All ETDs from UAB

Advisory Committee Chair

Wendy Landier

Advisory Committee Members

Smita Bhatia

Gwendolyn Childs

Karen Heaton

James Klosky

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Advances in treatment for childhood cancer have led to increased survival rates. There are currently an estimated 400,000 survivors of childhood cancer living in the United States who are at risk for developing subsequent malignancies, including cancers associated with the human papillomavirus (HPV). HPV is the most common sexually transmitted infection; sexual behaviors associated with increased risk for HPV acquisition include younger age at first intercourse, multiple sexual partners, and inconsistent condom use. The prevalence of high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among young adult cancer survivors is unknown. This study used data collected as part of the HPV Vaccine in Cancer Survivors Study (R01CA166559; PIs Landier/Klosky) to characterize sexual behaviors and explore the relationship between sexual behaviors and HPV vaccination among 376 cancer survivors, aged 18 to 26 years, and one to five years from cancer treatment completion. Among participants with evaluable sexual behavior data (n = 312), 115 (36.9%) reported no previous sexual intercourse, while 147 (47.1%) reported high-risk sexual behavior. In a multivariable parsimonious model that controlled for sex and age at diagnosis, factors significantly associated with high-risk sexual behavior included dating or being in a partnered relationship (OR = 4.42, 95% CI [2.57, 7.79], p < .001), low/appropriate education (OR = 2.53, 95% CI [1.33, 4.97], p = .006), cancer diagnosis of leukemia/lymphoma (OR = 1.99, 95% CI [1.15, 3.50], p = .015), minority race (OR = 2.18, 95% CI [1.23, 3.92], p = .008), and increased perceived susceptibility to HPV (OR = 1.72, 95% CI [1.24 to 2.41], p = .001); odds of high-risk sexual behavior were decreased among participants who reported more open parental communication regarding sexual issues (OR = 0.64, 95% CI [0.42, 0.96], p = .035). We found no relationship between sexual behaviors and HPV vaccination status; of the 147 participants with high-risk sexual behavior, 114 (77.6%) had also not initiated the HPV vaccine, placing these survivors at highest risk for HPV acquisition. These findings may inform future interventions to reduce risky sexual behaviors and increase HPV vaccination among young adult cancer survivors.

Included in

Nursing Commons



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