Knowledge, Attitudes, Beliefs, Practices Regarding Human Papillomavirus (HPV), and Barriers to Vaccination Against HPV Infection: A Cross-Sectional Survey of Guam Residents

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is linked to several cancers. In Guam, the HPV vaccination rate falls short of the National Healthy People 2030 goal. Only half of eligible Guam teens have received the HPV vaccination series. Additionally, research on Guam HPV vaccination is limited. A cross-sectional survey was conducted, and a representative sample of Guam residents (n=775) was surveyed to examine their knowledge, attitudes, beliefs, practices regarding HPV, and barriers to HPV vaccination. Aggregated scores were calculated for these scale items: attitude, knowledge, subjective norms, and perceived behavioral control regarding HPV. One-way Analysis of Variance (ANOVA) was used to compare the means of the scores and check for significant differences. Binary logistic regression helped to identify significant predictors of HPV vaccination among respondents with children. Significant differences were found for sex, education, income, and ethnicity. Women and those with higher education and income demonstrated higher positive attitudes and knowledge about HPV vaccination. Also, those with health insurance and those who were advised by their physician were more likely to get their children vaccinated. These results will guide the implementation of effective strategies for developing targeted behavioral and other appropriate interventions to increase HPV vaccination in Guam.

Abstract PO-070: Knowledge, attitudes, beliefs, practices regarding human papillomavirus (HPV), and barriers to vaccination against HPV infection: A cross-sectional survey of Guam residents

Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is linked to cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. In the U.S. territory of Guam, the incidence of cervical cancer is six times higher in Micronesians and over three times higher for CHamorus than the U.S. population. Though nasopharyngeal cancer has other contributing factors beyond HPV infection such as smoking and drinking, the CHamorus, who are the Indigenous people of Guam, have an incidence rate of nasopharyngeal cancer 20 times that of the U.S. population. In Guam, HPV vaccination rate is sub-optimally short of the National Healthy People 2020 goal to have at least 80% of females and males between the ages 13-15 years complete the HPV vaccine series. In 2016, 55.8% females and 33.2% males completed the HPV vaccination. Objective Our study sought to analyze a representative sample of Guam residents to examine their knowledge, attitudes, beliefs, practices regarding HPV, and barriers to HPV vaccination. Methods The cross-sectional survey of 776 respondents included 38% males and 62% females. The three major ethnic groups in the sample were CHamoru (48%), Filipino (26%), and Micronesians (11%). Sixty-eight percent of the respondents had at least one child. The aggregated scores were calculated for the following scale items: attitude (A), knowledge (K), subjective norms (SN), and perceived behavioral control (PBC) regarding HPV. Results Almost 45% of respondents admitted that they do not have enough knowledge to have their children vaccinated. However, 88% of those respondents stated that they would have their children vaccinated if the doctor told them. Women had significantly higher mean scores than men for A, K, and PBC/SN. Participants with more than high school education and higher incomes have significantly higher mean scores for all three measures. There were significant differences among different ethnic groups, with Micronesians having the lowest average score for all three measures. There were no significant differences between participants who had their children vaccinated and those who did not. Only 48% of respondents with children reported having their children vaccinated. Only ethnicity and having insurance were significant predictors of HPV vaccination. The respondents with medical insurance were almost three times as likely to have their children vaccinated for HPV (OR=2.8; 95% CI: 1.4, 5.2) Conclusions The results highlighted the significance of the physician’s role in having the HPV vaccination. Our results will serve as a guide to implement effective strategies for the development of targeted behavioral interventions and to develop appropriate interventions to increase the HPV vaccination uptake on Guam.

Citation Format: Ana Joy Mendez, Lilnabeth Somera, Grazyna Badowski, Angelina Mummert, Lucy Castro, Angrenilda Antolin. Knowledge, attitudes, beliefs, practices regarding human papillomavirus (HPV), and barriers to vaccination against HPV infection: A cross-sectional survey of Guam residents [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-070.

Abstract B025: “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam

Background. The island of Guam is a U.S. territory where a large proportion of Pacific Islanders and Filipinos reside. CHamoru, the indigenous people of Guam, have the overall highest incidence and mortality rates in colorectal cancer (CRC). CRC is the third leading cause of cancer death for both men and women on island. CRC screening data indicate 44.2% of persons age 50 and above have met USPSTF screening standards for CRC compared to 67.3% of the same cohort in the U.S. (CDC, 2019). In addition, CRC diagnoses often occur in the late stages with recent data revealing that 75.0% of these occur at Stage 3, while 18.0% occur at Stage 1 (Pacific Regional Central Cancer Registry, 2018). These late stage diagnoses have implications for early detection and CRC screening education interventions. The aim of this study was to provide CRC education via a giant inflatable colon and to assess changes in CRC knowledge, intent to screen for CRC, and willingness to discuss CRC with others. Methods. A pre- and post-test study design was used to assess changes in knowledge, beliefs, likelihood of discussing CRC screening with family members, and intent to screen after a guided tour through a giant inflatable colon. Participant response to whether the inflatable colon was a culturally appropriate education tool was also evaluated. We recruited participants at a health fair in a mall and an island-wide university event, through flyers, and convenience sampling. At the launch of the inflatable colon, we held a name-the-colon contest to engage community. The winning entry was “Kulu,” which is the CHamoru word for a conch shell and symbolizes a “call to action” to get screened for CRC. Results. A total of 201 participants completed a pre/post assessment. Majority of participants were CHamoru (40.8%) and Filipino (33.8%), female (65.0%), had a college degree (31.8%), and had health insurance (89.6%). Mean age was 36.6. Preliminary results at baseline indicate half of participants reported knowing what CRC (53.0%) and a polyp (50.5%) are. Overall, 72.4% reported knowing what a colonoscopy is and 42.4% indicated they knew what a stool test was. Prior to participating in the guided tour, 73.5% rated their general knowledge about CRC as neutral or unknowledgeable. At baseline, participants reported intent to discuss CRC screening with others (parents = 84.0%; spouses/partners = 90.3%). Conclusion. We hypothesize that using an inflatable colon to deliver CRC information: 1) increases CRC and related screening knowledge; 2) is a culturally appropriate way to provide CRC education; and 3) facilitates increased willingness to talk to others about CRC, especially among families. Pre-/post-test comparisons regarding CRC knowledge, willingness to talk to others about CRC, and intention to screen among persons 50 and above will be presented. Findings may provide insight toward more interactive CRC education for Pacific Islanders, and potentially improve CRC screening participation in Guam.

Citation Format: Tressa P. Diaz, Maurissa Sayama, Lilnabeth Somera, Angelina Mummert. “Kulu the Colon”: An assessment of a colorectal cancer education intervention in Guam [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B025.

Acculturation, Biculturalism and Cancer Risk and Preventive Behaviors Among Pacific Islander Immigrant Youths in Hawaii

Background: Culture is an important force which affects health behaviors linked to cancer risks among immigrants. Studies have demonstrated the process of acculturation can produce a form of stress that impact health negatively. On the other hand, research suggests that biculturalism, defined as the combining and practicing of customs from two cultures, may be a healthy approach to acculturation. Biculturalism is especially relevant for youth immigrants as their cultural identities are still developing. Pacific Islanders, a fastest growing populations in the US, often experience discrimination in the society at large and in the health care system. Pacific Islander youth in the US navigate between two cultural identities: their native culture as they live in a close-knit community that still maintains strong cultural norms and values, and the dominant American culture that they face once they step outside their community. This is one of the rare studies that examine the relationship between acculturation and cancer preventive behaviors among Pacific Islander youth. Aim: We aim to study the process through which biculturalism influences cancer risk and preventive behaviors such as smoking, sunscreen applications, physical activity and healthy eating among Pacific Islander youth immigrants in Hawaii. Specifically, we map the process of influence that links biculturalism to self-esteem and to these cancer risk and preventive behaviors. Methods: Using survey data from 284 Pacific Islander youth, we developed and tested a theoretically driven model that specifies the relationship among variables listed above. Results: Results show that self-esteem serves as an important mediator connecting biculturalism to cancer preventive behaviors. While biculturalism did not have a direct influence on behaviors and outcomes, it led to increased self-esteem which, in turn, directly influenced attitudes about sunscreen application, physical activity and healthy eating. However, there was neither direct nor indirect link between biculturalism and smoking. Conclusion: While numerous studies have shown links between biculturalism and health, not many studies focus on the specific process through which the influence is exerted. This study provides an important insight into the process through which biculturalism impacts cancer preventive behaviors among minority youth in America. Data from the study showed a clear relationship between biculturalism, self-esteem, their attitudes and behavior related to cancer prevention among Pacific Islander youth living in Hawaii. This study provides insights into potentially novel methods and interventions designed to increase cancer preventive behaviors among migrant youth by dually promoting adoption of U.S. cultural norms, while concurrently embracing an individual´s historic cultural identity.

Culture, Communication, and Cancer Risk Behaviors Among Pacific Islanders in Hawaii

Background: A priority of the National Cancer Institute (NCI) is to acquire, aggregate and integrate cancer control data that facilitates collaborations to address health disparities and communication inequalities. To better communicate cancer research to the public, the NCI developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance systems, HINTS nationally obtained data are not sufficient to address the behaviors of unique demographic and geographic subpopulations. US Pacific Islanders are one of the fastest growing population groups in the US, and cancer is the leading cause of death in this group. Limited knowledge about the cancer communication practices and risk behaviors of US Pacific Islanders drive the poor implementation of effective cancer prevention interventions. Aim: This study aims to document the prevalence and differences in the cancer relevant knowledge, attitudes, and information seeking practices of Pacific Islander populations residing in Hawaii. Specifically, we aim to expand HINTS assessment to native Hawaiians and recent migrant Marshallese and Chuukese populations in Hawaii. Methods: We conducted surveys with 352 native Hawaiians, 282 Chuukese, and 129 Marshallese residing in HI. We used Respondent Driven Sampling method (RDS) to recruit these geographically diffuse populations in HI. The survey included questions about basic knowledge, attitude and behavior about various cancers, detailed communication behaviors about health information, and cultural beliefs and practices. Results: Data show there are clear differences among the three ethnic groups across a variety of cancer-related attitudes, knowledge, behaviors and risk factors. For example, a larger proportion of Chuukese have BMIs that can be described as obese or morbidly obese compared with native Hawaiians. On the other hand, native Hawaiians are significantly more likely to smoke than Marshallese and Chuukese. These groups also differ significantly regarding the level of acculturation, religiosity, fatalism about cancer, and trust in medical professionals. Regarding communication, cell phone use was common with 75% of native Hawaiians, 80% of Marshallese and 88% of Chuukese having cell phones. This use of cellphone technology was in stark contrast to Internet use with only 45% of native Hawaiians, 49% of Marshallese and 27% of Chuukese reporting access to the Web. Conclusion: There is a need for cancer prevention programs for Pacific Islanders in Hawaii. An effective health program has to address their unique cultural beliefs and practices, and fit their unique communication ecology. This study provides new knowledge concerning the use of nonprobability based study sampling methods, and the role of culture in cancer-related communications in influencing cancer risk behaviors that may be generalizable to the growing number of migrant Pacific Islander populations living in the US.

Intravenous perfluorocarbon emulsion increases nitrogen washout after venous gas emboli in rabbits

Intravenous perfluorocarbon emulsion (IV-PFC) has been shown to provide hemodynamic protection from gas embolism (Venous-VGE or arterial-AGE). The objective of this study was to investigate the mechanism of PFC protection from controlled VGE by quantifying the effects of IV-PFC emulsion on pulmonary elimination of nitrogen (N2). All rabbits received an intravenous pretreatment of PFC emulsion (Oxygent, 2.7 g/kg) or saline, then either a continuous room air infusion (0.25 ml/kg for 10 minutes) or a bolus of air (0.8 ml/kg within 10 seconds) through the femoral vein. Expiratory N2 peaked higher with PFC infusion immediately after air injection. The recovery to baseline of end tidal N2 was faster for PFC-treated animals (40 +/- 4.7 vs. 58 +/- 6.5 minutes). In PFC-treated animals, expired CO2, O2, arterial pressure and central venous pressure returned to baseline faster than the saline group. This study demonstrated that PFC increased pulmonary N2 washout. Correspondingly, PFC treatment better preserved the animals' hemodynamics after VGE injury. The use of IV-PFC promises to be a breakthrough non-recompression therapy for gas embolism in the treatment of Decompression Sickness (DCS) and in surgery.

Intergenerational communication across cultures: young people's perceptions of conversations with family elders, non-family elders and same-age peers

Young adults from three Western (Canada, U.S.A., and New Zealand) and three East Asian (The Philippines, South Korea and Japan) nations completed a questionnaire regarding their perceptions of interactions with family elders, non-family elders, and same-age peers. Results showed that East Asians perceived family elders to be as accommodating as same-age peers, whereas Westerners perceived family elders as more accommodating than their same-age peers. Participants in both cultural blocks indicated an obligation to be most deferential towards non-family elders, followed by family elders, followed by same-age peers. Whereas both groups perceived interactions with same-age peers more positively than with the two older groups, the Western group perceived the older age groups more positively than did East Asians. Intergenerational communication is reportedly be more problematic than intragenerational communication and, consistent with previous findings, this pattern is more evident in East Asian nations on some variables.