SURVEY OF KNOWLEDGE AND ATTITUDES ON PREVENTION OF CERVICAL CANCER

Cancer of the cervix is the second most common cause of death among women of malignancies after breast cancer. Human Papilloma Virus (HPV) is transmitted through sexual contact (vaginal, anal and oral) and in contact skin-skin i n the genital area. It is highly resistant to environmental conditions and is therefore widespread. Every sexually active woman is at risk. HPV is transmitted from man to woman and in most cases the infection is asymptomatic from 6 to 15 years after the time of infection, which further contributes to the spread of the virus. The aim of the research is exploring the opinion of students and their parents about the use of a vaccine to prevent cervical cancer. The subject of the research is the process of building a culture of health of young people and their subject position for participation n health prevention. Objects of the survey are the attitudes, knowledges and assessment of different social groups for protection and preservation of th eir health and the health of others. Scope of the resea ch are 141 respondents: students and their parents. Approaches and methods for the study of the problem: theoretical analysis of the problem in the medical literature; documentary research; anonymous questionnaire survey; comparative analysis. Results of the study outline the unwillingness of the majority of parents 54% to vaccinate their daughters. 62.3% of students said they "would not be vaccinated because the vaccine i s considered as dangerous to health, and because ther e are not enough studies about the benefits of it."


INTRODUCTION
Cancer of the cervix is an actual and significant problem for health protecting and pedagogical practice [1], [2], [3], [4], [5], [6], [7], [8].The necessity of prevention of this malignancy is determined by high death-rate, which it causes among women worldwide, as well as in Bulgaria.Cancer of cervix is the second most common cause of death among women of malignancies after breast cancer.About 300 000 women die from this disease every year, and 1 400 000 women in the world are ill at this moment.Facts from Bulgarian Health Register point that in our country 1000 women get ill annually and 400 of them die.These figures are increasing constantly and concern much younger women.Human Papilloma Virus (HPV) is transmitted from a man to a woman through sexual contact (vaginal, anal and oral) and in contact skin-skin in the genital area.It is highly resistant to environmental conditions and is therefore widespread.Every sexually active woman is at risk.In most cases the infection is asymptomatic from 6 to 15 years after the time of infection, which further contributes to the spread of the virus.Vaccines are offered on Bulgarian market which are claimed to be very effective (98% for one of them and 92% for the other).The applied vaccines aren't pointed towards cancer as a whole, but towards the virus that causes the cancer.They lessen the risk of getting ill, but do not eliminate it at all, because they protect the organism only from the types, which are aimed to.
www.japmnt.comThey do not have cure effect, do not treat the infection, do not destroy the viruses.The vaccine creates immunity only in not affected by the virus women and against the virus, towards which it is pointed, i.e. the purpose of vaccination is to be done before the sexual activity.
The aim of the research is exploring the opinion of students and their parents about the use of a vaccine to prevent cervical cancer.
The subject of the research is the process of building a culture of health of young people and their subject position for participation in health prevention.
The objects of the survey are the attitudes, knowledge and assessment of different social groups for protection and preservation of their health and the health of others.
The sphere of the research are students from Medical Academy, Sofia, "Pharmacy" -61, students from "St .St.Cyril and Methodius" school, Burgas -30, students` parents -50.The whole number of participants in the survey is 141.The research data is processed statistically and shown graphically with computer programme EXCEL.
Approaches and methods for the study of the problem: theoretical analysis of the problem in the medical literature; documentary research; anonymous questionnaire survey; comparative analysis.The results from the research are processed statistically and shown graphically with computer programme EXCEL.

EXPOSURE
In order to understand the state of the problem in practice, an anonymous survey in Medical Academy was done in January, 2016.61 students from Pharmacy faculty participate in this survey.The age characteristic of the participating students is the following: the biggest group is that of 19-year-old students -59%, followed by the 20-year-old students -29.5%, 21-yearold are 8.2% and 18-year-old are presented by 3.3% (see fig. 1):

Fig. 1 Age characteristic of students
The facts from the survey show the students` willingness to be vaccinated in order to protect themselves from HPV (Human Papilloma Virus).49.2% of the students announce their decision not to be vaccinated, because according to them it is dangerous for their health.13.1% say that they would not be vaccinated, because there isn`t enough exploration for its benefit.For 8.2 % the reason is "financial", the other 8.2% "aren`t interested in the problem".Much lower is the percentage of these students who are ready to be vaccinated: 19.7% and of those who have already been vaccinated -only 1.6% (see fig. 2):

Fig. 2 Students' attitude towards vaccination
A recent study between 50 parents has been done about the opinion their daughters to be vaccinated, so that to be protected against infection with HPV.The age characteristic of parent can be introduced this way: the biggest group is that of 38year-old, the smallest is the group of 54year-old (see fig. 3) Fig. 3 Age characteristic of parents 30 % of parents, whose opinion has been studied, are with secondary education, 70 % have university education.The source of information about the significance of the vaccination and the necessity of it for parents is media -60% and for the others -GP doctor -18%.22% of parents "are not interested in this vaccine", because they think it is dangerous for health (see fig.The results from this study feature the unwillingness of one bigger part of parents to vaccinate their daughters -54%.From them 44% think that the vaccine is dangerous and 10% "no, because there are not clinically proved facts for its benefit.30% agree to vaccinate their daughters, but "after some research".Only 16% are convinced that it is useful (see fig. 5): Fig. 5 Parents' inclination for vaccination of their daughters Knowledge and tendency have been surveyed among students at following age: • 12-year-old students -76.7% • 13-year-old students -23.3% 83% of children confess that they have discussed the problem with their parents and have information from them, 10% are informed by a medical specialist at school, but 6.7% of children are ashamed to answer these questions.(see fig. 6) The bigger part of children -70% point, that they will consult with their parents, if they want to be vaccinated (see fig. 7): Fig. 6 Children's knowledge about the necessity of vaccination Fig. 7 Children's attitude towards vaccination In the process of this study a comparative analysis has been done, held in November 2012.A hundred of students from different subjects at "Prof.d-r A. Zlatarov" university, faculty of social sciences, Burgas participated.The results show that the students don't know well the ways of infection with HPV (Human Papilloma Virus).Although, during the last years the problem for the necessity of vaccination against this disease is widely discussed, in 2012 nearly 15% of students didn't know about the vaccines for prevention against HPV.The comparative analysis shows that in both years, 2012 and 2016, the participants in the survey share their fear and that's why they refrain: do vaccines cause any health complications, are there any side effects and what kind?In 2012 71% of students say that they are not informed enough with vaccines and they need more information.Facts from the answers of 62% young people, studying in Burgas, featured their readiness to support their relative, sister or girlfriend to be vaccinated.Only 5% aren't sure that "vaccine will solve the problem".

CONCLUSION
It's a human right everyone to determine the rules for his / her life, in this case -to be vaccinated or not.But when it concerns health, the rules are built on knowledge and formed attitude towards it as a value still in childhood, in the process of acquiring knowledge, information and skills.
One of the ways for improving personal health culture is creating conditions for realization of the process health education in all educating grades.[5] Knowing forms and methods of health education, organizing of thematic and informational days, concerning different health problems, help establishing proper attitude for health protection.The effect from final results in expression of preventing potential of health education aims bio-, psycho-and social health of personality.[6] The necessity of realization of the process health education prove these many questions, asked by students after they have filled in the survey card.

Fig. 4
Fig.4 Source of information about the necessity of vaccination

Fig. 5
Fig. 5 Parents' inclination for vaccination of their daughters