuster M.
        • et al.
        Human papillomavirus vaccine uptake, knowledge and attitude among 10th grade students in Berlin, Germany, 2010.
        Hum Vaccin Immunother. 2013; 9: 74
        • Steens A.
        • Wielders C.C.
        • Bogaards J.A.
        • et al.
        Association between human papillomavirus vaccine uptake and cervical cancer screening in the Netherlands: implications for future impact on prevention.
        Int J Cancer. 2013; 132: 932
        • Marek E.
        • Dergez T.
        • Rebek-Nagy G.
        • et al.
        Adolescents' awareness of HPV infections and attitudes towards HPV vaccination 3 years following the introduction of the HPV vaccine in Hungary.
        Vaccine. 2011; 29: 8591
        • Fagot J.P.
        • Boutrelle A.
        • Ricordeau P.
        • et al.
        HPV vaccination in France: uptake, costs and issues for the National Health Insurance.
        Vaccine. 2011; 29: 3610
        • Deleré Y.
        • Böhmer M.M.
        • Walter D.
        • et al.
        HPV vaccination coverage among women aged 18-20 years in Germany three years after recommendation of HPV vaccination for adolescent girls: results from a cross-sectional survey.
        Hum Vaccin Immunother. 2013; 9: 1706
        • Vandoros S.
        • Hessel P.
        • Leone T.
        • et al.
        Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach.
        Eur J Public Health. 2013; 23: 727
        • Simou E.
        • Koutsogeorgou E.
        Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review.
        Health Policy. 2014; 115: 111
        • Rajmil L.
        • Fernandez de Sanmamed M.J.
        • Choonara I.
        • et al.
        Impact of the 2008 economic and financial crisis on child health: a systematic review.
        Int J Environ Res Public Health. 2014; 11: 6528
        • Fisher H.
        • Trotter C.L.
        • Audrey S.
        • et al.
        Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis.
        Int J Epidemiol. 2013; 42: 896
        • Kessels S.J.
        • Marshall H.S.
        • Watson M.
        • et al.
        Factors associated with HPV vaccine uptake in teenage girls: a systematic review.
        Vaccine. 2012; 30: 3546
        • Duderstadt K.G.
        • Hughes D.C.
        • Soobader M.J.
        • et al.
        The impact of public insurance expansions on children's access and use of care.
        Pediatrics. 2006; 118: 1676
        • Chou B.
        • Krill L.S.
        • Horton B.B.
        • et al.
        Disparities in human papillomavirus vaccine completion among vaccine initiators.
        Obstet Gynecol. 2011; 118: 14
        • Donadiki E.M.
        • Jiménez-García R.
        • Hernández-Barrera V.
        • et al.
        Human papillomavirus vaccination coverage among Greek higher education female students and predictors of vaccine uptake.
        Vaccine. 2012; 30: 6967
        • Tsakiroglou M.
        • Bakalis M.
        • Valasoulis G.
        • et al.
        Women's knowledge and utilization of gynecological cancer prevention services in the Northwest of Greece.
        Eur J Gynaecol Oncol. 2011; 32: 178
        • Bakogianni G.D.
        • Nikolakopoulos K.M.
        • Nikolakopoulou N.M.
        HPV vaccine acceptance among female Greek students.
        Int J Adolesc Med Health. 2010; 22: 271
        • Papagiannis D.
        • Rachiotis G.
        • Symvoulakis E.K.
        • et al.
        Vaccination against human papillomavirus among 865 female students from the health professions in central Greece: a questionnaire-based cross-sectional study.
        J Multidiscip Healthc. 2013; 6: 435
        • Donadiki E.M.
        • Jiménez-García R.
        • Hernández-Barrera V.
        • et al.
        Knowledge of the HPV vaccine and its association with vaccine uptake among female higher-education students in Greece.
        Hum Vaccin Immunother. 2013; 9: 300
        • Mammas I.N.
        • Theodoridou M.
        Financial crisis and childhood immunization: when parents disagree.
        Acta Paediatr. 2013; 102: e145