HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity

Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study

Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.

Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study

BACKGROUND

Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans.

OBJECTIVE

We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations.

METHODS

Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability.

RESULTS

Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders.

CONCLUSIONS

This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).

COVID-19 mitigation behaviors among English-Speaking Hmong Americans

BACKGROUND

COVID-19 mitigation strategies such as masking, social distancing, avoiding group gatherings, and vaccination uptake are crucial interventions to preventing the spread of COVID-19. At present, COVID-19 data are aggregated and fail to identify subgroup variation in Asian American communities such as Hmong Americans. To understand the acceptance, adoption, and adherence to COVID-19 mitigation behaviors, an investigation of Hmong Americans' contextual and personal characteristics was conducted.

METHODS

This study aims to describe COVID-19 mitigation behaviors among Hmong Americans and the contextual and personal characteristics that influence these behaviors. A cross-sectional online survey was conducted from April 8 till June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher's Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation).

RESULTS

The sample included 507 participants who completed the survey. A majority of the Hmong American participants in our study reported masking (449/505, 88.9%), social distancing (270/496, 55.3%), avoiding group gatherings (345/505, 68.3%), avoiding public spaces (366/506, 72.3%), and obtaining the COVID-19 vaccination (350/506, 69.2%) to stay safe from COVID-19. Women were more likely to socially distance (P = .005), and avoid family (P = .005), and social gatherings (P = .009) compared to men. Social influence patterns related to mitigation behaviors varied by sex. Men were more likely compared to women to be influenced by Hmong community leaders to participate in family and group gatherings (P = .026), masking (P = .029), social distancing (P = .022), and vaccination uptake (P = .037), whereas healthcare providers and government officials were social influencers for social distancing and masking for women. Patterns of social distancing and group gatherings were also influenced by generational status.

CONCLUSION

Contextual and personal characteristics influence COVID-19 mitigation behaviors among English speaking Hmong Americans. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S

BACKGROUND

Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers' vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S.

METHODS

Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017-2020). Female caregivers aged 21-65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving.

RESULTS

An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91-6.85, adherence of aged 21-50 vs. 51-65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31-7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14-4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10-5.00, adherence of 5-14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts.

CONCLUSIONS

There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.

Is HPV vaccine awareness associated with HPV knowledge level? Findings from HINTS data across racial/ethnic groups in the US

BACKGROUND AND PURPOSE

Human papillomavirus (HPV) is recognized as a leading cause of multiple types of cancer. The current study examined HPV knowledge level and its associated factors, especially its relationship with HPV vaccine awareness, across race/ethnicity, including non-Hispanic White, non-Hispanic African American, and Hispanic.

METHODS

Cross-sectional data were merged from Cycles 1 (2017) and Cycle 2 (2018) of the National Cancer Institute (NCI) Health Information National Trends Survey 5 (HINTS5, total N = 3648), which was collected in the United States. A multiple linear regression was performed across the three race/ethnicity groups to determine potential associated factors with level of HPV knowledge.

FINDINGS

Overall HPV knowledge level among participants was low (Mean = 1.68; SD = 1.44; range 0-4). Among three racial/ethnic groups, non-Hispanic African American had the lowest level of HPV knowledge (Mean = 1.51). Less than 30% answered correctly to each of the three items assessing knowledge of HPV-associated (HPVa) cancers other than cervical (e.g. if HPV can cause penile, anal, and/or oral cancer). The HPV vaccine awareness was significantly associated with HPV knowledge across all three racial/ethnic groups.

CONCLUSIONS AND IMPLICATIONS

The lowest level of HPV knowledge among non-Hispanic African American suggests that HPV education is urgently needed for this population. Specific interventions should emphasize information regarding HPVa cancers other than cervical cancer. Additionally, promoting awareness of the HPV vaccine will help to improve HPV knowledge among general population. Lastly, various factors associated with HPV knowledge across different racial/ethnic groups need to be addressed when implementing HPV education programs.

What do South Asian immigrant women know about HPV, cervical cancer and its early detection: A cross-sectional Australian study

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Low HPV and cervical cancer knowledge levels among South Asian immigrant women.

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One third participants aware of the renewed cervical screening program changes.

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Screening uptake significantly associated with HPV and cervical cancer awareness.

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GP discussion on the topic found to have important role in increasing knowledge.

Cervical cancer commonly caused by Human Papillomavirus (HPV) imposes a significant burden in Asia. This study examined the awareness and knowledge of HPV, cervical cancer, and its early detection methods among South Asian immigrant women in Australia to determine factors associated with knowledge deficits. A cross-sectional internet-based survey was completed by a convenience sample of women (n=148), with South-Asian background, residing in Queensland during May-October 2019. Main outcome variables were awareness of HPV, cervical cancer, cervical screening test (Pap test and HPV test) and HPV test self-sampling availability (Yes/No). HPV and cervical cancer knowledge were assessed via 16-item and 20 item aggregated scales respectively, (higher scores indicating better knowledge). Five individual items queried knowledge of the Pap and HPV test, and one item actual cervical screening uptake. One-way ANOVA was used to study differences in HPV and cervical cancer knowledge among sociodemographic groups. Of 148 participating women, 55% (n=86) had heard of HPV, 77% (n=114) of cervical cancer and 81.8% (n=121) of Pap tests. Only one third of participants (n=49) were aware that now an HPV test is used for cervical screening and 10% (n=15) of its self-sampling availability, whereas 55.4% (n=82) reported participation in screening previously. The mean HPV knowledge score was 5.3 (S.D: 5.7) and mean cervical cancer knowledge score 9.8 (S.D: 6.5) with zero being the most common score on both scales. Higher knowledge scores were significantly associated with higher educational level, English language proficiency, discussion with a GP on the topic and previous participation in screening. The majority of participants lacked detailed knowledge about the available screening tests. This study identified key target groups for future interventions.

Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review

There has been a growing number of sexual health and blood-borne virus (SHBBV) surveys specifically administered to migrant populations. The purpose of this scoping review is to collate available information about how SHBBV surveys have been administered in migrant populations and the effect that mode of administration has on data quality, reliability and other practical considerations, e.g. response rates (RR) and social desirability bias. A methodological framework for scoping reviews was applied. SHBBV survey studies administered to international migrants published since 2000 were included if they contained some description of mode of administration. Ninety one studies were identified for inclusion from Embase, Medline, Web of Science, Google Scholar and supplementary grey literature. 'Interview only' was the most common mode of administration (n = 48), predominately comprising face-to-face interviews. Thirty six studies reported data from 'self-completed' surveys only, with pen-and-paper being most common (n = 17). Few studies (n = 7) combined interview and self-completed methods of survey administration. Sixty one studies did not report (or only partially reported) RR or the data necessary to calculate RR. Of the studies that reported RR, most were missing other key information including method of recruitment, consent procedures and whether incentives were offered. Strengths and limitations of all administration modes are summarised. Guidelines to inform future SHBBV survey research in migrant populations are presented.

Online media scans: Applying systematic review techniques to assess statewide human papillomavirus vaccination activities

Background. Although the human papillomavirus (HPV) vaccine has been approved for use in adolescents in the US for over a decade, vaccination uptake remains low. Of concern, HPV vaccine coverage is below the national average in Minnesota, USA. To understand the reach of current HPV programming and research, we use an online media scan; this method may be applied to other jurisdictions to gain insight about various public health issues.

Design and Methods. This online media scan describes the nature and scope of ongoing activities to increase HPV vaccination in Minnesota. The media scan included: a) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and b) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018.

Results. Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria. Results were categorized by activities focusing on race/ethnicity, sex, health providers, parents, lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) populations, geographic location, catchup vaccination, and insurance status. Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research) with only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural areas.

Conclusions. A range of local and statewide HPV vaccine health education/promotion and research activities were identified in Minnesota. Several efforts partnered with American Indian and Somali/Somali-American communities, but fewer activities focused on HPV vaccination among LGBTQ youth and HPV vaccination in rural areas.