Objective: We investigated whether and to what extent the uptake of the Human Papillomavirus (HPV)
vaccine by girls aged 12–18 was related to the cervical cancer screening history of age-appropriate older
female household members (assumed to be their mothers) in Flanders (Belgium).
Methods: We studied administrative records on 127,854 female members of the National Alliance of
Christian Mutualities, which is the largest health insurance fund in Flanders. Reimbursement data for
HPV vaccination of girls for the period 2007–2009 were linked with reimbursement data for cervical
cancer screening of their mothers in the three preceding years. A multilevel logit model was used to
study associations between both preventive behaviors. In the model we controlled for both the girl’s and
the mother’s age, the province of residence and the socio-economic background of the family.
Results: A clear association between a mother’s history of participation in cervical cancer screening and
her daughter’s HPV vaccination initiation was found. The conditional odds of HPV vaccination initiation
were more than 4 times higher for girls whose mother had one Pap test than for girls whose mother
had none (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 3.5–5.9). For girls whose mother had three
or more Pap tests, the conditional odds were 16 times higher than for girls whose mother did not have
any pap tests ([OR] = 16.0; 95% [CI] = 12.1–21.2). The effect of screening (having received 1 pap smear as
compared to none) was larger for girls living in neighborhoods with the lowest median income ([OR] = 6.0,
95% [CI] = 3.6–10.1).
Conclusion: In a situation where both cervical cancer screening and HPV vaccination are opportunistic,
we found evidence that these preventive behaviors cluster within families.