Pubertal timing, childhood maltreatment, and cervical human papillomavirus infection in inner-city female adolescents

• In Event: 3-019 - Understudied Populations in Puberty Research: New Insights

Integrative Statement

Introduction

Research suggests that early puberty increases propensity for self-reported early sexual debut and sexual risk behaviors for girls (Copeland et al., 2010; Mendle et al., 2007), however, few studies have looked at objectively measured incidence of sexually transmitted infection (STI), or examined how pubertal timing interacts with environmental stressors to affect STI risk in adolescents. This study explores the effects of pubertal timing (i.e., age of menarche), and its interaction with prior childhood maltreatment, on risk of clinically detected cervical human papillomavirus (HPV) in primarily low-income urban Latina and African American female adolescents. HPV is the most common STI in females, and the rates of HPV and HPV-related diseases are disproportionally high in African Americans and Latinas (CDC, 2017). Grounded in the contextual amplification hypothesis (Ge & Natsuaki, 2009) – which theorizes that early puberty is particularly challenging for youth exposed to early adversity – we hypothesize that childhood maltreatment would exacerbate the risk of HPV infection in girls who mature early.

Methods

Participants were 882 sexually-active girls (Mage = 17.6, SD = 1.3 years) enrolled in a HPV4 vaccine (Gardasil) surveillance study at the Mount Sinai Adolescent Health Center in New York City. Age of menarche was obtained from medical records, with “early” and “late” pubertal timing defined as one standard deviation below (8-10 years) or above (14-16 years) the relative distribution within the sample. Child maltreatment was assessed using the Childhood Trauma Questionnaire, a 28-item retrospective inventory of childhood exposure to abuse (sexual, physical and emotional) and neglect (physical and emotional). Detection of over 40 HPV types was performed using cervical specimens; positive test results were categorized as: any type, high-risk types associated with cervical cancer, or HPV4 vaccine types (HPV6/11/16/18). Covariates included sociodemographic (age, race/ethnicity) and behavioral (age of sexual debut, number of sexual partners) correlates of HPV, as well as depression, body mass index (BMI) and HPV vaccination status.

Results

Results from multiple logistic regression showed that early menarche was associated with higher risk of HPV infection for any type (OR = 1.5, p = .040) and high-risk types (OR = 1.5, p = .039); late menarche was associated with higher risk of HPV infection for any type (OR = 1.8, p = .011), controlling for age, BMI, depression, sexual behaviors, and HPV vaccination status (Table 1). Pubertal timing was not associated with HPV4 vaccine types. However, we found a significant interaction between menarche timing and maltreatment in predicting HPV infection (Figure 1). Specifically, early maturing females exposed to childhood maltreatment were at heightened risk of HPV infection for any type (OR = 3.8, p = .004), and high-risk types (OR = 3.5, p = .006), compared to females with on-time pubertal timing.

Conclusion

Our findings underscore the need for a comprehensive approach to STI prevention that reaches all racial/ethnic groups and ensures that primary care settings provide supportive relationships where youth feel comfortable talking about safe sex and life experiences.

Authors

• Li Niu, Fordham University
  Presenting Author

• Lindsay Till Hoyt, Fordham University
  Non-Presenting Author

• Anthony Salandy, Icahn School of Medicine at Mount Sinai
  Non-Presenting Author

• Nicolas F. Schlecht, Albert Einstein College of Medicine and Roswell Park Comprehensive Cancer Center
  Non-Presenting Author

• Robert D. Burk, Albert Einstein College of Medicine
  Non-Presenting Author

• Angela Diaz, Icahn School of Medicine at Mount Sinai
  Non-Presenting Author