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BALTIMORE -- A diagnosis of HPV may make women more susceptible to smoking, alcohol abuse, or use of recreational drugs -- so-called negative coping skills -- researchers reported here.

In a small cross-sectional study a history of HPV was associated with a more than two-fold increased risk of negative coping skills and self-destructive escape behaviors, such as drinking alcohol, smoking cigarettes or marijuana (OR 2.8, P=0.02 and 2.6, P=0.004, respectively) compared with women with no history of HPV, reported , of the University of California at San Francisco, and colleagues.

Women with persistent HPV infections had an increased risk of self-perceived stress (OR 2.5), self-destructive escape behaviors (OR 2.2), negative coping skills (OR 1.8), and depression (OR 1.6) versus women who tested negative for HPV.

Even after adjusting for recent new sex partner and substance use, self-destructive escape behavior remained significant among women with HPV incidence and HPV persistence. The relationship between negative coping skills and HPV incidence remained significant after adjustments.

These results were presented at the (PAS) annual meeting.

Moscicki told MedPage Today in an email interview that this is the first study to show a relationship between stress and HPV persistence.

"Because HPV persistence is necessary for cervical cancer development, this study has important implications for cervical cancer prevention," she said.

Not surprisingly, stress was more likely to be reported in women who used antidepressants, sleeping pills, smoked cigarettes, used marijuana or had a recent sexually transmitted infection. Similar patterns were observed in women who reported depression.

This was a substudy of a previous cohort study where participants were ages 13-21 years at recruitment from 2000-2003. In 2013, the mean age of participants was 28.7 years. Examining risk factors in these participants, a quarter smoked cigarettes, drank alcohol or used marijuana (25%), 16% reported a new sex partner in the past 4 months, and 16% were on antidepressants.

The participants were tested every 6 months for HPV. There were two visits during the time of this study, and afterwards, participants were classified into one of four categories:

• 46% tested negative at both visits
• 7% reported an incident of HPV between visits
• 13% were cleared (reporting an incident one visit that went away the next time)
• 34% reported persistent HPV at both visits.

As part of the substudy, participants were surveyed about their current state of stress and depression using the , a 14 item , and a 31 item scale about coping with illness.

At the presentation, Howard said she found it "very alarming" that coping, stress, and depression influenced HPV persistence, given that some of these women had acquired their infections as adolescents.

Howard said that clinicians who diagnose women with HPV at their cervical cancer screening visits should ask about stress, and ask about their coping mechanisms to see if patients are drinking or smoking more because of the stress of their infection.

"If the patient tells the provider they are very stressed and don't feel like they are coping well, then referral might be important," Howard told MedPage Today. "Counseling to reduce smoking and drinking should always be important, but this would be another time to introduce healthy stress reduction options."

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