2-1-1 research and program innovation
Human Papillomavirus Vaccine: 2-1-1 Helplines and Minority Parent Decision-Making

https://doi.org/10.1016/j.amepre.2012.09.003Get rights and content

Background

Research is needed to understand parental factors influencing human papillomavirus (HPV) vaccination, particularly in groups with a higher burden of cervical cancer.

Purpose

To determine correlates of HPV vaccination among a sample of low-income parents of age-eligible daughters (aged 9–17 years) who called the 2-1-1 Helpline. Secondary analyses describe potential differences in HPV vaccination correlates by Hispanic and black parent groups, in particular.

Methods

This 2009 cross-sectional feasibility survey of cancer prevention needs was conducted in Houston at the 2-1-1 Texas/United Way Helpline. In 2012, to examine the association between parental psychosocial, cognitive, and decisional factors and HPV vaccination uptake (one or two doses), bivariate and multivariable logistic regression analyses were conducted for minority parents and for Hispanic and black parent groups, separately.

Results

Lower rates of HPV vaccination uptake were reported among minority daughters of 2-1-1 callers (29% overall) compared with national and Texas rates. In final adjusted analysis, factors positively associated with HPV vaccination uptake included being offered the vaccination by a doctor or nurse, belief that the vaccine would prevent cervical cancer, and Hispanic ethnicity. Secondary analyses detected differences in factors associated with vaccination in Hispanic and black groups.

Conclusions

Findings indicate low levels of vaccination among 2-1-1 callers. Increased understanding of determinants of HPV vaccination in low-income minority groups can guide interventions to increase coverage. Because 2-1-1 informational and referral services networks reach populations considered medically underserved, 2-1-1 can serve as a community hub for informing development of and implementing approaches aimed at hard-to-reach groups.

Introduction

In 2012, a total of 12,170 U.S. women are expected to be diagnosed and 4220 deaths are expected from cervical cancer.1 Compared with non-Hispanic whites (NHWs), Hispanic and black women have higher cervical cancer incidence rates (70% and 39% higher than NHWs, respectively) and higher mortality rates (48% and 100% higher than NHWs, respectively).2, 3 Vaccination against human papillomavirus (HPV) provides an important prevention tool to help decrease cervical cancer in medically underserved populations. Although HPV does not pose a health problem for most people, persistent HPV infection is the primary cause of cervical cancer. For girls and young women (aged 9–26 years), recommended HPV vaccination can prevent infection from high-risk types that cause an estimated 70% of cervical cancers.4, 5

Since HPV vaccination recommendations were established, few studies have examined parental factors influencing vaccination uptake (one or two doses) among low-income minority populations. In a 2007 review of HPV vaccine acceptability among U.S. parents, Brewer and Fazekas6 identified 28 studies and reported that parents found the vaccine acceptable if (1) they believed it was effective; (2) a physician recommended it; and (3) they felt that the risk of HPV infection was likely. One study reported predictors of vaccine acceptability by race and ethnicity and found no differences.7

In a 2010 review of parents HPV vaccination acceptability, Fernandez et al.8 found parent populations had low knowledge of HPV; high willingness to vaccinate daughters (70%–85%); and varying acceptance of the vaccine related to health beliefs and attitudes. The Fernandez review also highlighted the dearth of studies examining differences in acceptability of vaccination across racial/ethnic groups.8 Since these reviews, additional studies conducted in the U.S. have examined racial/ethnic minority parents' HPV and HPV vaccination knowledge and awareness,9, 10 attitudes and beliefs regarding HPV vaccination,9, 10, 11, 12 and provider-related recommendations.9, 12

Because 2-1-1 helplines represent a unique opportunity to reach large numbers of medically underserved people,13 the current study examined parent-level factors associated with vaccination among a low-income minority population. This study also assessed the feasibility of partnering with the 2-1-1 Texas/United Way Helpline to conduct a cancer needs assessment survey of callers. Results from this feasibility study will inform larger studies, and ultimately, intervention program strategies that could be implemented through a 2-1-1 helpline-based program.

To identify parent-level factors associated with HPV vaccination in groups with a higher burden of cervical cancer, a survey was conducted of low-income parents of daughters (aged 9–17 years) identified through the Greater Houston Area 2-1-1 Helpline. This helpline serves primarily socioeconomically and medically vulnerable people seeking information to help meet basic needs (e.g., assistance with food, medical/prescriptions, utilities, or shelter).13, 14 To understand correlates of HPV vaccination among minority parents, the current study described minority parent-level correlates of HPV vaccination of daughters, and explored correlates of HPV vaccination by Hispanic and black groups separately.

Section snippets

The 2-1-1 Helpline Center and Study Participants

This cross-sectional HPV vaccination study was embedded in a larger cancer prevention pilot study conducted during a 6-week period (September to October 2009). The larger survey assessed cancer prevention needs of 2-1-1 callers in collaboration with the 2-1-1 Texas/United Way Helpline. Nationally, 2-1-1 helplines are staffed with professional information and referral specialists (specialists), trained to respond to callers' needs using computerized referral databases of local and affordable

Results

A total of 99 parent participants reported having a daughter aged 9–17 years living at home with them, 90% of whom reported their race/ethnicity. The majority of parents identified as Hispanic or black (47% and 43%, respectively), only 3.4% reported non-Hispanic white ethnicity, and 7% identified as Other. Most parents participating were women (n=73; 91%), and 43% of parents reported having no health insurance.

Among the Hispanic parents, 45% completed the survey in Spanish. Overall, 29% of

Discussion

Human papillomavirus vaccination uptake rates overall (29%), and among Hispanic (31%) and black (26%) girls, were similar to HPV vaccination uptake rates among Hispanic (33%) and black girls (24%) reported in a Los Angeles–based study10 conducted in a low-income minority population. In the current final adjusted multivariable analysis, Hispanic ethnicity, provider recommendation, and perceived efficacy of the vaccine to prevent cancer all increased the odds of daughters' vaccination. Among

References (19)

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