Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles

doi:10.1016/j.vaccine.2014.11.032

Vaccine

Volume 33, Issue 2, 3 January 2015, Pages 289-293

https://doi.org/10.1016/j.vaccine.2014.11.032 Get rights and content

Abstract

Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.

Introduction

The benefits of the prophylactic human papillomavirus (HPV) vaccines will not be fully realized without high levels of coverage across all eligible populations. Despite the availability of the HPV vaccine since 2006, rates for initiation of the three dose series among adolescent girls in the U.S. hover at around 57% [1]. Ethnic minority women bear a disproportionate burden of cervical cancer in the U.S. [2]. Although data from the National Immunization Survey suggest ethnic minority adolescents may initiate the HPV vaccine at a higher rate than non-Latino whites [3], a number of other studies suggest HPV vaccine initiation rates among ethnic minorities may be lower than national estimates, at least in some settings [4], [5], [6], [7], [8].

A growing number of studies have assessed correlates of HPV vaccine uptake among adolescent girls [4], [9], [10], [11]. In prior studies, HPV and HPV vaccine awareness among caregivers have been found to be two of the strongest predictors of vaccine uptake among adolescent girls [5], [11], [12], [13], [14], [15]. These findings are consistent with numerous health behavior theories, which posit that knowledge, of which awareness is the most basic form, is a necessary condition for health behavior change [16], [17], [18]. Many of these prior studies, however, focus on national samples and provide little information about underserved populations or racial/ethnic minorities.

This study reports on data from a survey of mothers of vaccine-eligible girls in Los Angeles to assess rates and correlates of HPV vaccine initiation [5]. The purpose of this study was to identify correlates of HPV awareness, including demographics, health care access, general vaccine attitudes, and childhood vaccine history among mothers of adolescent girls eligible for the vaccine, for future intervention development.

Section snippets

Setting

The study was a collaboration between the University of California, Los Angeles (UCLA) and the Los Angeles County Department of Public Health, Office of Women's Health (OWH). The OWH operates a multi-language health education hotline targeting low-income, uninsured, and ethnic minority women in the county. OWH operates the telephone hotline in six languages (English, Spanish, Korean, Cantonese, Mandarin, Armenian), receiving approximately 10,000 calls per year from low-income women (<200% of

Results

Demographic information is displayed in Table 1. The study participants (n = 490) were almost exclusively foreign-born (88%) and about half were Latina (52%), 20% Chinese and 13% Korean. Women in the “other” race/ethnicity category (7%) reported being non-Hispanic white, multiracial, or from other Asian subgroups. Among foreign-born women, the mean number of years in the U.S. was 18. Nearly half of women had less than a high school diploma (47%), and the majority made less than $24,000 per year

Discussion

Results revealed that about one third of mothers in our sample were not aware of HPV, with a similar proportion not aware of the HPV vaccine. These levels of awareness are somewhat lower than other studies conducted around the same time. Dorell and colleagues [3] showed that among a national sample of caregivers for teens, 92% had heard of HPV and 85% had heard of the HPV vaccine. This finding suggests the need for efforts to enhance awareness as an important step in increasing use of the

Acknowledgements

We gratefully acknowledge the mothers who participated in the study and the Office of Women's Health hotline operators who conducted the telephone interviews. This work was supported by CDC/NCI UCLA Cancer Prevention and Control Research Network (U48 DP000056/SIP 16-04).

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

References (25)

R. Caskey et al.
Knowledge and early adoption of the HPV vaccine among girls and young women results of a national survey
J Adolesc Health
(2009)
S.L. Guerry et al.
Human papillomavirus vaccine initiation among adolescent girls in high-risk communities
Vaccine
(2011)
A. Gelman et al.
Racial disparities in human papillomavirus vaccination: does access matter?
J Adolesc Health
(2013)
S.J. Kessels et al.
Factors associated with HPV vaccine uptake in teenage girls: a systematic review
Vaccine
(2012)
M.A. Gerend et al.
Parental response to human papillomavirus vaccine availability: uptake and intentions
J Adolesc Health
(2009)
A.F. Dempsey et al.
Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus
Ann Epidemiol
(2009)
A.E. Maxwell et al.
Constructing a theoretically based set of measures for liver cancer control research studies
Prev Med
(2010)
L.Y. Fu et al.
Educational interventions to increase HPV vaccination acceptance: a systematic review
Vaccine
(2014)
L.M. Kester et al.
The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18–26 year old young adults
Gynecol Oncol
(2014)
L.D. Elam-Evans et al.
National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2013
MMWR Morb Mortal Wkly Rep
(2014)

American Cancer Society

Cancer facts & figures

(2014)

C.G. Dorell et al.

Human papillomavirus vaccination series initiation and completion, 2008–2009

Pediatrics

(2011)

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Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood
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These interviews focused on perceived patient and provider knowledge and attitudes about HPV vaccination, current practices regarding discussing the HPV vaccine with patients, and perceived patient and health care system barriers and facilitators to HPV vaccination (Table 1). Domains assessed during interviews were guided by prior published literature, including our own HPV research [39–42]. Providers and clinic staff interviews lasted on average 30 min, and participants received a $25 gift card.
Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university.
We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination.
Many young adults cited their parents’ views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine’s benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers’ vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.
Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.
Human Papillomavirus (HPV): unawareness of the causal role of HPV infection in cervical cancer, HPV vaccine availability, and HPV vaccine uptake among female schoolteachers in a Middle Eastern country
2021, Journal of Infection and Public Health
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The proportion (24.5%) of the participants in this study who were aware of HPV as a sexually transmissible infection is nearly comparable with the similar proportions from above noted neighboring countries in the region. In contrast however, unawareness of HPV causal role in cervical cancer and its sexual transmission was much lower among schoolteachers in Vermont [18], Los Angeles, USA [19] and Italy [20], wherein, the corresponding proportions of unawareness of the causal role of HPV in cervical cancer and HPV being a sexually transmissible infection were less than 40%. These high levels of unawareness of HPV as a causal infection in cervical cancer and HPV being a sexually transmissible infection among the participants in this study can be explained by the lack of a reproductive health education component in public health programs in Kuwait.
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. This cross-sectional study among female schoolteachers assessed the prevalence of i) unawareness of HPV infection’s causal role in cervical cancer; ii) unawareness of HPV vaccine availability and iii) examined the sociodemographic variables associated both the outcome variables.
This cross-sectional study was conducted among female schoolteachers employed in public and private sectors schools in Kuwait using a structured questionnaire for data collection. Prevalence of each of the outcome variables was computed. Multivariable logistic regression analyses were used to evaluate independent predictors of two dependent variables.
A total 1341 female schoolteachers were enrolled. Of the participants, 60% were unaware of HPV causal role in cervical cancer and 88% were unaware of HPV vaccine availability. Among those who were aware of HPV vaccine availability, 83.8% were unvaccinated. Multivariable logistic regression (MLR) model showed that 20–29 years old participants or those with low family income (< 500 KD/month) were significantly (p < 0.05) more likely to be unaware of HPV causal role in cervical cancer. Moreover, participants with family/ personal history of cervical cancer were significantly (p < 0.05) less likely to be unaware of HPV role in causation of cervical cancer. A separate MLR model revealed that the participants were significantly more likely to be unaware of HPV vaccine availability if they were Kuwaiti nationals or non-Kuwaiti Arabs (p < 0.05), employed in public schools (p = 0.003) or less likely to be unaware if they had personal or family history of cervical cancer (p < 0.001).
High prevalences of unawareness of causal role of HPV in cervical cancer and unawareness of HPV vaccine availability were recorded. Targeted education among identified sociodemographic groups with high levels of unawareness is warranted. If undertaken, future studies may evaluate the impact of recommended efforts.
Knowledge and attitudes toward HPV infection and vaccination among immigrants and refugees in Italy
2018, Vaccine
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Indeed, approximately 650,000 peoples arrived in Italy in the last five years and more than 5,000,000 immigrants currently live accounting for 8.3% of the resident population [18,19]; whereas, over 2,000,000 refugees are in Europe among which 131,000 live in Italy [18]. To the best of our knowledge, the knowledge and attitudes regarding HPV infection and its vaccination among immigrants and refugees have not been investigated extensively in the literature [20–23], and no published research has provided information on these vulnerable populations in Italy. It is important to address this gap where such data was not available and understanding this topic may provide critical guidance to public health practitioners for successfully develop preventive practices.
The objectives of the present cross-sectional study were to investigate the level of knowledge and attitudes regarding Human papillomavirus (HPV) infection and its vaccination and to understand the impact of different determinants among immigrants and refugees in Italy.
Between September 2016 and March 2018, a total of 519 potential participants were randomly recruited. The information was collected through a questionnaire administered by two researchers.
Only 15.9% reported that they had heard of HPV infection before completing the survey and 83.8% of them were aware that the infection could be transmitted through sexual intercourses, 32.3% that it can lead to cervical cancer, 22% to warts, 16.2% to penile cancer, 13.2% to oral cancer, 39.7% that cervical cancer is a very severe disease, 47.1% that receiving the vaccine could protect against the infection, and 44.1% that a vaccine against HPV is available in Italy. Females, those who originated from Eastern Europe, Asia and South America, those who lived in a house compared to those who lived in a street, and those who had 1–10 years and 11 or more years of education compared to those illiterate were more likely to have heard about the HPV infection before completing the survey. Only 3 participants (0.7%) received the HPV vaccination. Out of the unvaccinated who had heard of HPV, 50.7% and 59% of those between the ages of 12 and 26 and of those who had at least one child aged 12–26 years, were willing to receive vaccination for themselves as well as their children.
The results underscored the necessity to develop health education and promotion aimed at improving the knowledge and vaccination practice in immigrants and refugees.
Disparities in parental human papillomavirus (HPV) vaccine awareness and uptake among adolescents
2018, Vaccine
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HPV vaccine uptake was defined as having received at least one shot. Other measures, informed by literature and prior work [10–12], included parental and child demographics and child’s access to health care. All statistical analyses employed weighted data to account for design effects.
Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13–17) and HPV vaccine uptake (≥1 dose) among girls (ages 13–17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware. HPV vaccine initiation among daughters nearly doubled from 25% in 2007 to 48% in 2011, and girls who were older, uninsured, and had access-related barriers showed the largest improvements. In 2011, daughters who were younger and who had older and African American parents were at risk for low uptake. Thus, initiatives targeting male and younger adolescents, culturally-relevant information, and access to vaccination may help to reduce identified disparities.
Human papillomavirus vaccine trials and tribulations Vaccine efficacy
2015, Journal of the American Academy of Dermatology
Citation Excerpt :
Starting in 2014, health plans on the health insurance exchanges must also provide ACIP-recommended vaccinations at no cost to beneficiaries.35 The lowest immunization rates in the United States are currently among low-income groups.36 An ever-increasing number of countries are integrating HPV vaccinations into their national health programs (Table III).37,38
As of December 2014, there were 3 approved vaccines for human papillomavirus (HPV): bivalent Cervarix (GlaxoSmithKline, New York, NY), quadrivalent Gardasil (Merck and Co, Kenilworth, NJ), and 9-valent Gardasil-9 (Merck and Co). The average cost per dose is $120, with a recommended 3-dose course. The quadrivalent vaccine is the most widely administered worldwide. As with the bivalent and 9-valent vaccines, the vaccine is considered safe, although concerns have been raised. In addition to immunization against the targeted HPV types, there is evidence that there is cross protection against other types of HPV. This continuing medical education review evaluates the differences in vaccines that are currently on the market; part II focuses on the cost-effectiveness of vaccination, the HPV vaccination programs currently instituted around the globe, efficacy, and safety.
Drivers for human papillomavirus vaccination in Valencia (Spain)
2018, Gaceta Sanitaria
Citation Excerpt :
The same occurs with cervical screening, since immigrant women do not undergo as many smear tests as native women.17 One may also associate these differences with the socioeconomic status of immigrant families and not just with their cultural beliefs.18 However, this is not the case here as there is free access to the HPV vaccine in Valencia.
To describe the drivers associated with HPV vaccination in adolescent girls and their parent's opinion on the vaccine.
We conducted an observational and cross-sectional study on adolescent girls and their parents in Valencia (Spain), between September 2011 and June 2012. A consultation was made at a random sample of schools of the 14-year-old girls that should have received the vaccine in the free vaccination programme. We ran a personal survey on knowledge and attitudes regarding HPV infection and the vaccine. A binary logistic regression model was performed to determine which factors were most associated with vaccination.
The survey was run on a binomial of 1,278 girls/mothers in 31 schools, to which 833 girls and their mothers responded (64.0%). The factors associated with vaccination were: country of origin of the families (adjusted OR [aOR]: 0.49; 95% confidence interval [95%CI]: 0.24-0.98), civil status of the parents (aOR: 0.33; 95%CI: 0.13-0.81), knowledge/beliefs about the vaccine when the source of information was the nurse (aOR: 1.83; 95%CI: 1.01-3.35), information source about the vaccine (aOR: 2.32; 95%CI: 1.37-3.92), preventive health centre visits (aOR: 2.1; 95%CI: 1.10-4.07), and nurse advice (aOR: 6.6; 95%CI: 3.19-13.56).
The main factor associated with HPV vaccination was the advice of health professionals. Therefore, the most effective interventions to improve vaccination coverage should focus on health professionals.
Describir qué factores se asocian a la vacunación contra el virus del papiloma humano (VPH) en adolescentes y la opinión de sus padres/madres sobre dicha vacuna.
Se llevó a cabo un estudio observacional y transversal en chicas adolescentes y sus progenitores en Valencia (España), entre septiembre de 2011 y junio de 2012. Se realizaron consultas a las niñas de 14 años que tendrían que haber sido vacunadas dentro del programa de vacunación gratuita, en una muestra aleatoria de colegios. Se preguntó sobre conocimientos y actitud respecto a la infección por el VPH y la vacuna, mediante entrevista personal. Se llevó a cabo un modelo de regresión logística binaria para determinar qué factores estaban más asociados con la vacunación.
Se entrevistó a 1278 binomios chica/madre, con una tasa de respuesta del 64,0% (833). Los factores asociados a la vacunación fueron el país de origen de las familias (odds ratio ajustada [ORa]: 0,49; intervalo de confianza del 95% [IC95%]: 0,24-0,98), el estado civil de los progenitores (ORa: 0,33; IC95%: 0,13-0,81), los conocimientos/creencias sobre la vacuna cuando la principal fuente de información fue la enfermera (ORa: 1,83; IC95%: 1,01-3,35), la fuente de información sobre la vacuna (ORa: 2,32; IC95%: 1,37-3,92), las visitas preventivas al centro de salud (ORa: 2,12; IC95%: 1,10-4,07) y el consejo de la enfermera (ORa: 6,57; IC95%: 3,19-13,56).
El principal factor asociado a la vacuna del VPH fue el consejo del personal sanitario, por lo que las intervenciones para aumentar la cobertura vacunal deben centrarse en este colectivo.

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¹: Present address: Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ 08903, USA.

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Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles

Abstract

Introduction

Section snippets

Setting

Results

Discussion

Acknowledgements

J Adolesc Health

Vaccine

J Adolesc Health

Vaccine

J Adolesc Health

Ann Epidemiol

Prev Med

Vaccine

Gynecol Oncol

National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2013

MMWR Morb Mortal Wkly Rep

Cancer facts & figures

Human papillomavirus vaccination series initiation and completion, 2008–2009

Pediatrics