|Year : 2017 | Volume
| Issue : 6 | Page : 1704-1708
|Evaluation of awareness and high-risk behavior associated with genital wart in married female students
Nasibeh Roozbeh1, Ali Safari-Moradabadi2, Mojdeh Banaei1, Asiyeh Pormehr Yabandeh1, Elham Sadeghifar3, Shila Mahdavi1, Sakineh Dadipoor4
1 Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2 Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah; Department of Health Education School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Nursing, Islamic Azad University, Rasht Branch, Rasht, Iran
4 Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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|Date of Web Publication||11-Jan-2018|
| Abstract|| |
Introduction: Human papilloma virus (HPV) is a widespread sexually transmitted disease that could cause serious consequences for women. Students' high-risk behavior and lack of preventive activities are associated with an increased risk of HPV infection. This study evaluates the awareness and high-risk behavior associated with genital wart in married female students. Methods: This is a descriptive study conducted on 410 married female students of nonmedical majors in Scientific-Practical Center of Health Department in Bandar Abbas, Iran. Sampling was done based on systematic random sampling method. Data were collected by valid and reliable questionnaires made by researcher that had 3 parts (demographics, awareness investigation, and high-risk behaviors detection). The data were entered into SPSS statistical software and were analyzed using t-test, Chi-square, correlation, and regression test. Results: The average age of students was 23.1 years .Most of subjects (88%) did not pass check-ups for regular screening of genital wart in the last two years. Most of them had never heard the name of genital wart (82%) and those students who had heard the name of genital wart were informed by their friends as the source of information (98%). Evaluation of awareness about genital wart in married female students showed that most of the students had not complete awareness (score 9) toward the illness. The relationship between age and high-risk behaviors of students was statistically significant (P < 0.05). Conclusion: Based on this study, students' awareness about genital wart disease was very poor. Therefore, a deeper and practical training by qualified personnel for nonmedical students as well as educational program of media can be very effective.
Keywords: Awareness, human papilloma virus, student
|How to cite this article:|
Roozbeh N, Safari-Moradabadi A, Banaei M, Yabandeh AP, Sadeghifar E, Mahdavi S, Dadipoor S. Evaluation of awareness and high-risk behavior associated with genital wart in married female students. Ann Trop Med Public Health 2017;10:1704-8
|How to cite this URL:|
Roozbeh N, Safari-Moradabadi A, Banaei M, Yabandeh AP, Sadeghifar E, Mahdavi S, Dadipoor S. Evaluation of awareness and high-risk behavior associated with genital wart in married female students. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Oct 13];10:1704-8. Available from: http://www.atmph.org/text.asp?2017/10/6/1704/222701
| Introduction|| |
Human papillomavirus (HPV) is a widespread sexually transmitted disease that could cause serious consequences for women. The most important consequences of this disease include genital wart, cervix, vulva, vagina, penis, anus, oropharynx area, mouth, and throat cancer. There are more than 100 different types of HPV. Genital HPV types are divided into two groups: low-risk and high-risk. Low-risk types of HPV are mostly of types 6 and 11 that clinically may cause benign obvious genital wart. At least, 15% of genital warts are of high-risk type so that high-risk type DNA is detected in more than 95% of all cervical cancers in women., High-risk HPV types include types 16 and 18 that have been identified in 70% of all cervical cancers. Most cases of cervical cancer detected in 18–24 years women and only 2%–5% of patients aged over 35 years. Depending on the techniques used in diagnosis, genital HPV infection was estimated from 20% to 46% of young women in different countries. However, some studies have shown that the potential risk of infections may reach 60% or more. Pap smear test as a simple, inexpensive, and uncomplicated method is still the method of choice for screening of genital HPV infection. Since 1950, the Pap smear test has been assisted in reducing cervical cancer incidence to 79% and its mortality rate to 70%. Studies have shown that women's awareness about testing for cervical cancer led to early diagnosis, early treatment, and reduce morbidity caused by HPV infection. It is rare for single women be infected by this virus, but one study showed the incidence of the HPV in single girls presented in universities at about 7.9%. Students' high-risk behavior and lack of preventive activities were associated with an increased risk of HPV infection. Younger women have a higher risk of HPV infection transfer than older women. Increased risk of infection is in relationship with intercourse, alcohol consumption, and an increase of female sexual partner. Khan et al. in 2016 showed that Pakistani students had poor awareness about HPV. In addition, in another study that was conducted by Makwe et al.in Lagos, Nigeria, students awareness of students about HPV virus was as reported 17.7%. Another study by Rajiah et al. in 2015 in Malaysia was performed on health-care students about awareness and acceptance of HPV vaccine. In their study, 80% of students were aware that HPV could cause cervical cancer and about 54.6% reported that HPV infection affects both men and women equally. In 2012, Ghotbi and Anai conducted a study on awareness and orientation of Asian students. Awareness of the students about cervical cancer and its prevention was weak. Winer et al. in 2003 showed that the presence of a new sexual partner is associated with a higher risk of developing HPV infection in students. Due to higher rate of sexual activity and alcohol consumption in academic settings and also lack of awareness about high-risk behaviors associated with transmission of HPV, a large number of students are at the risk of HPV infection. Studies on college girls showed that they have risky sexual behaviors and their awareness about preventive activities is weak. Regarding the necessity and importance of controlling this fatal and contagious disease, it seems that providing necessary trainings to talented people, including young people is the most effective and least costly method for HPV prevention. Unfortunately, in our country, few studies have been done on awareness, attitude, and especially the performance of young people. Therefore, it is necessary to study about the state of knowledge and activity of talented individuals to design and implement more realistic preventive programs. On the other hand, no curriculum is considered for nonmedical students to recognize the disease, prevention ways and its controlling. Therefore, they may have less information than medical students. For this reason, the researchers decided to examine nonmedical students in regard to their knowledge and activity about genital wart. Awareness of genital wart and high-risk behaviors in students could help in planning and designing more effective strategies to reduce diseases associated with HPV infection. The aim of this study was to evaluate the awareness and high-risk behavior associated with genital wart in married female students.
| Methods|| |
This is a descriptive study conducted on 410 married female students of nonmedical majors in Scientific-Practical Center of Health Department in Bandar Abbas, Iran. Sampling was done based on systematic random sampling method. Inclusion criteria include a minimum ability to read and write, marriage, and having tendency to participate in the study. If these conditions were not met by participants, they were excluded from the study. Data were collected by valid and reliable questionnaires made by researcher that had 3 parts (demographics, awareness investigation, and high-risk behaviors detection). To collect demographic information, the questionnaire included questions about age, family income, academic degree, life state, student insurance status, insurance for the cervical test, number of check-ups in the past 2 years and information source about genital wart. Nine awareness questions were included in the questionnaire. Among them, four questions were involved true or false answers and five questions contained four-choice answers. True answers were scored 1 score and false answers scored 0 score. Total scores ranged from 0 to 9 in which high scores represent more points and low scores represent lower points. In high-risk behavior, survey part of questionnaire, participants were questioned about behaviors related to sexual activity, intercourse, first sexual activity, number of sexual partners, contraception method, frequency of condom use, alcohol, and drugs use. This part of questionnaire contained 13 questions: 2 open questions and 11 questions with yes or no answers. 0 score was given to no answers and 1 score was given to yes answers. Total score of this part was 11 scores in which, lower scores indicated less points. Questionnaire total score was 20 scores. More scores indicated more points. To verify the validity of questionnaire, 10 experts within health education, midwifery, and reproductive health were utilized. Validity of questionnaire was evaluated, and some questions were modified and few was added. To test the reliability of questionnaire, 15 students were asked to complete questionnaires. Finally, Cronbach's alpha was 0.85 that was acceptable. To standardize questionnaire, instructions for completing the questionnaire were given to students. The data were entered into SPSS statistical software (V.17.0, SPSS Inc., Chicago, IL, USA) statistical software and were analyzed using t-test, Chi-square, correlation, and regression tests. After gaining the permission of research department and faculty authorities, the aim of the study was explained to volunteer students, and it was wanted from them to enter the study after answering the questionnaire if they liked. It was explained to participants that the questionnaire is completely confidential and if they wish, they could be informed of the results.
| Results|| |
The average age of students was 23.1 years and most of them were graded at associate degree (65%). Most of the study participants lived in urban areas (63%) and insurance did not cover HPV vaccination for none of the students. Most of the subjects (88%) did not passed check-ups for regular screening of genital wart in the last 2 years. Most of them had never heard of genital wart (82%) and those students who had heard of genital wart were informed by their friends as the source of information (98%) and less had heard from health-care providers and TV about genital wart. The evaluation of awareness about genital wart in married female students showed that most of the students had not complete awareness (score 9) about the disease (59%) and 40% had partial awareness (score 5–9) and only 1% of students had complete awareness about the disease. About 82% of participants had regular sexual activity and 18% were sexually inactive. The average age of first intercourse was 21 years old. In regard to high-risk behaviors associated with genital wart, 90% of participants in the study had experienced vaginal intercourse and only 10% had experienced rectal sex. 16% had experienced unwanted pregnancy and 70% did not use condoms. Most of them had no history of alcohol and drug consumption (98%). None of the participants had multiple sexual partners. Most of them did not had a history of HPV infection (84%) and only 8% reported to having genital wart. 20% of participants had a history of other sexual disease. The relationship between age and high-risk behaviors of students was statistically significant (P = 0.040) and with age rising in students, the prevalence of high-risk behaviors was decreased. The relationship between educational level and high-risk behaviors of students was statistically significant (P = 0.035) and with increasing in level education, the prevalence of high-risk behavior decreased. There was no significant correlation between awareness and location (P = 0.28).
| Discussion|| |
This study was conducted on 410 married female students to assess the level of awareness and high-risk behavior associated with genital wart. The results of this study showed that the majority of participants had low scores for awareness and in limited cases, the awareness was complete. Some studies had shown that awareness and attitude of students toward HPV, cervical cancer, and the way of their prevention were weak.,, In study Ghojazadeh et al. in Tabriz, the awareness of students was evaluated to be at moderate level. However, in that study, the awareness of American young people in ages of 18–26 years old was reported high. In contrast to these studies, one study in Keele University in England showed that women awareness about the HPV was 75%. However, despite this awareness, only 27% reported that HPV causes cervical cancer. Not only in developing countries the level of awareness and knowledge about HPV infection was reported to be very low but also in developed countries such as the USA and England. It was shown that awareness is low although there was annual program for Pop-smear screening for cervical cancer.,, The level of awareness among our study subjects was lower than other studies that could have been caused by difference in knowledge level between developed and developing countries and difference in sample size among various studies. It seems that seminars, conferences, and symposiums held by health organizations as well as consulting and training to young people have a special place in this context. In the present study, such as Salehifar et al. study, there was a significant relationship between age and awareness level as well as showing high-risk behaviors and with rising the age, awareness level of students about genital wart, and rate of high-risk behaviors were lowered. Khan et al. in 2016 and Overtashi et al. in 2013 showed this results in their studies too. These results are normal because with increasing in age, personal experiences, and also the possibility that students exposed to more information about HPV and cervical cancer are increased too. Among high-risk behaviors associated with genital wart, 70% of students did not use condoms. Consistent with our results, Silassie et al. work in 2015 in Ethiopia, it was indicated that a lot of students did not used condoms for the prevention of sexually transmitted disease although they had enough knowledge and attitude about preventative role of mechanical methods about sexually transmitted disease that may be related to the lack of accessibility. Health advice on the role of condoms in the prevention of sexually transmitted diseases as well as providing free advice could help in reducing the transmission of these diseases. Effective information of reproductive health advisors to women could be achieved by educational channels such as websites, radio, and television programs and training in universities and faculties. This study showed that by increasing in education level, high-risk behaviors associated with genital wart decreased. Hargreaves et al. in a review study reported that incidence of sexually transmitted disease among people with higher educational levels is lower and prevention behaviors against these disease is seen frequently among people with lower educational levels. High educational level could affect people health and choice of suitable behaviors related to their health and also development of personal and public sanitation through various ways including rising the cognitive and noncognitive skills in people about health and accessibility to economic sources for health cares. What was attained in this study about achievement of health information by the students was that despite low information among students, the greatest source of information for them were their friends (98%). However, the role of health-care providers and television in context of genital wart was very poor. In Salehifar et al. study, about 41% of persons expressed that university courses were their source of informational and after that media (24%). Ghotbi and Anai in a study involving Japanese students reported that university courses (90%), media (7%) and health-care providers (0.1%) were their source of information and this problem was confirmed. In general, it is important to note that some studies suggest poorly informed health-care providers and even physicians about HPV infection. In this study, the role of health-care providers was very poor despite its importance. Hence, the necessity of supporting and highlighting the role of health institutions and the media in the prevention of this infection is of high importance. Training about these diseases should be included in educational curriculum of nonmedical students. More investigations should be performed in other universities on awareness about HPV and high-risk-related behaviors. By this, the findings can be used to estimate the future educational needs. In addition, by providing and broadcasting television programs, films, theater, and media which would be of interest to these people and involving them in educational planning, would prompted to obtain more information. This study increased the generalizability of the results by randomizing the sampling; but one of the limitations was self-reporting of questionnaires. In this study, despite justifying and inspiring participating students to be factual, some people may have not answered correctly because of the sensitivity of the issue. In general, based on the result of this study, it can be inferred that students' awareness of genital wart disease was very poor.
| Conclusion|| |
Based on this study, students' awareness about genital wart disease was very poor and most cases their source of information was their friends which does not solve the problem of educational needs. Therefore, the deeper and practical training by qualified personnel for nonmedical students as well as educational program of media can be very effective.
This article was part of an Approved Project (9410) in Hormozgan University of Medical Sciences. All of authors would like to express their thankfulness to the colleagues at Hormozgan University of Medical Sciences in conduct of this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Friedman AL, Shepeard H. Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: Findings from CDC focus group research and implications for practice. Health Educ Behav 2007;34:471-85.
Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Prev Med 2007;45:107-14.
Braaten KP, Laufer MR. Human papillomavirus (HPV), HPV-related disease, and the HPV vaccine. Rev Obstet Gynecol 2008;1:2-10.
Juckett G, Hartman-Adams H. Human papillomavirus: Clinical manifestations and prevention. Am Fam Physician 2010;82:1209-13.
Tábora N, Zelaya A, Bakkers J, Melchers WJ, Ferrera A. Chlamydia trachomatis and genital human papillomavirus infections in female university students in Honduras. Am J Trop Med Hyg 2005;73:50-3.
Safaeian M, Solomon D, Castle PE. Cervical cancer prevention – Cervical screening: Science in evolution. Obstet Gynecol Clin North Am 2007;34:739-60, ix.
Wong LP, Wong YL, Low WY, Khoo EM, Shuib R. Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: A qualitative study. Singapore Med J 2009;50:49-53.
Thomas JO, Herrero R, Omigbodun AA, Ojemakinde K, Ajayi IO, Fawole A, et al.
Prevalence of papillomavirus infection in women in Ibadan, Nigeria: A population-based study. Br J Cancer 2004;90:638-45.
Tang SY, Liu ZH, Li L, Cai HL, Wan YP. Awareness and knowledge about human papillomavirus among high school students in China. J Reprod Med 2014;59:44-50.
Schabath MB, Thompson ZJ, Egan KM, Torres BN, Nguyen A, Papenfuss MR, et al.
Alcohol consumption and prevalence of human papillomavirus (HPV) infection among US men in the HPV in Men (HIM) study. Sex Transm Infect 2015;91:61-7.
Khan TM, Buksh MA, Rehman IU, Saleem A. Knowledge, attitudes, and perception towards human papillomavirus among university students in Pakistan. Papillomavirus Res 2016;2:122-7.
Makwe CC, Anorlu RI, Odeyemi KA. Human papillomavirus (HPV) infection and vaccines: Knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria. J Epidemiol Glob Health 2012;2:199-206.
Rajiah K, Maharajan MK, Chin NS, Num KS. Awareness and acceptance of human papillomavirus vaccination among health sciences students in Malaysia. Virusdisease 2015;26:297-303.
Ghotbi N, Anai A. Assessment of the knowledge and attitude of female students towards cervical cancer prevention at an international university in Japan. Asian Pac J Cancer Prev 2012;13:897-900.
Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA, et al.
Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003;157:218-26.
Guiella G, Madise NJ. HIV/AIDS and sexual-risk behaviors among adolescents: Factors influencing the use of condoms in Burkina Faso. Afr J Reprod Health 2007;11:182-96.
Ghojazadeh M, Azar ZF, Saleh P, Naghavi-Behzad M, Azar NG. Knowledge and attitude of Iranian university students toward human papilloma virus. Asian Pac J Cancer Prev 2012;13:6115-9.
Sherman SM, Nailer E, Minshall C, Coombes R, Cooper J, Redman CW, et al.
Awareness and knowledge of HPV and cervical cancer in female students: A survey (with a cautionary note). J Obstet Gynaecol 2016;36:76-80.
Brabin L, Roberts SA, Farzaneh F, Kitchener HC. Future acceptance of adolescent human papillomavirus vaccination: A survey of parental attitudes. Vaccine 2006;24:3087-94.
Dell DL, Chen H, Ahmad F, Stewart DE. Knowledge about human papillomavirus among adolescents. Obstet Gynecol 2000;96:653-6.
Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. Know about human papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev 2007;16:288-94.
Salehifar D, Lotfi R, Akbari Kamrani M. Knowledge about cervical cancer, human papilloma virus and attitude towards acceptance of vaccination among female students. J Iran Inst Health Sci Res (Payesh) 2015;2:217-26.
Ortashi O, Raheel H, Shalal M, Osman N. Awareness and knowledge about human papillomavirus infection and vaccination among women in UAE. Asian Pac J Cancer Prev 2013;14:6077-80.
Silassie AG, Giorgis MW, Kahsay N, Fisaha Y, Zerihun Z, Tadesse K, et al
. Knowledge, attitude and practice of condom utilization among Axum preparatory school students. J AIDS Clin Res 2016;8:2016.
Long L, Yuan T, Wang M, Xu C, Yin J, Xiong C, et al.
Factors associated with condom use among male college students in Wuhan, China. PLoS One 2012;7:e51782.
Hargreaves JR, Bonell CP, Boler T, Boccia D, Birdthistle I, Fletcher A, et al.
Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS 2008;22:403-14.
David DH, Spittel ML, Kaplan RM. Population Health: Behavioral and Social Science Insights. New Directions for Behavioral and Social Science Strategies to Improve Health | Agency for Healthcare Research & Quality1916;2:33.
Wong MC, Lee A, Ngai KL, Chor JC, Chan PK. Knowledge, attitude, practice and barriers on vaccination against human papillomavirus infection: A cross-sectional study among primary care physicians in Hong Kong. PLoS One 2013;8:e71827.
Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas
Source of Support: None, Conflict of Interest: None
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