题名

人類乳突病毒、子宮頸癌預防策略與性行為模式

并列篇名

Human Papillomavirus, Cervical Cancer Prevention, and Sexual Behavior

DOI

10.3966/160857872014052001004

作者

陳菁徽(Ching-Hui Chen);邱立軒(Li-Hsuan Chiu);黎進三(Chin-San Lee);阮芳賦(Fang-Fu Ruan);陳國彥(Kuo-Yen Chen);劉偉民(Wei-Min Liu);朱元祥(Yuan-Hsiang Chu)

关键词

人類乳突病毒 ; 人類乳突病毒疫苗 ; 性態度 ; human papillomavirus ; human papillomavirus vaccine ; sex behavior

期刊名称

台灣性學學刊

卷期/出版年月

20卷1期(2014 / 05 / 01)

页次

83 - 110

内容语文

繁體中文

中文摘要

人類乳突病毒(human papillomavirus, HPV)是一種極為普遍的性傳染病毒,其致病原因與發生率亦與性行為模式息息相關。致癌型的人類乳突病毒感染為女性子宮頸癌、外陰癌及陰道癌的致病主因,而非致癌型則為生殖道尖形濕疣的致病原因。研究顯示,HPV在子宮頸的感染案例中,兩成左右為持續性感染,而這些案例則可能形成女性子宮頸的癌前病變,甚至可能造成子宮頸癌。因此,對HPV感染與預防的知識便極為重要。目前的研究已證實施打HPV疫苗已成為預防子宮頸癌及相關癌前病變之有效方式,在許多國家的醫學界亦已建立接種疫苗之相關共識。但對不同族群而言,如未有性行為之年輕族群、男、女同志族群等,其接種與防治HPV傳染之意義皆有所不同。本文以一綜觀面相,綜論與此病毒相關之傳染、預防知識,以及其預防手段在性態度或對不同性傾向族群之關聯與意義,並期待大眾對其建立正確之疾病預防策略與認知。

英文摘要

Human papillomavirus (HPV) infection is a highly prevalent sex-transmitted disease. The spreading of HPV is associated with sex behavior. Oncogenic types of HPV are the etiologic agent of cervical cancer, while non-oncogenic types of HPV may result in genital warts. Eighty percent of cervical HPV-infected women may have disease regression within 2 years, while the other 20% have a persistent infection, which may result in cervical intraepithelial neoplasia (CIN). Current studies have confirmed the effectiveness of pap smear cervical cancer screening and HPV vaccination for the prevention of cervical cancer and certain sex-transmitted diseases. However, consensus varies regarding the target population for HPV vaccination. This article introduces the updated information for HPV etiology, epidemiology and prevention, and discusses the current status and underlying barrier for HPV vaccination to particular age or sex groups.

主题分类 社會科學 > 教育學
社會科學 > 社會學
社會科學 > 社會學
参考文献
  1. 晏涵文、劉潔心、鄭其嘉(2009)。台北市五專五年級學生近三十年約會與性行為變化趨勢研究。中華輔導與諮商學報,25,251-274。
    連結:
  2. (1996).NIH releases consensus statement on cervical cancer.Am Fam Physician,54(7),2310+2315-2316.
  3. 衛生福利部國民健康局(2013)。中華民國99年癌症登記報告。取自http://www.hpa.gov.tw/Bhpnet/Portal/File/StatisticsFile/201305061037065219/99%E5%B9%B4%E7%99%8C%E7%97%87%E7%99%BB%E8%A8%98%E5%A0%B1%E5%91%8A.pdf
  4. 衛生福利部國民健康局(2012)。中華民國100年子宮頸癌篩檢登記報告。取自http://www.hpa.gov.tw/bhpnet/Portal/File/StatisticsFile/201304150247295571/100%E5%B9%B4%E5%B9%B4%E5%A0%B1.pdf
  5. United States Center for Disease Control (2014). Genital HPV infection-fact sheet. Retrieved from http://www.cdc.gov/std/hpv/stdfact-hpv.htm
  6. 衛生福利部國民健康局(2010)。中華民國97年癌症登記報告。取自http://www.hpa.gov.tw/DOWNLOAD/Statistics/1.%E7%99%8C%E7%97%87%E7%99%BB%E8%A8%98%E5%B9%B4%E5%BA%A6%E5%A0%B1%E5%91%8A%EF%BC%88%E5%85%A8%EF%BC%89%2892%E5%B9%B4%E4%BB%A5%E5%BE%8C%E8%B3%87%E6%96%99%E5%83%85%E5%90%AB%E4%BE%B5%E8%A5%B2%E7%99%8C%29/Y97-%E7%99%8C%E7%97%87%E7%99%BB%E8%A8%98%E5%B9%B4%E5%BA%A6%E5%A0%B1%E5%91%8A%EF%BC%88%E5%85%A8%29.pdf
  7. Adams, M.,Jasani, B.,Fiander, A.(2007).Human papilloma virus (HPV) prophylactic vaccination: Challenges for public health and implications for screening.Vaccine,25(16),3007-3013.
  8. Association of Reproductive Health Professionals(2005).Cervical cancer prevention and HPV DNA testing.Health & Sexuality,10(1),1-22.
  9. Bednarczyk, R. A.,Birkhead, G. S.,Morse, D. L.,Doleyres, H.,McNutt, L. A.(2011).Human papillomavirus vaccine uptake and barriers: Association with perceived risk, actual risk and race/ethnicity among female students at New York State University, 2010.Vaccine,29(17),3138-3143.
  10. Bednarczyk, R. A.,Davis, R.,Ault, K.,Orenstein, W.,Omer, S. B.(2012).Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds.Pediatrics,130(5),798-805.
  11. Belinson, J.,Qiao, Y.-L.,Pretorius, R.,Zhang, W.-H.,Elson, P.,Li, L.,Zahniser, D.(2001).Shanxi province cervical cancer screening study: A cross-sectional comparative trial of multiple techniques to detect cervical neoplasia.Gynecol Oncol,83(2),439-444.
  12. Benard, V. B.,Eheman, C. R.,Lawson, H. W.,Blackman, D. K.,Anderson, C.,Helsel, W.,Lee, N. C.(2004).Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995-2001.Obstet Gynecol,103(3),564-571.
  13. Bleeker, M. C.,Hogewoning, C. J.,Voorhorst, F. J.,van den Brule, A. J.,Snijders, P. J.,Starink, T. M.,Meijer, C. J.(2003).Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia.Int J Cancer,107(5),804-810.
  14. Bosch, F. X.,de Sanjose, S.(2003).Chapter 1: Human papillomavirus and cervical cancer-burden and assessment of causality.J Natl Cancer Inst Monogr,31,3-13.
  15. Brabin, L.,Roberts, S. A.,Farzaneh, F.,Kitchener, H. C.(2006).Future acceptance of adolescent human papillomavirus vaccination: A survey of parental attitudes.Vaccine,24(16),3087-3094.
  16. Brewer, N. T.,Ng, T. W.,McRee, A. L.,Reiter, P. L.(2010).Men's beliefs about HPV-related disease.J Behav Med,33(4),274-281.
  17. Brisson, M.,van de Velde, N.,Franco, E. L.,Drolet, M.,Boily, M. C.(2011).Incremental impact of adding boys to current human papillomavirus vaccination programs: Role of herd immunity.J Infect Dis,204(3),372-376.
  18. Bulk, S.,Visser, O.,Rozendaal, L.,Verheijen, R. H.,Meijer, C. J.(2005).Cervical cancer in the Netherlands 1989-1998: Decrease of squamous cell carcinoma in older women, increase of adenocarcinoma in younger women.Int J Cancer,113(6),1005-1009.
  19. Burchell, A. N.,Tellier, P. P.,Hanley, J.,Coutlee, F.,Franco, E. L.(2010).Human papillomavirus infections among couples in new sexual relationships.Epidemiology,21(1),31-37.
  20. Castellsague, X.,Munoz, N.(2003).Chapter 3: Cofactors in human papillomavirus carcinogenesis-role of parity, oral contraceptives, and tobacco smoking.J Natl Cancer Inst Monogr,31,20-28.
  21. Cates, W., Jr.(1999).Estimates of the incidence and prevalence of sexually transmitted diseases in the United States.American Social Health Association Panel. Sex Transm Dis,26(4 Suppl),S2-7.
  22. Czegledy, J.(2001).Sexual and non-sexual transmission of human papillomavirus.Acta Microbiol Immunol Hung,48(3-4),511-517.
  23. Daling, J. R.,Madeleine, M. M.,Johnson, L. G.,Schwartz, S. M.,Shera, K. A.,Wurscher, M. A.,McDougall, J. K.(2004).Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer.Cancer,101(2),270-280.
  24. Dunne, E. F.,Sternberg, M.,Markowitz, L. E.,McQuillan, G.,Swan, D.,Patel, S.,Unger, E. R.(2011).Human papillomavirus (HPV) 6, 11, 16, and 18 prevalence among females in the United States-National Health and Nutrition Examination Survey, 2003-2006: Opportunity to measure HPV vaccine impact?.J Infect Dis,204(4),562-565.
  25. Eaton, D. K.,Kann, L.,Kinchen, S.,Shanklin, S.,Ross, J.,Hawkins, J.,Wechsler, H.(2010).Youth risk behavior surveillance-United States, 2009.MMWR Surveill Summ,59(5),1-142.
  26. Fazekas, K. I.,Brewer, N. T.,Smith, J. S.(2008).HPV vaccine acceptability in a rural southern area.J Womens Health (Larchmt),17(4),539-548.
  27. Forster, A.,Wardle, J.,Stephenson, J.,Waller, J.(2010).Passport to promiscuity or lifesaver: Press coverage of HPV vaccination and risky sexual behavior.J Health Commun,15(2),205-217.
  28. Franco, E. L.,Schlecht, N. F.,Saslow, D.(2003).The epidemiology of cervical cancer.Cancer J,9(5),348-359.
  29. Garland, S. M.,Smith, J. S.(2010).Human papillomavirus vaccines: Current status and future prospects.Drugs,70(9),1079-1098.
  30. Gilbert, P. A.,Brewer, N. T.,Reiter, P. L.(2011).Association of human papillomavirus-related knowledge, attitudes, and beliefs with HIV status: A national study of gay men.J Low Genit Tract Dis,15(2),83-88.
  31. Giraldi, G.,De Luca d'Alessandro, E.(2012).The HPV infection in males: An update.Ann Ig,24(6),497-506.
  32. Gray, N. M.,Sharp, L.,Cotton, S. C.,Masson, L. F.,Little, J.,Walker, L. G.,Woolley, C. M.(2006).Psychological effects of a low-grade abnormal cervical smear test result: Anxiety and associated factors.Br J Cancer,94(9),1253-1262.
  33. Hildesheim, A.,Herrero, R.,Castle, P. E.,Wacholder, S.,Bratti, M. C.,Sherman, M. E.,Schiffman, M.(2001).HPV co-factors related to the development of cervical cancer: Results from a population-based study in Costa Rica.Br J Cancer,84(9),1219-1226.
  34. Ho, G.-Y.,Bierman, R.,Beardsley, L.,Chang, C.-J.,Burk, R. D.(1998).Natural history of cervicovaginal papillomavirus infection in young women.N Engl J Med,338(7),423-428.
  35. Hogewoning, C. J.,Bleeker, M. C.,van den Brule, A. J.,Voorhorst, F. J.,Snijders, P. J.,Berkhof, J.,Meijer, C. J.(2003).Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: A randomized clinical trial.Int J Cancer,107(5),811-816.
  36. Johnson, L. G.,Madeleine, M. M.,Newcomer, L. M.,Schwartz, S. M.,Daling, J. R.(2004).Anal cancer incidence and survival: The surveillance, epidemiology, and end results experience, 1973-2000.Cancer,101(2),281-288.
  37. Kahn, J. A.,Ding, L.,Huang, B.,Zimet, G. D.,Rosenthal, S. L.,Frazier, A. L.(2009).Mothers' intention for their daughters and themselves to receive the human papillomavirus vaccine: A national study of nurses.Pediatrics,123(6),1439-1445.
  38. Kohli, M.,Ferko, N.,Martin, A.,Franco, E. L.,Jenkins, D.,Gallivan, S.,Drummond, M.(2007).Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK.Br J Cancer,96(1),143-150.
  39. Koutsky, L.(1997).Epidemiology of genital human papillomavirus infection.Am J Med,102(5A),3-8.
  40. Krane, J. F.,Granter, S. R.,Trask, C. E.,Hogan, C. L.,Lee, K.-R.(2001).Papanicolaou smear sensitivity for the detection of adenocarcinoma of the cervix: A study of 49 cases.Cancer,93(1),8-15.
  41. Kulasingam, S. L.,Hughes, J. P.,Kiviat, N. B.,Mao, C.,Weiss, N. S.,Kuypers, J. M.,Koutsky, L. A.(2002).Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: Comparison of sensitivity, specificity, and frequency of referral.Journal of the American Medical Association,288(14),1749-1757.
  42. Ley, C.,Bauer, H. M.,Reingold, A.,Schiffman, M. H.,Chambers, J. C.,Tashiro, C. J.,Manos, M. M.(1991).Determinants of genital human papillomavirus infection in young women.J Natl Cancer Inst,83(14),997-1003.
  43. Liao, C.-H.(2007).Taipei,Taipei Medical University.
  44. Liddon, N. C.,Hood, J. E.,Leichliter, J. S.(2012).Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006-2008 National Survey of Family Growth.Vaccine,30(16),2676-2682.
  45. Liddon, N. C.,Leichliter, J. S.,Markowitz, L. E.(2012).Human papillomavirus vaccine and sexual behavior among adolescent and young women.Am J Prev Med,42(1),44-52.
  46. Litton, A. G.,Desmond, R. A.,Gilliland, J.,Huh, W. K.,Franklin, F. A.(2011).Factors associated with intention to vaccinate a daughter against HPV: A statewide survey in Alabama.J Pediatr Adolesc Gynecol,24(3),166-171.
  47. Manhart, L. E.,Koutsky, L. A.(2002).Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis.Sex Transm Dis,29(11),725-735.
  48. Mao, C.,Koutsky, L. A.,Ault, K. A.,Wheeler, C. M.,Brown, D. R.,Wiley, D. J.,Barr, E.(2006).Efficacy of human papillomavirus-16 vaccine to prevent cervical intraepithelial neoplasia: A randomized controlled trial.Obstet Gynecol,107(1),18-27.
  49. Markowitz, L. E.,Dunne, E. F.,Saraiya, M.,Lawson, H. W.,Chesson, H.,Unger, E. R.(2007).Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization pxractices (ACIP).MMWR Recomm Rep,56(RR-2),1-24.
  50. Marlow, L. A.,Forster, A. S.,Wardle, J.,Waller, J.(2009).Mothers' and adolescents' beliefs about risk compensation following HPV vaccination.J Adolesc Health,44(5),446-451.
  51. Marrazzo, J. M.,Koutsky, L. A.,Stine, K. L.,Kuypers, J. M.,Grubert, T. A.,Galloway, D. A.,Handsfield, H. H.(1998).Genital human papillomavirus infection in women who have sex with women.J Infect Dis,178(6),1604-1609.
  52. Marrazzo, J. M.,Stine, K.,Koutsky, L. A.(2000).Genital human papillomavirus infection in women who have sex with women: A review.Am J Obstet Gynecol,183(3),770-774.
  53. Martinez, G.,Copen, C. E.,Abma, J. C.(2011).Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.Vital Health Stat,23(31),1-35.
  54. Mather, T.,McCaffery, K.,Juraskova, I.(2012).Does HPV vaccination affect women's attitudes to cervical cancer screening and safe sexual behaviour?.Vaccine,30(21),3196-3201.
  55. McNair, R.,Power, J.,Carr, S.(2009).Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations.Aust N Z J Public Health,33(1),87-93.
  56. Moscicki, A. B.,Hills, N.,Shiboski, S.,Powell, K.,Jay, N.,Hanson, E.,Palefsky, J.(2001).Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females.Journal of the American Medical Association,285(23),2995-3002.
  57. Moscicki, A. B.,Schiffman, M.,Kjaer, S.,Villa, L. L.(2006).Chapter 5: Updating the natural history of HPV and anogenital cancer.Vaccine,24(3),S3/42-51.
  58. Mullins, T. L.,Zimet, G. D.,Rosenthal, S. L.,Morrow, C.,Ding, L.,Shew, M.,Kahn, J. A.(2012).Adolescent perceptions of risk and need for safer sexual behaviors after first human papillomavirus vaccination.Arch Pediatr Adolesc Med,166(1),82-88.
  59. Nanda, K.,McCrory, D. C.,Myers, E. R.,Bastian, L. A.,Hasselblad, V.,Hickey, J. D.,Matchar, D. B.(2000).Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review.Ann Intern Med,132(10),810-819.
  60. Nobbenhuis, M. A.,Walboomers, J. M.,Helmerhorst, T. J.,Rozendaal, L.,Remmink, A. J.,Risse, E. K.,Meijer, C. J.(1999).Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: A prospective study.Lancet,354(9172),20-25.
  61. Palefsky, J. M.,Holly, E. A.(2003).Chapter 6: Immunosuppression and co-infection with HIV.J Natl Cancer Inst Monogr,31,41-46.
  62. Patel, D. A.,Zochowski, M.,Peterman, S.,Dempsey, A. F.,Ernst, S.,Dalton, V. K.(2012).Human papillomavirus vaccine intent and uptake among female college students.J Am Coll Health,60(2),151-161.
  63. Pelullo, C. P.,Di Giuseppe, G.,Angelillo, I. F.(2012).Human papillomavirus infection: Knowledge, attitudes, and behaviors among lesbian, gay men, and bisexual in Italy.PLoS One,7(8),e42856.
  64. Pitts, M. K.,Fox, C.,Willis, J.,Anderson, J.(2007).What do gay men know about human papillomavirus? Australian gay men's knowledge and experience of anal cancer screening and human papillomavirus.Sex Transm Dis,34(3),170-173.
  65. Raab, S. S.(2000).Can glandular lesions be diagnosed in pap smear cytology?.Diagn Cytopathol,23(2),127-133.
  66. Read, D. S.,Joseph, M. A.,Polishchuk, V.,Suss, A. L.(2010).Attitudes and perceptions of the HPV vaccine in Caribbean and African-American adolescent girls and their parents.J Pediatr Adolesc Gynecol,23(4),242-245.
  67. Reiter, P. L.,Brewer, N. T.,McRee, A. L.,Gilbert, P.,Smith, J. S.(2010).Acceptability of HPV vaccine among a national sample of gay and bisexual men.Sex Transm Dis,37(3),197-203.
  68. Richardson, H.,Abrahamowicz, M.,Tellier, P. P.,Kelsall, G.,du Berger, R.,Ferenczy, A.,Franco, E. L.(2005).Modifiable risk factors associated with clearance of type-specific cervical human papillomavirus infections in a cohort of university students.Cancer Epidemiol Biomarkers Prev,14(5),1149-1156.
  69. Roden, R. B.,Lowy, D. R.,Schiller, J. T.(1997).Papillomavirus is resistant to desiccation.J Infect Dis,176(4),1076-1079.
  70. Sasieni, P.,Adams, J.,Cuzick, J.(2003).Benefit of cervical screening at different ages: Evidence from the UK audit of screening histories.Br J Cancer,89(1),88-93.
  71. Schlecht, N. F.,Kulaga, S.,Robitaille, J.,Ferreira, S.,Santos, M.,Miyamura, R. A.,Franco, E. L.(2001).Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia.Journal of the American Medical Associate,286(24),3106-3114.
  72. Schuler, C. L.,Reiter, P. L.,Smith, J. S.,Brewer, N. T.(2011).Human papillomavirus vaccine and behavioural disinhibition.Sex Transm Infect,87(4),349-353.
  73. Sedjo, R. L.,Roe, D. J.,Abrahamsen, M.,Harris, R. B.,Craft, N.,Baldwin, S.,Giuliano, A. R.(2002).Vitamin A, carotenoids, and risk of persistent oncogenic human papillomavirus infection.Cancer Epidemiol Biomarkers Prev,11(9),876-884.
  74. Silins, I.,Ryd, W.,Strand, A.,Wadell, G.,Tornberg, S.,Hansson, B. G.,Rylander, E.(2005).Chlamydia trachomatis infection and persistence of human papillomavirus.Int J Cancer,116(1),110-115.
  75. Stone, K. M.(1995).Human papillomavirus infection and genital warts: Update on epidemiology and treatment.Clin Infect Dis,20(Suppl 1),S91-97.
  76. Sun, X. W.,Kuhn, L.,Ellerbrock, T. V.,Chiasson, M. A.,Bush, T. J.,Wright, T. C., Jr.(1997).Human papillomavirus infection in women infected with the human immunodeficiency virus.N Engl J Med,337(19),1343-1349.
  77. Walboomers, J. M.,Jacobs, M. V.,Manos, M. M.,Bosch, F. X.,Kummer, J. A.,Shah, K. V.,Munoz, N.(1999).Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.J Pathol,189(1),12-19.
  78. Waller, J.,Marlow, L. A.,Wardle, J.(2006).Mothers' attitudes towards preventing cervical cancer through human papillomavirus vaccination: A qualitative study.Cancer Epidemiol Biomarkers Prev,15(7),1257-1261.
  79. Walsh, C. D.,Gera, A.,Shah, M.,Sharma, A.,Powell, J. E.,Wilson, S.(2008).Public knowledge and attitudes towards human papilloma virus (HPV) vaccination.BMC Public Health,8,368.
  80. Wang, C.-H.,Garvilles, R. G.,Chen, C.-Y.(2010).Characterization of human papillomavirus infection in north Taiwan.J Med Virol,82(8),1416-1423.
  81. Weinstock, H.,Berman, S.,Cates, W., Jr.(2004).Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000.Perspect Sex Reprod Health,36(1),6-10.
  82. Wheldon, C. W.,Daley, E. M.,Buhi, E. R.,Nyitray, A. G.,Giuliano, A. R.(2011).Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States.Vaccine,29(45),8060-8065.
  83. Winer, R. L.,Hughes, J. P.,Feng, Q.,O'Reilly, S.,Kiviat, N. B.,Holmes, K. K.,Koutsky, L. A.(2006).Condom use and the risk of genital human papillomavirus infection in young women.N Engl J Med,354(25),2645-2654.
  84. Winer, R. L.,Lee, S. K.,Hughes, J. P.,Adam, D. E.,Kiviat, N. B.,Koutsky, L. A.(2003).Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students.Am J Epidemiol,157(3),218-226.
  85. Woodman, C. B.,Collins, S.,Rollason, T. P.,Winter, H.,Bailey, A.,Yates, M.,Young, L.-S.(2003).Human papillomavirus type 18 and rapidly progressing cervical intraepithelial neoplasia.Lancet,361(9351),40-43.
  86. Wright, T. C.,Van Damme, P.,Schmitt, H. J.,Meheus, A.(2006).Chapter 14: HPV vaccine introduction in industrialized countries.Vaccine,24(3),S3/122-131.
  87. Zimet, G. D.,Liddon, N.,Rosenthal, S. L.,Lazcano-Ponce, E.,Allen, B.(2006).Chapter 24: Psychosocial aspects of vaccine acceptability.Vaccine,24(3),S3/201-209.
被引用次数
  1. 黃莉芸、張鳳琴、苗迺芳(2017)。以健康信念模式探討台灣北部大學生接種人類乳突病毒疫苗之行為意圖及相關因素研究。臺灣公共衛生雜誌,36(1),77-86。