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Rosado-Santiago C, Pérez-Guerra CL, Vélez-Agosto NM, Colón-Burgos C, Marrero-Santos KM, Partridge SK, Lockwood AE, Young C, Waterman SH, Paz-Bailey G, Cardona-Gerena I, Rivera A, Adams LE, Wong JM. Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico. Hum Vaccin Immunother 2024; 20:2323264. [PMID: 38599678 PMCID: PMC11008542 DOI: 10.1080/21645515.2024.2323264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024] Open
Abstract
Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.
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Affiliation(s)
- Coral Rosado-Santiago
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Carmen L. Pérez-Guerra
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Nicole M. Vélez-Agosto
- Department of Clinical Psychology, The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Claudia Colón-Burgos
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Karla M. Marrero-Santos
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna K. Partridge
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Amy E. Lockwood
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Cathy Young
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steve H. Waterman
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Gabriela Paz-Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | | | - Angel Rivera
- Puerto Rico Department of Health, San Juan, PR, USA
- Immunization Program, Puerto Rico Department of Health, San Juan, PR, USA
| | - Laura E. Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - Joshua M. Wong
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
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2
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Ye X, Lee HH, Hui KH, Xin M, Mo PKH. Effects of Negative Attitudes towards Vaccination in General and Trust in Government on Uptake of a Booster Dose of COVID-19 Vaccine and the Moderating Role of Psychological Reactance: An Observational Prospective Cohort Study in Hong Kong. Vaccines (Basel) 2023; 11:vaccines11020393. [PMID: 36851270 PMCID: PMC9961443 DOI: 10.3390/vaccines11020393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Uptake of a booster dose of COVID-19 vaccine is effective in preventing infection and severe consequences caused by COVID-19. The present study examined the effects of negative attitudes towards vaccination in general and trust in government on uptake of a COVID-19 booster dose, as well as the moderating role of psychological reactance to pro-vaccination messages in Hong Kong. An observational prospective cohort study using online survey was conducted among 264 adults. Findings showed that, after adjustment for significant background characteristics, negative attitudes towards vaccination in general negatively predicted uptake of a booster dose, and trust in government positively predicted uptake of a booster dose. In addition, the association between negative attitudes towards vaccination in general and uptake of a booster dose was weaker among those who reported a higher level of psychological reactance. The present study highlighted the importance of improving attitudes towards vaccination in general especially among those who are not experiencing psychological reactance, and building trust in government. This study also suggested that interventions aimed at improving attitudes towards vaccination in general should seek to avoid psychological reactance, and special attention should be given to people who are experiencing psychological reactance to pro-vaccination messages.
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Affiliation(s)
- Xinchen Ye
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho-Hin Lee
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam-Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Correspondence: (M.X.); (P.K.H.M.)
| | - Phoenix K. H. Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: (M.X.); (P.K.H.M.)
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3
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Calderón-Mora J, Ferdous T, Shokar N. HPV Vaccine Beliefs and Correlates of Uptake Among Hispanic Women and Their Children on the US-Mexico Border. Cancer Control 2021; 27:1073274820968881. [PMID: 33121254 PMCID: PMC7791461 DOI: 10.1177/1073274820968881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Human Papilloma Virus (HPV) is the most common sexually transmitted infection
nationally. Although preventable, uptake of the HPV vaccine is low. The
purpose of this study was to describe HPV vaccine knowledge and beliefs and
psychosocial correlates of vaccine uptake among adult females and their
children in a US-Mexico border community. Materials and Methods: We conducted a survey of uninsured women aged 21-65 years living in Texas who
were due for cervical cancer screening. We utilized descriptive statistics
to report demographic and psychosocial variables. We used logistic
regression analysis to identify correlates of prior vaccine uptake. Results: 599 women completed surveys: mean age was 44.69 years, 97.8%, were Hispanic
and 86% were Spanish speaking; 5% had been vaccinated. Awareness of HPV
infection & HPV vaccine was 81.6% & 68.6% respectively. Scores for
mean perceived susceptibility was low and mean perceived benefits was high;
the mean score for knowledge was 3.69 out of 6. Common parental barriers to
child vaccination were cost, lack of accessibility and lack of information.
Correlates of past HPV vaccine uptake among adult women were younger age,
monthly income of $2,500-$5,000, full-time employment, US birth, and higher
perceived severity of HPV. Older age was a correlate of vaccine uptake for
daughters. Discussion and Conclusion: Findings revealed low HPV vaccine uptake among adult Hispanic women, but high
vaccine acceptability for their sons and daughters. Culturally tailored
educational interventions are needed to improve HPV knowledge and HPV
vaccine uptake among adults and their children.
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Affiliation(s)
- Jessica Calderón-Mora
- Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, TX, USA.,Department of Family and Community Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Tamanna Ferdous
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Navkiran Shokar
- Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, TX, USA.,Department of Family and Community Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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4
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Chu H, Ko LK, Ibrahim A, Mohamed FB, Lin J, Shankar M, Amsalu F, Ali AA, Richardson BA, Taylor VM, Winer RL. The impact of an educational forum intervention on East African mothers' HPV vaccine-related knowledge, attitudes, and intentions to vaccinate their adolescent children. Vaccine 2021; 39:3767-3776. [PMID: 34053792 PMCID: PMC9984200 DOI: 10.1016/j.vaccine.2021.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE HPV vaccine uptake in U.S. East African adolescents is low. We developed and evaluated a culturally-targeted interactive educational intervention for East African immigrant mothers to increase HPV-vaccine-related knowledge, attitudes, and intentions to vaccinate adolescent children. METHODS Eligible mothers had ≥ 1 11-17-year-old child and reported all children's HPV vaccination status as unvaccinated or unknown. The intervention was delivered via 10 dinners in the Seattle metropolitan area (8 with the Somali community, 2 with the Ethiopian community). Educational presentations and pre/post-tests on knowledge, attitudes, and intentions were conducted in the participants' native language by a co-ethnic physician. Pre/post differences in responses were evaluated with McNemar's tests and GEE models. HPV vaccination uptake 6-months post-intervention was evaluated using state immunization registry data. RESULTS Of 115 participating mothers, most (84%) were Somali and < 40 years of age (60%). Median years of formal education was 8 (range 0-16), and 61% reported a household income <$25,000. Knowledge of HPV/HPV-vaccines was low pre-intervention, with correct responses ranging from 4% to 39% (61%-91% of responses were "not sure"); correct post-intervention responses ranged from 29% to 97%. Pre-intervention, only 12% of mothers thought they had enough information to make a decision about vaccination, compared to 90% post-intervention. Pre-intervention, only 16% of mothers reported that they were somewhat or very likely to vaccinate their child, compared to 83% post-intervention. All pre/post comparisons were statistically significantly different (p < 0.0001). Although mothers were more likely to report correct HPV-related knowledge and positive vaccine attitudes and intentions post-intervention, only two mothers' children initiated HPV vaccination within 6 months after the intervention. CONCLUSIONS Results illustrate that a culturally targeted educational intervention effectively increased East African mothers' HPV vaccine-related knowledge, attitudes, and intentions to vaccinate their adolescent children. Future research should identify additional intervention components that can bridge the gap between intention and behavior to facilitate HPV vaccine uptake.
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Affiliation(s)
- Huong Chu
- Department of Global Health, University of Washington School of Public Health, 3980 15(th) Ave NE, Box 351620, Seattle, WA 98195, USA.
| | - Linda K. Ko
- Department of Health Services, University of Washington School of Public Health, 3980 15th Ave NE Box 357660, Seattle, WA 98195 USA.,Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M3-B232, Seattle, WA 98102 USA
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA; Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118, USA.
| | - Farah Bille Mohamed
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 981195 USA
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195, USA.
| | - Megha Shankar
- Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356421, Seattle, WA 98195, USA.
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195, USA.
| | - Ahmed A. Ali
- Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118 USA
| | - Barbra A. Richardson
- Department of Global Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351620, Seattle, WA 98195, USA.,Department of Biostatistics, University of Washington School of Public Health, 3980 15th Ave NE, Box 351617, Seattle, WA 98195 USA
| | - Victoria M. Taylor
- Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M3-B232, Seattle, WA 98102 USA
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 981195 USA
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5
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Fernandez-Pineda M, Cianelli R, Villegas N, Matsuda Y, Iriarte Parra ES, Montano NP. Salient factors among Hispanic parents in South Florida rural communities for vaccinating their children against human papillomavirus. J Pediatr Nurs 2020; 54:24-33. [PMID: 32521437 PMCID: PMC7484143 DOI: 10.1016/j.pedn.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Few studies have tried to understand the factors related to HPV vaccination among Hispanics living in rural communities in the United States (US). Nationally, HPV vaccination among Hispanics is suboptimal (26.1%) compared to the HealthyPeople 2020 goal of 80% and even more suboptimal in rural communties. This study aimed to determine the salient factors among Hispanic parents for vaccinating their children against HPV and for designing a future HPV prevention intervention for Hispanics. DESIGN AND METHODS A descriptive qualitative design was used. Saturation was reached after conducting four focus groups with 23 Hispanic parents from rural communities in South Florida. Directed content analysis using the Theory of Planned Behavior (TPB) constructs was used to analyze the transcripts. RESULTS All TPB constructs were identified as salient factors for HPV vaccination including background factors, attitudes towards the behavior, perceived norms, perceived behavioral control, actual control, intention, and behavior. CONCLUSIONS Addressing HPV vaccination by developing educational programs based on the TPB and tailored to meet the needs of Hispanic parents is urgently needed to prevent HPV among Hispanics in rural US communities. This approach can also serve as a directive to target HPV vaccination among Hispanics in other rural areas in the US. PRACTICE IMPLICATIONS Pediatric nurses must proactively promote and recommend the HPV vaccine (HPVV), educate parents on having sex-related discussions with their children, include children in the HPVV education and decision, bundle the HPVV with other child vaccines, and utilize reminder systems to ensure completion of the vaccine series.
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Affiliation(s)
| | - Rosina Cianelli
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.
| | - Natalia Villegas
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.
| | - Yui Matsuda
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.
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6
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Nan X, Daily K, Richards A, Holt C. Parental Support for HPV Vaccination Mandates Among African Americans: The Impact of Message Framing and Consideration of Future Consequences. HEALTH COMMUNICATION 2019; 34:1404-1412. [PMID: 29979884 PMCID: PMC6922083 DOI: 10.1080/10410236.2018.1493419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Is parents' support for mandating human papillomavirus (HPV) vaccination for their adolescent children influenced by how the policy advocacy message is framed? In this research, we conducted an experiment in which a group of African-American parents were exposed to messages advocating HPV vaccination mandates that were framed in either gains or losses. Our results demonstrate the importance of considering the personality trait - consideration of future consequences - when assessing the efficacy of gain- and loss-framed health advocacy. We found that parents responded more positively to gain-frames if they focused on the distant future and to loss-frames if they focused on the immediate future. Thus, it is important to recognize that public support of HPV vaccination policy is not only contingent on the message-based educational strategy employed to parent, but on the degree to which parents consider how present behaviors influence future well-being.
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Affiliation(s)
- Xiaoli Nan
- Department of Communication, University of Maryland-College Park
| | - Kelly Daily
- Department of Communication, La Salle University
| | - Adam Richards
- Department of Communication, Texas Christian University
| | - Cheryl Holt
- School of Public Health, University of Maryland-College Park
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7
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Shukla A, Nyambose J, Vanucci R, Johnson LB, Welch K, Lind E, Villa A. Evaluating the Effectiveness of Human Papillomavirus Educational Intervention among Oral Health Professionals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:890-896. [PMID: 30006799 DOI: 10.1007/s13187-018-1391-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims to evaluate the effectiveness of an educational intervention that was designed to increase human papillomavirus (HPV) awareness and knowledge among oral health providers (OHPs). HPV educational lectures and a dental information toolkit on HPV were offered to OHPs in New England in 2016-2017. OHPs included dentists and dental hygienists. Post intervention surveys were distributed 1 month later. A total of 230 participants attended the educational lectures and received the toolkit. Descriptive statistics were used to compare the difference in knowledge and preparedness about HPV before and after the intervention. Eighty-nine OHPs completed the surveys. The response rate was 38.7%; however, for each question, the number of responses varied. Fifty-four (54%) (n = 26) of survey respondents were between 55 and 75 years of age with 73.5% (n = 36) being female and 55% (n = 45) working in private practice. Post intervention, 67.5% (n = 27) of the respondents felt more prepared, 82.6% (n = 38) reported clarity of their roles in educating their patients about HPV, and 91.6% (n = 44) reported an increase in knowledge about HPV. The HPV educational intervention was well received and successful at improving self-reported knowledge, comfort level, and preparedness of OHPs in discussing HPV with their patients. OHPs have the great opportunity to educate their patients about HPV and HPV vaccination. Further continuing education efforts may improve OHPs' participation in HPV prevention.
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Affiliation(s)
- Anubhuti Shukla
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA, 02215, USA.
| | - Joshua Nyambose
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Rebecca Vanucci
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Lisa Bennett Johnson
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Eileen Lind
- Team Maureen, North Falmouth, MA, USA
- Division of Pediatric Oncology, Dana Farber Cancer Center, Boston, MA, USA
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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8
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Calo WA, Brewer NT. HPV vaccine requirements, opt-outs and providers' support: Key studies missing from a recent systematic review. Hum Vaccin Immunother 2019; 16:128-130. [PMID: 31339803 DOI: 10.1080/21645515.2019.1646580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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9
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Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine X 2019; 3:100037. [PMID: 31463471 PMCID: PMC6708991 DOI: 10.1016/j.jvacx.2019.100037] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/25/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified. Methods A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources. Results 1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers’ knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers’ lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established. Conclusions HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.
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10
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Feder MA, Kulasingam SL, Kiviat NB, Mao C, Nelson EJ, Winer RL, Whitham HK, Lin J, Hawes SE. Correlates of Human Papillomavirus Vaccination and Association with HPV-16 and HPV-18 DNA Detection in Young Women. J Womens Health (Larchmt) 2019; 28:1428-1435. [PMID: 31264912 DOI: 10.1089/jwh.2018.7340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite a reduction in the prevalence of vaccine-preventable types of human papillomavirus (HPV), attributed to increased HPV vaccine uptake, HPV continues to be a major cause of cancer in the United States. Methods: We assessed factors associated with self-reported HPV vaccine uptake, HPV vaccination effectiveness, using DNA testing to assess HPV types 16 and/or 18 (HPV 16/18) positivity, and patterns of HPV vaccination in 375 women aged 21-29 years who were eligible to receive catch-up vaccination, using baseline data collected from March 2012 to December 2014 from a randomized controlled trial evaluating a novel approach to cervical cancer screening. Results: More than half (n = 228, 60.8%) of participants reported receipt of at least one HPV vaccine dose and 16 (4.3%) tested positive for HPV 16/18 at baseline. College-educated participants were four times more likely to have been vaccinated than those reporting high school education or less. 56.5% of HPV-vaccinated participants reported first dose after age 18 and 68.4% after first vaginal intercourse. Women vaccinated after age 18 and women vaccinated after first vaginal intercourse were somewhat more likely to be infected with HPV 16/18 infection compared with women vaccinated earlier, but these associations did not reach statistical significance. Conclusions: HPV vaccination is common among college-educated women in the catch-up population but less common among those without college education. Contrary to current guidelines, catch-up females frequently obtain HPV vaccination after age 18 and first vaginal intercourse. Women without a college education represent an ideal population for targeted HPV vaccination efforts that emphasize vaccination before sexual debut.
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Affiliation(s)
- Molly A Feder
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Shalini L Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Nancy B Kiviat
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Constance Mao
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Hilary K Whitham
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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11
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Ko LK, Taylor VM, Mohamed FB, Do HH, Gebeyaw FA, Ibrahim A, Ali AA, Winer RL. "We brought our culture here with us": A qualitative study of perceptions of HPV vaccine and vaccine uptake among East African immigrant mothers. PAPILLOMAVIRUS RESEARCH 2018; 7:21-25. [PMID: 30594650 PMCID: PMC6319298 DOI: 10.1016/j.pvr.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 10/29/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022]
Abstract
Background HPV vaccine studies in East African communities are few and focus mainly on Somali women and girls. We examined how HPV vaccine perceptions and uptake are shaped among Somali, Ethiopian, and Eritrean mothers. Methods We convened three focus groups in Somali, Amharic, and Tigrinya with mothers of 11–17 year old children. The Socio-Context Framework (social, cultural, and religious factors) and Andersen's Behavioral Model (predisposing, enabling, and need for care factors) informed question development. Results Negative vaccine perceptions, lack of HPV vaccine knowledge, and concerns about side effects emerged as predisposing factors. Having a provider who engages parents on HPV vaccination and takes responsibility for vaccine-related risks emerged as enabling factors. Availability of vaccine information resources (e.g., person-to-person, word of mouth education for parents) were also enabling factors. Need for care factors included having comprehensive vaccine information, strong recommendation from a doctor, and validation from a co-ethnic medical professional. Women exerted strong social influence on vaccine uptake (social), had concerns about pork gelatin in vaccines (religious), and felt discussions about sex with children were culturally unacceptable (cultural). Conclusion Strategies for vaccine uptake among East African immigrants need to address factors that shape HPV vaccine perceptions for adolescents, caregivers, and providers.
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Affiliation(s)
- Linda K Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98102 USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific Street, Magnuson Health Sciences Bldg. Box 357660, Seattle, WA 98195 USA.
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98102 USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific Street, Magnuson Health Sciences Bldg. Box 357660, Seattle, WA 98195 USA.
| | - Farah Bille Mohamed
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104 USA; Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118 USA.
| | - H Hoai Do
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98102 USA.
| | - Fanaye A Gebeyaw
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104 USA.
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA; Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118 USA.
| | - Ahmed A Ali
- Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118 USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104 USA.
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Rodriguez SA, Roncancio AM, Savas LS, Lopez DM, Vernon SW, Fernandez ME. Using Intervention Mapping to Develop and Adapt Two Educational Interventions for Parents to Increase HPV Vaccination Among Hispanic Adolescents. Front Public Health 2018; 6:164. [PMID: 29963542 PMCID: PMC6013574 DOI: 10.3389/fpubh.2018.00164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Effective interventions to increase HPV vaccination are needed to reach national vaccination goals and to reduce later HPV-related cancer disparities. We used Intervention Mapping (IM) to develop and adapt a theory- and evidence-based educational intervention targeting parents of Hispanic adolescents to increase HPV vaccination. Methods: We followed IM steps 1–6 to: (1) develop a logic model and identify modifiable factors associated with vaccination among Hispanic adolescents by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; (2) develop outcomes, write performance objectives, and develop a matrix of change objectives; (3) develop and identify a program theme, program components, theoretical methods, and practical applications; (4) develop an intervention design plan; (5) develop implementation strategies; and (6) develop an evaluation plan. We completed Steps 1–6 for to develop an intervention targeting parents of females, and we followed the steps again to adapt the program once HPV vaccine recommendations included males. Results: The program Por Nuestras Hijas (For Our Daughters) included two components: a print fotonovela and a tailored interactive multimedia intervention (TIMI). The program utilized the methods tailoring, targeting, framing, anticipated regret, modeling, skill building, and education and counseling to target the following determinants: parental knowledge, attitudes, self-efficacy, skills, perceived benefits/barriers, perceived susceptibility, perceived norms, and outcome expectations as modifiable factors influencing HPV vaccination. Lay health workers implemented the program in community clinics. A logic model of change guided evaluation planning. We later adapted the outcome and intervention content for parents of Hispanic adolescent males and changed the theme to Por Nuestros Hijos (For Our Children). Throughout the development and adaptation processes, we relied on theory, empirical evidence, and new data to make decisions. Discussion: IM provided a systematic methodology for program development and adaptation. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory to develop two educational programs for parents to increase HPV vaccination. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.
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Affiliation(s)
- Serena A Rodriguez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Angelica M Roncancio
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Diana M Lopez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Furgurson KF, Sandberg JC, Hsu FC, Mora DC, Quandt SA, Arcury TA. HPV Knowledge and Vaccine Initiation Among Mexican-Born Farmworkers in North Carolina. Health Promot Pract 2018; 20:445-454. [PMID: 29597873 DOI: 10.1177/1524839918764671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The human papilloma virus (HPV) vaccine is an effective but underused cancer prevention tool. This study assessed knowledge of HPV and HPV vaccine initiation among Mexican-born farmworkers in North Carolina. Interviewer-administered questionnaires were conducted with 100 Latino farmworkers and 100 nonfarmworker Latino North Carolina residents in 2015 as part of an ongoing community-based participatory research project. Farmworkers had low levels of knowledge about HPV and the HPV vaccine. They had a similar amount of HPV and HPV vaccine knowledge compared to nonfarmworkers. Farmworkers and nonfarmworkers learned about the HPV vaccine from different sources. Adolescent children of farmworkers and nonfarmworkers had low HPV vaccine initiation. However, for children living in the United States with farmworker parents, vaccine initiation was high. To prevent HPV-related cancers and improve health equity, interventions are needed in order to increase HPV education and vaccine initiation among children of Mexican-born farmworkers and nonfarmworkers. Public health programs should look for partners outside the traditional health care setting to reach underserved populations. Other key strategies include promoting catch-up vaccines, improving patient-provider communication, and providing case management services.
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Affiliation(s)
| | | | - Fang-Chi Hsu
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dana C Mora
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sara A Quandt
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
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Colón-López V, Toro-Mejías LM, Conde-Toro A, Serra-Rivera MJ, Martínez TM, Rodríguez V, Ríos AM, Berdiel L, Villanueva H. Views on HPV and HPV Vaccination: The Experience at a Federal Qualified Clinic in Puerto Rico. J Health Care Poor Underserved 2018; 27:1411-26. [PMID: 27524776 DOI: 10.1353/hpu.2016.0126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to understand through a quantitative assessment, the views of HPV and HPV vaccination among parents of sons from a FQHC in PR. METHODS A self-administered questionnaire was given to a convenience sample of 200 parents of sons 9-17 years old. RESULTS Nearly 30% of the parents reported that their sons had initiated the HPV vaccine regimen. Health care provider recommendation was significantly associated with vaccine initiation. Among parents of unvaccinated sons, the main reason for not getting the HPV vaccine was they did not know that boys were allowed to get the vaccine. CONCLUSIONS Future efforts should focus on multilevel interventions aimed to increase knowledge as well as other modified behavioral determinants in parents of young males about HPV and the vaccine. Capacity building efforts should be targeted also to increase health providers' education and communication skills to promote HPV vaccination effectively.
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Kim K, LeClaire AR. A systematic review of factors influencing human papillomavirus vaccination among immigrant parents in the United States. Health Care Women Int 2017; 40:696-718. [PMID: 29161198 DOI: 10.1080/07399332.2017.1404064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To critically appraise factors influencing human papillomavirus (HPV) vaccination among immigrant parents in the United States, a comprehensive search of electronic databases and reference lists was conducted. The findings from 22 articles were ordered based on a socioecological model. About 30% of children initiated and 14% completed a three-dose series. Correlates of HPV vaccine initiation rates included lack of information, concerns about vaccine safety and promiscuity, providers' recommendations, school mandates, financial issues, immigration laws, and living in disadvantaged neighborhoods. Upstream initiatives embracing cultural descriptors could facilitate HPV vaccination, reducing HPV-related disparities in cancer among immigrants in the US.
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Affiliation(s)
- Kyounghae Kim
- a School of Nursing, University of Connecticut , Storrs , CT , USA
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16
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Chakraborty P, Colditz JB, Silvestre AJ, Friedman MR, Bogen KW, Primack BA. Observation of public sentiment toward human papillomavirus vaccination on Twitter. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1390853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Priam Chakraborty
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, USA
- Center for Research on Media, Technology and Health, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA, 15213 USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jason B. Colditz
- Center for Research on Media, Technology and Health, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA, 15213 USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Katherine W. Bogen
- Center for Research on Media, Technology and Health, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA, 15213 USA
| | - Brian A. Primack
- Center for Research on Media, Technology and Health, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA, 15213 USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Loke AY, Kwan ML, Wong YT, Wong AKY. The Uptake of Human Papillomavirus Vaccination and Its Associated Factors Among Adolescents: A Systematic Review. J Prim Care Community Health 2017; 8:349-362. [PMID: 29161946 PMCID: PMC5932744 DOI: 10.1177/2150131917742299] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The purpose of this review was to explore the uptake of the human papillomavirus (HPV) vaccination, its associated factors, and the facilitators of and barriers to HPV vaccination among adolescents. Methods: A comprehensive literature search was conducted through 5 electronic databases, including PubMed, CINAHL, Cochrane Library, Medline, and PsycInfo from January 2006 to March 2015 for studies examining the uptake, awareness, knowledge, acceptability, and intention of adolescents with regard to HPV vaccination. Results: Twenty-eight studies were identified and included. The HPV vaccination uptake rate (at least 1 dose) varied significantly among countries, ranging from 2.4% to 94.4%. Scotland achieved the highest uptake of all the studies included in this review, while Hong Kong had the lowest, at 2.4% to 9.1%. This review also showed that adolescents had limited awareness and knowledge of HPV infections and vaccines, even 10 years after the vaccine had become available. Conclusions: It is recommended that barriers to the uptake of the vaccine should be addressed, and that school-based sexual health education of HPV infection and vaccine promotion should be reinforced.
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Affiliation(s)
- Alice Yuen Loke
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Miu Ling Kwan
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR.,2 Tuen Mun Hospital, Hospital Authority, Hong Kong SAR
| | - Yuen-Ting Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Alice Kar Yan Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
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Zanini NV, Prado BS, Hendges RDC, Dos Santos CA, Callegari FVR, Bernuci MP. Motivos para recusa da vacina contra o Papilomavírus Humano entre adolescentes de 11 a 14 anos no município de Maringá-PR. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introdução: O Ministério da Saúde incluiu a vacina contra o Papilomavírus Humano (HPV) no calendário básico de imunizações em 2014 com a meta vacinar pelo menos 80% das adolescentes entre 11 e 13 anos de idade. Objetivos: Frente à baixa adesão à campanha nacional de vacinação contra o HPV no município de Maringá, PR, em 2014, o presente estudo teve como objetivos: 1) identificar o nível de conhecimento das adolescentes acerca do vírus e da vacina; e 2) descrever os motivos pelos quais elas não se vacinaram. Métodos: Trata-se de um estudo observacional transversal, do tipo inquérito domiciliar com delineamento descritivo, conduzido com 58 adolescentes que não tomaram a 1ª e/ou a 2ª dose da vacina dentro do prazo estipulado pela campanha vacinal de 2014. Para coleta de dados, foi aplicado questionário por meio de entrevistas face a face. Resultados: 86% das adolescentes já ouviram falar do vírus, 74% sabe que sua transmissão é sexual, 49% conhece sua relação com o câncer de colo de útero e 88% já ouviu falar da vacina. A maior parte das meninas entrevistadas não se vacinou por recusa por parte dos pais. Conclusão: Os resultados do presente estudo sugerem que o desconhecimento sobre a infecção pelo HPV e sobre a campanha de vacinação entre as entrevistadas e seus responsáveis, bem como o medo de efeitos colaterais da vacina, como apontado pela população do estudo, interferiram negativamente na tomada de decisão.
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Turiho AK, Okello ES, Muhwezi WW, Katahoire AR. Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: a qualitative study. BMC Res Notes 2017; 10:431. [PMID: 28854964 PMCID: PMC5577844 DOI: 10.1186/s13104-017-2749-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination has been perceived in diverse ways some of which encourage its uptake while others could potentially deter its acceptability. This study explored community member’s perceptions about HPV vaccination in Ibanda district and the implications of the perceptions for acceptability of HPV vaccination. The study was conducted following initial vaccination of adolescent schoolgirls in the district between 2008 and 2011. Methods This qualitative study employed focus group discussions (FGDs) and key informant interviews (KIIs). FGDs were conducted with schoolgirls and parents/guardians and KIIs were conducted with school teachers, health workers and community leaders. Transcripts from the FGDs and KIIs were coded and analyzed thematically using ATLAS.ti (v. 6). Results The HPV vaccination was understood to safely prevent cervical cancer, which was perceived to be a severe incurable disease. Vaccinations were perceived as protection against diseases like measles and polio that were known to kill children. These were major motivations for girls’ and parents’ acceptance of HPV vaccination. Parents’ increased awareness that HPV is sexually transmitted encouraged their support for vaccination of their adolescent daughters against HPV. There were reports however of some initial fears and misconceptions about HPV vaccination especially during its introduction. These initially discouraged some parents and girls but over the years with no major side effects reported, girls reported that they were willing to recommend the vaccination to others and parents also reported their willingness to get their daughters vaccinated without fear. Health workers and teachers interviewed however explained that, some concerns stilled lingered in the communities. Conclusions The perceived benefits and safety of HPV vaccination enhanced girls’ and parents’ acceptability of HPV vaccination. The initial rumors, fears and concerns about HPV vaccination that reportedly discouraged some girls and parents, seemed to have waned with time giving way to more favourable perceptions regarding HPV vaccination although the study still found that a few concerns still lingered on and these have implications for HPV vaccination acceptability.
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20
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Chen ACC, Lightfoot M, Szalacha LA, Lindenberg CS. A Pilot, Web-Based HIV/STI Prevention Intervention Targeting At-Risk Mexican American Adolescents: Feasibility, Acceptability, and Lessons Learned. ACTA ACUST UNITED AC 2017; 4:86-92. [PMID: 33313361 DOI: 10.5176/2345-718x_4.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Information technology provides new avenues to increase opportunities to deliver HIV/STI prevention interventions in a confidential, sensitive, and engaging manner for youth. While technology-based HIV/STI interventions show promise in preventing HIV/STI among different populations, few have targeted young Latinas. This pilot study examined the feasibility and acceptability of a bilingual, web-based HIV/STI prevention intervention among Latino females aged 15-19. We used a mix-method approach, including a prospective 2-group design with 3 repeated measures, and a post-intervention focus group discussion. We recruited 14 participants from an alternative high school and randomized into each study condition. Participants took 5 structurally equivalent modules focusing on either HIV/STI prevention (intervention) or nutrition/exercise (comparison) and completed assessments before the intervention, immediately post-intervention, and 2 months post-intervention. The findings suggested that the intervention had high levels of feasibility and acceptability. We discuss the keys to success, challenges encountered, and future directions.
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Affiliation(s)
| | | | - Laura A Szalacha
- Research Methods and Statistics, University of Arizona College of Nursing, USA
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21
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Maertens JA, Jimenez-Zambrano AM, Albright K, Dempsey AF. Using Community Engagement to Develop a Web-Based Intervention for Latinos about the HPV Vaccine. JOURNAL OF HEALTH COMMUNICATION 2017; 22:285-293. [PMID: 28276945 DOI: 10.1080/10810730.2016.1275890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV) infection is pervasive among sexually active women and men, and Hispanic women are at particularly high risk as they have higher rates of invasive cervical cancer compared to other racial or ethnic groups in the United States. There is a need for interventions to increase HPV vaccination among this high-risk population. This study investigated how to modify a previously developed web-based intervention that provided individually tailored information about HPV to improve its use among the Latino population. A community-oriented modification approach incorporated feedback from a community advisory committee, and focus groups among the Latino population, to modify the intervention. Several themes emerged including a need for basic information about HPV and HPV vaccination, changes to make the intervention appear less clinical, and incorporation of information addressing barriers specific to the Latino community. This work was done in preparation for a randomized trial to assess the impact of this modified intervention on HPV vaccination attitudes and uptake among Latino young adults and parents of adolescents. If effective, our intervention could be a resource for reducing HPV vaccination concerns, improving immunization rates, and educating Latinos about HPV and the HPV vaccine outside of the time boundaries of the traditional clinical encounter.
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Affiliation(s)
- Julie A Maertens
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Andrea M Jimenez-Zambrano
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Karen Albright
- b Department of Sociology and Criminology , University of Denver , Denver , Colorado , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
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Roncancio AM, Ward KK, Carmack CC, Mu�oz BT, Cribbs FL. Hispanic mothers' beliefs regarding HPV vaccine series completion in their adolescent daughters. HEALTH EDUCATION RESEARCH 2017; 32:96-106. [PMID: 28088755 PMCID: PMC5914321 DOI: 10.1093/her/cyw055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 06/01/2023]
Abstract
Rates of human papillomavirus (HPV) vaccine series completion among adolescent Hispanic females in Texas in 2014 (∼39%) lag behind the Healthy People 2020 goal (80%). This qualitative study identifies Hispanic mothers' salient behavioral, normative and control beliefs regarding having their adolescent daughters complete the vaccine series. Thirty-two mothers of girls (aged 11-17) that had received at least one dose of the HPV vaccine, completed in-depth interviews. Six girls had received one dose of the HPV vaccine, 10 girls had received two doses, and 16 girls had received all three doses. The questions elicited salient: (i) experiential and instrumental attitudes (behavioral beliefs); (ii) supporters and non-supporters (normative beliefs) and (iii) facilitators and barriers (control beliefs). Directed content analysis was employed to select the most salient beliefs. Mothers: (i) expressed salient positive feelings (e.g. good, secure, happy and satisfied); (ii) believed that completing the series resulted in positive effects (e.g. protection, prevention); (iii) believed that the main supporters were themselves, their daughter's father and doctor with some of their friends not supporting series completion and (iv) believed that vaccine affordability, information, transportation, ease of scheduling and keeping vaccination appointments and taking their daughter's immunization card to appointments were facilitators. This study represents the first step in building theory-based framework of vaccine series completion for this population. The beliefs identified provide guidance for health care providers and intervention developers.
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Affiliation(s)
- A. M. Roncancio
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX 77030, USA
| | - K. K. Ward
- Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL 32209, USA
| | - C. C. Carmack
- University of Houston, Psychological Health and Learning Sciences, Houston, TX 77204, USA
| | - B. T. Mu�oz
- Department of Psychology, Mount St. Mary’s University, Emmitsburg, MD 21727, USA
| | - F. L. Cribbs
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX 77030, USA
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Ashing KT, Chávez NR, Serrano M. HPV Vaccine-Related Knowledge, Beliefs, Acceptability, and Uptake Among Latinas Who Prefer English and Those Who Prefer Spanish. JOURNAL OF HEALTH COMMUNICATION 2016; 21:1209-1216. [PMID: 27858522 PMCID: PMC5521174 DOI: 10.1080/10810730.2016.1240266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Latinas compose almost 10% of the U.S. population and suffer the highest incidence of and one of the highest mortality rates from cervical cancer. Human papillomavirus (HPV) vaccination can prevent most HPV infections that cause more than 90% of cervical cancer. Unfortunately, limited knowledge and low rates of HPV vaccination persist among Latinas. The current study compared awareness, knowledge, beliefs, acceptability, uptake, and 3-dose series completion of HPV vaccination between Latinas who prefer English (EPL) and those who prefer Spanish (SPL), ages 18-62, living in Southern California. (The 3-dose series completion was based on HPV vaccine completion guidelines at the time of the study. HPV vaccination guidelines do change over time to improve coverage.) More EPL (n = 57) than SPL (n = 150) reported significantly (a) more HPV vaccine awareness and more knowledge of where to access the vaccine and additional vaccine information and (b) greater endorsement of vaccine effectiveness and safety (p < .05). Regardless of language preference, Latinas reporting knowledge of where to access the vaccine and additional information endorsed greater acceptability of the vaccine and more favorable beliefs regarding vaccine safety and effectiveness (p < .05). In multivariate analyses, language and income predicted the outcomes of knowledge regarding accessing the vaccine and additional information. Only 15.6% of all eligible Latinas (n = 45) initiated the HPV vaccine, with 8.9% completion. Interventions seeking to improve HPV vaccination should address linguistic and socioecological differences within Latinas to enhance effectiveness.
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Affiliation(s)
- Kimlin Tam Ashing
- Center of Community Alliance for Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Noé Rubén Chávez
- Center of Community Alliance for Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Mayra Serrano
- Center of Community Alliance for Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
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Roncancio AM, Vernon SW, Carmack CC, Ward KK, Muñoz BT, Cribbs FL. Identifying Hispanic mothers' salient beliefs about human papillomavirus vaccine initiation in their adolescent daughters. J Health Psychol 2016; 24:453-465. [PMID: 27852885 DOI: 10.1177/1359105316676627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Guided by the Integrative Model of Behavioral Prediction, we identify mothers' salient beliefs regarding their daughters' initiation of the human papillomavirus vaccine series. In all, 34 Hispanic mothers responded to elicitation questions. Salient beliefs included the following: (1) feeling secure, happy, relieved, concerned, and fear about vaccinating; (2) believing that vaccinating prevents and protects from human papillomavirus but may result in side effects and sexual disinhibition; (3) identifying the daughter, father, mother, aunt, friends, and grandmothers as supporters/non-supporters; and (4) affordability, transportation, clinic distance, and making appointments as facilitators/barriers. This study begins the process of building a model of human papillomavirus vaccine initiation for this population.
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Glenn BA, Tsui J, Coronado GD, Fernandez ME, Savas LS, Taylor VM, Bastani R. Understanding HPV vaccination among Latino adolescent girls in three U.S. regions. J Immigr Minor Health 2016; 17:96-103. [PMID: 24557745 DOI: 10.1007/s10903-014-9996-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A multi-site study was conducted to assess HPV vaccine initiation and correlates of initiation among Latina adolescents. The study was a collaboration of the CDC/NCI-funded Cancer Prevention and Control Research Network. Data were collected in 2009 from caregivers of Latina adolescents recruited from Los Angeles Country (n = 274), Washington State (Yakima Valley region; n = 90), and Texas (Houston, n = 38; Lower Rio Grande Valley, n = 42). A set of 24 survey items assessed use of the HPV vaccine and awareness, attitudes and barriers to vaccination. Moderate levels of vaccine awareness among caregivers and low uptake of the vaccine (26-37%) among girls were observed. Attitudinal barriers such as concerns about negative effects of the vaccine on daughter's sexual behavior, fertility, and future health were infrequently endorsed. Efforts to understand regional similarities and differences may help inform interventions.
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Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA,
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Wentzell E, Flores YN, Salmerón J, Bastani R. Factors Influencing Mexican Women's Decisions to Vaccinate Daughters Against HPV in the United States and Mexico. FAMILY & COMMUNITY HEALTH 2016; 39:310-319. [PMID: 27536936 DOI: 10.1097/fch.0000000000000102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mexican and Mexican-American women bear high cervical cancer burdens, yet relationships between mothers' experiences of vaccinating daughters against cervical cancer-causing human papillomavirus (HPV) on both sides of the border are unknown. We surveyed 400 Mexican-born women in Oxnard, California, United States and Cuernavaca, Morelos, Mexico, about their beliefs and practices regarding daughters' HPV vaccination, conducting in-depth interviews with 35 participants. Contextualizing interview findings in survey data, we identify key factors influencing mothers' experiences regarding daughters' HPV vaccination in both countries. Although US acculturation influenced some participants' concerns, US and Mexico participants overwhelmingly desired eventual vaccination; structural rather than cultural barriers limited vaccine uptake.
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Affiliation(s)
- Emily Wentzell
- Department of Anthropology, University of Iowa, Iowa City, Iowa (Dr Wentzell); Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos, Instituto Mexicano del Seguro Social, Mexico (Drs Flores and Salmerón); and Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California (Drs Flores and Bastani)
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27
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Mupandawana ET, Cross R. Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study. Reprod Health 2016; 13:97. [PMID: 27549328 PMCID: PMC4994299 DOI: 10.1186/s12978-016-0209-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12-13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher. The study's objectives were to explore factors influencing UK based African parents' acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views. METHODS A qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing. RESULTS HPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it's still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person's disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood. CONCLUSION Tailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.
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Affiliation(s)
| | - Ruth Cross
- Leeds Beckett University, 518 Calverley, Portland Way, LS1 3HE, UK
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Calo WA, Gilkey MB, Shah PD, Moss JL, Brewer NT. Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study. Cancer Epidemiol Biomarkers Prev 2016; 25:1317-25. [PMID: 27543621 DOI: 10.1158/1055-9965.epi-15-1159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements. METHODS A national sample of 1,501 parents of 11- to 17-year-old children completed a web-based survey between November 2014 and January 2015. Analyses used multivariable logistic regression to assess correlates of support for school-entry requirements for HPV vaccination. RESULTS Overall, 21% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea," and 54% disagreed. If school-entry requirements included opt-out provisions, agreement increased to 57%, and only 21% disagreed. Parents more often agreed with requirements without opt-out provisions if they were Hispanic [OR = 1.53; 95% confidence interval (CI), 1.05-2.22], believed HPV vaccine was as or more important than other adolescent vaccines (OR = 2.76; 95% CI, 1.98-3.83), or believed HPV vaccine was effective for preventing cervical cancer (OR = 2.55; 95% CI, 1.93-3.37). Parents less often agreed if they resided in Midwest states or believed that HPV vaccine was being pushed to make money for drug companies (both P < 0.05). CONCLUSION Opt-out provisions almost tripled parents' support for HPV vaccine school-entry requirements. Our findings suggest that race/ethnicity, attitudes about HPV vaccine, and region of residence may influence support for requirements without opt-out provisions. IMPACT Opt-out provisions greatly increase parent support of school-entry requirements for HPV vaccination but may make them ineffective. Cancer Epidemiol Biomarkers Prev; 25(9); 1317-25. ©2016 AACR.
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Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts. Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Moss
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review. Soc Sci Med 2016; 159:116-26. [DOI: 10.1016/j.socscimed.2016.04.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 03/31/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022]
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Mansfield LN, Onsomu EO, Merwin E, Hall NM, Harper-Harrison A. Association Between Parental HPV Knowledge and Intentions to Have Their Daughters Vaccinated. West J Nurs Res 2016; 40:481-501. [PMID: 28322641 DOI: 10.1177/0193945916682953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human papillomavirus (HPV) 16 and 18 causes 66% of cervical cancers (Dunne et al., 2014). Vaccination during adolescence can prevent HPV-associated cervical cancers, yet less than half of adolescent girls are vaccinated. This study examined the association between HPV knowledge and parental intentions to vaccinate daughters against HPV. A retrospective, cross-sectional, national data set from the 2006-2007 Health Information National Trends Survey (HINTS) was used. A multivariate multinomial logistic regression analysis was used to estimate the association between intent to vaccinate and HPV knowledge. After controlling for other covariates, parents who were knowledgeable were more likely to intend to have their daughters vaccinated compared with those who were not knowledgeable (adjusted relative risk ratio [aRRR] = 3.96, p = .004). Having HPV knowledge would significantly increase parents' intent for vaccination against the disease for their daughters. Health care providers should integrate HPV-related education for parents within their services, and policymakers should consider requiring HPV vaccination for school attendance.
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Affiliation(s)
- Lisa N Mansfield
- 1 Winston-Salem State University, Winston-Salem, NC, USA.,2 Duke University, Durham, NC, USA
| | | | | | - Naomi M Hall
- 1 Winston-Salem State University, Winston-Salem, NC, USA
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Navarro-Illana P, Caballero P, Tuells J, Puig-Barberá J, Diez-Domingo J. Acceptability of human papillomavirus vaccine in mothers from Valencia (Spain). An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Development of a Cost-Effective Educational Tool to Promote Acceptance of the HPV Vaccination by Hispanic Mothers. J Community Health 2015; 41:468-75. [DOI: 10.1007/s10900-015-0116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aragones A, Bruno DM, Ehrenberg M, Tonda-Salcedo J, Gany FM. Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children. Prev Med Rep 2015; 2:554-8. [PMID: 26844117 PMCID: PMC4721322 DOI: 10.1016/j.pmedr.2015.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Latino populations, particularly Mexican-Americans who comprise 65% of the Latinos in the U.S., are disproportionately affected by HPV-related diseases. The HPV vaccination completion rates remain low, well below the Healthy People 2020 goal. In this study we assessed the effect of parental education and a text messaging reminder service on HPV vaccine completion rates among eligible children of Mexican American parents. STUDY DESIGN Nonequivalent group study of Mexican parents of HPV vaccine eligible children attended the Health Window program at the Mexican Consulate in New York City, a non-clinical, trusted community setting, during 2012-2013. 69 parents received HPV education onsite, 45 of whom also received a series of text message vaccination reminders. We measured HPV vaccination completion of the youngest eligible children of Mexican parents as the main outcome. RESULTS 98% of those in the education plus text messaging group reported getting the first dose of the vaccine for their child and 87% among those in the educational group only (p = 0.11). 88% of those receiving the 1st dose in the text messaging group reported completing the three doses versus 40% in the educational group only (p = 0.004). CONCLUSIONS Parental text messaging plus education, implemented in a community based setting, was strongly associated with vaccine completion rates among vaccine-eligible Mexican American children. Although pilot in nature, the study achieved an 88% series completion rate in the children of those who received the text messages, significantly higher than current vaccination levels.
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Affiliation(s)
- Abraham Aragones
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 300 East 66 st 15th Floor, New York, NY 10065, United States
| | - Denise M. Bruno
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Brooklyn, New York 11203, NY, United States
| | - Mariane Ehrenberg
- General Consulate of Mexico in New York, 27 East 39th Street, New York, NY 10016, United States
| | - Josana Tonda-Salcedo
- General Consulate of Mexico in New York, 27 East 39th Street, New York, NY 10016, United States
| | - Francesca M. Gany
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 300 East 66 st 15th Floor, New York, NY 10065, United States
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Knowledge, opinions and attitudes of Italian mothers towards HPV vaccination and Pap test. TUMORI JOURNAL 2015; 101:339-46. [PMID: 25908043 DOI: 10.5301/tj.5000293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/20/2022]
Abstract
AIM This study evaluated the knowledge and attitudes of Italian mothers - whose daughters had been vaccinated in 2012 - towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. METHODS The survey - part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) - was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test. RESULTS The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test. CONCLUSIONS The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.
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Navarro-Illana P, Caballero P, Tuells J, Puig-Barberá J, Diez-Domingo J. [Acceptability of human papillomavirus vaccine in mothers from Valencia (Spain)]. An Pediatr (Barc) 2015; 83:318-27. [PMID: 25619797 DOI: 10.1016/j.anpedi.2014.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/02/2014] [Accepted: 11/28/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In October 2008, Valencian Community started its human papillomavirus (HPV) vaccination schedules for 14 year-old girls. The aim of this study is to assess knowledge about HPV infection and its vaccine among the mothers of these girls, and to identify factors associated with the willingness to vaccinate their daughters. MATERIAL AND METHODS Cross-sectional study by means of a questionnaire to mothers of girls born in 1995, and attending secondary schools in the province of Valencia during 2010-2011. Cluster stratified random sample (n=1279). STATISTICAL ANALYSIS percentages, confidence intervals, OR, Chi-squared and multivariate logistic regression contrasts. RESULTS A total of 833 (65.1%) questionnaires were completed. The results obtained showed that, 76.6% of mothers had vaccinated their daughters against HPV; 93.8% knew about the vaccine, particularly through television (71.5%); and 78.5% received positive advice from a health professional which increased the vaccination of their daughters (OR: 2.4). There was low overall knowledge about HPV infection and vaccination. Confidence of the mothers in vaccines as a preventative method increases the HPV vaccination (OR: 3.8). The first reason for refusal was the fear of adverse events (45.6%). CONCLUSIONS Apparently, the media does not influence the willingness to vaccinate. It would be desirable to minimize the perception of risk of the vaccine. Positive health advice from a health professional can have a positive effect on vaccination. There is a gap between the level of knowledge and decision-making to vaccinate.
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Affiliation(s)
- P Navarro-Illana
- Facultad de Enfermería, Universidad Católica de Valencia «San Vicente Mártir», Valencia, España
| | - P Caballero
- Cátedra de Vacunología Balmis UA-FISABIO, Universidad de Alicante, Alicante, España
| | - J Tuells
- Cátedra de Vacunología Balmis UA-FISABIO, Universidad de Alicante, Alicante, España.
| | - J Puig-Barberá
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, Valencia, España
| | - J Diez-Domingo
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, Valencia, España
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Fernández ME, Le YCL, Fernández-Espada N, Calo WA, Savas LS, Vélez C, Aragon AP, Colón-López V. Knowledge, attitudes, and beliefs about human papillomavirus (HPV) vaccination among Puerto Rican mothers and daughters, 2010: a qualitative study. Prev Chronic Dis 2014; 11:E212. [PMID: 25474384 PMCID: PMC4264466 DOI: 10.5888/pcd11.140171] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction The incidence of human papillomavirus (HPV) infection and cervical cancer can be reduced by increasing vaccination for HPV. Yet vaccination uptake and completion of the 3-dose series remain low among Puerto Rican females. This study explored psychosocial factors associated with HPV vaccination uptake decisions among Puerto Rican mothers and daughters. Methods We conducted 7 focus groups with young women aged 16 to 24 (n = 21) and their mothers (n = 9) to assess knowledge, attitudes, and beliefs related to cervical cancer, HPV, and HPV vaccination. We analyzed the focus group transcripts and identified themes by using a constant comparison method of qualitative data analysis and interpretation, guided by a grounded theory approach. Results The analysis identified several emergent themes related to vaccine uptake: 1) low knowledge about cervical cancer, HPV, and the HPV vaccine; 2) inconsistent beliefs about susceptibility to HPV infection and cervical cancer; 3) vaccine effectiveness; 4) vaccine safety and side effects; 5) concerns that the vaccine promotes sexual disinhibition; and 6) availability of insurance coverage and overall cost of the vaccine. Conclusion Our study found that adolescent girls and young women in Puerto Rico have low levels of knowledge about HPV and cervical cancer, low perceived susceptibility to HPV, and concerns about the safety and efficacy of the vaccine, and these factors may influence uptake and completion of HPV vaccination. Interventions are needed for both mothers and daughters that address these psychosocial factors and increase access to vaccination.
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Affiliation(s)
- María E Fernández
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin UCT no. 2558, Houston, TX 77030. E-mail:
| | - Yen-Chi L Le
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, Texas
| | - Natalie Fernández-Espada
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, Texas
| | - William A Calo
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Lara S Savas
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, Texas
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Osis MJD, Duarte GA, Sousa MHD. [SUS users' knowledge of and attitude to HPV virus and vaccines available in Brazil]. Rev Saude Publica 2014; 48:123-33. [PMID: 24789645 PMCID: PMC4206129 DOI: 10.1590/s0034-8910.2014048005026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/10/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate knowledge of HPV and HPV vaccines in men and women, users of
the Brazilian Unified Health System, and the intention to get themselves and
their teenage children vaccinated. METHODS A descriptive, cross-sectional study with 286 women (18-49 years old) and 252
men (18-60 years old), users of five primary health units and two
polyclinics in Campinas, SP, Southeastern Brazil, was carried out.
Participants were interviewed in 2011 using a structured questionnaire.
Bivariate and Poisson regression analysis were performed to identify
variables associated with knowledge of HPV and HPV vaccines, and
participants vaccination intentions. RESULTS Almost 40.0% of the participants reported having heard of HPV and 28.9%
mentioned adequate information. The main information source was the media
(41.7%). Only 8.6% of the participants had heard of the HPV vaccines. Once
the participants were informed of the existence of HPV vaccines about 94% of
them said they would get vaccinated and/or vaccinate their teenage children,
if the vaccines were available in the public health system. Schooling of
over 8 years and being female were the variables independently associated
with having heard of HPV, the vaccines and having adequate knowledge of the
virus. Advanced age was associated with having heard of HPV vaccines. There
were no variables associated with the vaccination intentions. CONCLUSIONS These results reinforce the need for educational activities that provide the
population with adequate information on HPV and preventive measures.
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Jeudin P, Liveright E, Del Carmen MG, Perkins RB. Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clin Ther 2014; 36:24-37. [PMID: 24417783 DOI: 10.1016/j.clinthera.2013.11.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake. OBJECTIVES This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention. METHODS We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized. RESULTS Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination. CONCLUSIONS As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.
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Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Liveright
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Perkins
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.
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Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M. Knowledge, Acceptance, and Willingness to Pay for Human Papilloma Virus (HPV) Vaccination among Female Parents in Thailand. Asian Pac J Cancer Prev 2014; 15:5469-74. [DOI: 10.7314/apjcp.2014.15.13.5469] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Predictors of human papillomavirus vaccination among daughters of low-income Latina mothers: the role of acculturation. J Adolesc Health 2013; 53:623-9. [PMID: 23871803 DOI: 10.1016/j.jadohealth.2013.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination is a safe and effective primary prevention strategy for cervical cancer. Little is known about correlates of HPV vaccination among Hispanic adolescents living in the United States. The purpose of this study was to (1) examine relationships between both U.S./American and Latina acculturation and variables typically associated with HPV vaccine uptake (e.g., physician recommendation); and (2) identify predictors of HPV vaccine uptake among daughters of Latina mothers. METHODS Latina mothers (N = 200) recruited from a Federally Qualified Health Center serving low-income families in Florida completed a semistructured interview that assessed awareness of and knowledge about HPV and HPV-vaccines, vaccination beliefs, whether their daughter's physician had recommended the HPV vaccine, health history, U.S./American and Latina acculturation, mother and daughter demographics, and daughter's HPV vaccination status. RESULTS Only 18% of daughters had received at least one dose of the vaccine. Higher levels of U.S./American acculturation were associated with greater odds of vaccine uptake and other common predictors of HPV vaccination (e.g., physician recommendation, vaccine awareness). A multivariate logistic regression analysis identified three independent predictors of vaccine uptake: physician recommendation, daughter's age, and low worry about how to pay for the vaccine. CONCLUSIONS Despite generally favorable views of HPV vaccination, observed rates of vaccine uptake in this sample were substantially lower than national estimates. Latina mothers who are more integrated into U.S. society may be more likely to vaccinate their daughters against HPV. Findings provide promising directions for future HPV vaccination interventions with Hispanic adolescents.
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"HPV? Never heard of it!": a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination. Vaccine 2013; 31:5152-67. [PMID: 24029117 DOI: 10.1016/j.vaccine.2013.08.091] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Two human papillomavirus vaccines were licenced in 2006/2007 for cervical cancer prevention. National vaccination programmes for schoolgirls were subsequently introduced in some European countries, North America and Australia. To understand factors influencing vaccine uptake and to inform the development of appropriate UK educational materials, we aimed to synthesise evidence of girls' and parents' information needs, views and preferences regarding HPV vaccination. DESIGN Systematic review and mixed method synthesis of qualitative and survey data. DATA SOURCES Twelve electronic databases; bibliographies of included studies 1980 to August 2011. REVIEW METHODS Two reviewers independently screened papers and appraised study quality. Studies were synthesised collaboratively using framework methods for qualitative data, and survey results integrated where they supported, contrasted or added to the themes identified. RESULTS Twenty-eight qualitative studies and 44 surveys were included. Where vaccination was offered, uptake was high. Intention to decline was related to a preference for vaccinating later to avoid appearing to condone early sexual activity, concerns about vaccine safety and low perception of risk of HPV infection. Knowledge was poor and there were many misconceptions; participants tried to assess the potential benefits and harms of vaccination but struggled to interpret limited information about HPV in the context of existing knowledge about sexually transmitted infections and cancer. Conclusion Many girls and their parents have limited understanding to an extent that impinges on their ability to make informed choices about HPV vaccination and could impact on future uptake of cervical screening. This is a considerable challenge to those who design and provide information, but getting the messages right for this programme could help in developing patient information about other HPV related cancers.
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Morales-Campos DY, Markham CM, Peskin MF, Fernandez ME. Hispanic mothers' and high school girls' perceptions of cervical cancer, human papilloma virus, and the human papilloma virus vaccine. J Adolesc Health 2013; 52:S69-75. [PMID: 23601613 DOI: 10.1016/j.jadohealth.2012.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/13/2012] [Accepted: 09/13/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE Cervical cancer incidence and mortality are higher for Hispanic women than for women in other population groups. However, the incidence could be reduced if teenaged Hispanic girls received the human papillomavirus (HPV) vaccine before they become sexually active. Unfortunately, few Hispanic girls receive this vaccine, which prevents cervical cancer. This study assessed Hispanic mothers' and girls' perceptions about cervical cancer, HPV, and the HPV vaccine. Results show factors that affect whether Hispanic high school girls receive the vaccine. METHODS Twenty-four Hispanic mothers and 28 Hispanic girls from an urban school district in southeast Texas each participated in one of eight focus groups. Bilingual moderators facilitated the mothers' groups in English and Spanish and the girls' groups in English. We analyzed transcripts of the discussions and identified themes using the grounded theory approach. RESULTS Our analysis found several themes that affect whether Hispanic girls get the HPV vaccine: gaps in knowledge; fears and concerns about the vaccine; sociocultural communication practices; and decision-making about HPV vaccination. Both mothers and girls had limited knowledge about cervical cancer, HPV, and the vaccine. Some girls who received the vaccine said they wished their mothers had involved them in making the decision. CONCLUSIONS Findings may help in developing school or community-based educational programs for Hispanic families. Such programs should provide information on the HPV vaccine and the link between HPV and cervical cancer, and they should assist mothers and girls in communicating to make informed decisions about the vaccine.
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Affiliation(s)
- Daisy Y Morales-Campos
- Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
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Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M. Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis. Int J Epidemiol 2013; 42:896-908. [PMID: 23620381 PMCID: PMC3733698 DOI: 10.1093/ije/dyt049] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level. Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity. Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation. Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.
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Affiliation(s)
- Harriet Fisher
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Al-Naggar RA, Bobryshev YV, Al-Jashamy K, Al-Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev 2013; 13:3835-40. [PMID: 23098480 DOI: 10.7314/apjcp.2012.13.8.3835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study is to determine the practice and associated factors of HPV vaccine among school girls in Melaka, Malaysia. METHODOLOGY A total number of 612 secondary school girls participated in this study. The questionnaire consists of 38 questions which included 3 sections. The first section is about socio- demography. The Second section is about knowledge and awareness of HPV vaccines. The third section is about practices with associated barriers of HPV vaccination. Verbal consent was obtained from all participants, and data were analyzed using SPSS 13. RESULTS A total number of 612 secondary school girl students participated in this study. The mean age was 13.93 ± SD (1.09); minimum age was 13 years old and maximum was 17 years old. The majority of them was Malay, from rural areas and had a family monthly income of RM 3000 or less (91.8%, 53.1%, 69.6%; respectively). The majority of the parents of the school girls were with secondary education level (56.4%). The majority of the participants did not have a family history of cervical cancer (99.0%). The prevalence of HPV vaccination was 77.9% among school girls in Melaka. The majority of the participants were vaccinated in their schools (77.0%). About 69% knew about cervical cancer and 77.6% had ever heard about HPV vaccine. Regarding the factors that influence the practice of uptake HPV vaccine, they were age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine (p<0.001). CONCLUSION The prevalence of HPV vaccine among school girls is high. Age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine were the significant factors that influence the practice of uptake HPV vaccine among school girls.
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Affiliation(s)
- Redhwan Ahmed Al-Naggar
- Community Medicine Department, International Medical School, Management and Science University, Malaysia.
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Jeudin P, Liveright E, del Carmen MG, Perkins RB. Race, ethnicity and income as factors for HPV vaccine acceptance and use. Hum Vaccin Immunother 2013; 9:1413-20. [PMID: 23571170 DOI: 10.4161/hv.24422] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
If distributed equitably, Human Papillomavirus (HPV) vaccines have the potential to reduce racial disparities in HPV-related diseases and cervical cancers. However, current trends in the US indicate low uptake among all adolescents, with persistent disparities among minority and low-income adolescents despite largely positive views of vaccination among their parents. As Black, Hispanic, and Asian populations continue to grow in the US over the next 40 y, it is imperative that we not only improve HPV vaccination rates overall, but focus on high-risk populations to prevent an increase in cervical cancer disparities. This review discusses initiation and completion rates of the three-dose HPV vaccine series among adolescents in high-risk groups and describes cultural similarities and differences in motivation and barriers to vaccination. The goal of this review is to highlight factors leading to vaccination in different adolescent racial groups and to help guide the development of strategies to increase rates of vaccine initiation and completion among groups at the highest risk for developing cervical cancer.
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Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine; Boston Medical Center; Boston, MA USA
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Tsui J, Singhal R, Rodriguez HP, Gee GC, Glenn BA, Bastani R. Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls. Vaccine 2013; 31:2028-34. [PMID: 23474310 DOI: 10.1016/j.vaccine.2013.02.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/30/2013] [Accepted: 02/25/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE Human Papillomavirus (HPV) vaccine uptake remains low. Although publicly funded programs provide free or low cost vaccines to low-income children, barriers aside from cost may prevent disadvantaged girls from getting vaccinated. Prior studies have shown distance to health care as a potential barrier to utilizing pediatric preventive services. This study examines whether HPV vaccines are geographically accessible for low-income girls in Los Angeles County and whether proximity to safety-net clinics is associated with vaccine initiation. METHODS Interviews were conducted in multiple languages with largely immigrant, low-income mothers of girls ages 9 to 18 via a county health hotline to assess uptake and correlates of uptake. Addresses of respondents and safety-net clinics that provide the HPV vaccine for free or low cost were geo-coded and linked to create measures of geographic proximity. Logistic regression models were estimated for each proximity measure on HPV vaccine initiation while controlling for other factors. RESULTS On average, 83% of the 468 girls had at least one clinic within 3-miles of their residence. The average travel time on public transportation to the nearest clinic among all girls was 21min. Average proximity to clinics differed significantly by race/ethnicity. Latinas had both the shortest travel distances (2.2 miles) and public transportation times (16min) compared to other racial/ethnic groups. The overall HPV vaccine initiation rate was 25%. Increased proximity to the nearest clinic was not significantly associated with initiation. By contrast, daughter's age and insurance status were significantly associated with increased uptake. CONCLUSIONS This study is among the first to examine geographic access to HPV vaccines for underserved girls. Although the majority of girls live in close proximity to safety-net vaccination services, rates of initiation were low. Expanding clinic outreach in this urban area is likely more important than increasing geographic access to the vaccine for this population.
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Affiliation(s)
- Jennifer Tsui
- Department of Health Policy & Management, Fielding School of Public Health and Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center University of California, Los Angeles 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Perkins RB, Tipton H, Shu E, Marquez C, Belizaire M, Porter C, Clark JA, Pierre-Joseph N. Attitudes toward HPV vaccination among low-income and minority parents of sons: a qualitative analysis. Clin Pediatr (Phila) 2013; 52:231-40. [PMID: 23362316 DOI: 10.1177/0009922812473775] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the attitudes of low-income and minority parents/guardians toward vaccinating sons against human papillomavirus (HPV). METHODS In 2010-2011, we conducted qualitative interviews with 68 black, 24 white, and 28 Latino parents/guardians of sons. We identified attitudes related to HPV vaccination, vaccine mandates for males and females, and adolescent male sexuality using constructs from the Health Belief Model and methods based in grounded theory. RESULTS Most participants were concerned that their sons could be exposed to HPV through sexual experimentation and believed that the consequences of HPV infection could be severe; thus, 75% would accept HPV vaccine for their sons. Yet the lack of efficacy and safety information specifically pertaining to males posed barriers. More black (73%) and Latino (86%) than white (44%) participants supported school-entry requirements for HPV vaccination. CONCLUSIONS Low-income and minority parents/guardians were generally receptive toward vaccinating their sons against HPV; racial/ethnic differences emerged regarding school-entry mandates.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
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Haesebaert J, Lutringer-Magnin D, Kalecinski J, Barone G, Jacquard AC, Régnier V, Leocmach Y, Vanhems P, Chauvin F, Lasset C. French women's knowledge of and attitudes towards cervical cancer prevention and the acceptability of HPV vaccination among those with 14 - 18 year old daughters: a quantitative-qualitative study. BMC Public Health 2012. [PMID: 23186288 PMCID: PMC3533507 DOI: 10.1186/1471-2458-12-1034] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In France, it is recommended that girls and women aged 14–23 are vaccinated against the human papillomavirus (HPV). However, French women’s knowledge of and attitude towards the vaccine has been little studied. Methods Thirty-nine general practitioners, representative of those working in the large Rhône-Alpes region, offered a self-administered questionnaire on cervical cancer (CC) prevention to all 18–65 year-old women who came for consultation during June and July 2008. In addition, semi-structured interviews were undertaken with a sample of those who had daughters aged 14–18. Results Of the 1,478 women who completed the questionnaire, only 16.9% mentioned HPV as the cause of CC, even though 76.2% knew of the vaccine. 210 women had daughters aged 14–18, and 32 were interviewed. Compared with the wider group, more of these women were aware of the HPV vaccine (91.4%). 44.8% knew the target population and 17.1% the recommended ages for vaccination. 54.3% favoured HPV vaccination; 37.2% were undecided and only 0.9% were opposed. The main barrier to acceptance was the recency of the vaccine’s introduction and concern about possible side effects (54.9%); 14.1% preferred to rely on their GP’s decision. Factors associated with acceptance of the HPV vaccine were having previously vaccinated a child against pneumococcus (OR=3.28 [1.32-8.11]) and knowing the target population for HPV vaccination (OR=2.12 [1.15-3.90]). Knowing the recommended frequency of Papanicolaou smear testing (Pap test) screening was associated with lower acceptance (OR=0.32 [0.13-0.82]). Conclusions Few mothers are opposed to HPV vaccination. Factors associated with acceptability were knowledge about the vaccine, acceptance of other vaccines and, unexpectedly, lack of knowledge about the recommended frequency of Pap testing. On multivariate analysis, compliance with recommendations for Pap test screening and socioeconomic factors had no effect on views about HPV vaccination. Given that concern about possible side effects is the major barrier to wider acceptance of the HPV vaccine in France, GPs have a key role in providing information.
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Affiliation(s)
- Julie Haesebaert
- Université Lyon 1, CNRS UMR 5558 Centre Léon Bérard, 28, rue Laënnec, 69373 cedex 08, Lyon, France
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Donadiki EM, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, López de Andrés A, Jimenez-Trujillo I, Velonakis EG. Knowledge of the HPV vaccine and its association with vaccine uptake among female higher-education students in Greece. Hum Vaccin Immunother 2012; 9:300-5. [PMID: 23111121 DOI: 10.4161/hv.22548] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aims of the study were to assess the awareness and knowledge of HPV vaccination among female university and technological institutes students, and their association with vaccine uptake, and to identify the variables associated with higher levels of knowledge.
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Affiliation(s)
- Elisavet M Donadiki
- Department of Public Health; University of Athens; Faculty of Nursing; Athens, Greece
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Wu DW, Tsai LH, Chen PM, Lee MC, Wang L, Chen CY, Cheng YW, Lee H. Loss of TIMP-3 promotes tumor invasion via elevated IL-6 production and predicts poor survival and relapse in HPV-infected non-small cell lung cancer. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1796-806. [PMID: 22982189 DOI: 10.1016/j.ajpath.2012.07.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/19/2012] [Accepted: 07/20/2012] [Indexed: 12/21/2022]
Abstract
Human papillomavirus (HPV) 16/18 E6 oncoprotein is expressed in lung tumors and is associated with p53 inactivation. The tissue inhibitor of metalloproteinase 3 (TIMP-3) is essential for limiting inflammation; therefore, we expected that TIMP-3 loss might induce chronic inflammation, thereby promoting tumor malignancy as well as poor survival and relapse in patients with HPV-infected non-small cell lung cancer. In this study, the loss of TIMP-3 by loss of heterozygosity and/or promoter hypermethylation was more frequent in HPV16/18 E6-positive tumors than in E6-negative tumors. To explore the possible underlying mechanism, E6-negative TL4 and CL1-0 cells were transfected with an E6 cDNA plasmid. A marked decrease in TIMP-3 expression was caused by promoter hypermethylation via increased DNA (cytosine-5-)-methyltransferase 1 (DNMT1) expression. Mechanistic studies indicated that TIMP-3 loss promoted interleukin-6 (IL-6) production, which led to cell invasion and anchorage-independent growth on soft agar plates. Kaplan-Meier and Cox regression models showed that patients with low-TIMP-3/high-IL-6 tumors had shorter overall survival and relapse-free survival periods when compared with patients with high-TIMP-3/low-IL-6 tumors. In summary, loss of TIMP-3 may increase IL-6 production via the tumor necrosis factor α/nuclear factor κB axis, thereby promoting tumor malignancy and subsequent relapse and poor survival in patients with HPV-infected non-small cell lung cancer.
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Affiliation(s)
- De-Wei Wu
- Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taiwan
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