"Should I Give it to My Kids?": Factors that Influence HPV Vaccine Hesitancy Among African American Parents

PURPOSE

The purpose of our study was to describe the influences that impact vaccine hesitancy in African American parents who have previously delayed or denied vaccinating their children against HPV.

METHODS

We conducted three focus groups, approx. 90 minutes each. Participants were recruited from various community clinics and organizations in Michigan. Using thematic analysis and the Vaccine Hesitancy Determinants framework, we described the experiences of parents who have delayed or denied vaccinating their children against HPV.

RESULTS

Twenty parents participated in the focus groups; the majority of the parents had Medicaid (75%), were employed full-time (55%), and had some college education but no degree (50%). Several contextual factors influenced decision-making: historical events, perceptions of both pharmaceutical and governmental figures, and perceived discrimination based on race and socioeconomic status. Whether it was the result of mistrust due to the ongoing Flint water crisis or concern over the profit-driven industry of pharmaceutical companies, these parents were deeply mistrustful of the motivations behind vaccination programs. Parental beliefs and attitudes focused on ensuring the health and safety of their children, which involved being hesitant to vaccinate. Some parents were swayed by vaccination experiences of personal acquaintances, while others maintained their hesitancy status. Knowledge and awareness in this group were mixed regarding the HPV vaccine. Most struggled to articulate the purpose of the vaccine thoroughly and often refused to vaccinate their children. Meanwhile, only a few vaccine-specific issues were relevant in group discussions, such as vaccination schedule and provider recommendation. Some parents viewed weak recommendations as a subtle signal to not vaccinate their children, while others viewed too strong of a recommendation as a cause for concern.

CONCLUSION

Findings highlight parents' willingness to stick with their strong beliefs, despite recommendations from healthcare providers and personal acquaintances. Effective communications strategies are essential for health education and establishing a trustworthy patient-provider relationship.

Insulin autoantibodies at diagnosis of insulin-dependent diabetes: effect on the antibody response to insulin treatment

Insulin autoantibodies (IAA) are frequently found in newly diagnosed untreated insulin-dependent diabetics. We evaluated whether the insulin antibody response over the first year of treatment with insulin was different in individuals with IAA v those without IAA. One hundred five previously untreated type I diabetics were randomly assigned to treatment with either pure porcine or mixed bovine/porcine insulin. Twenty-one in each group had detectable IAA at diagnosis. Percent binding rose in all patients after commencing insulin therapy and was significantly greater in those with IAA at diagnosis irrespective of the type of insulin administered. The elevated binding in the IAA positive patients at all time points was equivalent to the binding that could be attributed to the insulin autoantibodies. Two different mechanisms could explain this greater insulin antibody binding during insulin therapy in the IAA positive patients. First, there may be summation of binding due to insulin autoantibodies and binding due to insulin antibodies formed in response to the exogenous insulin. Alternatively, the insulin antibodies formed in response to exogenous insulin could replace the IAA, with those individuals positive for IAA at diagnosis having a proportionately greater antibody response to injected insulin. Irrespective of the mechanism, patients with IAA at diagnosis develop higher insulin antibody measurements when subsequently treated with exogenous insulin.

Randomized prospective trial of pure porcine and conventional bovine/porcine insulin

Use of pure porcine insulin versus partially purified insulin of bovine/porcine origin might be expected to have certain clinical benefits, e.g., a lower incidence of skin reactions, a lower insulin dosage, better diabetes regulation, and greater preservation of endogenous insulin secretion. To test this hypothesis, we randomly assigned 112 newly diagnosed, untreated, insulin-dependent diabetic children to therapy with either pure porcine or partially purified bovine/porcine insulin. They were followed for 1 yr, data being available on at least 90 subjects at each visit. More skin reactions were found in the group treated with the bovine/porcine insulin. This insulin was of higher antigenicity, and binding of radiolabeled insulin (mean +/- SE) by serum from bovine/porcine insulin treatment was 35.5 +/- 2.6 versus 16.8 +/- 1.4% (P less than .001) for pure porcine insulin treatment 12 mo after initiation of insulin therapy. However, throughout the 12 mo of observation the levels of glycosylated hemoglobin, insulin dosage, fasting plasma glucose, and C-peptide concentration were similar for the groups. Reported incidences of hypoglycemia and nocturia were also similar. Thus, insulin-antibody formation and skin reactions were minimized by the use of pure porcine versus partially purified bovine/porcine insulin, but no other clinical advantages were apparent.

Puberty decreases insulin sensitivity

Puberty is commonly associated with an increase in insulin requirement in patients with insulin-dependent diabetes. To investigate whether this pubertal increase in insulin requirement is confined to diabetic subjects, we examined insulin responses during oral glucose tolerance testing with glucose loads per unit weight (1.75 g/kg) or unit surface area (55 g/m2), and insulin sensitivity via euglycemic-hyperinsulinemic clamp in prepubertal and pubertal children without diabetes. Irrespective of glucose dose, glucose tolerance testing elicited a threefold greater insulin response, but equivalent euglycemia, in pubertal versus prepubertal children (P less than 0.05). As assessed by the clamp procedure, prepubertal children were approximately 30% more sensitive than their pubertal counterparts (P less than 0.01). Insulin sensitivity correlated inversely with body mass index (r = -0.49, P less than 0.02), serum dehydroepiandrosterone sulphate concentration (r = -0.57, P less than 0.01), and log somatomedin C/insulinlike growth factor I (r = -0.45, P less than 0.05). We conclude that puberty is associated with decreased sensitivity to insulin that normally is compensated for by increased insulin secretion. Thus, in patients with insulin-dependent diabetes, an approximately 30% increase in insulin dosage should be anticipated with the onset of puberty.

Insulin antibodies in insulin-dependent diabetics before insulin treatment

A sensitive assay was used to measure the binding of iodine-125-labeled insulin in serum obtained from 112 newly diagnosed insulin-dependent diabetics before insulin treatment was initiated. Two groups of nondiabetics served as controls: children with a variety of diseases other than diabetes and nondiabetic siblings of insulin-dependent diabetics. Eighteen of the diabetics were found to have elevated binding and 36 were above the 95th percentile of control values. The insulin-binding protein is precipitated by antibody to human immunoglobulin G, has a displacement curve that is parallel and over the same concentration range as serum from long-standing insulin-dependent diabetics, and elutes from a Sephacryl S-300 column at the position of gamma globulin. These insulin antibodies are present in a large percentage of newly diagnosed, untreated diabetics and may be an immune marker of B-cell damage.