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.
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201
6
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4
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I
SS
N:
2252
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8806
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late
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ti
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K
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w
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d
:
B
elief
s
HP
V
Hu
m
an
P
ap
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a
v
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Gr
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m
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s
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o
s
t
co
m
m
o
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s
e
x
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s
m
it
ted
in
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(
ST
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)
in
th
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w
o
r
ld
[
1
]
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H
P
V
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th
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lead
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[
2
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ab
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s
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[
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[
4
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[
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HP
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cin
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[
3
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Desp
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av
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HP
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[
2
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,
[
8
]
,
[
9
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.
T
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I
J
P
HS
I
SS
N:
2252
-
8806
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[
9
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14
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1
5
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W
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a
g
e
[
1
4
]
,
[
1
6
]
.
A
d
d
itio
n
all
y
,
r
esear
c
h
o
n
e
x
p
ats
is
i
m
p
o
r
ta
n
t,
as
t
h
er
e
ar
e
an
i
n
cr
ea
s
i
n
g
n
u
m
b
er
o
f
in
d
i
v
id
u
al
s
a
n
d
f
a
m
i
lies
m
o
v
in
g
ab
r
o
ad
f
o
r
p
r
o
f
es
s
io
n
al
r
ea
s
o
n
s
,
a
n
d
f
o
r
a
d
u
r
atio
n
o
f
lo
n
g
er
th
a
n
6
m
o
n
t
h
s
at
a
ti
m
e
[
1
7
]
.
E
x
p
ats
f
ac
e
a
u
n
iq
u
e
s
et
o
f
f
a
cto
r
s
th
at
h
a
v
e
t
h
e
p
o
ten
t
ial
t
o
cr
ea
te
an
i
n
cr
ea
s
ed
c
u
m
u
lat
iv
e
r
is
k
o
f
ex
p
o
s
u
r
e
to
v
ac
cin
e
-
p
r
ev
e
n
ta
b
le
illn
ess
e
s
in
t
h
eir
h
o
s
t
co
u
n
tr
y
[
5
]
,
[
1
8
]
.
Ma
n
y
f
ac
to
r
s
in
cr
ea
s
e
th
e
lik
el
ih
o
o
d
o
f
h
ea
lt
h
r
is
k
s
i
n
m
o
v
i
n
g
f
r
o
m
d
e
v
elo
p
ed
to
less
d
ev
el
o
p
ed
co
u
n
tr
ies,
in
cl
u
d
i
n
g
p
r
o
b
lem
s
ad
ap
tin
g
to
d
if
f
er
e
n
t
asp
ec
t
s
o
f
t
h
eir
h
o
s
t
co
u
n
tr
y
(
la
n
g
u
a
g
e,
cli
m
at
e,
p
o
liti
cs),
cu
lt
u
r
e
(
s
tat
u
s
o
f
w
o
m
en
,
att
itu
d
e
s
,
r
elig
io
n
)
,
an
d
f
ac
ilit
ie
s
(
h
o
u
s
in
g
,
tr
a
n
s
p
o
r
tatio
n
,
i
n
f
r
as
tr
u
c
tu
r
e
s
u
c
h
as
h
o
s
p
ital
s
,
p
o
lice
s
er
v
ice)
[
1
9
]
.
I
n
B
an
g
k
o
k
,
e
x
p
a
ts
ar
e
e
x
p
o
s
ed
to
a
u
n
iq
u
e
s
et
o
f
1
)
e
n
v
ir
o
n
m
en
tal
f
ac
to
r
s
s
u
c
h
a
s
co
n
g
es
ted
u
r
b
an
ar
ea
s
an
d
in
f
r
astru
ct
u
r
e,
w
h
ich
r
estrict
m
o
b
il
it
y
a
n
d
ac
ce
s
s
to
m
ed
ical
o
r
h
ea
lth
ca
r
e,
2
)
s
o
cio
-
cu
lt
u
r
al
f
ac
to
r
s
s
u
c
h
a
s
lan
g
u
a
g
e
b
ar
r
ier
s
a
n
d
th
e
i
n
a
b
ilit
y
to
co
m
m
u
n
icate
i
n
T
h
ai
to
clea
r
l
y
ex
p
lai
n
h
ea
lt
h
n
e
ed
s
o
r
is
s
u
es,
a
n
d
a
lack
o
f
n
e
ig
h
b
o
r
h
o
o
d
o
r
co
m
m
u
n
it
y
co
n
n
ec
tio
n
w
h
ic
h
r
ed
u
ce
s
p
ar
en
ts
‘
h
ea
lt
h
y
s
u
p
p
o
r
t
s
y
s
te
m
,
3
)
g
r
o
w
in
g
p
o
liti
ca
l
in
s
ec
u
r
it
y
a
n
d
v
io
le
n
ce
w
ith
r
ec
en
t
c
h
a
n
g
e
s
i
n
g
o
v
er
n
m
e
n
t
w
h
ic
h
r
estrict
s
m
o
v
e
m
en
t
i
n
a
n
d
ar
o
u
n
d
th
e
cit
y
,
4
)
g
r
ea
ter
ex
p
o
s
u
r
e
t
o
h
i
g
h
-
r
is
k
b
e
h
av
io
r
s
s
u
ch
as
s
ex
to
u
r
is
m
,
co
n
s
u
m
p
t
io
n
o
f
alco
h
o
l,
d
r
u
g
s
,
a
n
d
cig
ar
ettes.
L
itt
le
in
f
o
r
m
atio
n
ex
is
t
s
ab
o
u
t
b
est
m
o
d
es
o
f
d
is
s
e
m
i
n
ati
n
g
h
ea
lt
h
-
r
elate
d
in
f
o
r
m
a
tio
n
to
ex
p
ats,
an
d
ab
o
u
t
w
h
et
h
er
m
o
d
e
o
f
co
m
m
u
n
ica
tio
n
in
f
l
u
e
n
ce
s
co
m
p
lian
ce
to
r
ec
o
m
m
en
d
ed
p
r
ev
e
n
tati
v
e
m
ea
s
u
r
es.
E
x
p
at
p
ar
en
ts
ca
n
b
e
d
if
f
ic
u
lt
to
ac
ce
s
s
th
r
o
u
g
h
tr
ad
itio
n
al
ch
a
n
n
el
s
,
th
er
e
f
o
r
e
th
is
s
t
u
d
y
i
n
ter
v
en
t
io
n
in
cl
u
d
ed
e
m
ail
as
th
e
m
o
d
e
o
f
d
is
s
e
m
in
ati
n
g
HP
V
-
r
ela
ted
in
f
o
r
m
at
io
n
.
Of
th
e
f
e
w
s
tu
d
ie
s
th
at
h
av
e
e
v
alu
ated
th
e
ef
f
ec
t
o
f
e
m
ail
as
a
h
ea
lt
h
p
r
o
m
o
tio
n
to
o
l,
r
esu
lts
h
a
v
e
b
ee
n
p
r
o
m
i
s
i
n
g
,
an
d
e
m
a
il
h
as
p
r
o
v
en
to
b
e
f
ast,
ec
o
n
o
m
ic
al,
an
d
co
n
v
e
n
ien
t [
2
0
]
-
[
2
3
]
.
T
h
e
p
u
r
p
o
s
e
o
f
th
is
s
t
u
d
y
w
a
s
to
in
v
e
s
ti
g
ate
t
h
e
p
r
eli
m
i
n
a
r
y
e
f
f
icac
y
o
f
an
e
m
ail
co
m
m
u
n
icat
io
n
in
ter
v
e
n
tio
n
f
o
r
ex
p
atr
iate
(
ex
p
at)
p
ar
en
ts
li
v
i
n
g
i
n
B
an
g
k
o
k
,
T
h
ailan
d
,
o
n
m
ea
s
u
r
es
o
f
HP
V
k
n
o
w
led
g
e.
T
h
e
d
ata
g
en
er
ated
f
r
o
m
t
h
i
s
s
t
u
d
y
w
ill d
eter
m
i
n
e
w
h
et
h
er
a
lar
g
er
co
n
f
ir
m
a
to
r
y
s
t
u
d
y
is
w
ar
r
a
n
ted
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
s
tu
d
y
w
as
ap
p
r
o
v
ed
b
y
t
h
e
E
th
ic
s
R
e
v
ie
w
C
o
m
m
it
tee
f
o
r
R
esear
ch
I
n
v
o
l
v
i
n
g
Hu
m
a
n
R
e
s
ea
r
c
h
Su
b
j
ec
ts
,
Hea
lt
h
Sc
ien
ce
s
Gr
o
u
p
at
C
h
u
lalo
n
g
k
o
r
n
U
n
i
v
er
s
it
y
i
n
Dec
e
m
b
er
2
0
1
2
.
I
n
N
o
v
e
m
b
er
-
Dec
e
m
b
er
2
0
1
3
,
th
e
s
tu
d
y
w
as
ad
v
er
ti
s
ed
w
id
el
y
i
n
v
ar
io
u
s
p
r
o
f
es
s
i
o
n
al,
r
eso
u
r
ce
an
d
s
o
c
ial
n
et
w
o
r
k
s
f
o
r
ex
p
ats
i
n
B
an
g
k
o
k
.
Six
t
y
-
s
ix
p
ar
en
ts
wer
e
r
ec
r
u
ited
.
T
o
p
ar
ticip
ate
in
t
h
e
s
t
u
d
y
,
e
x
p
at
p
ar
en
ts
h
ad
to
b
e
f
r
o
m
f
a
m
ilie
s
th
at
r
elo
ca
ted
ab
r
o
ad
f
o
r
p
r
o
f
ess
io
n
a
l
r
ea
s
o
n
s
,
h
ad
liv
ed
i
n
B
an
g
k
o
k
f
o
r
a
m
i
n
i
m
u
m
o
f
1
y
ea
r
,
b
e
a
b
i
o
lo
g
ical
o
r
a
n
o
n
-
b
io
lo
g
ical
p
ar
e
n
t
o
r
g
u
ar
d
ia
n
o
f
a
c
h
ild
(
r
en
)
b
elo
w
t
h
e
a
g
e
o
f
1
8
y
ea
r
s
,
h
av
e
n
o
t
v
ac
ci
n
ated
t
h
eir
ch
ild
(
r
en
)
w
it
h
th
e
HP
V
v
ac
c
i
n
e(
s
)
,
p
r
o
f
icien
c
y
i
n
E
n
g
lis
h
(
r
ea
d
in
g
an
d
w
r
iti
n
g
)
,
an
d
ac
ce
s
s
to
e
m
ai
l a
d
d
r
ess
,
r
eg
u
lar
u
s
e
o
f
a
co
m
p
u
ter
a
n
d
I
n
ter
n
et.
I
n
to
t
al,
f
o
r
t
y
-
th
r
e
e
p
ar
en
ts
w
er
e
eli
g
ib
le
to
p
ar
t
icip
ate
in
t
h
e
s
tu
d
y
.
W
r
itten
co
n
s
e
n
t
w
a
s
o
b
tain
e
d
f
r
o
m
all
s
tu
d
y
p
ar
ticip
an
t
s
.
I
n
to
tal,
f
o
r
t
y
-
th
r
ee
p
ar
en
ts
w
er
e
eli
g
ib
le
to
p
ar
ticip
ate
in
th
e
s
t
u
d
y
.
P
ar
en
ts
w
er
e
r
an
d
o
m
l
y
allo
c
ated
to
eith
er
g
r
o
u
p
1
(
n
=
2
3
)
o
r
g
r
o
u
p
2
(
n
=
2
0
)
.
Gr
o
u
p
1
w
a
s
e
m
ailed
a
s
er
ie
s
o
f
1
2
p
o
s
ter
s
o
v
er
a
p
er
io
d
o
f
o
n
e
m
o
n
t
h
(
r
ec
eiv
i
n
g
a
n
e
w
p
o
s
ter
t
h
r
ee
ti
m
es p
er
w
ee
k
)
.
E
ac
h
p
o
s
ter
co
n
tain
ed
u
n
b
iased
,
ac
cu
r
ate
in
f
o
r
m
at
io
n
ab
o
u
t
HP
V
o
r
th
e
HP
V
v
ac
cin
e
t
h
at
was
d
er
iv
ed
f
r
o
m
t
h
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
,
th
e
P
u
b
lic
Hea
lth
Ag
en
c
y
o
f
C
an
ad
a,
an
d
th
e
C
DC
w
eb
s
i
t
es.
C
h
ar
ac
ter
is
tics
f
r
o
m
o
th
er
s
t
u
d
y
‘
s
I
n
ter
n
et
-
b
ased
h
ea
lth
i
n
ter
v
en
t
io
n
s
a
n
d
in
p
u
t
f
r
o
m
ex
p
er
ts
w
er
e
s
o
u
g
h
t
a
n
d
co
n
s
id
er
ed
th
r
o
u
g
h
o
u
t
th
is
s
tu
d
y
‘
s
i
n
ter
v
en
tio
n
d
esi
g
n
p
r
o
ce
s
s
.
24
P
ar
e
n
ts
f
r
o
m
g
r
o
u
p
2
r
ec
eiv
ed
th
e
s
tu
d
y
in
ter
v
en
tio
n
at
th
e
en
d
o
f
t
h
e
s
t
u
d
y
.
T
h
e
r
esear
ch
tea
m
m
o
n
ito
r
ed
u
p
tak
e
o
f
th
e
i
n
ter
v
e
n
tio
n
b
y
ac
tiv
ati
n
g
a
n
a
u
to
m
atic
r
ep
l
y
to
o
l
in
th
e
tea
m
s
‘
e
m
a
il
s
er
v
er
,
p
r
o
m
p
ti
n
g
p
ar
en
t
s
to
ac
k
n
o
w
led
g
e
r
ec
eip
t
o
f
th
e
e
m
ail
p
r
io
r
t
o
v
ie
w
i
n
g
t
h
e
p
o
s
ter
,
w
h
ic
h
w
as
s
e
n
t
to
th
e
r
esear
c
h
tea
m
e
m
ail.
Up
o
n
o
p
en
i
n
g
th
e
e
m
a
il
th
e
p
o
s
ter
w
as
p
r
es
en
ted
as
an
i
m
ag
e
w
it
h
i
n
t
h
e
e
m
ai
l.
T
h
e
s
tu
d
y
u
tili
ze
d
q
u
an
titati
v
e
d
ata
m
ea
s
u
r
e
m
e
n
t
to
o
ls
i
n
cl
u
d
in
g
a
b
aseli
n
e
s
u
r
v
e
y
,
an
d
t
w
o
f
o
llo
w
-
u
p
s
u
r
v
e
y
s
.
T
h
e
f
ir
s
t
f
o
llo
w
-
u
p
s
u
r
v
e
y
w
as
ad
m
i
n
i
s
ter
ed
im
m
ed
iatel
y
a
f
ter
th
e
in
ter
v
en
tio
n
f
i
n
is
h
ed
.
T
h
e
s
ec
o
n
d
f
o
llo
w
-
u
p
s
u
r
v
e
y
w
as
co
n
d
u
cted
th
r
ee
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Gr
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at
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0
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ts
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Par
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also
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w
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elt
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h
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ar
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al
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f
d
ata
w
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u
s
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n
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h
e
Statis
tical
P
ac
k
a
g
e
f
o
r
t
h
e
So
cial
Sc
ien
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s
v
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n
2
1
.
0
(
SP
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,
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h
icag
o
,
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lli
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atis
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ts
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h
9
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as
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id
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ig
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ica
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t.
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ll
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les
w
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e
a
n
al
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ze
d
f
o
r
f
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eq
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e
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cies
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ea
r
s
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n
r
test
w
a
s
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d
u
cted
to
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al
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r
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s
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h
i
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s
q
u
ar
e
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d
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test
s
w
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n
d
u
cted
to
test
w
h
et
h
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th
er
e
w
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e
an
y
d
if
f
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ce
s
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h
e
k
n
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e
m
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o
f
t
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p
1
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p
2
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ch
s
u
r
v
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y
p
er
io
d
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A
ch
i
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s
q
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ar
e
te
s
t
w
a
s
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m
p
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to
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k
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n
t
t
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test
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a
s
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m
p
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ted
to
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lo
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th
e
k
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led
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s
ca
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I
t
s
h
o
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ld
b
e
n
o
ted
th
at
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n
clu
s
io
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s
f
r
o
m
t
h
ese
a
n
al
y
s
es
ar
e
m
ad
e
w
it
h
ca
u
tio
n
,
as
th
e
s
a
m
p
le
s
ize
w
a
s
s
m
all
as t
h
i
s
s
t
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y
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y
a
p
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t o
f
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e
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i
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ter
v
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.
3.
RE
SU
L
T
S
A
ND
AN
AL
Y
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So
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ap
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ata
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n
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ican
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ce
s
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s
t
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d
y
p
ar
ticip
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ts
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h
e
m
aj
o
r
it
y
o
f
th
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ar
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t
s
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n
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th
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s
t
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d
y
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e
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al
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7
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d
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t
h
e
ag
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o
f
3
0
to
4
5
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s
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T
h
e
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ar
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ts
w
er
e
f
r
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m
f
i
f
teen
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n
tr
ie
s
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ig
in
,
d
ef
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ed
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th
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n
tr
y
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m
w
h
ich
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ts
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eld
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p
ass
p
o
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in
clu
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g
co
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n
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ie
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in
A
s
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th
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E
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r
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n
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th
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ed
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n
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al
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ld
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t
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ted
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s
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f
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n
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s
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s
ticall
y
s
ig
n
i
f
ica
n
t
d
if
f
er
e
n
ce
s
b
et
w
ee
n
th
e
s
o
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-
d
em
o
g
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ap
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ic
c
h
ar
ac
ter
is
tics
o
f
g
r
o
u
p
1
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d
g
r
o
u
p
2
.
Of
all
p
ar
en
ts
,
7
4
%
(
n
=
3
2
)
h
ad
h
ea
r
d
o
f
HP
V
p
r
io
r
to
th
e
s
t
u
d
y
.
7
0
%
(
n
=3
2
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ad
h
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d
o
f
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lea
s
t
o
n
e
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V
v
ac
cin
e,
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d
3
7
%
o
f
th
e
p
ar
en
ts
(
n
=1
6
)
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ad
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ec
eiv
ed
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n
f
o
r
m
at
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t
h
at
w
as
s
u
p
p
o
r
tin
g
/r
ec
o
m
m
en
d
i
n
g
th
e
HP
V
v
ac
cin
e.
On
l
y
4
2
%
(
n
=
1
8
)
o
f
p
ar
en
ts
k
n
e
w
w
h
et
h
er
t
h
eir
ch
ild
w
as
i
n
an
ag
e
g
r
o
u
p
t
h
at
w
as e
li
g
ib
le
f
o
r
HP
V
v
ac
cin
atio
n
.
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e
b
aselin
e
k
n
o
w
led
g
e
s
ca
l
e
m
ea
n
f
o
r
all
p
ar
en
t
s
w
a
s
l
o
w
w
i
th
les
s
t
h
an
h
a
lf
o
f
t
h
e
p
ar
en
ts
an
s
w
er
i
n
g
t
h
e
q
u
es
tio
n
s
co
r
r
ec
tl
y
(
m
=4
9
%;
SD0
.
0
6
)
.
On
l
y
6
3
%
o
f
th
e
p
ar
en
ts
(
n
=2
7
)
k
n
e
w
t
h
at
HP
V
i
s
a
s
ex
u
all
y
tr
an
s
m
itted
i
n
f
ec
tio
n
,
6
5
%
(
n
=2
8
)
k
n
e
w
t
h
at
HP
V
ca
n
ca
u
s
e
ce
r
v
ical
ca
n
ce
r
a
n
d
4
2
%
(
n
=1
8
)
k
n
e
w
th
at
HP
V
co
u
ld
ca
u
s
e
g
e
n
ital
w
ar
t
s
.
Kn
o
w
led
g
e
o
f
HP
V
p
r
ev
en
ti
o
n
an
d
tr
ea
t
m
en
t
w
a
s
lo
w
w
it
h
o
n
l
y
1
9
%
o
f
t
h
e
p
ar
en
ts
(
n
=
8
)
r
ep
o
r
tin
g
th
at
th
e
y
k
n
e
w
th
a
t
HP
V
ca
n
g
o
aw
a
y
w
i
th
o
u
t
t
r
ea
t
m
en
t.
5
8
%
(
n
=2
5
)
o
f
th
e
p
ar
en
ts
k
n
e
w
t
h
at
g
etti
n
g
a
r
e
g
u
lar
P
ap
s
m
ea
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e
x
a
m
i
n
atio
n
ca
n
r
ed
u
ce
a
w
o
m
a
n
‘
s
ch
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n
ce
s
o
f
co
n
tr
ac
ti
n
g
an
HP
V
in
f
ec
tio
n
,
an
d
o
n
l
y
4
7
% (
n
=2
0
)
k
n
e
w
t
h
at
H
P
V
co
u
ld
ca
u
s
e
ab
n
o
r
m
al
P
ap
s
m
ea
r
r
es
u
lts
.
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t
b
aseli
n
e,
th
er
e
w
er
e
t
w
o
ca
teg
o
r
ical
k
n
o
w
led
g
e
v
ar
i
ab
les
th
at
h
ad
s
tatis
ticall
y
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
b
et
w
ee
n
t
h
e
g
r
o
u
p
1
an
d
g
r
o
u
p
2
:
w
h
eth
er
th
e
p
ar
en
t
k
n
e
w
if
t
h
eir
ch
il
d
w
a
s
eli
g
ib
le
f
o
r
v
ac
cin
a
tio
n
at
t
h
e
ti
m
e
o
f
t
h
e
s
tu
d
y
(
χ²
(
1
)
=6
.
5
1
,
p
=
0
.
0
5
)
,
an
d
if
th
e
p
ar
en
t
h
ad
h
ea
r
d
p
o
s
itiv
e
i
n
f
o
r
m
atio
n
ab
o
u
t th
e
HP
V
v
ac
ci
n
e
(
χ²
(
1
)
=1
0
.
0
3
,
p
=0
.
0
1
)
.
Gr
o
u
p
1
(
n
=2
3
)
m
ea
n
k
n
o
w
le
d
g
e
s
ca
le
w
as
lo
w
w
it
h
o
n
l
y
m
=5
7
%
(
SD0
.
3
9
)
an
d
t
h
e
g
r
o
u
p
2
m
ea
n
w
a
s
m
=3
9
%
(
SD0
.
3
5
)
.
A
ch
i
-
s
q
u
ar
e
test
r
ev
ea
led
n
o
s
tati
s
ti
ca
ll
y
s
i
g
n
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Kn
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m
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d
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r
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1
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o
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g
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p
1
k
n
e
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th
at
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ca
n
ca
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s
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2
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.
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4
4
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o
k
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t
h
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n
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I
.
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o
m
g
r
o
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p
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,
9
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e
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h
at
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V
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ld
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s
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r
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n
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s
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n
d
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at
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ca
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s
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o
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m
al
P
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s
m
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s
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n
g
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p
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t
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g
o
a
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ch
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o
s
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n
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f
ican
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k
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2
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d
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s
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en
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d
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et
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s
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s
e
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s
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th
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n
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t
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4
;
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;
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s
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ata
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n
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llo
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u
p
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n
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ch
s
u
r
v
e
y
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p
ar
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ts
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er
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w
h
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er
th
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y
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ad
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f
f
icie
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t
in
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m
at
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o
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t
HP
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d
th
e
HP
V
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ter
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(
r
en
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T
h
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p
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p
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tio
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h
o
ag
r
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r
d
is
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r
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d
w
it
h
th
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m
en
t
w
a
s
m
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w
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h
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g
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p
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elat
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Ne
m
ar
T
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d
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g
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p
s
a
t e
ac
h
s
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r
v
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d
.
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r
g
r
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p
1
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o
s
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g
n
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f
ica
n
t
c
h
an
g
e
w
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s
o
b
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et
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n
d
f
ir
s
t
f
o
llo
w
-
u
p
(
p
=0
.
1
8
)
.
T
h
er
e
w
a
s
also
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o
s
ig
n
i
f
ica
n
t
d
if
f
er
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n
ce
b
et
w
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n
b
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eli
n
e
a
n
d
s
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o
n
d
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p
(
p
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2
3
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s
s
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t
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h
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h
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ts
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g
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d
t
h
at
th
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f
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atio
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e
f
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llo
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p
s
u
r
v
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y
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(
7
0
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elativ
e
to
th
e
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s
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r
v
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8
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As
f
o
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g
r
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p
2
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ig
n
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f
ica
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t
d
if
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er
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ce
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e
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s
er
v
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b
et
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ee
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th
e
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aseli
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e
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n
d
f
ir
s
t
f
o
llo
w
-
u
p
(
p
=0
.
5
0
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er
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w
a
s
h
o
w
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s
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h
t
in
cr
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n
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h
e
p
r
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p
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f
p
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t
s
w
h
o
f
elt
t
h
e
y
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ad
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f
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icie
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t
in
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atio
n
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t
f
ir
s
t
f
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llo
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-
u
p
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5
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at
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aselin
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d
2
5
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ir
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t
f
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llo
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-
u
p
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Si
g
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f
ica
n
t
d
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er
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ce
s
w
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f
o
u
n
d
b
et
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d
t
h
e
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n
d
f
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es
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s
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g
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f
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t
d
if
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ce
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n
th
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tal
p
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ad
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f
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r
v
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m
p
a
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et
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t
h
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g
r
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p
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g
r
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p
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ce
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h
e
t
w
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p
s
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w
o
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t
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ir
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s
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p
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r
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w
it
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en
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th
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2
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χ²(
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ize
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ate
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h
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er
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A
t
f
ir
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t
f
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if
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.
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CO
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T
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s
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u
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y
co
r
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b
o
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i
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in
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s
f
r
o
m
m
an
y
o
t
h
er
s
tu
d
ies.
First,
co
n
s
i
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w
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f
in
d
in
g
s
f
r
o
m
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HP
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HP
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v
ac
cin
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t
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as
elin
e
[
2
4
]
-
[
2
7
]
.
Ov
er
all
k
n
o
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led
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e
o
f
HP
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[
at
b
aseli
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e]
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a
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Seco
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a
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r
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ctiv
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ch
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g
e
[
2
8
]
,
[
2
9
]
,
w
e
f
o
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n
d
th
at
ex
p
at
p
ar
en
t
s
f
ee
l
m
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co
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id
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t
m
a
k
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in
f
o
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m
ed
-
d
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ab
o
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ch
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n
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u
d
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to
v
ac
cin
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th
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HP
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in
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w
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en
t
h
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y
h
a
v
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s
u
f
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h
is
b
r
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tu
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ld
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s
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ail
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tio
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ata
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in
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th
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i
n
ter
v
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tio
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s
t
u
d
ies
t
h
at
m
ea
s
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r
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e
e
f
f
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t o
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ai
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s
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m
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n
g
h
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lth
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elate
d
in
f
o
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[
2
0
]
,
[
22
]
,
[
3
0
]
.
T
h
er
e
ar
e
m
an
y
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m
itatio
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s
to
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is
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tu
d
y
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T
h
e
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tu
d
y
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m
ed
to
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clu
d
e
a
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iv
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u
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a
m
p
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o
f
ex
p
at
p
ar
en
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li
v
in
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B
an
g
k
o
k
,
T
h
ailan
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o
w
e
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as
th
e
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o
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d
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ap
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ata
r
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y
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is
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o
t
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tativ
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i
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e
s
tu
d
y
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ar
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ts
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also
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ig
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r
ee
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i
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ce
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t
h
e
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en
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b
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o
f
t
h
e
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n
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a
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ex
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ats
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v
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an
d
w
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r
k
a
w
a
y
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m
th
e
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n
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y
o
f
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ig
in
.
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s
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ite
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is
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o
ten
tia
l
li
m
itatio
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th
e
s
tu
d
y
s
a
m
p
le
w
as
a
d
iv
er
s
e
g
r
o
u
p
o
f
ex
p
at
p
ar
en
ts
.
Stu
d
y
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ar
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ts
w
er
e
s
el
f
-
s
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ted
w
h
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h
m
a
y
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s
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u
ce
th
e
g
en
er
aliza
b
ili
t
y
,
as
t
h
e
s
a
m
p
l
e
m
a
y
b
e
r
ep
r
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tativ
e
o
f
ex
p
at
p
ar
en
ts
w
h
o
ar
e
in
ter
este
d
in
lear
n
in
g
ab
o
u
t
s
ex
u
al
h
ea
lt
h
.
Fu
tu
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e
s
tu
d
ies
ca
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b
e
ex
p
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to
in
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f
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W
ith
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[
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3
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v
ac
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in
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te
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ld
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e
k
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s
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d
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v
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s
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m
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[1
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W
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―
S
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to
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rriers
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c
.
g
o
v
/v
a
c
c
in
e
s/v
p
d
-
v
a
c
/h
p
v
/
A
c
c
e
ss
e
d
1
2
De
c
e
m
b
e
r
2
0
1
4
.
[8
]
A
ll
e
n
JD
.
,
De
Je
su
s
M
.
,
M
a
rs
D
.
,
T
o
m
L
.
,
Clo
u
ti
e
r
L
.
,
S
h
e
lt
o
n
RC
.,
―
De
c
isio
n
-
m
a
k
in
g
a
b
o
u
t
t
h
e
HPV
v
a
c
c
in
e
a
m
o
n
g
e
th
n
ica
ll
y
d
iv
e
rse
p
a
re
n
ts:
Im
p
li
c
a
ti
o
n
s
f
o
r
h
e
a
lt
h
c
o
m
m
u
n
ica
ti
o
n
s‖
,
J
On
c
o
l
,
4
0
1
9
7
9
,
2
0
1
2
.
[9
]
B
a
ti
sta
F
e
rre
r
H
.
,
T
ro
tt
e
r
C
.
,
Hi
c
k
m
a
n
M
.
,
A
u
d
re
y
S
.,
―
Ba
rri
e
rs
a
n
d
f
a
c
il
it
a
to
rs
to
HPV
v
a
c
c
in
a
ti
o
n
o
f
y
o
u
n
g
w
o
m
e
n
in
h
ig
h
-
in
c
o
m
e
c
o
u
n
tri
e
s
:
a
q
u
a
li
tativ
e
s
y
ste
m
a
ti
c
re
v
ie
w
a
n
d
e
v
id
e
n
c
e
s
y
n
th
e
sis‖
,
BM
C
P
u
b
He
a
lt
h
,
v
o
l.
14
,
p
p
.
7
0
0
,
2
0
1
4
.
[1
0
]
Ja
v
a
n
b
a
k
h
t
M
.
,
S
tah
lm
a
n
S
.
,
W
a
lk
e
r
S
.
,
e
t
a
l.
,
―
P
ro
v
id
e
r
p
e
rc
e
p
ti
o
n
s
o
f
b
a
rriers
a
n
d
f
a
c
il
it
a
to
rs
o
f
HPV
v
a
c
c
in
a
ti
o
n
in
a
h
ig
h
-
risk
c
o
m
m
u
n
it
y
‖
,
Va
c
c
in
e
,
v
o
l/
issu
e
:
3
0
(
3
0
)
,
p
p
.
4
5
1
1
-
4
5
1
6
,
2
0
1
2
.
[1
1
]
Re
y
n
o
ld
s
D
.
,
O'
Co
n
n
e
ll
KA
.,
―
T
e
stin
g
a
m
o
d
e
l
f
o
r
p
a
re
n
tal
a
c
c
e
p
tan
c
e
o
f
h
u
m
a
n
p
a
p
il
l
o
m
a
v
iru
s
v
a
c
c
in
e
in
9
-
to
18
-
y
e
a
r
-
o
ld
g
irl
s: a t
h
e
o
ry
-
g
u
id
e
d
stu
d
y
‖
,
J
Ped
ia
tr
N
u
rs
,
v
o
l/
issu
e
:
2
7
(
6
)
,
p
p
.
6
1
4
-
6
2
5
,
2
0
1
2
.
[1
2
]
Do
re
ll
C
.
,
Ya
n
k
e
y
D
.
,
Ke
n
n
e
d
y
A
.
,
S
to
k
le
y
S
.,
―
F
a
c
to
rs
th
a
t
in
f
lu
e
n
c
e
p
a
re
n
tal
v
a
c
c
in
a
ti
o
n
d
e
c
isio
n
s
f
o
r
a
d
o
les
c
e
n
ts,
1
3
t
o
1
7
y
e
a
rs
o
ld
:
Na
ti
o
n
a
l
Im
m
u
n
iza
ti
o
n
S
u
rv
e
y
-
Tee
n
,
2
0
1
0
‖
,
Cli
n
Ped
i
a
tr
(
Ph
il
a
)
,
v
o
l/
issu
e
:
5
2
(
2
)
,
pp.
1
6
2
-
1
7
0
,
2
0
1
3
.
[1
3
]
Dro
let
M
.
,
Bé
n
a
rd
É
.
,
Bo
il
y
M
C
.
,
A
li
H
.
,
e
t
a
l.
,
―
P
o
p
u
latio
n
-
l
e
v
e
l
i
m
p
a
c
t
a
n
d
h
e
rd
e
ff
e
c
ts
f
o
ll
o
w
in
g
h
u
m
a
n
p
a
p
il
l
o
m
a
v
iru
s
v
a
c
c
in
a
ti
o
n
p
ro
g
r
a
m
m
e
s:
a
s
y
ste
m
a
ti
c
re
v
ie
w
a
n
d
m
e
ta
-
a
n
a
l
y
sis
‖
,
T
h
e
L
a
n
c
e
t
In
fe
c
ti
o
u
s
Dise
a
se
s
v
o
l/
issu
e
:
1
5
(5
)
,
p
p
.
5
6
5
-
5
8
0
,
2
0
1
5
.
[1
4
]
W
o
o
d
F
.
,
M
o
rris
L
.
,
Da
v
ies
M
.
,
El
wy
n
G
.,
―
W
h
a
t
c
o
n
stit
u
tes
c
o
n
se
n
t
w
h
e
n
p
a
re
n
ts
a
n
d
d
a
u
g
h
ters
h
a
v
e
d
if
f
e
r
e
n
t
v
ie
w
s
a
b
o
u
t
h
a
v
in
g
t
h
e
H
P
V
v
a
c
c
in
e
:
q
u
a
li
tativ
e
in
terv
iew
s
w
it
h
sta
k
e
h
o
ld
e
rs‖
,
J
M
ed
Et
h
ics
,
v
o
l/
i
ss
u
e
:
37
(
8
)
,
p
p
.
466
-
4
7
1
,
2
0
1
1
.
[1
5
]
Co
o
p
e
r
Ro
b
b
i
n
s
S
C
.
,
Be
rn
a
rd
D
.
,
M
c
Ca
ff
e
r
y
K
.
,
e
t
a
l.
,
―‖
I
ju
st
si
g
n
e
d
‖
:
F
a
c
to
rs
i
n
f
lu
e
n
c
in
g
d
e
c
isi
o
n
-
m
a
k
in
g
f
o
r
sc
h
o
o
l
-
b
a
se
d
H
P
V
v
a
c
c
in
a
ti
o
n
of
a
d
o
les
c
e
n
t
g
irl
s
‖
,
He
a
lt
h
Psy
c
h
o
l
,
v
o
l/
issu
e
:
29
(
6
)
,
p
p
.
6
1
8
-
6
2
5
,
2
0
1
0
.
[1
6
]
Bro
w
n
K
.
,
Kro
l
l
J
.
,
Hu
d
s
o
n
M
.
,
Ra
m
sa
y
M
.
,
G
r
e
e
n
J
.
,
e
t
a
l.
,
―
F
a
c
to
rs
u
n
d
e
rly
in
g
p
a
re
n
tal
d
e
c
isio
n
s
a
b
o
u
t
c
o
m
b
in
a
ti
o
n
c
h
il
d
h
o
o
d
v
a
c
c
in
a
ti
o
n
s
in
c
l
u
d
i
n
g
M
M
R:
A
s
y
ste
m
a
t
ic
re
v
ie
w
‖
,
Va
c
c
in
e
,
v
o
l/
issu
e
:
28
(2
6
)
,
p
p
.
4
2
3
5
-
4
2
4
8
,
2
0
1
0
.
[1
7
]
P
a
tel
D
.
,
Eas
m
o
n
C
.
,
S
e
e
d
P
.
,
e
t
a
l.
,
―
M
o
r
b
id
i
ty
in
e
x
p
a
tri
a
tes
—
a
p
ro
sp
e
c
ti
v
e
c
o
h
o
rt
stu
d
y
‖
,
Oc
c
u
p
M
e
d
,
v
o
l.
56
,
pp.
3
4
5
–
5
2
,
2
0
1
4
.
[1
8
]
S
h
e
p
h
e
r
d
S
M
.
,
S
h
o
f
f
W
H
.,
―
V
a
c
c
in
a
ti
o
n
f
o
r
t
h
e
e
x
p
a
tri
a
te
a
n
d
l
o
n
g
-
term
trav
e
ler
‖
,
In
fo
rm
a
He
a
lt
h
c
a
re
,
Ex
p
e
rt
Rev
iew o
f
Va
c
c
in
e
s
,
v
o
l/
issu
e
:
1
3
(6
)
,
pp.
7
7
5
-
8
0
0
,
2
0
1
4
.
[1
9
]
Jo
n
e
s S
.,
―
M
e
d
ica
l
a
sp
e
c
ts
o
f
e
x
p
a
tri
a
te h
e
a
lt
h
:
h
e
a
lt
h
t
h
re
a
ts‖
,
Oc
c
u
p
.
M
e
d
,
v
o
l/
issu
e
:
5
0
(
8
)
,
p
p
.
5
7
2
-
5
7
8
,
2
0
0
0
.
[2
0
]
L
i
m
M
S
C
.
,
Ho
c
k
in
g
JS
.
,
A
it
k
e
n
CK
.
,
e
t
a
l.
,
―
Im
p
a
c
t
o
f
tex
t
a
n
d
e
m
a
il
m
e
ss
a
g
in
g
o
n
t
h
e
se
x
u
a
l
h
e
a
lt
h
o
f
y
o
u
n
g
p
e
o
p
le
:
a
ra
n
d
o
m
ize
d
c
o
n
tro
ll
e
d
t
rial
‖
,
J
o
u
rn
a
l
o
f
E
p
id
e
mi
o
lo
g
y
&
Co
mm
u
n
it
y
He
a
lt
h
,
v
o
l.
66
,
p
p
.
69
-
7
4
,
2
0
1
2
.
[2
1
]
Ko
th
e
EJ
.
,
M
u
ll
a
n
BA
.,
―
A
c
c
e
p
ta
b
il
it
y
o
f
a
th
e
o
ry
o
f
p
lan
n
e
d
b
e
h
a
v
io
r
e
m
a
il
-
b
a
se
d
n
u
tri
ti
o
n
in
terv
e
n
ti
o
n
‖
,
He
a
lt
h
Pro
mo
ti
o
n
I
n
ter
n
a
ti
o
n
a
l
,
v
o
l/
issu
e
:
2
9
(
1
)
,
p
p.
81
-
9
0
,
2
0
1
4
.
[2
2
]
Co
n
sta
n
ti
n
o
RE
.,
―
Co
m
p
a
rin
g
f
a
c
e
-
to
-
f
a
c
e
a
n
d
e
m
a
il
in
terv
e
n
ti
o
n
f
o
r
in
ti
m
a
te
p
a
rtn
e
r
v
io
len
c
e
(
IP
V
)
su
rv
iv
o
rs
:
T
e
c
h
n
o
lo
g
ies
in
f
lu
e
n
c
in
g
n
u
rsin
g
‖
,
26
th
In
tern
a
ti
o
n
a
l
Nu
rsin
g
Re
se
a
rc
h
Co
n
g
re
ss
,
2
3
-
2
7
Ju
ly
2
0
1
5
,
S
a
n
Ju
a
n
,
P
u
e
rto
R
ico
.
[2
3
]
Bro
u
w
e
r
W
.
,
Kro
e
z
e
W
.
,
Cru
tze
n
R
.
,
e
t
a
l.
,
―
W
h
ich
in
terv
e
n
ti
o
n
c
h
a
ra
c
teristics
a
re
re
late
d
to
m
o
re
e
x
p
o
su
re
t
o
in
tern
e
t
-
d
e
li
v
e
re
d
h
e
a
lt
h
y
li
f
e
st
y
le
p
ro
m
o
ti
o
n
in
terv
e
n
ti
o
n
s?
A
sy
ste
m
a
ti
c
re
v
ie
w‖
,
J
o
u
rn
a
l
o
f
M
e
d
ica
l
In
ter
n
e
t
Res
e
a
rc
h
,
v
o
l/
issu
e
:
1
3
(
1
)
,
p
p
.
e
2
,
2
0
1
1
.
[2
4
]
R
e
it
e
r
P
L
.
,
Bre
we
r
N
T
.
,
G
o
tt
li
e
b
S
.
,
M
c
Re
e
AL
.,
S
m
it
h
JS
.,
―
P
a
r
e
n
ts'
h
e
a
lt
h
b
e
li
e
f
s
a
n
d
HPV
v
a
c
c
in
a
ti
o
n
o
f
th
e
ir
a
d
o
les
c
e
n
t
d
a
u
g
h
ters
‖
,
S
o
c
i
a
l
S
c
ien
c
e
&
M
e
d
icin
e
,
v
o
l/
issu
e
:
6
9
(3
)
,
p
p
.
4
7
5
-
4
8
0
,
2
0
0
9
.
[2
5
]
S
a
d
a
f
A
.
,
Rich
a
rd
s
JL
.
,
G
lan
z
J
.
,
S
a
lm
o
n
DA
.
,
e
t
a
l.
,
―
A
s
y
ste
m
a
t
ic
re
v
ie
w
o
f
in
terv
e
n
ti
o
n
s
f
o
r
re
d
u
c
in
g
p
a
re
n
ta
l
v
a
c
c
in
e
re
f
u
sa
l
a
n
d
v
a
c
c
in
e
h
e
sitan
c
y
‖
,
Va
c
c
in
e
,
v
o
l/
issu
e
:
3
1
(4
0
)
,
p
p
.
4
2
9
3
-
4
3
0
4
,
2
0
1
3
.
[2
6
]
F
ish
m
a
n
J
.
,
T
a
y
lo
r
L
.
,
Ko
o
k
e
r
P
.,
―
P
a
re
n
t
a
n
d
a
d
o
les
c
e
n
t
k
n
o
w
led
g
e
o
f
HP
V
a
n
d
s
u
b
se
q
u
e
n
t
v
a
c
c
in
a
ti
o
n
‖
,
Ped
ia
trics
,
v
o
l
/i
ss
u
e
:
1
3
4
(
4
)
,
p
p
.
2
0
1
3
-
3
4
5
4
,
2
0
1
4
.
[2
7
]
F
u
L
Y
.
,
Bo
n
h
o
m
m
e
LA
.
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