Aim The introduction of the human papillomavirus (HPV) vaccine enables for the first time in the history of cancer prevention the possibility of combating the major cause of a cancer even before its onset. The secondary prevention measure of cervical cancer screening has thus been complemented by a primary prevention measure. The aim of this study is to analyse the determinants of uptake of preventive measures against cervical cancer as a basis for comparing the determinants of screening attendance with those of HPV vaccination attendance. Subject and methods A population-based representative survey comprising 760 randomly selected women aged 14 to 65 was performed in the German federal state of Mecklenburg-Western Pomerania. Prevention behaviour, attitudes towards cervical cancer screening and HPV vaccination, and knowledge about cervical cancer and HPV were investigated by means of a structured questionnaire. Descriptive analyses and multivariate logistic regression analyses were conducted to identify the determinants of screening and HPV vaccine uptake. Results Attendance both at screening and at HPV vaccination was best predicted by attitudinal factors. Positive connotations of cancer prevention measures and utility expectations, fear of cancer and high subjective risk perception were conducive to attendance at screening and HPV vaccination. Screening attendance was less regular among women of lower socioeconomic status. In contrast, HPV vaccination uptake was higher for young women with lower educational attainment and lower social class. Knowledge did not impact prevention behaviour significantly. There is no trade-off between screening and vaccination attendance; the vast majority of respondents was aware of the necessity of regular screening attendance even when vaccinated against HPV. Conclusions Uptake rates for existing primary and secondary prevention measures against cervical cancer can be enhanced by fostering perceptions of utility and positive connotations of regular screening and becoming vaccinated against HPV. Elderly women in particular should be encouraged to attend screening by means of a recall system. Given the low overall level of knowledge about cervical cancer and its risk factors, there is a need for education about the necessity and utility of prevention to reach women of all social classes.

Die Schwierigkeiten der Demokratiemessung im Hinblick auf eine adäquate Erfassung der Wirklichkeit demokratischer Systeme erfordert eine Überprüfung der Messansätze. Die vorliegende Arbeit schlägt dazu ein Evaluierungsprogramm für die Konzeptqualität von Demokratiemaßen vor und testet dieses anhand sechs populärer Demokratie-Indizes. Während die Ergebnisse für die einzelnen Indizes stark differieren -der Index Defekter Demokratie schneidet am besten, der Freedom-House-Index am schlechtesten ab -, ergeben sich auch Aussagen zu indexübergrei-fenden Schwächen. Diese betreffen die Logik der Demokratiekonzepte, die Validität der Indikatoren, aber auch die theoretische Stützung von Aggregationsniveau und -regeln.

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New indices measuring the quality of democracy constitute a significant innovation in comparative political science. They might, however, provide a biased perspective because they largely focus on macro-level criteria. Thus, the question is whether the measurement of the quality of democracy can be improved by complementing the evaluations of these indices with assessments based on individual-level survey data. Using data from 20 established democracies in the European Social Survey 2012 and the Democracy Barometer, we compare the understandings and evaluations of the quality of democracy underlying these two measurement approaches. We demonstrate that while the results coincide to a certain extent, individual-level data provide an important complementary perspective that adds to the validity of the measurement of the quality of democracy.

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