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1 Original Article Korean J Health Promot 2015;15(3): pissn: eissn: 남녀대학생의인유두종바이러스백신접종및의도관련요인 이승연 1,2, 한미아 3, 박종 3, 류소연 3 1 조선대학교보건대학원보건학과 2 신가병원진단검사의학과 3 조선대학교의학전문대학원예방의학교실 Factors Associated with Human Papillomavirus Vaccination and Intention among Male and Female College Students Seung Yeun Lee 1,2, Mi Ah Han 3, Jong Park 3, So Yeon Ryu 3 1 Department of Public Health, Chosun University Graduate School of Health Science, Gwangju, Korea 2 Department of Laboratory Medicine, Singa Hospital, Gwangju, Korea 3 Department of Preventive Medicine, Chosun University School of Medicine, Gwangju, Korea Background: Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancers. The purpose of this study was to investigate HPV vaccination status and related factors among male and female college students. Methods: The study subjects were 489 students conveniently sampled from Seoyeong University located in Gwangju. General characteristics, HPV vaccination status and knowledge of cervical cancer and HPV infection were collected by self- administered questionnaires between August 25 and September 19. The collected data were analyzed by chi-square tests, t-tests and multiple logistic regression analyses. Results: Of 328 female students, 22.9% were vaccinated. But none of the male students (n=161) were vaccinated. Vaccination intention of male and female students were 18.6% and 55.5%, respectively. In multiple logistic regression analysis, adjusted odds ratio (aor) for HPV vaccination were significantly high in female subjects with high allowance (aor=2.23, 95% confidence interval [CI]= ) or high knowledge score of cervical cancer (OR=1.10, 95% CI= ). Intention of HPV vaccination were associated with participation in school clubs, chronic disease and knowledge score of cervical cancer in male students. In female students, school record, family history, self-rated health and knowledge score of cervical cancer were associated with intention of vaccination. Conclusions: HPV vaccination rate was found to be low. Prevention efforts considering these results might be helpful in increasing HPV vaccination rate and reducing HPV-associated health risks. Korean J Health Promot 2015;15(3): Keywords: Awareness, Human papillomavirus, Uterine cervical neoplasms, Vaccination 서 론 자궁경부암은전세계적으로매년약 53 만명의여성이 Received:February 3, 2015 Accepted:June 15, 2015 Corresponding author:mi Ah Han, MD, PhD Department of Preventive Medicine, Chosun University School of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: , Fax: mahan@chosun.ac.kr This article is a condensed form of the first author's master's thesis from Chosun University. 새로진단을받으며, 27만여명정도의여성이자궁경부암으로사망하는것으로추정되었다. 1) 우리나라의경우여성생식기암중발생빈도가가장높은질환으로, 2012년약 3천 6백명의자궁경부암환자가새로이발생하였고, 사망자는구백여명에이른다. 2) 인유두종바이러스 (human papilloma virus) 는자궁경부암의주요원인으로침윤성자궁암과그전구단계에필수적이다. 3) 또한인유두종바이러스감염은여성뿐아니라남성에서도생식기사마귀, 음경암, 항문암등을발생시키기

2 142 Korean J Health Promot Vol. 15, No. 3, 2015 때문에남녀모두이에대한관리가필요하다. 4) 우리나라에서인유두종바이러스감염현황을살펴보면 18-79세의국내여성 6만여명을대상으로한연구에서대상자의 34.2% 가인유두종바이러스에감염되어있었으며, 그중 18-29세의연령에서감염률이 49.9% 로가장높았다. 5) 또한남자대학생의 8.7% 가인유두종바이러스에감염되었고, 성경험이있는경우는 10.6% 로더높았다. 6) 인유두종바이러스가자궁경부암및생식기암의위험요인으로밝혀졌고, 인유두종바이러스백신이개발되면서자궁경부암예방법가운데인유두종바이러스백신접종이가장효과적인예방법으로권고되고있다. 4) 남성의경우인유두종바이러스에감염되어도별다른증상이나타나지않고감염여부를알아내기위해권고되는검사방법도없어자신이감염되었다는사실을알지못한채여성에게인유두종바이러스를전파시키는역할을한다. 7) 이에 2011년미국예방접종위원회는 11-12세남녀청소년모두에게 3회에걸친백신예방접종을권고하였고, 13-21세의남성과 13-26세의여성의경우도사전에접종을받지않았거나 3회접종을모두마치지않은경우접종을권고하고있다. 4) 우리나라의경우 9-26세의남녀모두에게인유두종바이러스백신접종이승인되어접종이가능하다. 8) 백신접종은남성이함께백신을접종할때여성만접종하는경우보다인유두종바이러스감염률과관련질환의발생률을낮출수있다고하였다. 9) 현재국내여성의인유두종바이러스백신접종은약 2-5% 로매우저조한수준으로알려져있으며, 10) 대부분여성의자궁경부암예방이나백신접종에초점을두고있어, 10-12) 남성의인유두종바이러스백신접종현황이나중요성은덜알려져있다. 인유두종바이러스백신접종에영향을미치는요인으로는부모님, 주변인또는의료인의권유, 13) 용돈, 부모님의최종학력, 백신지식점수등이었다. 14) 또한백신접종의도와관련된대상자특성을살펴보면여자의경우연령, 흡연, 백신의필요성과안전성걱정이었으며, 10) 남자의경우는교육수준이높을수록백신접종의도가높았으며 9), 백신에대한인지나지식이백신접종의도와관련있었다. 15) 비접종자의인유두종바이러스백신접종저해요인은백신에대한지식부족, 10) 접종비나무관심등이었다. 13) 이처럼자궁경부암및인유두종바이러스인지및접종에관한연구가이루어져왔으나남성대상인유두종바이러스백신접종에대한연구가미흡하고, 여성을대상으로한연구에서낮은인유두종바이러스백신접종률을보면남녀모두에게서인유두종바이러스접종실태및관련요인을파악할필요가있다. 이에본연구에서는일부지역남녀대학생을대상으로인유두종바이러스백신접종실태및접종에영향을미치는요인을파악하고자수행하였다. 방법 1. 연구대상및자료수집방법 연구대상자는광주광역시에소재한서영대학교에서편의추출을통해선정하였다. 연구자가직접학생들을찾아가서연구취지및목적을설명한후동의를얻어자기기입식설문조사를실시하였고, 자료수집장소는설문지작성이가능한강의실, 휴게실등에서연구자가직접설문지를배부하고자가작성하도록한뒤회수하는방법으로조사하였다. 자료수집기간은 2014년 8월 25일-2014년 9월 19 일로총 500부의설문지를배포하여 490부를회수하였으며, 이중응답이불충분한 1부를제외한 489부를최종분석하였다. 이연구는조선대학교병원기관생명윤리위원회의승인후시작하였다. 2. 조사변수설문내용은일반적특성, 인유두종바이러스백신접종실태및인유두종바이러스백신접종의도, 자궁경부암과인유두종바이러스지식으로구성되었다. 대상자의일반적특성은전공 ( 보건 / 비보건 ), 성별, 연령, 한달용돈 (20만원이하 /21-40만원 /41만원이상 ), 학업성적 ( 상위권 / 중위권 / 하위권 ), 이성친구여부 ( 있음 / 없음 ), 흡연상태 ( 평생비흡연 / 과거흡연 / 현재흡연 ), 음주빈도 ( 전혀마시지않음 / 한달에 1번이하 / 한달에 2-3번 / 일주일에 2번이상 ), 질병력, 부모님최종학력, 유방이나자궁질환가족력, 주관적건강상태 ( 좋음 / 보통 / 나쁨 ), 성교경험 ( 있음 / 없음 ) 등이었다. 질병은천식, 알레르기비염, 간염, 아토피등의질환을앓은적이있는지조사한후있음, 없음으로재분류하였고, 유방이나자궁질환가족력은가족중에유방이나자궁에질환을앓은적이있는지를없음, 있음, 모름으로조사하였다. 인유두종바이러스에대한인지도는 인유두종바이러스에대해들어본적있습니까? 라는문항에예 / 아니오, 인유두종바이러스백신에대한인지도는 인유두종바이러스백신접종에대해들어본적있습니까? 라는문항에예 / 아니오, 인유두종바이러스백신접종여부는 인유두종바이러스백신접종을하셨습니까? 라는문항에예 / 아니오답변으로조사하였으며, 백신접종자에한해서현재백신접종횟수, 2차및 3차접종시기, 접종계기등에대하여조사하였다. 인유두종바이러스백신접종의도는백신비접종자를대상으로 인유두종바이러스백신접종을받을의향이있습니까? 라는문항에예 / 아니오답변으로응답하게하였으며, 추가적으로백신접종을받지않은이유, 어떤방법이주어진다면인유두종바이러스백신접종을시행할것같은

3 Seung Yeun Lee, et al. Human papillomavirus vaccination 143 지를조사하였다. 자궁경부암과인유두종바이러스지식은자궁경부암증상, 위험요인, 검사방법, 인유두종바이러스특성, 치료및예방접종관련내용을묻는총 23문항에대한점수를의미한다. 이는여대생을대상으로자궁경부암지식을파악하기위해개발된도구로관련분야전문가및문항별타당도를검정하여개발된도구이다. 10) 각문항은그렇다 / 아니다 / 잘모르겠다답변으로선택하여, 정답일경우 1점, 오답일경우와잘모르겠다는 0점으로처리하여점수를합산하였다. 지식의점수는 0-23점으로점수가높을수록자궁경부암관련지식이높음을의미하며, 14) 본연구에서 Cronbach alpha 계수는 0.89였다. 여성건강에대한질문으로는초경시기 ( 13, 14세 ), 산부인과질병이나검진을위해병원방문여부등을조사하였다. 3. 통계분석본연구의수집된자료는 SAS 9.3 version 통계프로그램 (SAS Institute, Cary, NC, USA) 을이용하여분석하였다. 성별에따른대상자의인유두종바이러스백신접종실태는빈도와백분율로산출하였으며, 카이제곱검정을통해분석하였다. 인유두종바이러스접종여부, 접종의도및관련요인은성별에따라층화분석을하였다. 대상자의특성에따른인유두종바이러스백신접종여부및의도는카이제곱검정, 피셔의정확한검정및 t검정을통해비교하였다. 마지막으로단순분석에서유의확률 0.10 미만인변수를대상으로대상자의인유두종바이러스백신접종관련요인과인유두종바이러스백신접종의도에미치는요인을다중로지스틱회귀분석을이용하였고, 오즈비 (odds ratio, OR) 와 95% 신뢰구간 (confidence interval, CI) 을산출하였다. 통계적유의수준은 0.05로하였다. 결과 1. 남녀대학생의인유두종바이러스백신접종실태 총대상자 489명중인유두종바이러스에대해들어본적이있는경우는남자 27명 (16.8%), 여자 218명 (66.5%) 이었고, 인유두종바이러스백신접종에대해들어본적이있는경우는남자 13.7%, 여자 61.6% 이었다. 인유두종바이러스백신접종을한경우는여자 22.9% 이었고, 남자는한명도없었다. 인유두종바이러스백신접종을받은여자 75 명중접종회차는 1차만시행한경우 4.0%, 2차까지시행한경우 10.7%, 3차까지시행한경우 85.3% 이었다. 접종계기로는스스로가 41.4%, 부모님의권유가 46.7% 로가장많 았다 (Table 1). 인유두종바이러스백신접종을받지않은이유는 백신 Table 1. Awareness of HPV and vaccination status by sex a Awareness and vaccination status Male (n=161) Female (n=328) Awareness of HPV Yes 27 (16.8) 218 (66.5) No 134 (83.2) 110 (33.5) Awareness of HPV vaccination Yes 22 (13.7) 202 (61.6) No 139 (86.3) 126 (38.4) Status of HPV vaccination Yes 0 (0.0) 75 (22.9) No 161 (100) 253 (77.1) Characteristics of vaccinated subjects Female (n=75) Vaccination number 1st 3 (4.0) 2nd 8 (10.7) 3rd 64 (85.3) Time interval between 1st and 2nd vaccination (mo) <2 42 (56.0) (40.0) 7 3 (4.0) Time interval between 2nd and 3rd vaccination (mo) <2 6 (8.0) (69.3) 7 6 (8.0) None 11 (14.7) Reason for vaccination Parental advice 35 (46.7) Self-decision 31 (41.4) Medical team's advice 4 (5.3) Friend s advice 4 (5.3) Others 1 (1.3) Characteristics of unvaccinated subjects Male (n=161) Female (n=253) Perceived reason for not having HPV vaccination Didn t know about vaccine 150 (93.2) 155 (61.3) High cost 1 (0.6) 42 (16.6) Afraid of side-effect - 25 (9.8) Unconvinced about efficacy 1 (0.6) 12 (4.7) of vaccine No time 6 (3.7) 11 (4.4) Afraid of injection 3 (1.9) 8 (3.2) Intention for HPV vaccination Yes 30 (18.6) 141 (55.5) No 131 (81.4) 112 (44.5) Perceived facilitators to future HPV vaccination uptake b Reduction of vaccination cost 12 (40.0) 73 (51.8) Useful information about 14 (46.7) 40 (28.4) vaccine Health professional 2 (6.7) 15 (10.6) recommendation Plenty of time 2 (6.7) 10 (7.1) Other vaccination methods such as oral pills except injection - 3 (2.1) Abbreviation: HPV, human papilloma virus. a Values are presented as N (%). b Including subjects who have intention for HPV vaccination.

4 144 Korean J Health Promot Vol. 15, No. 3, 2015 접종에대해모른다 가남자 93.2%, 여자 61.3% 로가장많았고, 시간이없어서 남자 3.7%, 여자 4.4% 이었고, 값이비싸서 남자 0.6%, 여자 16.6% 이었다. 인유두종바이러스백신접종을받지않은대상자중향후백신접종의도는남자 18.6%, 여자 55.5% 가있다고응답하였다 (Table 1). 2. 여학생의인유두종바이러스백신접종관련요인 여자 328명을대상으로일반적인특성과인유두종바이러스백신접종과의관련성을살펴본결과접종군의나이 20.7±2.0 세, 비접종군의나이 20.1±2.3 세였고 (P=0.083), 한달용돈의경우 20만원이하 15.0%, 21-40만원 27.0% 에서접종했다고응답하였다 (P=0.086). 또한학업성적에서하위권 17.7%, 중위권 20.8%, 상위권 34.3% 이접종을하였다고응답하였으며 (P=0.052), 자궁경부암과인유두종바이러스지식점수에서는접종군이 10.3±8.2점, 비접종군이 8.2±5.4점으로접종군의지식점수가유의하게높았다 (P=0.004; Table 2). 여자에서인유두종바이러스백신접종에관련요인을다중로지스틱회귀분석으로분석한결과한달용돈이 20만원이하에비해 만원인경우 (OR=2.23, 95% CI= ), 자궁경부암과인유두종바이러스지식정도가높을수록 (OR=1.06, 95% CI= ) 인유두종바이러스백신접종가능성이높았다 (Table 3). Table 2. HPV vaccination status by subjects characteristics in female college students a Characteristics Vaccination Yes (n=75) No (n=253) P Age, y 20.7± ± Major Health related 63 (22.3) 220 (77.7) Non-health related 12 (26.7) 33 (73.7) Allowance (10,000 won) (15.0) 79 (85.0) (27.0) 130 (73.0) (22.8) 44 (77.2) School record High 21 (34.3) 40 (65.6) Middle 45 (20.8) 171 (79.2) Low 9 (17.7) 42 (82.3) Participate in a club Activity 13 (18.1) 59 (81.9) Not 62 (24.2) 194 (75.8) Friend of opposite sex Yes 33 (26.4) 92 (73.6) No 42 (20.7) 161 (79.3) Father s education level Middle school 7 (18.9) 30 (81.1) High school 33 (23.4) 108 (76.6) Table 2. Continued Characteristics Vaccination Yes (n=75) No (n=253) P College 34 (23.6) 110 (76.4) Unknown 1 (16.7) 5 (83.3) Mother s education level Middle school 11 (29.7) 26 (70.3) High school 32 (18.0) 146 (82.0) College 30 (28.6) 75 (71.4) Unknown 2 (25.0) 6 (75.0) Smoking status Never smoker 70 (24.3) 218 (75.7) Ex-smoker 2 (11.8) 15 (88.2) Current smoker 3 (13.0) 20 (87.0) Frequency of alcohol drinking None 20 (25.0) 60 (75.0) 1/mo 22 (23.0) 74 (77.0) 2-3/mo 29 (22.8) 98 (77.2) 2/wk 4 (16.0) 21 (84.0) Chronic disease No 40 (23.7) 129 (76.3) Yes 35 (22.0) 124 (78.0) Family history of cervix/breast disease Yes 12 (21.8) 43 (78.2) No 38 (23.6) 123 (76.4) Unknown 25 (22.3) 87 (77.7) Self-rated health Good 32 (24.4) 99 (75.6) Fair 40 (24.1) 126 (75.9) Poor 3 (9.7) 28 (90.3) Intercourse experience Yes 12 (25.0) 36 (75.0) No 63 (22.5) 217 (77.5) Menarche, y (25.7) 101 (74.3) (20.8) 152 (79.2) Knowledge score of cervical cancer and HPV 10.3± ± Abbreviation: HPV, human papilloma virus. a Values are presented as N (%) or mean±sd. Table 3. OR (95% CI) for HPV vaccination in female college students Female (n=328) Age 1.10 ( ) Allowance (ref= 20) (10,000 won) ( ) ( ) School record (ref=low) High 2.43 ( ) Middle 1.19 ( ) Knowledge score of cervical cancer and HPV 1.06 ( ) Abbreviations: CI, confidence interval; HPV, human papilloma virus; OR, odds ratios; ref, reference.

5 Seung Yeun Lee, et al. Human papillomavirus vaccination 남녀대학생의인유두종바이러스백신접종의도관련요인성별에따른대상자의특성과인유두종바이러스백신접종의도와의관련성을살펴본결과남자는전공이보건인경우 26.5%, 보건이아닌경우 12.9% 으로전공하는경우백신접종의도가높았고 (P=0.029), 동아리활동을하지않는경우 16.2%, 동아리활동을하는경우 32.0% 으로활동을하는경우에백신접종의도가높았다 (P=0.089). 또한자궁경부암과인유두종바이러스지식점수는접종의도가있는군 6.3±5.4점, 백신접종의도가없는군 3.8±5.2 점으로백신접종의도가있는군에서유의하게지식점수가높았다 (P=0.018). 여자는학업성적이상위권 65.0%, 중위권 58.5%, 하위권 35.7% 으로성적에따라백신접종의도에유의한차이가있었고 (P=0.013), 자궁과유방질환의가족력이있는경우 72.1%, 없는경우 55.3%, 모르는경우 48.3% 으로백신접종의도에차이가있었고 (P=0.036), 산부인과진료경험이없는경우 51.8%, 진료경험이있는경우 69.6% 으로진료경험이있는경우백신접종의도가유의하게높았다 (P=0.018). 자궁경부암과인유두종바이러스지식점수에서백신접종의도가없는경우 6.7±5.5점에비해의도가있는경우는 9.3±5.0 점으로유의한차이를보여백신접종의도와관련성이있었다 (P<0.001; Table 4). 인유두종바이러스백신접종의도의관련요인을다중로지스틱회귀분석으로분석한결과남자에서동아리활동을하는경우 (OR=4.37, 95% CI= ), 만성질병이있는경우 (OR=2.69, 95% CI= ), 자궁경부암과인유두종바이러스지식점수가높을수록 (OR=1.13, 95% CI= ) 인유두종바이러스백신접종의도가높았다. 여자에서는학업성적이하위권에비해중위권 (OR=3.10, 95% CI= ), 상위권인경우 (OR=2.80, 95% CI= ), 자궁과유방질환의가족력이있는경우 (OR=2.42, 95% CI = ), 주관적건강상태가나쁜경우 (OR=3.21, 95% CI= ), 자궁경부암과인유두종바이러스지식점수가높을수록 (OR=1.10, 95% CI= ) 인유두종바이러스백신접종의도가높았다 (Table 5). 고찰 본연구는남녀대학생들을대상으로인유두종바이러스백신접종현황및관련요인을파악하고자하였다. 인유두종바이러스백신접종을받은경우는여학생 22.9% 으로 5개대학여대생을대상으로수행한연구에서백신접종률 12.0% 보다높았고, 13) 일부여자대학생을대상으로수행한연구에서 11.2% 보다높았다. 14) 반면남자의인유 두종바이러스백신접종자는 161명중한명도없었는데, 선행연구에서도남학생의백신접종률은 1.3% 로낮았다. 16) 본조사에서는남자에서인유두종바이러스백신이필요하다고생각하는지혹은남자에서의인유두종바이러스로인한질병발생가능성에대한지식이나인지를직접적으로조사하지않았지만, 선행연구에서인유두종바이러스백신이여자에게만국한되는접종이라생각하며, 인유두종바이러스는여성에게만감염된다라는남학생의지식이나인지가반영된결과로생각된다. 12) 본연구에서인유두종바이러스에대해들어본적이있는남자는 16.8%, 여자는 66.5% 였고, 인유두종바이러스백신접종에대해들어본적이있는경우도남자는 13.7%, 여자는 61.6% 로남학생에서인유두종바이러스나인유두종백신에대한인지도가여학생보다낮았다. 이는선행연구와일치하는경우로 16) 인유두종바이러스나관련질환의경우남녀간의성관계를통해전파되는경우가많기때문에인유두종바이러스예방및관리를위해남자의인지도를높이는방안이필요하다고사료된다. 인유두종바이러스백신접종자의특성을보면백신접종을한이유로는부모님의권유가 46.7% 로가장많았고, 스스로인유두종바이러스백신접종이자궁경부암을예방한다고믿어서가 41.4% 로다음순이었다. 이러한결과는일부여학생을대상으로한선행연구에서부모님의권유가 77.8%, 스스로믿어서 22.2% 로, 10) 부모님의권유가높기는하나과거보다는부모님의권유에서스스로의의지변화로변화하고있음을알수있다. 현재까지부모님의권유가가장높은것은인유두종바이러스백신접종이의무화되지않아접종을하려면부모의동의나접종비지원이필요하기때문으로생각된다. 인유두종바이러스백신접종은 1년이내에 3회접종을모두완료해야하며, 2차접종은 1차접종일로부터 2개월후, 3차접종은 1차접종일로부터 6개월후에접종을권고하고있다. 8) 본연구에서인유두종바이러스백신접종자 75명중 11명 (14.7%) 이 3차접종을시행하지않았고, 6명 (8.0%) 이 7개월이상되어서접종을하여권고사항에따르지않았다. 백신접종은권고된지침을따라야충분한예방효과를기대할수있기때문에향후접종완료여부에대한추적및관리도필요할것이다. 한편인유두종바이러스백신비접종자의특성을보면백신접종을받지않은이유로는백신접종을알지못한경우가남자 93.2%, 여자 61.3% 로가장많았다. 이러한결과는인유두종바이러스백신접종에대해잘몰라서백신접종을하지않았다는선행연구와일치하는결과로 10,17) 향후백신에대한인지도를높이는경우백신접종이높아질수있으리라사료된다.

6 146 Korean J Health Promot Vol. 15, No. 3, 2015 Table 4. Intention for HPV vaccination according to subjects' characteristics by sex a Characteristics Male (n=161) Female (n=253) Yes No P Yes No P Age, y 20.7± ± ± ± Major Health related 18 (26.5) 50 (73.5) 121 (55.0) 99 (45.0) Non-health related 12 (12.9) 81 (87.1) 20 (60.6) 13 (39.4) Allowance (10,000 won) (15.4) 33 (84.6) 43 (54.4) 36 (45.6) (20.2) 67 (79.8) 76 (58.5) 54 (41.5) 41 7 (18.4) 31 (81.6) 22 (50.0) 22 (50.0) School record High 9 (23.7) 29 (76.3) 26 (65.0) 14 (35.0) Middle 15 (16.3) 77 (83.7) 100 (58.5) 71 (41.5) Low 6 (19.4) 25 (80.6) 15 (35.7) 27 (64.3) Participate in a club Activity 8 (32.0) 17 (68.0) 37 (62.7) 22 (37.3) Not 22 (16.2) 114 (83.8) 104 (53.6) 90 (46.4) Friend of opposite sex Yes 14 (21.2) 50 (78.1) 57 (62.0) 35 (38.0) No 16 (16.5) 81 (83.5) 84 (51.2) 77 (47.8) Father s education level Middle school 3 (25.0) 9 (75.0) 14 (46.7) 16 (53.3) High school 14 (17.7) 65 (82.3) 63 (58.0) 46 (42.6) College 13 (22.8) 57 (77.2) 64 (58.2) 50 (41.8) Mother s education level Middle school 1 (11.1) 8 (88.9) 13 (50.0) 13 (50.0) High school 22 (23.4) 72 (76.6) 83 (56.3) 65 (44.5) College 7 (15.2) 51 (84.8) 45 (60.0) 34 (40.0) Smoking status Never smoker 13 (16.7) 65 (83.3) 122 (56.0) 96 (44.0) Ex-smoker 6 (26.1) 17 (73.9) 6 (40.0) 9 (60.0) Current smoker 11 (18.3) 49 (81.7) 13 (65.0) 7 (35.0) Frequency of alcohol drinking b None 3 (10.7) 25 (89.3) 33 (55.0) 27 (45.0) <1/mo 4 (16.7) 20 (83.3) 40 (54.1) 34 (45.9) 2-3/mo 20 (26.0) 57 (74.0) 56 (57.1) 42 (42.9) 2/wk 2 (6.5) 29 (93.5) 12 (57.1) 9 (42.9) Chronic disease No 10 (11.9) 74 (88.1) 70 (56.5) 54 (43.6) Yes 20 (26.0) 57 (74.0) 71 (55.0) 58 (45.0) Family history of cervix/breast disease Yes 5 (35.7) 9 (64.3) 31 (72.1) 12 (27.9) No 16 (22.2) 56 (77.8) 68 (55.3) 55 (44.7) Unknown 9 (12.0) 66 (88.0) 42 (48.3) 45 (51.7) Self-rated health Good 20 (18.2) 90 (81.8) 58 (58.6) 41 (41.4) Fair 9 (20.5) 35 (79.5) 63 (50.0) 63 (50.0) Poor 1 (14.3) 6 (85.7) 20 (71.4) 8 (28.6) Intercourse experience Yes 10 (20.4) 39 (79.6) 23 (63.9) 13 (36.1) No 20 (17.9) 92 (82.1) 118 (54.4) 99 (45.6) Menarche, y (55.3) 68 (44.7) (56.4) 44 (43.6) OBGY visiting experience No (51.8) 95 (48.2) Yes (69.6) 17 (30.4) Knowledge score of cervical cancer and HPV 6.3± ± ± ±5.5 <0.001 Abbreviations: HPV, human papillomavirus; OBGY, obstetrics and gynecology. a Values are presented as N (%) or mean±sd. b Excluded one case with missing value.

7 Seung Yeun Lee, et al. Human papillomavirus vaccination 147 Table 5. OR (95% CI) of intention HPV vaccination by sex Male (n=161) Female (n=253) Age 0.76 ( ) 0.89 ( ) Major (ref=non-health related) Health related 2.38 ( ) - School record (ref=low) High ( ) Middle ( ) Participate in a club (ref=not) Activity 4.37 ( ) - Alcohol drinking (ref=none) <1/mo 1.48 ( ) - 2-3/mo 1.89 ( ) - 2/wk 0.32 ( ) - Chronic disease (ref=no) Yes 2.69 ( ) - Family history (ref=unknown) Yes 4.51 ( ) 2.42 ( ) No 2.60 ( ) 1.09 ( ) Self-rated health (ref=fair) Good ( ) Poor ( ) OBGY visiting (ref=no) Yes ( ) Knowledge score of cervical cancer and HPV 1.13 ( ) 1.10 ( ) Abbreviations: CI, confidence interval; HPV, human papillomavirus; OBGY, obstetrics and gynecology; OR, odds ratios; ref, reference. 건강행위나예방활동의도는향후예방접종실행을가장강력히예측하는변수로, 본연구에서인유두종바이러스백신접종률은낮았지만접종의도는남자 18.6%, 여자 55.5% 로상대적으로높았다. 접종의도가있는대상자들에게어떤방법이주어지면백신접종시행을하겠냐는문항에남자는백신접종에관해유용한정보를얻으면접종하겠다는경우가 43.8% 로이러한결과는백신의유용성이접종의도에영향을끼쳤다는선행연구와일치하는결과이다. 18) 여자는가격이저렴해지거나무료로해주면접종하겠다는응답이 51.8% 로가장많았는데이는무료접종이인유두종바이러스백신접종률을증가시킨다고보고한결과와일치하였다. 19) 향후백신의효과나임상적의의에대해홍보하고, 접종가격을낮춘다면인유두종바이러스백신접종이나접종의도를높일수있으리라생각된다. 대상자의인유두종바이러스백신접종이나접종의도에관련요인을살펴보면남자에서는동아리활동을하는경우와만성질병이있는경우및자궁경부암지식이높은경우접종의향이높았다. 본조사에서동아리활동의종류나내용을조사하지는않았지만선행연구에서대학교내동아리활동은개인이알고있는지식을공유하고건강행태에긍정적영향을미친다고보고하였다. 20) 또한만성질병이있는경우는건강에대한관심의향상이나의료진과의접촉빈도증가등으로예방접종률이높아진것으로보인다. 17) 여자에서는용돈이많은경우, 학업성적이높은경우, 질병에대한가족력이있는경우, 주관적건강상태가나쁜경우및자궁경부암지식이높은경우에백신접종이나접종가능성이높았다. 용돈을많이쓰는경우백신접종가능성이높았는데이는백신접종비용이고가이기때문으로판단된다. 실제로선행연구에서백신비용을낮추거나부모님의도움을받아야백신접종가능성이높아진다고하였다. 13,17) 또한학업성적이높은경우백신접종가능성이높았는데이는선행연구에서성적이좋을수록흡연과음주를하지않고약물을하지않는등성적이좋은학생들이일반적으로좋은건강행태를취한다고보고된결과와유사하다. 21) 자궁이나유방질환가족력이있는경우도백신접종가능성이높았는데, 이는선행연구와일치하는결과로 22-24) 질병의가족력이있는경우이는질병에대한인식도나민감도증가로인해흡연, 음주등의 1차예방이나건강검진등의 2차예방행태가좋아지는것으로알려져있다. 또한주관적건강인식이보통인사람보다나쁘다고응답한사람이백신접종가능성이높았는데이는본인의건강상태가나쁘다고인지하는경우건강상태향상을위해예방행태를취하려는의지가있는것으로판단되며, 선행연구에서도주관적건강상태가나쁜경우건강행위실천이좋았다. 25) 남녀모두에서자궁경부암지식점수가높은경우백신접종률이나접종의도가유의하게높아졌는데, 선행연구에서여학생이나성인여성을대상으로한연구에서도인유두종바이러스관련지식이높을수록백신에대한접종의도나수용도가높아진다고하였다. 12,23) 이처럼인유두종바이러스나인유두종바이러스백신에대해잘알고있는경우올바른건강행태로연결이되므로향후인지도향상및지식향상을위한다양한교육을통해지식이나인지도를향상시킨다면인유두종바이러스접종률을높일수있을거라고생각되며, 남학생에서도인유두종바이러스백신이나관련질병에대해교육하고관련지식을향상시킨다면, 접종의도를높일수있을것으로판단된다. 본연구의제한점으로는특정지역소재대학교에서일부대학생을임의표본추출하였으므로연구결과를전체남녀대학생으로일반화하는데어려움이있다. 또한자가보고형설문조사를통해자료수집을시행하여성관계와접종현황등이과소혹은과대응답의가능성이있고, 단면연구로선후관계를확인하는데어려움이있었다. 그럼에도불구하고본연구의의의를살펴보자면선행연구에서는대부분여성을초점으로인유두종바이러스백신접종실태및접종의향을파악하지만남성의인유두종바이러스백신접종현황과접종의도를연구한데의의가있다고하겠다. 결론적으로여자에서인유두종바이러스백신접종률은

8 148 Korean J Health Promot Vol. 15, No. 3, %, 남자에서는 0% 로인유두종바이러스백신접종률은낮은수준이었다. 향후남녀모두에서인유두종바이러스백신및인지도를향상시킬수있는방안이필요할것으로판단되며, 본연구에서밝힌접종이나접종의도관련요인을고려한다면인유두종바이러스백신접종률을높일수있으리라판단된다. 요약 연구배경 : 인유두종바이러스는가장흔한생식기감염으로, 여성에서자궁경부암의원인이다. 본연구는광주지역일부대학생들을대상으로인유두종바이러스백신접종실태와관련요인을파악하고자하였다. 방법 : 광주광역시에위치한 1개대학교학생들을대상으로자기기입식설문조사를통해일반적특성, 인유두종바이러스백신접종여부및의도를수집하였고카이제곱, t검정, 다중로지스틱회귀분석을통해접종및의도와관련된요인을파악하였다. 결과 : 대상자는총 489명, 평균연령남자는 20.7±2.0세, 여자는 20.1±2.3 세였다. 인유두종바이러스접종현황에서남자는한명도접종을하지않았고, 여자는 75명 (22.9%) 이예방접종을받았다고응하였다. 여학생에서한달용돈이 20만원이하인군에비해 만원인경우 (OR=2.23, 95% CI= ), 자궁경부암과인유두종바이러스지식이높을수록 (OR=1.06, 95% CI= ) 인유두종바이러스백신접종가능성이높았다. 인유두종바이러스백신접종의도가있는경우남자 30명 (18.6%), 여자 141명 (55.5%) 이었다. 백신접종의도는남자에서는동아리활동을하는경우, 만성질병이있는경우, 자궁경부암과인유두종바이러스지식점수가높을경우의도가높았고, 여자에서는학업성적이상위권인경우, 자궁과유방질환의가족력이있는경우, 주관적건강상태가나쁜경우, 자궁경부암과인유두종바이러스지식점수가높을수록백신접종의도가높았다. 결론 : 본연구에서남녀대학생들은인유두종바이러스백신접종률은전체적으로낮았다. 향후남녀모두에서인유두종바이러스백신및인지도를향상시킬수있는방안이필요할것으로판단되며, 본연구에서밝힌접종이나접종의도관련요인을고려한다면인유두종바이러스백신접종률을높일수있으리라판단된다. 중심단어 : 인지, 사람유두종바이러스, 자궁경부암, 예방접종 REFERENCES 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, CA Cancer J Clin 2015; 65(2): Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in Cancer Res Treat 2015;47(2): Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002;55(4): Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males--advisory Committee on Immunization Practices (ACIP), MMWR Morb Mortal Wkly Rep 2011;60 (50): Lee EH, Um TH, Chi HS, Hong YJ, Cha YJ. Prevalence and distribution of human papillomavirus infection in Korean women as determined by restriction fragment mass polymorphism assay. J Korean Med Sci 2012;27(9): Shin HR, Franceschi S, Vaccarella S, Roh JW, Ju YH, Oh JK, et al. Prevalence and determinants of genital infection with papillomavirus, in female and male university students in Busan, South Korea. J Infect Dis 2004;190(3): Pitts M, Smith A, Croy S, Lyons A, Ryall R, Garland S, et al. Singaporean men's knowledge of cervical cancer and human papillomavirus (HPV) and their attitudes towards HPV vaccination. Vaccine 2009;27(22): Kim YT. Current status of cervical cancer and HPV infection in Korea. J Gynecol Oncol 2009;20(1): Park SJ, Park HJ. Knowledge regarding cervical cancer, human papillomavirus and acceptance of vaccination in Korean adult men. J Korean Acad Fundam Nurs 2012;19(2): Lee EJ, Park JS. Knowledge about cervical cancer, health beliefs and human papillomavirus vaccination rate in female university students. J Korean Oncol Nurs 2011;11(1): Lee KE. Factors Associated with Intention to receive Human Papillomavirus Vaccine in Undergraduate Women: An Application of the Theory of Planned Behavior. J Korean Acad Fundam Nurs 2014;21(4): Kim HW. Factors influencing mothers acceptance of human papillomavirus vaccination to prevent cervical cancer in their daughters. Korean J Women Health Nurs 2011;17(2): Bang KS, Sung S, Koo B, Kim M, Kim Y, Kim J, et al. Female university students' HPV-related knowledge and influencing factors on HPV vaccination. J Korean Oncol Nurs 2011;11(3): Bang S, Yoo A, Cho S, Choi I, Kim S, Jeong Y, et al. Human papillomavirus vaccination status and related factors among some female college students. J Korean Soc Matern Child Health 2012;16(2): Kim HW. Awareness of human papillomavirus and factors associated with intention to obtain HPV vaccination among Korean youth: quasi experimental study. BMC Int Health Hum Rights 2015;15: Park SM, Choi JS. Comparison of human papillomavirus vaccivation status, associated with health belief and knowledge between male and female highschool students. J Korean Biol Nurs Sci 2013;15(1):24-32.

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon