High-Risk Human Papillomavirus (HPV) Infection and Cervical Cancer Prevention in Britain: Evidence of Differential Uptake of Interventions from a Probability Survey

Clare Tanton; Kate Soldan; Simon Beddows; Catherine H. Mercer; Jo Waller; Nigel Field; Soazig Clifton; Andrew J. Copas; Kavita Panwar; Precious Manyenga; Filomeno da Silva; Kaye Wellings; Catherine A. Ison; Anne M. Johnson; Pam Sonnenberg

doi:10.1158/1055-9965.EPI-14-1333

DOI: 10.1158/1055-9965.EPI-14-1333 Published May 2015

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Figure 1.
Uptake of cervical cancer interventions. A, time since last cervical smear test by age group among women ages 26 to 74 years. B, HPV vaccination uptake by school year at eligibility for vaccination in either the routine (Year 8/S2) or catch-up programs. A, women are eligible for cervical screening every 3 to 5 years depending on regional protocols (3 yearly to age 49 in England then 5 yearly to age 64; 3 yearly to age 64 in Wales and 3 yearly to age 60 in Scotland). Denominators exclude women who report having had a hysterectomy and those with no lifetime sexual partners. *, All women in eligible age range for screening. Denominators (unwt., wt.) are as follows: 26–29 (1,121, 547), 30–34 (1,025, 648), 35–39 (580, 664), 40–44 (571, 710), 45–49 (536, 694), 50–54 (427, 553), 55–59 (399, 505), 60–64 (381, 444), 65–69 (349, 387), 70–74 (225, 226), all eligible (5,012, 4,731). Percentage screened in past 5 years when women reporting a hysterectomy are included in the denominator (N = 5,372, 5,164) is 86.2%. B, denominators (unwt., wt.) are as follows: Y10 (153, 78), Y11 (244, 123), Y12 (238, 117), Y13 (415, 243), all catch-up (1,050, 562), routine (44, 21).
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Figure 2.
Relationship between risk factors for HR-HPV and uptake of cervical cancer programs: (A) cervical screening and (B) HPV catch-up vaccination. All ORs adjusted for age. 95% CIs for AORs exclude 1 with the exception of the association between hormonal contraception use and HR-HPV (see Tables 1, 2, and 4). Top right quadrant for each graph indicates increased risk of HR-HPV and lower uptake of cervical cancer prevention program. The area of the bubble represents the size of the group as a proportion of those eligible for screening. Letters indicate reference groups: (a) 1 lifetime sexual partner; (b) non/ex-smoker; (c) resident in 2 least deprived quintiles; (d) white/white British; (e) not used hormonal contraception, past year; (f) never attended a sexual health (GUM) clinic.

Tables

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Table 1.

Factors associated with high-risk HPV in urine in sexually experienced women ages 16 to 44 years

	% (95% CI)	OR (95% CI)	Age-adjusted OR (95% CI)	Denominator (unwt, wt)^a
All	15.9% (14.4–17.5)	—		2,569, 2,189
Socio-demographic characteristics
Age (years)		P < 0.0001
16–19	24.4% (20.0–29.3)	1 (—)		377, 203
20–24	26.6% (22.8–30.8)	1.13 (0.82–1.56)		580, 370
25–34	15.6% (13.4–18.2)	0.58 (0.42–0.79)		1,108, 779
35–44	9.3% (7.1–12.2)	0.32 (0.22–0.47)		504, 837
Relationship status at interview		P < 0.0001	P < 0.0001
Living with a partner	11.2% (9.5–13.1)	1 (—)	1 (—)	1,256, 1,357
In a steady relationship (but not living with a partner)	26.0% (22.2–30.1)	2.79 (2.13–3.66)	1.95 (1.44–2.65)	602, 360
Previously in a live-in partnership	19.9% (15.3–25.4)	1.97 (1.37–2.84)	1.92 (1.34–2.76)	353, 240
Not in a steady relationship (never lived with partner)	23.9% (18.8–29.8)	2.49 (1.76–3.54)	1.65 (1.13–2.42)	355, 229
IMD (quintiles)^b		P = 0.0238	P = 0.0578
1–2 (least deprived)	13.5% (11.2–16.1)	1 (—)	1 (—)	873, 778
3	15.0% (11.8–18.7)	1.13 (0.80–1.58)	1.12 (0.80–1.57)	502, 439
4–5 (most deprived)	18.3% (15.9–20.9)	1.43 (1.10–1.87)	1.37 (1.05–1.80)	1,194, 973
Academic qualifications^c		P = 0.6717	P = 0.1250
No academic qualifications	15.1% (10.5–21.4)	0.99 (0.63–1.56)	1.13 (0.72–1.77)	215, 191
Academic qualifications typically gained at age 16	16.7% (14.1–19.6)	1.12 (0.87–1.44)	1.3 (1.01–1.68)	877, 748
Studying for/attained further academic qualifications	15.2% (13.3–17.4)	1 (—)	1 (—)	1,348, 1,157
Housing tenure		P < 0.0001	P = 0.0011
Own outright	14.3% (10.0–19.9)	1.38 (0.88–2.16)	1.15 (0.72–1.81)	218, 201
Buying with a mortgage or loan^d	10.8% (8.9–13.0)	1 (—)	1 (—)	911, 912
Rent it	20.5% (18.0–23.1)	2.13 (1.64–2.78)	1.71 (1.30–2.26)	1,325, 996
Lives rent free	24.1% (16.6–33.8)	2.64 (1.59–4.38)	1.53 (0.91–2.56)	106, 74
Respondent's NS-SEC		P < 0.0001	P = 0.0009
Managerial and professional occupations	10.3% (8.3–12.7)	1 (—)	1 (—)	709, 714
Intermediate occupations	16.6% (13.0–21.1)	1.74 (1.21–2.52)	1.60 (1.11–2.30)	464, 423
Semiroutine/routine occupations	18.5% (15.6–21.7)	1.98 (1.45–2.69)	1.57 (1.14–2.17)	780, 617
No job (10+ hours/week) or not in last 10 years	22.5% (16.6–29.8)	2.53 (1.62–3.96)	2.08 (1.31–3.31)	210, 173
Student in full-time education	19.8% (15.8–24.6)	2.16 (1.50–3.11)	1.01 (0.66–1.55)	398, 256
Ethnic group^e		P = 0.0061	P = 0.0150
White	16.2% (14.6–18.0)	1 (—)	1 (—)	2,312, 1,914
Mixed	29.7% (19.4–42.7)	2.18 (1.24–3.85)	2.00 (1.09–3.67)	74, 58
Asian/Asian British	7.0% (2.9–15.5)	0.39 (0.16–0.95)	0.40 (0.17–0.97)	82, 114
Black/Black British	12.6% (6.8–22.0)	0.74 (0.38–1.46)	0.69 (0.36–1.32)	77, 77
Religion		P = 0.0286	P = 0.2671
None	17.7% (15.7–20.0)	1 (—)	1 (—)	1,509, 1,189
Christian—Church of England/Anglican	9.8% (6.2–15.2)	0.51 (0.30–0.85)	0.70 (0.42–1.19)	220, 235
Christian—Roman Catholic	14.2% (10.3–19.3)	0.77 (0.52–1.14)	0.84 (0.57–1.25)	261, 226
Christian—other	17.0% (13.4–21.5)	0.96 (0.69–1.32)	1.01 (0.73–1.39)	457, 396
Non-Christian	10.4% (5.9–17.7)	0.54 (0.29–1.01)	0.57 (0.31–1.05)	122, 142
Sexual identity		P = 0.2447	P = 0.1893
Heterosexual/straight	16.1% (14.5–17.8)	1 (—)	1 (—)	2,457, 2,108
Gay/lesbian/bisexual	11.4% (6.1–20.1)	0.67 (0.34–1.32)	0.62 (0.31–1.26)	107, 79
Health behaviors
Smoking status		P < 0.0001	P < 0.0001
Non/ex-smoker	12.9% (11.4–14.7)	1 (—)	1 (—)	1,702, 1,568
Current smoker	23.4% (20.1–26.9)	2.05 (1.61–2.60)	1.91 (1.49–2.43)	867, 622
Frequency of binge drinking^f		P = 0.0001	P = 0.0011
Never/less than monthly	13.9% (12.2–15.7)	1 (—)	1 (—)	1,730, 1,573
Monthly	19.1% (15.6–23.2)	1.47 (1.10–1.96)	1.31 (0.98–1.75)	484, 355
Weekly or more often	23.8% (19.1–29.3)	1.94 (1.42–2.66)	1.80 (1.31–2.47)	355, 261
Sexual behaviors
Age at first heterosexual sex (years)		P < 0.0001	P = 0.0059
18+	11.0% (8.5–14.0)	1 (—)	1 (—)	577, 642
17	12.9% (9.8–16.7)	1.20 (0.79–1.82)	1.18 (0.78–1.80)	432, 419
16	20.5% (17.2–24.3)	2.10 (1.48–2.97)	1.78 (1.24–2.56)	659, 517
<16	20.2% (17.4–23.4)	2.06 (1.47–2.89)	1.65 (1.17–2.34)	859, 577
Number of sexual partners, lifetime^g		P < 0.0001	P < 0.0001
1	4.2% (2.4–7.2)	1 (—)	1 (—)	342, 361
2	11.3% (7.5–16.5)	2.89 (1.40–5.96)	2.74 (1.32–5.69)	234, 213
3–4	13.7% (10.6–17.5)	3.60 (1.91–6.81)	3.71 (1.97–7.01)	441, 388
5–9	17.2% (14.3–20.6)	4.74 (2.55–8.79)	5.67 (3.07–10.46)	709, 593
10+	24.0% (20.9–27.4)	7.19 (3.94–13.10)	9.35 (5.14–17.02)	822, 614
Number of sexual partners, past 5 years^g		P < 0.0001	P < 0.0001
0/1	7.1% (5.7–8.9)	1 (—)	1 (—)	1,162, 1,258
2	21.9% (17.5–26.9)	3.64 (2.52–5.25)	3.34 (2.29–4.86)	425, 316
3–4	23.0% (19.0–27.4)	3.88 (2.77–5.42)	3.43 (2.45–4.79)	424, 290
5+	37.5% (32.7–42.7)	7.82 (5.63–10.86)	6.62 (4.68–9.38)	544, 313
Number of sexual partners without a condom, past year^g		P < 0.0001	P < 0.0001
0	11.3% (8.5–14.8)	1 (—)	1 (—)	449, 405
1	14.0% (12.3–15.9)	1.28 (0.91–1.80)	1.35 (0.96–1.90)	1,741, 1,566
2+	40.1% (33.9–46.5)	5.27 (3.49–7.95)	4.35 (2.87–6.60)	347, 193
Sexual health and services
Used hormonal contraception^h, past year		P = 0.0001	P = 0.1711
No	13.1% (11.1–15.5)	1 (—)	1 (—)	1,172, 1,137
Yes	19.7% (17.5–22.1)	1.63 (1.28–2.07)	1.20 (0.92–1.55)	982, 1,388
Attended a sexual health (GUM) clinic, past 5 years		P < 0.0001	P < 0.0001
No	11.7% (10.2–13.4)	1 (—)	1 (—)	1,779, 1,686
Yes	30.4% (26.8–34.2)	3.29 (2.62–4.14)	2.54 (2.00–3.23)	765, 484
STI diagnosisⁱ, past 5 years		P < 0.0001	P < 0.0001
No	14.7% (13.2–16.4)	1 (—)	1 (—)	2,316, 2,038
Yes	35.3% (29.2–41.9)	3.16 (2.33–4.28)	2.36 (1.76–3.16)	237, 134
Genital warts diagnosis, ever		P = 0.2095	P = 0.0891
No	15.8% (14.3–17.5)	1 (—)	1 (—)	2,436, 2,085
Yes	20.2% (13.9–28.3)	1.35 (0.85–2.14)	1.47 (0.94–2.30)	117, 86

↵^aParticipants who reported at least one lifetime sexual partner, with urine test results [unweighted (unwt), weighted (wt)].
↵^bIMD is a multidimensional measure of area (neighborhood)-level deprivation based on the participant's postcode. IMD scores for England, Scotland, and Wales were adjusted before being combined and assigned to quintiles, using a method by Payne and Abel (20).
↵^cParticipants aged ≥17 years.
↵^dIncludes 29 women paying part mortgage and part rent (shared ownership).
↵^eThose of Chinese/other ethnicity are excluded from the denominator due to small numbers.
↵^fBinge drinking defined as having six units on one occasion.
↵^gIncludes both opposite-sex and same-sex partners.
↵^hDefined as having used the oral contraceptive pill, hormonal IUD, injections, or implants.
↵ⁱDefined as having been diagnosed with one of chlamydia, gonorrhea, syphilis, genital herpes, genital warts, trichomonas, nonspecific urethritis/non-gonococcal urethritis.

Table 2.

Factors associated with nonattendance at cervical screening in the past 5 years in women ages 26 to 64 years

		Not screened versus screened in past 5 years
	Not in past 5 years% (95% CI)	OR (95% CI)	Age-adjusted OR (95% CI)	Denominator (unwt, wt)^a
All ages	8.9% (8.0–9.8)			5,012, 4,731
Sociodemographic characteristics
Age, years		P < 0.0001
26–29	14.9% (12.7–17.4)	2.28 (1.72–3.00)		1,121, 547
30–39	7.1% (5.9–8.7)	1 (—)		1,605, 1,312
40–49	6.2% (4.9–8.0)	0.86 (0.61–1.21)		1,107, 1,404
50–59	9.6% (7.8–11.9)	1.38 (1.01–1.90)		826, 1,058
60–64	13.4% (9.7–18.2)	2.01 (1.32–3.05)		353, 411
Relationship status at interview		P < 0.0001	P = 0.0004
Living with a partner	8.0% (7.0–9.1)	1 (—)	1 (—)	3,151, 3,476
In a steady relationship (but not living with a partner)	8.4% (6.3–11.2)	1.06 (0.75–1.50)	1.04 (0.73–1.46)	585, 373
Previously in a live-in partnership	11.5% (9.4–14.0)	1.50 (1.14–1.96)	1.43 (1.09–1.87)	1,015, 717
Not in a steady relationship (never lived with partner)	18.5% (13.1–25.4)	2.61 (1.71–3.99)	2.31 (1.49–3.57)	234, 145
IMD (quintiles)^b		P < 0.0001	P < 0.0001
1–2 (least deprived)	6.3% (5.2–7.6)	1 (—)	1 (—)	1,885, 1,938
3	8.9% (7.1–11.2)	1.46 (1.06–2.00)	1.44 (1.05–1.98)	1,003, 943
4–5 (most deprived)	11.5% (10.1–13.2)	1.95 (1.52–2.50)	1.91 (1.48–2.47)	2,124, 1,850
Academic qualifications		P < 0.0001	P = 0.0001
No academic qualifications	14.1% (11.5–17.1)	2.04 (1.53–2.73)	1.95 (1.43–2.66)	751, 764
Academic qualifications typically gained at age 16	8.1% (6.8–9.5)	1.09 (0.84–1.42)	1.16 (0.88–1.52)	1,828, 1,730
Studying for/attained further academic qualifications	7.4% (6.3–8.7)	1 (—)	1 (—)	2,278, 2,102
Housing tenure		P < 0.0001	P < 0.0001
Own outright	9.6% (7.7–12.0)	1.77 (1.28–2.46)	1.34 (0.93–1.92)	868, 1,034
Buying with a mortgage or loan^c	5.7% (4.7–6.9)	1 (—)	1 (—)	2,092, 2,118
Rent it	12.6% (11.0–14.3)	2.40 (1.86–3.08)	2.14 (1.65–2.78)	1,967, 1,505
Lives rent free	17.3% (9.4–29.8)	3.49 (1.70–7.19)	2.88 (1.44–5.77)	71, 59
Respondent's NS-SEC		P < 0.0001	P < 0.0001
Managerial & professional occupations	6.4% (5.3–7.7)	1 (—)	1 (—)	1,868, 1,810
Intermediate occupations	7.0% (5.5–8.8)	1.10 (0.80–1.53)	1.07 (0.77–1.49)	1,160, 1,081
Semiroutine/routine occupations	11.8% (10.0–13.9)	1.96 (1.49–2.59)	1.88 (1.42–2.49)	1,361, 1,249
No job (10+ hours/week) or not in last 10 years	14.8% (11.4–18.9)	2.54 (1.77–3.65)	2.40 (1.66–3.47)	475, 474
Student in full-time education	9.5% (5.1–17.1)	1.55 (0.77–3.11)	1.32 (0.67–2.62)	124, 95
Ethnic group		P = 0.0066	P = 0.0052
White	8.3% (7.4–9.2)	1 (—)	1 (—)	4,415, 4,155
Mixed	11.7% (5.7–22.4)	1.46 (0.68–3.17)	1.49 (0.68–3.25)	89, 72
Asian/Asian British	15.1% (10.9–20.6)	1.97 (1.32–2.93)	1.96 (1.32–2.90)	254, 256
Black/Black British	11.8% (6.8–19.6)	1.48 (0.81–2.71)	1.62 (0.88–2.97)	174, 176
Other	12.5% (6.5–22.7)	1.58 (0.78–3.24)	1.52 (0.73–3.16)	69, 63
Religion		P = 0.0076	P = 0.0049
None	9.4% (8.2–10.9)	1 (—)	1 (—)	2,330, 2,052
Christian—Church of England/Anglican	6.3% (4.8–8.4)	0.65 (0.46–0.92)	0.60 (0.42–0.86)	832, 906
Christian—Roman Catholic	7.9% (5.9–10.6)	0.83 (0.58–1.19)	0.80 (0.55–1.16)	582, 558
Christian—other	9.2% (7.2–11.7)	0.97 (0.72–1.32)	0.93 (0.68–1.28)	930, 903
Muslim	13.9% (8.8–21.1)	1.55 (0.91–2.63)	1.50 (0.88–2.56)	160, 152
Hindu	19.6% (11.2–32.1)	2.34 (1.20–4.57)	2.21 (1.13–4.32)	68, 57
Other	8.6% (3.8–18.5)	0.91 (0.38–2.18)	0.91 (0.40–2.08)	102, 94
Sexual identity		P = 0.0271	P = 0.0234
Heterosexual/straight	8.7% (7.9–9.7)	1 (—)	1 (—)	4,849, 4,599
Gay/lesbian	20.9% (11.1–35.7)	2.76 (1.31–5.78)	2.94 (1.36–6.38)	63, 56
Bisexual	8.3% (3.9–16.5)	0.94 (0.43–2.05)	0.93 (0.44–1.98)	75, 53
Health behaviors
Smoking status		P < 0.0001	P < 0.0001
Non/ex-smoker	7.5% (6.6–8.5)	1 (—)	1 (—)	3,700, 3,646
Current smoker	13.5% (11.5–15.7)	1.92 (1.54–2.40)	1.97 (1.57–2.47)	1,312, 1,085
Frequency of binge drinking^d		P = 0.0277	P = 0.0473
Never/less than monthly	9.5% (8.5–10.6)	1 (—)	1 (—)	3,769, 3,636
Monthly	6.7% (5.0–9.0)	0.69 (0.49–0.96)	0.69 (0.49–0.97)	664, 568
Weekly or more often	7.1% (5.3–9.4)	0.73 (0.52–1.02)	0.77 (0.55–1.09)	578, 527
Sexual behaviors
Age at first heterosexual sex (years)		P = 0.3000	P = 0.5485
18+	9.7% (8.3–11.2)	1 (—)	1 (—)	1,971, 2,033
16/17	8.2% (6.9–9.7)	0.83 (0.65–1.06)	0.89 (0.69–1.14)	1,943, 1,825
<16	8.4% (6.7–10.5)	0.86 (0.64–1.15)	0.87 (0.64–1.18)	1,040, 812
Number of sexual partners, lifetime^e		P = 0.0612	P = 0.2391
1	11.4% (9.3–13.9)	1 (—)	1 (—)	832, 923
2	9.4% (7.0–12.4)	0.80 (0.54–1.19)	0.81 (0.55–1.21)	468, 478
3–4	8.5% (6.8–10.6)	0.72 (0.51–1.02)	0.77 (0.54–1.09)	920, 890
5–9	8.0% (6.5–9.9)	0.68 (0.49–0.94)	0.74 (0.54–1.03)	1,338, 1,246
10+	7.5% (6.0–9.3)	0.63 (0.45–0.87)	0.68 (0.48–0.96)	1,367, 1,105
Number of sexual partners, past 5 years^e		P < 0.0001	P < 0.0001
0	19.3% (15.0–24.5)	2.72 (1.94–3.82)	2.45 (1.67–3.61)	358, 342
1	8.1% (7.1–9.2)	1 (—)	1 (—)	3,133, 3,311
2	8.2% (6.1–10.9)	1.02 (0.72–1.45)	0.94 (0.66–1.34)	625, 471
3–4	7.1% (5.1–9.8)	0.87 (0.60–1.25)	0.73 (0.50–1.05)	489, 328
5+	8.2% (5.6–12.0)	1.02 (0.66–1.58)	0.77 (0.49–1.22)	349, 216
Number of sexual partners without a condom, past year^e		P < 0.0001	P < 0.0001
0	14.1% (12.0–16.6)	1 (—)	1 (—)	1,263, 1,136
1	7.1% (6.2–8.1)	0.46 (0.37–0.59)	0.48 (0.38–0.62)	3,420, 3,358
2+	8.2% (5.0–12.9)	0.54 (0.31–0.93)	0.50 (0.28–0.89)	259, 163
Health-related factors
Used hormonal contraception^f, past year		P = 0.0001	P < 0.0001
No	9.8% (8.7–10.9)	1 (—)	1 (—)	3,369, 3,489
Yes	6.3% (5.1–7.6)	0.62 (0.48–0.79)	0.53 (0.41–0.69)	1,573, 1,168
Ever attended a sexual health (GUM) clinic		P = 0.0002	P < 0.0001
No	9.7% (8.7–10.8)	1 (—)	1 (—)	3,611, 3,636
Yes	6.0% (4.8–7.5)	0.60 (0.46–0.78)	0.53 (0.40–0.69)	1,353, 1,041
Ever diagnosed with a STI^g		P = 0.0004	P = 0.0002
No (or only thrush)	9.5% (8.6–10.6)	1 (—)	1 (—)	4,080, 3,958
Yes (excluding thrush)	5.1% (3.7–7.1)	0.51 (0.35–0.74)	0.49 (0.33–0.71)	882, 717
STI risk: to self		P = 0.0377	P = 0.0200
Greatly at risk/quite a lot	5.5% (2.9–10.0)	1 (—)	1 (—)	130, 97
Not very much	7.1% (5.6–9.1)	1.33 (0.65–2.71)	1.34 (0.67–2.67)	903, 715
Not at all at risk	9.3% (8.3–10.3)	1.78 (0.92–3.44)	1.83 (0.97–3.48)	3958, 3900
All women ages 26 to 44 who have not had a hysterectomy and who provided a urine sample	10.6% (8.7–12.8)			1,474, 1,512^h
1+ high-risk HPV type(s)		P = 0.2062	P = 0.2775
Negative	10.1% (8.1–12.5)	1 (—)	1 (—)	1,243, 1,329
Positive	13.7% (9.0–20.5)	1.42 (0.83–2.44)	1.35 (0.79–2.31)	231, 184

↵^aParticipants who have not had a hysterectomy and who reported at least 1 lifetime sexual partner (unweighted, weighted).
↵^bIMD is a multidimensional measure of area (neighborhood)-level deprivation based on the participant's postcode. IMD scores for England, Scotland, and Wales were adjusted before being combined and assigned to quintiles, using a method by Payne and Abel (20).
↵^cIncludes 46 women paying part mortgage and part rent (shared ownership).
↵^dBinge drinking defined as having six units on one occasion.
↵^eIncludes both opposite-sex and same-sex partners.
↵^fDefined as having used the oral contraceptive pill, hormonal IUD, injections, or implants.
↵^gDefined as having been diagnosed with one of chlamydia, gonorrhea, syphilis, genital herpes, genital warts, trichomonas, nonspecific urethritis/non-gonococcal urethritis.
↵^hParticipants ages 26 to 44 years who have not had a hysterectomy, who reported at least 1 lifetime sexual partner and who provided a urine sample.

Table 3.

Key characteristics of women who have not attended for cervical screening in the past 5 years, by number of lifetime partners

	Not attended for screening in past 5 years
	All not attended (100%)	1 lifetime partner^a (25%)	2+ lifetime partners^a (75%)
	% (95% CI)	% (95% CI)	% (95% CI)
Denominator (unweighted, weighted)	496, 420	111, 105	385, 314
Age, years
26–29	19.4% (16.3–22.9)	18.4% (12.6–26.0)	19.8% (16.3–23.8)
30–39	22.3% (18.5–26.7)	26.5% (18.3–36.6)	21.0% (16.8–25.9)
40–49	20.8% (16.6–25.8)	14.3% (7.2–26.3)	23.0% (18.2–28.7)
50–59	24.3% (19.9–29.3)	20.3% (12.4–31.5)	25.6% (20.5–31.5)
60–64	13.1% (9.6–17.6)	20.6% (12.5–31.9)	10.6% (7.1–15.5)
IMD (quintiles)^b		P = 0.4394^c
1–2 (least deprived)	29.1% (24.4–34.2)	28.8% (20.3–39.2)	29.1% (23.8–35.1)
3	20.0% (16.0–24.7)	15.7% (10.0–23.9)	21.5% (16.7–27.2)
4–5 (most deprived)	50.9% (45.7–56.1)	55.5% (44.9–65.6)	49.4% (43.4–55.4)
Academic qualifications		P = 0.1289^c
No academic qualifications	26.7% (22.1–31.8)	34.7% (24.2–46.9)	24.1% (19.4–29.7)
Academic qualifications typically gained at age 16	34.6% (29.6–39.9)	26.4% (17.4–38.0)	37.2% (31.5–43.2)
Studying for/attained further academic qualifications	38.7% (33.6–44.1)	38.9% (28.4–50.6)	38.7% (32.9–44.8)
Ethnic group		P < 0.0001^c
White	82.0% (77.5–85.8)	59.3% (47.9–69.8)	89.6% (85.3–92.7)
Mixed	2.0% (1.0–4.1)	1.4% (0.3–5.8)	2.2% (1.0–4.9)
Asian/Asian British	9.2% (6.5–12.8)	25.5% (17.2–36.1)	3.7% (2.1–6.6)
Black/Black British	4.9% (2.8–8.5)	9.4% (3.8–21.2)	3.5% (1.7–6.9)
Other	1.9% (1.0–3.5)	4.5% (1.9–9.9)	1.0% (0.4–2.7)
Smoking status		P = 0.0022^c
Non/ex-smoker	65.1% (60.2–69.7)	79.7% (68.9–87.4)	60.2% (54.6–65.6)
Current smoker	34.9% (30.3–39.8)	20.3% (12.6–31.1)	39.8% (34.4–45.4)
Age at first heterosexual sex (years)		P < 0.0001^c
18+	47.4% (42.4–52.6)	81.6% (71.3–88.8)	36.1% (30.6–41.9)
16/17	36.1% (31.2–41.2)	17.5% (10.4–27.9)	42.3% (36.5–48.3)
<16	16.5% (13.1–20.5)	0.9% (0.3–2.9)	21.7% (17.3–26.8)
Sexual partner, past 5 years^a		P = 0.2239^c
No	15.9% (12.2–20.3)	20.3% (12.5–31.4)	14.4% (10.6–19.2)
Yes	84.1% (79.7–87.8)	79.7% (68.6–87.5)	85.6% (80.8–89.4)
Denominator (unwt, wt)^d	148, 160	31, 47	117, 112
1+ high-risk HPV type(s)		P = 0.0216^c
Negative	84.2% (76.2–89.8)	94.8% (82.8–98.6)	79.7% (69.5–87.1)
Positive	15.8% (10.2–23.8)	5.2% (1.4–17.2)	20.3% (12.9–30.5)

↵^aIncludes both opposite-sex and same-sex partners.
↵^bIMD is a multidimensional measure of area (neighborhood)-level deprivation based on the participant's postcode. IMD scores for England, Scotland, and Wales were adjusted before being combined and assigned to quintiles, using a method by Payne and Abel (20).
↵^cP values for comparison between nonattenders with 1 and 2+ lifetime partners.
↵^dNonattenders ages 26 to 44 years who provided a urine sample.

Table 4.

Factors associated with noncompletion of HPV catch-up vaccination

		Not completed versus completed
	Not completed% (95% CI)	OR (95% CI)	Age-adjusted OR (95% CI)	Denominator (unwt, wt)
All eligible for HPV catch-up vaccination program	38.5% (35.3–41.9)			1,050, 562
Socio-demographic factors
Age at interview (years)		P < 0.0001
16–17	28.0% (23.2–33.4)	1 (—)		394, 195
18–19	41.7% (36.7–47.0)	1.84 (1.33–2.56)		449, 241
20–21	48.7% (41.3–56.1)	2.44 (1.64–3.63)		207, 125
School year at eligibility for HPV vaccination program		P < 0.0001	P = 0.0060
14 (Y10/S3)	27.1% (20.1–35.3)	1 (—)	1 (—)	153, 78
15 (Y11/S4)	26.8% (21.1–33.3)	0.99 (0.61–1.59)	1.01 (0.62–1.65)	244, 123
16 (Y12/S5)	35.8% (29.5–42.6)	1.50 (0.94–2.39)	1.57 (0.90–2.74)	238, 117
17 (Y13/S6 or post school)	49.4% (44.1–54.8)	2.64 (1.69–4.10)	2.87 (1.39–5.95)	415, 243
Grouped government office region		P < 0.0001	P < 0.0001
Rest of England	36.4% (32.7–40.2)	1 (—)	1 (—)	803, 421
London	62.4% (52.3–71.5)	2.90 (1.87–4.50)	2.76 (1.77–4.30)	100, 66
Scotland	19.8% (13.1–28.8)	0.43 (0.26–0.72)	0.41 (0.24–0.70)	89, 46
Wales	44.4% (31.0–58.6)	1.40 (0.78–2.48)	1.31 (0.74–2.35)	58, 29
IMD (quintiles)^a		P < 0.0001	P = 0.0001
1–2 (least deprived)	30.1% (25.3–35.4)	1 (—)	1 (—)	393, 210
3	36.7% (29.4–44.7)	1.34 (0.90–2.01)	1.35 (0.90–2.04)	209, 116
4–5 (most deprived)	46.9% (42.0–51.9)	2.05 (1.50–2.81)	1.99 (1.44–2.74)	448, 236
Parents' social class		P = 0.0308	P = 0.0285
I/II/III	35.1% (31.2–39.2)	1 (—)	1 (—)	714, 385
IV/V	44.9% (37.0–53.1)	1.51 (1.04–2.19)	1.52 (1.05–2.21)	196, 103
Academic qualifications^b		P < 0.0001	P < 0.0001
No academic qualifications	75.2% (55.9–87.9)	6.04 (2.63–13.85)	5.84 (2.50–13.62)	39, 18
Academic qualifications typically gained at age 16	57.2% (49.3–64.7)	2.66 (1.85–3.83)	2.52 (1.75–3.65)	188, 92
Studying for/attained further academic qualifications	33.4% (29.5–37.6)	1 (—)	1 (—)	650, 361
Ethnic group		P = 0.0015	P = 0.0001
White	36.3% (32.9–39.7)	1 (—)	1 (—)	937, 491
Non-white	54.1% (43.5–64.5)	2.07 (1.32–3.25)	2.01 (1.29–3.13)	113, 71
Health behaviors
Smoking status		P < 0.0001	P < 0.0001
Non/ex-smoker	31.8% (28.3–35.7)	1 (—)	1 (—)	737, 400
Current smoker	55.0% (48.9–61.0)	2.62 (1.95–3.53)	2.61 (1.93–3.55)	313, 162
Frequency of binge drinking^c		P = 0.0665	P = 0.1886
Never/less than monthly	36.8% (32.9–41.0)	1 (—)	1 (—)	712, 376
Monthly	36.9% (30.0–44.5)	1.00 (0.71–1.43)	0.90 (0.62–1.30)	200, 107
Weekly or more often	48.4% (39.4–57.6)	1.61 (1.07–2.42)	1.41 (0.92–2.15)	137, 78
Sexual behaviors (all eligible for catch-up vaccination)
Number of sexual partners, lifetime^d		P < 0.0001	P = 0.0107
0	24.5% (18.4–31.7)	0.62 (0.38–1.01)	0.72 (0.43–1.18)	205, 109
1	34.4% (27.1–42.5)	1 (—)	1 (—)	203, 113
2	37.6% (29.1–46.8)	1.15 (0.69–1.89)	1.12 (0.68–1.84)	147, 77
3–4	39.6% (31.6–48.2)	1.25 (0.77–2.03)	1.22 (0.75–2.00)	171, 93
5+	49.9% (43.6–56.1)	1.89 (1.23–2.91)	1.70 (1.09–2.63)	317, 167
All eligible for HPV catch-up vaccination program with 1+ lifetime partner^d	41.9% (38.3–45.6)			843, 451
Sexual behaviors (those with 1+ lifetime partner)
Had heterosexual sex before 16		P = 0.0088	P = 0.0014
No	37.5% (32.7–42.6)	1 (—)	1 (—)	456, 252
Yes	47.7% (42.0–53.4)	1.52 (1.11–2.07)	1.68 (1.22–2.30)	355, 181
Number of sexual partners, past year^d		P = 0.3294	P = 0.2689
0/1	39.7% (35.0–44.6)	1 (—)	1 (—)	475, 260
2	44.8% (36.2–53.6)	1.23 (0.82–1.84)	1.28 (0.85–1.93)	156, 78
3+	45.7% (38.2–53.3)	1.28 (0.89–1.84)	1.30 (0.90–1.88)	203, 108
Number of sexual partners without a condom, past year^d		P = 0.0092	P = 0.0065
0	38.8% (31.0–47.2)	1 (—)	1 (—)	196, 106
1	39.6% (34.7–44.7)	1.03 (0.68–1.56)	1.03 (0.69–1.55)	443, 238
2+	53.1% (45.1–60.9)	1.79 (1.13–2.83)	1.83 (1.16–2.88)	185, 98
Health-related factors
Used hormonal contraception, past year^e		P < 0.0001	P < 0.0001
No	54.3% (47.1–61.4)	1 (—)	1 (—)	235, 131
Yes	36.4% (32.4–40.7)	0.48 (0.34–0.68)	0.47 (0.34–0.67)	570, 299
Ever attended a sexual health (GUM) clinic		P = 0.0044	P = 0.0100
No	37.2% (32.6–42.1)	1 (—)	1 (—)	462, 251
Yes	47.8% (42.3–53.3)	1.54 (1.15–2.08)	1.49 (1.10–2.02)	377, 199
Ever diagnosed with an STI (excluding thrush)^f		P = 0.1735	P = 0.4147
No (or only thrush)	41.0% (37.1–45.0)	1 (—)	1 (—)	730, 395
Yes	48.5% (38.3–58.8)	1.36 (0.87–2.10)	1.20 (0.77–1.88)	109, 55
Ever been pregnant		P < 0.0001	P < 0.0001
No	35.4% (31.4–39.8)	1 (—)	1 (—)	633, 346
Yes	63.4% (55.9–70.2)	3.15 (2.21–4.49)	2.94 (2.04–4.23)	210, 105
All eligible for HPV catch-up vaccination program with 1+ lifetime partner^d who provided a urine sample	41.0% (36.1–46.1)			481, 273
HPV markers in urine
Any HPV type(s)		P = 0.0302	P = 0.0383
HPV negative	36.0% (29.3–43.2)	1 (—)	1 (—)	253, 152
HPV positive	47.2% (40.0–54.6)	1.60 (1.04–2.44)	1.57 (1.02–2.40)	228, 121
1+ high-risk HPV type(s)		P = 0.0003	P = 0.0005
Negative	35.3% (29.6–41.4)	1 (—)	1 (—)	347, 200
Positive	56.6% (46.8–65.9)	2.39 (1.49–3.83)	2.33 (1.45–3.74)	134, 73

^aIMD is a multidimensional measure of area (neighborhood)-level deprivation based on the participant's postcode. IMD scores for England, Scotland, and Wales were adjusted before being combined and assigned to quintiles, using a method by Payne and Abel (20).
↵^bParticipants aged ≥17 years.
^cBinge drinking defined as having six units on one occasion.
↵^dIncludes both opposite-sex and same-sex partners.
↵^eDefined as having used the oral contraceptive pill, hormonal IUD, injections, or implants.
↵^fDefined as having been diagnosed with one of chlamydia, gonorrhea, syphilis, genital herpes, genital warts, trichomonas, nonspecific urethritis/non-gonococcal urethritis.