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Coleman DC, Markham C, Guilamo-Ramos V, Santa Maria D. Relationship between religiosity and HPV vaccine initiation and intention in urban black and hispanic parents. BMC Public Health 2024; 24:265. [PMID: 38263012 PMCID: PMC10804600 DOI: 10.1186/s12889-024-17653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/03/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Religion is believed to be an important sociocultural influence in the U.S., but little is known about how religiosity shapes the human papillomavirus (HPV) vaccine decision in racial/ethnic minorities. The purpose of this study was to examine the relationship between religiosity and HPV vaccine initiation and intention among urban, racial/ethnic minority parents of adolescents 11-14 years old. DESIGN This study employed a descriptive, cross-sectional design using baseline data from Black and Hispanic parents (N = 175 and 285, respectively) recruited from medically underserved communities. Chi-square tests for independence and independent-samples t-tests were run to assess sociodemographic differences in vaccine initiation and vaccine intention. Binary logistic regression analyses were conducted to determine whether religious attendance and religious salience were associated with parents' HPV vaccine decisions for their children. RESULTS Approximately 47% of Black parents had vaccinated their youth against HPV. Of those who had not initiated the vaccine for their child, 54% did not intend to do so. 54% of Hispanic parents had initiated the HPV vaccine for their youth. Of those who had not initiated the vaccine for their child, 51% did not intend to do so. Frequency of attendance at religious services and the importance of religion in one's life was not significantly correlated with HPV vaccine decision-making for Black nor Hispanic parents. CONCLUSION This study suggests that religiosity does not influence the HPV vaccine decision for urban, Black and Hispanic parents. Future studies using measures that capture the complexity of religion as a social construct are needed to confirm the findings. In addition, studies with representative sampling will enable us to make generalizations about the influence of religion on HPV vaccine decision-making for urban, racial/ethnic minority parents.
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Affiliation(s)
- Deidra Carroll Coleman
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit. 1440, 77030, Houston, TX, USA.
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health, 77030, Houston, TX, USA
| | - Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University School of Nursing, 27710, Durham, MC, USA
| | - Diane Santa Maria
- Department of Research, The University of Texas Health Science Center at Houston, Cizik School of Nursing, 77030, Houston, TX, USA
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Arezo S, Naavaal S, Garrett C, Wright MS, Sheppard VB, Preston MA. Implementation of a Cancer Education Program in Rural Counties with the Lowest HPV Vaccination Rates and Health Rankings. JOURNAL OF HEALTH RESEARCH 2023; 38:88-93. [PMID: 37869728 PMCID: PMC10588440 DOI: 10.56808/2586-940x.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students' knowledge on the SCP topics, HPV knowledge, tobacco usage, and factors that reduced cancer development. Results 87% agreed that tobacco products are associated with cancer, and 81% did not agree that E-cigarettes are scientifically proven to be safer than cigarettes. Although we do not have pre-evaluation data about these students' HPV knowledge, our evaluation survey shows that 80% of students correctly identified HPV as the most common STI, and 84% of students correctly identified the factors that decrease their risk of developing cancer. Conclusion Through this initiative, students learned essential health concepts and HPV-related risk factors.
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Affiliation(s)
- Sarah Arezo
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Shillpa Naavaal
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, School of Dentistry, Department of Dental Public Health and Policy, 520 North 12th Street, PO Box 980566, Richmond, VA 23298-0566, USA
| | - Charlotte Garrett
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Marcie S. Wright
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, School of Medicine, Center on Health Disparities, 730 E. Broad St. 4th Floor, Richmond, VA 23219, USA
| | - Vanessa B. Sheppard
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Michael A. Preston
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
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Henderson RL, Zoucha R, Colbert A, Braxter BJ. Exploring Cultural Factors of Human Papillomavirus Vaccination Acceptance in African Americans: An Integrative Review. J Transcult Nurs 2022; 33:723-731. [PMID: 36197072 DOI: 10.1177/10436596221125899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccine can prevent HPV-related cancers. However, African Americans (AA) have a 30% higher incidence of HPV-related cervical cancer than Whites. The purpose of this integrative review is to explore cultural factors and beliefs impacting HPV vaccine decisions in AA adults. METHODOLOGY The Whittemore & Knafl model guided this review. Databases searched were PubMed, CINAHL, and Embase. Key terms included "human papillomavirus," "vaccine," "cultural values," "African American," and "adult." Inclusion criteria were AAs aged 18 years and over living in the United States. RESULTS A total of 634 articles were identified, and 20 studies published from 2010 to 2020 were used. Common factors influencing HPV vaccine decisions included religion, knowledge, physician recommendation, social network, attitudes, mistrust, benefits, and safety. DISCUSSION Limitations included omission of articles lacking AA representation, limited databases searched, and one-author-evaluated studies. Future studies to discover additional cultural factors influencing HPV vaccine acceptance are critical.
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Kuru O, Chan MPS, Lu H, Stecula DA, Jamieson KH, Albarracín D. Religious affiliation and philosophical and moral beliefs about vaccines: A longitudinal study. J Health Psychol 2022; 27:3059-3081. [PMID: 35289216 PMCID: PMC9580036 DOI: 10.1177/13591053221082770] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
How do religious affiliation and beliefs shape vaccine attitudes and behaviors? This study examined the associations of attitudes and behaviors relevant to the flu, measles-mumps-rubella (MMR), and human-papillomavirus (HPV) vaccines with religious affiliations, as well as philosophical, spiritual, and moral beliefs. Respondents were 3005 adults from a probability-based, four-wave panel survey in the United States. Longitudinal structural equation modeling examined how religious affiliations and philosophical/moral beliefs shaped attitudes toward vaccines and actual vaccination. Stronger philosophical beliefs predicted more negative attitudes toward each vaccine and stronger moral beliefs more negative attitudes toward the HPV vaccine. Negative vaccine attitudes then predicted weaker intentions to encourage others to vaccinate and lower probability of receiving a vaccine. Theoretical and public health messaging implications are discussed.
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Affiliation(s)
- Ozan Kuru
- National University of Singapore, Singapore
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5
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Grandahl M, Nevéus T. Barriers towards HPV Vaccinations for Boys and Young Men: A Narrative Review. Viruses 2021; 13:v13081644. [PMID: 34452508 PMCID: PMC8402923 DOI: 10.3390/v13081644] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. Results: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. Conclusions: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.
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6
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Vielot NA, Butler AM, Trogdon JG, Ramadas R, Smith JS, Eyler A. Association of State Legislation of Human Papillomavirus Vaccination with Vaccine Uptake Among Adolescents in the United States. J Community Health 2021; 45:278-287. [PMID: 31520188 DOI: 10.1007/s10900-019-00734-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We assessed the association of state legislation with adolescent human papillomavirus (HPV) vaccination rates in states that legislated information dissemination or administration of HPV vaccination. Using insurance claims, we calculated monthly HPV vaccination rates (November 2009-December 2017) among adolescents in states that passed HPV vaccination legislation during that period: Missouri (July 2010), Kentucky (February 2012), Indiana (March 2013), Oregon (June 2013). We used segmented regression to estimate levels and trends of HPV vaccination rates, comparing pre-legislation to post-legislation segments, adjusting for seasonal vaccination patterns and changes to the vaccination recommendation among males during the study period. Indiana's legislation allowed pharmacists to administer HPV vaccination; legislation in Kentucky, Missouri, and Oregon included provisions HPV and cervical cancer education. No statistically significant increases in HPV vaccination levels or trends were observed in the post-legislation segments among adolescents overall; however, a significant post-legislation increase in vaccination trends was observed among boys in Missouri (β = 0.16, p = 0.03). Evidence for a positive impact of legislation on HPV vaccination rates is limited. The scarcity of policies that directly facilitate or promote HPV vaccination, and the breadth of exemptions to school vaccination requirements, may limit the effectiveness of these policies. Continuing efforts to introduce and pass legislation that directly facilitates HPV vaccination, combined with promoting existing evidence-based interventions, can provide opportunities to identify the most effective strategies to increase adolescent HPV vaccination rates.
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Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27599, USA.
| | - Anne M Butler
- Division of Infectious Diseases, Washington University at St. Louis, St. Louis, MO, USA.,Division of Public Health Sciences, Washington University at St. Louis, St. Louis, MO, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ramya Ramadas
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer S Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Eyler
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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7
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Vu M, King AR, Jang HM, Bednarczyk RA. Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: a qualitative study of healthcare providers' perspectives. HEALTH EDUCATION RESEARCH 2020; 35:512-523. [PMID: 32879948 PMCID: PMC7768667 DOI: 10.1093/her/cyaa026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/16/2020] [Indexed: 05/22/2023]
Abstract
Georgia experiences higher human papillomavirus (HPV)-associated cancer burden and lower HPV vaccine uptake compared with national estimates. Using the P3 model that concomitantly assesses practice-, provider- and patient-level factors influencing health behaviors, we examined facilitators of and barriers to HPV vaccine promotion and uptake in Georgia. In 2018, we conducted six focus groups with 55 providers. Questions focused on multilevel facilitators of and barriers to HPV vaccine promotion and uptake. Our analysis was guided by the P3 model and a deductive coding approach. We found that practice-level influences included organizational priorities of vaccinations, appointment scheduling, immunization registries/records, vaccine availability and coordination with community resources. Provider-level influences included time constraints, role, vaccine knowledge, self-efficacy to discuss HPV vaccine and vaccine confidence. Patient-level influences included trust, experiences with vaccine-preventable diseases, perceived high costs, perceived side effects and concerns with sexual activity. Findings suggest that interventions include incentives to boost vaccine rates and incorporate appointment scheduling technology. An emphasis should be placed on the use of immunization registries, improving across-practice information exchange, and providing education for providers on HPV vaccine. Patient-provider communication and trust emerge as intervention targets. Providers should be trained in addressing patient concerns related to costs, side effects and sexual activity.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
- Correspondence to: M. Vu. E-mail:
| | - Adrian R King
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Hyun Min Jang
- The Center for the Study of Human Health, Emory College of Arts and Sciences, Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
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CELLA PAOLA, VOGLINO GIANLUCA, BARBERIS ILARIA, ALAGNA ENRICO, ALESSANDRONI CLAUDIA, CUDA ALESSANDRO, D’ALOISIO FRANCESCO, DALLAGIACOMA GIULIA, DE NITTO SARA, DI GASPARE FRANCESCA, GALLIPOLI ORIANA, GENTILE LEANDRO, KUNDISOV LUCIA, NAVARO MONICA, PROVENZANO SANDRO, SANTANGELO OMARENZO, STEFANIZZI PASQUALE, GIANFREDI VINCENZA. Resources for assessing parents' vaccine hesitancy: a systematic review of the literature. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E340-E373. [PMID: 33150224 PMCID: PMC7595070 DOI: 10.15167/2421-4248/jpmh2020.61.3.1448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
Abstract
The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.
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Affiliation(s)
- PAOLA CELLA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - GIANLUCA VOGLINO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, University of Turin, Italy
| | - ILARIA BARBERIS
- Health Science Department, University of Genoa, Italy
- Correspondence: Ilaria Barberis, Health Science Department, University of Genoa, largo Rosanna Benzi 10, Pad. 3 San Martino Hospital, Italy - Tel./Fax +39 010 3538502 - E-mail:
| | - ENRICO ALAGNA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - CLAUDIA ALESSANDRONI
- Post Graduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - ALESSANDRO CUDA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - FRANCESCO D’ALOISIO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - GIULIA DALLAGIACOMA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - SARA DE NITTO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - FRANCESCA DI GASPARE
- Post Graduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - ORIANA GALLIPOLI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - LEANDRO GENTILE
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - LUCIA KUNDISOV
- Post Graduate School of Public Health, University of Siena, Italy
| | - MONICA NAVARO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Campania “L. Vanvitelli”, Italy
| | - SANDRO PROVENZANO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - OMAR ENZO SANTANGELO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - PASQUALE STEFANIZZI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - VINCENZA GIANFREDI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Italy
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
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Dela Cruz MRI, Braun KL, Tsark JAU, Albright CL, Chen JJ. HPV vaccination prevalence, parental barriers and motivators to vaccinating children in Hawai'i. ETHNICITY & HEALTH 2020; 25:982-994. [PMID: 29745749 PMCID: PMC6230317 DOI: 10.1080/13557858.2018.1473556] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Objective: To determine the prevalence and barriers to human papillomavirus (HPV) vaccine uptake among 11-18 year olds in the Hawai'i's four major ethnic groups-Native Hawaiians, Filipinos, Japanese, and Caucasians. Study design: A telephone survey assessed parents' knowledge of HPV and the HPV vaccine, status of their child's HPV vaccine uptake, variables operationalizing the Health Belief Model, and barriers and motivators to uptake. Results: Across the groups, 799 parents completed the survey. About 35% of daughters and 19% of sons had received all three shots. Although ethnic differences in vaccine uptake were seen in bivariate analysis (with significantly lower uptake in Filipino youth), in multivariable logistic regression analysis, only Caucasian parents were significantly less likely to start their sons on the HPV vaccine series compared with Japanese parents (reference group). Having heard about the vaccine, believing in its effectiveness, and older age of the child were also associated with vaccine uptake. Motivators for HPV vaccination were physician's recommendation and wanting to protect one's child. The primary barrier to uptake was lack of knowledge about the vaccine. Conclusions: Findings reinforce the fact that a physician's recommendation and receipt of information about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity.
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Affiliation(s)
| | - Kathryn L. Braun
- Office of Public Health Sciences, University of Hawai’i at Mānoa, Honolulu, HI, USA
| | - Jo Ann Umilani Tsark
- Office of Public Health Sciences, University of Hawai’i at Mānoa, Honolulu, HI, USA
| | - Cheryl Lynn Albright
- School of Nursing & Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, HI, USA
| | - John J. Chen
- School of Medicine, University of Hawai’i at Manoa, Honolulu, HI, USA
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Quinn DA, Lewin A. Family factors associated with emerging adults' human papillomavirus vaccine behavior. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:528-535. [PMID: 30908148 DOI: 10.1080/07448481.2019.1583240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
Objective: The current study examined the role of family influences on the vaccine behavior of emerging adults. Participants: In Spring 2017, we conducted anonymous online surveys of undergraduate students (n = 608) at a large, public university in the mid-Atlantic. Methods: Logistic regression was used to examine associations between family factors and students' awareness of the HPV vaccine, vaccine receipt, and vaccine intentions. Family factors included sex communication, religiosity, parental monitoring, family structure, and parents' birthplace. Results: More comprehensive family sex communication is associated with less uncertainty regarding HPV vaccine receipt and greater likelihood of being already vaccinated. More frequent family religiosity and more parental monitoring are associated with greater likelihood of having decided against vaccination rather than already being vaccinated. Significant gender and racial disparities exist. Conclusion: Further research, policy, and programmatic intervention are needed to reduce disparities and to improve emerging adults' compliance with HPV vaccine recommendations.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Amy Lewin
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
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Koplas PA, Braswell J, Saray Smalls T. Uptake of HPV vaccine in traditional-age undergraduate students: Knowledge, behaviors, and barriers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:762-771. [PMID: 30395793 DOI: 10.1080/07448481.2018.1512499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/14/2018] [Accepted: 08/12/2018] [Indexed: 06/08/2023]
Abstract
Objective: This study investigated potential factors associated with HPV vaccine uptake in a diverse population of traditional-age undergraduate students. Participants: One hundred and twenty-nine undergraduate students aged 18-24 attending a small southeastern university completed surveys in January to March of 2013. Methods: Questionnaires included demographic information, basic HPV knowledge, HPV vaccine uptake, and factors influencing uptake decision. Survey results were analyzed with chi-square and t-test analyses. Results: Vaccine uptake was significantly higher in students who reported that health care provider, public health information, parents, and access to vaccine were important factors in their decision to get vaccinated. Female students had a significantly higher vaccine uptake in comparison to males and the HPV knowledge scores differed significantly by race but not gender. Conclusions: It is especially important to consider how public health campaigns and communication with parents and health care providers help promote HPV vaccine uptake in this high-risk group.
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Affiliation(s)
- Patricia A Koplas
- Department of Biology, Queens University of Charlotte, Charlotte, North Carolina, USA
| | - Jessica Braswell
- Department of Chemistry and Environmental Science, Queens University of Charlotte, Charlotte, North Carolina, USA
| | - T Saray Smalls
- Senior Health Promotion and Education Program Associate, The George Washington University, Washington, District of Columbia, USA
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12
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Williams CL, Walker TY, Elam-Evans LD, Yankey D, Fredua B, Saraiya M, Stokley S. Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey-Teen, 2016-2017. Hum Vaccin Immunother 2019; 16:562-572. [PMID: 31584312 PMCID: PMC7227662 DOI: 10.1080/21645515.2019.1670036] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The 2016 and 2017 National Immunization Surveys-Teen (NIS-Teen) highlighted disparities in human papillomavirus (HPV) vaccination coverage by metropolitan statistical area (MSA) status. Coverage with ≥1 dose of HPV vaccine was significantly lower among teens in suburban and mostly rural areas than it was among those in mostly urban areas. Reasons underlying this disparity are poorly understood; this analysis sought to identify sociodemographic factors associated with not initiating the HPV vaccine series and to determine whether these factors differed by MSA status. Using NIS-Teen data for a sample of 41,424 adolescents from the 2016 and 2017 survey years, multivariate logistic regression was utilized to assess associations between various sociodemographic factors and non-initiation of the HPV vaccine series by MSA status. Adjusted prevalence ratios and 95% confidence intervals are reported. A secondary analysis assessed missed opportunities for HPV vaccination by MSA status and estimated what coverage could be if these missed opportunities had not occurred. Most factors associated with not receiving HPV vaccine were similar across all three MSAs, including living in the South, having a mother with some college education, not having an 11–12-year-old well-child visit, and not receiving a provider recommendation for vaccination. Others were associated with non-initiation of the HPV vaccine series in only specific MSAs. Teens in suburban areas (82.2%) were more likely to miss opportunities for HPV vaccination than those in mostly urban (79.3%) areas. Coverage with ≥1 dose of HPV vaccine in all three MSAs would be substantially higher if these missed opportunities had been eliminated.
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Affiliation(s)
- Charnetta L Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tanja Y Walker
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center For Chronic Disease Prevention & Health Promotion, CDC, Atlanta, GA, USA
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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13
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Dennison C, King AR, Rutledge H, Bednarczyk RA. HPV Vaccine-Related Research, Promotion and Coordination in the State of Georgia: A Systematic Review. J Community Health 2019; 44:313-321. [PMID: 30374822 PMCID: PMC6414259 DOI: 10.1007/s10900-018-0589-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV) vaccine was first recommended for female adolescents in the United States in 2006, and for male adolescents in 2011. In 2016, national HPV vaccine coverage was 43.4%, and slightly higher in Georgia (45.6%). Little is known about sub-state-level variation in HPV vaccination or Georgia specific research conducted to improve HPV vaccine uptake. We aimed to describe current uptake of HPV vaccination and synthesize Georgia-specific research of HPV vaccine uptake. We reviewed existing published and grey literature for different development, implementation and best practices related to vaccine uptake in adolescents. Studies measuring HPV vaccine uptake in Georgia utilizing quantitative, qualitative, or mixed-methods approaches were included alongside state-level information from National Immunization Survey-Teen, Community Health Needs Assessments, Behavioral Risk Factor Surveillance and Georgia Adolescent Immunization Surveys. Key findings across these reports were summarized. Forty-two titles and abstracts were identified through electronic database search for literature published between 2006 and 2017. Of these, five were from database sources and 37 were from additional sources. The most often mentioned barriers of HPV vaccine uptake in Georgia include cultural norms, vaccination education and a misalignment of vaccine uptake goals between the state and regional hospital community needs assessments. Increasing knowledge and uptake of HPV vaccine in Georgia requires significant research and to understand the vast socioeconomic, cultural and geographic barriers preventing uptake among adolescents. Georgia-specific efforts have been limited, however ongoing collaborations spearheaded by the Georgia Cancer Control Coalition provide opportunities for state-level support of research to address these barriers.
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Affiliation(s)
- Cori Dennison
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adrian R King
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Rutledge
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
- Emory Vaccine Center, Emory University, Atlanta, GA, USA.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, CNR 7019, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Galbraith-Gyan KV, Lechuga J, Jenerette CM, Palmer MH, Moore (Ret.) LTCAD, Hamilton JB. HPV vaccine acceptance among African-American mothers and their daughters: an inquiry grounded in culture. ETHNICITY & HEALTH 2019; 24:323-340. [PMID: 28553758 PMCID: PMC6175663 DOI: 10.1080/13557858.2017.1332758] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Much of the research on African-Americans' HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture. OBJECTIVE To explore the influence of culture on African-American mothers' and daughters' HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework. METHODS Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n = 28) and their daughters (n = 34). RESULTS Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance. CONCLUSION Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.
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Affiliation(s)
- Kayoll V. Galbraith-Gyan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA,
| | - Julia Lechuga
- College of Education, Lehigh University, Bethlehem, PA, USA,
| | - Coretta M. Jenerette
- Department of Adult and Geriatric Health; School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, USA,
| | - Mary H. Palmer
- Health Care Environment Division, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, USA,
| | | | - Jill B. Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA,
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Carvalho AMCD, Andrade EMLR, Nogueira LT, Araújo TMED. HPV VACCINE ADHERENCE AMONG ADOLESCENTS: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify what factors are connected to adolescent adherence to the vaccination against Human Papillomavirus. Method: integrative developed using the following data base: Medical Literature Analysis and Retrieval System Online and Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-American and Caribbean Literature in Health Sciences), and Base de dados de Enfermagem (Nursing Database); using the descriptors and keywords: Papillomaviridae, immunization, vaccines. The final sample had 31 original articles. Result: Vaccine adherence predictors were identified as: knowledge about virus infection risk, vaccination and its benefits; cervical cancer and genital warts prevention; sexual activity; being over 14 years old; mothers’ intention to adhere to vaccination; mother-child communication about sexually transmitted infections, contraception and condoms; vaccination offered in school; recommendation by teachers and health professionals; vaccine safety and effectiveness. Conclusion: Evidence points towards the necessity to redesign the presentation strategy of the vaccine, because despite the cultural differences among the countries where the studies were carried out, it is noticeable that society shelters adolescents aged from 10 to 14 years old, considering it early for sexual initiation and presenting difficulties to broach sexuality-related topics with children.
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Harris VC, Links AR, Walsh J, Schoo DP, Lee AH, Tunkel DE, Boss EF. A Systematic Review of Race/Ethnicity and Parental Treatment Decision-Making. Clin Pediatr (Phila) 2018; 57:1453-1464. [PMID: 30014706 PMCID: PMC6460468 DOI: 10.1177/0009922818788307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient race/ethnicity affects health care utilization, provider trust, and treatment choice. It is uncertain how these influences affect pediatric care. We performed a systematic review (PubMed, Scopus, Web of Science, PsycINFO, Cochrane, and Embase) for articles examining race/ethnicity and parental treatment decision-making, adhering to PRISMA methodology. A total of 9200 studies were identified, and 17 met inclusion criteria. Studies focused on treatment decisions concerning end-of-life care, human papillomavirus vaccination, urological surgery, medication regimens, and dental care. Findings were not uniform between studies; however, pooled results showed (1) racial/ethnic minorities tended to prefer more aggressive end-of-life care; (2) familial tradition of neonatal circumcision influenced the decision to circumcise; and (3) non-Hispanic Whites were less likely to pursue human papillomavirus vaccination but more likely to complete the vaccine series if initiated. The paucity of studies precluded overarching findings regarding the influence of race/ethnicity on parental treatment decisions. Further investigation may improve family-centered communication, parent engagement, and shared decision-making.
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Affiliation(s)
- Vandra C. Harris
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Anne R. Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Desi P. Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andrew H. Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David E. Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland,Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Barriers and facilitators to HPV vaccination among rural Alabama adolescents and their caregivers. Vaccine 2018; 36:4126-4133. [PMID: 29793895 DOI: 10.1016/j.vaccine.2018.04.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/07/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Half of all new human papillomavirus (HPV) infections occur in adolescents and young adults, and this population has poor HPV vaccination rates. Rural areas of the U.S. have high rates of HPV-related diseases and low vaccination rates as well. The purpose of this study was to determine the perceived barriers and facilitators to HPV vaccination among adolescents and their caregivers in rural south Alabama. METHODS Vaccinated and non-vaccinated adolescents ages 11-18 years old and primary caregivers were recruited from three rural counties in south Alabama. Participants completed individual interviews to discuss perceived barriers to vaccination and factors influencing their decision to vaccinate. Discussion groups were held to determine potential solutions to barriers elucidated from the interviews. Interview and discussion group transcripts were analyzed, and themes were identified. RESULTS Approximately 62.5% of adolescents had not initiated the HPV vaccine series. Of those adolescents who started the vaccine series (n = 9, 37.5%), about half completed it (n = 5). Few participants in this study reported speaking with their health care provider (HCP) about the vaccine in the past year. Lack of information about the vaccine, its side effects, and no HCP recommendation were common barriers cited by non-vaccinators. Facilitators to vaccination included cancer prevention, discussion with HCP, and peer testimonials. Potential solutions to barriers were also discussed. CONCLUSIONS Proposed strategies to increase HPV vaccination were similar between vaccinated and non-vaccinated groups. Education about HPV and the HPV vaccine is needed throughout these rural south Alabama communities to ensure informed decisions are made about vaccination and to increase vaccination rates.
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Bodson J, Wilson A, Warner EL, Kepka D. Religion and HPV vaccine-related awareness, knowledge, and receipt among insured women aged 18-26 in Utah. PLoS One 2017; 12:e0183725. [PMID: 28841681 PMCID: PMC5571930 DOI: 10.1371/journal.pone.0183725] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/09/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We investigate the associations between religious practice and human papillomavirus (HPV) vaccine-related awareness, knowledge, and receipt among young women in Utah. METHODS We surveyed 326 insured women aged 18-26 by mail. Fisher's Exact Tests and multivariable logistic regression models were used to evaluate the relations between religious practice and HPV vaccine-related outcomes. Data collection occurred January-December 2013; analyses were conducted June-September 2015. RESULTS Multivariable analyses reveal that when controlling for age, educational attainment, and marital status, participants who practiced an organized religion were significantly less likely to have heard of HPV (aOR = 0.25, p = 0.0123), to have heard of the HPV vaccine (aOR = 0.41, p = 0.0368), to know how HPV is spread (aOR = 0.45, p = 0.0074), to have received a provider recommendation for the HPV vaccine (aOR = 0.36, p = 0.0332), and to have received at least one (aOR = 0.50, p = 0.0073) or all three (aOR = 0.47, p = 0.0026) doses of the HPV vaccine. Bivariate analyses produce parallel results. CONCLUSIONS Results indicate that religious young women in Utah are not only under-vaccinated, but are also under-informed about HPV and the HPV vaccine. These results suggest that suboptimal vaccine coverage among religious young women may present a serious health risk for the community. Strategies for educational interventions targeted to this population are discussed.
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Affiliation(s)
- Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Andrew Wilson
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
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Abstract
OBJECTIVES To provide an overview of human papillomavirus (HPV) vaccination as cancer prevention with current strategies that nurses can use to help patients and parents overcome barriers to HPV vaccination. DATA SOURCES Peer-reviewed literature, presentation abstracts, and current immunization recommendations from the Advisory Council on Immunization Practice. CONCLUSION Nurses can help prevent cancer by encouraging HPV vaccination during routine immunization and make HPV vaccination normal and routine. IMPLICATIONS FOR NURSING PRACTICE A vaccine to reduce/eliminate HPV-related cancers enables nurses' at all educational levels to advocate for cancer prevention through initiation and completion of the HPV vaccine series.
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Affiliation(s)
- Tami L. Thomas
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8 Street, AHC -3, Miami, Florida 33199
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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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The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices. ANS Adv Nurs Sci 2015; 38:E1-E12. [PMID: 26517344 DOI: 10.1097/ans.0000000000000094] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
General health implications of religiosity and spirituality on health have been associated with health promotion, so the purpose of this study was to examine the influence of religiosity and spirituality on rural parents' decision making to vaccinate their children against human papillomavirus (HPV). The associations of religiosity and spirituality with parental HPV vaccine decisions were examined in a sample of parents residing in small rural communities (N = 37). Parents of children aged 9 to 13 years participated in focus groups held in rural community contexts. Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing HPV vaccination. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which parents perceived their control over and coping with health issues potentially related to HPV vaccination. Together, religiosity and spirituality were found to play integral roles in these parents' lives and influenced their attitudes toward HPV vaccination uptake for their children.
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Hull PC, Williams EA, Khabele D, Dean C, Bond B, Sanderson M. HPV vaccine use among African American girls: qualitative formative research using a participatory social marketing approach. Gynecol Oncol 2014; 132 Suppl 1:S13-20. [PMID: 24491412 PMCID: PMC3966189 DOI: 10.1016/j.ygyno.2014.01.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/15/2014] [Accepted: 01/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To generate recommendations for framing messages to promote HPV vaccination, specifically for African American adolescents and their parents who have not yet made a decision about the vaccine (the "Undecided" market segment). METHODS Focus groups and interviews were conducted with African American girls ages 11-18 (N=34) and their mothers (N=31), broken into market segments based on daughter's vaccination status and mother's intent to vaccinate. RESULTS Findings suggested that the HPV vaccine should be presented to "Undecided" mothers and adolescents as a routine vaccine (just like other vaccines) that helps prevent cancer. Within the "Undecided" segment, we identified two sub-segments based on barriers to HPV vaccination and degree of reluctance. The "Undecided/Ready If Offered" segment would easily accept HPV vaccine if given the opportunity, with basic information and a healthcare provider recommendation. The "Undecided/Skeptical" segment would need more in-depth information to allay concerns about vaccine safety, mistrust of drug companies, and recommended age. Some mothers and girls had the erroneous perception that girls do not need the vaccine until they become sexually active. African American adolescents and their mothers overwhelmingly thought campaigns should target both girls and boys for HPV vaccination. In addition, campaigns and messages may need to be tailored for pre-teens (ages 9-12) versus teens (ages 13-18) and their parents. CONCLUSIONS Findings pointed to the need to "normalize" the perception of HPV vaccine as just another routine vaccine (e.g., part of pre-teen vaccine package). Findings can inform social marketing campaigns targeting Undecided or ethnically diverse families.
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Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 2014; 168:76-82. [PMID: 24276343 PMCID: PMC4538997 DOI: 10.1001/jamapediatrics.2013.2752] [Citation(s) in RCA: 635] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines. OBJECTIVE To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage. EVIDENCE REVIEW We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males. FINDINGS Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine's effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children. CONCLUSIONS AND RELEVANCE Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.
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Affiliation(s)
- Dawn M. Holman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vicki Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine B. Roland
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Liddon
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia (Stokley)
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