Latinos and Structural Racism

Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

BACKGROUND

Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles.

METHODS

We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9-17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination.

RESULTS

Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels.

CONCLUSION

Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.

COVID-19 and decreased asylum access: mother work, precarity and preocupación among Central American asylum-seekers in Los Angeles

In 2020, the public health response to the COVID-19 pandemic and the U.S. government's increased legal restrictions on asylum-seekers acted together to increase social, economic and legal precarity in the lives of Central American asylum-seeking mothers in Los Angeles. In this context, these asylum-seeking mothers discussed their intersectional precarities through the idiom of distress "preocupación", which signalled the concerns, worries, and fears they had in relation to the daily mother work of raising their children. Using ethnographic data collected during the COVID-19 pandemic, I examine how the intersectional precarities Central American asylum-seeking mothers faced necessitated protecting their children from their own preocupación. Through this, I argue that by using the analytic of preocupación it is possible to see exactly how racial and legal barriers to care increase precarity in the lives of asylum-seeking mothers in the U.S., and the detrimental impact that intersectional precarities have on asylum-seekers' mother work today.