Human Papillomavirus Vaccine Hesitancy in the United States

Although the US Advisory Committee on Immunization Practices recommends vaccinating adolescents against the human papillomavirus (HPV) to prevent HPV-associated cancers, vaccine initiation and completion rates are suboptimal. Parental and provider hesitancy contributes significantly to low HPV vaccine uptake. This review describes sources of HPV vaccine hesitancy using a World Health Organization framework that categorizes determinants of vaccine hesitancy as follows: contextual factors (historical, sociocultural, environmental, or political factors), individual and group factors (personal perception or influences of the social/peer environment), and vaccine/vaccination-specific issues (directly related to vaccine or vaccination).

Rural Latino Men’s Experiences and Attitudes Toward Health: A Pilot Photovoice Study

Much of the research regarding Latino men’s health tends to focus on specific health outcomes (e.g., HIV or diabetes). Few studies have examined how Latino men perceive factors that influence their health and/or health-related behaviors. This study explored rural Latino men’s experiences and attitudes toward health, using photovoice, in the context of a community-based participatory research partnership. We recruited nine Latino men living in a small town in Southeastern Iowa. Four to nine men attended four sessions and led a community forum. All the men were foreign-born, identified as Latino, aged between 34 and 67 years, and had lived in the United States for at least 7 years. Five themes were identified: (a) cultural conflict, (b) too much and discordant information, (c) lifestyles conflict, (d) sacrifice, and (e) family connectedness. An important implication of this study derives from familial and community connections and sacrifice. Feeling disconnected from family may impact physical and mental health and health-promoting behaviors. Future research should explore ways to inform community- and family-level interventions to connect rural Latino men more strongly to their family and local community and help them to take better control of their health.

Factors Associated with HPV Vaccine Adherence among Latino/a Adolescents in a Rural, Texas-Mexico Border County

Objective

Completion of human papillomavirus (HPV) vaccine series among Texas Hispanic adolescents is low compared to national data. We examined the association between HPV vaccine initiation and completion among Hispanic adolescents in a rural, Texas-Mexico border county and specific individual and neighborhood-level characteristics.

Design

Cross-sectional analysis of data from a broader cancer prevention program.

Setting

Underserved colonias communities in a Texas-Mexico border county.

Participants

Hispanic mothers or caregivers (n=712) and adolescents aged 11-17 years (n=1120) linked to publicly available data about their neighborhood.

Main Outcome Measures

HPV vaccine adherence (ie, initiation and completion) as reported in either the Texas Immunization Registry or adolescents' electronic medical records, measured at the end of the cancer prevention program.

Methods

Logit and multi-level mixed-effects logistic regression of individual- and neighborhood-level data.

Results

Factors associated with HPV vaccine initiation and completion were female gender (P<.01), adolescent insurance status (P<.001), and receipt of required vaccines (P<.001). After controlling for neighborhood-level characteristics, only receipt of required vaccines remained significant.

Conclusions

Findings indicate a relationship between Hispanic adolescents' receiving the required vaccine series for school admission and HPV vaccine initiation and completion. In resource-limited settings like federally qualified health centers, further efforts should focus on implementing best practices at both the provider level (eg, education on bundled vaccine recommendation) and practice-level (eg, outreach and support by trained immunization navigators).

A qualitative descriptive study of providers’ perspectives on human papillomavirus vaccine administration among Latino/a adolescents in South Texas clinics: barriers and facilitators

Background

South Texas Latinas experience higher cervical cancer incidence and mortality compared to Latinas nationwide. Despite the availability of effective human papillomavirus vaccines, South Texas Latino/a adolescents sub-optimally complete the series. Research shows provider recommendation strongly predicts vaccine uptake, but minority adolescents are less likely to report that their provider recommended the vaccine and series completion. There is also scant information on the HPV vaccine administration process in clinic practices providing vaccination services to Latino adolescents with limited access to healthcare resources. The purpose of the study was to describe providers’ experience with administering the HPV vaccine to Latino/a patients in their practices.

Methods

The study used qualitative description to describe the experience of 15 South Texas healthcare providers (doctors and nurses) with the process of HPV vaccine administration in their practices. We conducted open ended, audio-recorded interviews, which were subsequently transcribed verbatim and uploaded into Atlas.(ti) 7.0 for analysis. The interviews yielded detailed descriptions of barriers and facilitators that could potentially impact HPV vaccine uptake.

Results

Providers identified parental exposure to provider recommendation as enhancing HPV acceptance and existing policies and implementation of evidence-based practices as facilitators of HPV vaccine uptake. Barriers ranged from parental fears of adolescent sexual activity and potential vaccine side effects to lack of transportation and the cost of the vaccine.

Conclusion

These findings reflect barriers and facilitators to administering the HPV vaccine previously identified and also highlight issues unique to the situation among Latinos in South Texas. Implications include the need to design and implement efforts to improve provider-parent communication and enhance parental and adolescent patients’ understanding of and confidence in the HPV vaccine. Furthermore, policy changes are needed to rectify organizational/structural challenges to HPV vaccine administration.

Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults

Background: Gendered perspectives may be particularly important in shaping norms and values around HPV and HPV vaccination, as previous research suggests that sexuality taboos (e.g. promiscuity) may contribute to low perceived risk among adolescent and young adult Hispanic females. However, research to date focuses primarily on Hispanic mothers, adolescent females, and women of HPV vaccine-eligible age. Hispanic father's perspectives are relatively unknown despite father's important role in shaping norms for their female children. Objective: To close this gap, this study examines gendered perspectives in knowledge, beliefs, and attitudes about HPV and HPV vaccination from Hispanic parents (mothers and fathers), women of vaccine-eligible age (18-26 years old), and women eligible for Pap Test screening (>26 years old) living in two counties along the Texas-Mexico border. Design: We conducted eight focus groups. Research staff transcribed audio recordings verbatim and uploaded them into Atlas(ti) 5.0 for analysis. The research team analyzed the data for content, meaning, patterns and themes using the constant comparison approach. Results: Perspectives were highly gendered. Women's (all groups combined) beliefs focused on misconceptions around how the HPV virus is contracted (e.g. toilet surfaces). Women also linked HPV-related sexual risk to adultery and indiscretion of male partners. Fathers (men) were more likely to link risk to female promiscuity. Fathers also worried that HPV vaccination might increase promiscuity. All groups believe that HPV vaccination is a way to protect Hispanic females in the face of beliefs around sexual behavior and risk of contracting HPV. Conclusion: Results suggest gendered differences in risk beliefs concerning HPV among Hispanics living along the Texas-Mexico border. Researchers can use these findings to address barriers to HPV vaccination, as well as to create culturally appropriate prevention messages that may help reduce disparities in HPV among Hispanic women.

Abstract D029: What do veterans ages 27 years and older know and think about the HPV vaccine?

Objective. The purpose of this cross-sectional study was to examine HPV-related awareness, knowledge, beliefs, and risk factors among Veterans ages 27 years and older. Methods. We used data from a subsample of 167 Veterans who responded to the 2017 Health Information National Trends Survey (HINTS) to conduct this cross-sectional study. HPV vaccine awareness and beliefs were our primary outcomes of interest. HPV-related cancer risk factors (i.e., cigarette smoking, socioeconomic status) were our secondary outcomes of interest. HPV awareness and knowledge were also examined. Proportions with 95% confidence intervals were performed using Stata/SE version 15.1 (College Station, TX, USA). Results. All of the Veterans who responded to the 2017 HINTS were ages 27 years or older. Most were non-Hispanic White (80%, 73-88%); heterosexual, or straight (97%, 94-99%); male sex (89%, 85-94%); and had an annual household income greater than $50,000 (67%, 57-78%). While almost half had smoked combustible cigarettes in past (49%, 39-60%) and some (15%, 7-24%) still smoked combustible cigarettes, the majority had never (&lt;1-2 lifetime) smoked electronic cigarettes (82%, 73-91%). About half had heard of the HPV vaccine (52%, 40-64%), of which most were ambivalent about whether or not the HPV vaccine was effective at preventing cervical cancer (72%, 61-84%). Although 63% (52-74%) had heard of HPV, mean HPV knowledge scores (2.0±0.3) were low (range: 0-6). Conclusions. Although the Food and Drug Administration (FDA) has approved the HPV vaccine for use among adults ages 27-45 years, little is known about what adults ages 27 years and older in the general population know and think about the HPV vaccine. Even more concerning is the fact that almost twice as many of the Civilians (N=1,341) who completed the 2017 HINTS had never (&lt;100 lifetime) smoked combustible cigarettes (61%, 56-66%). Similarly, among the 1,341 Civilians who completed the 2017 HINTS were more aware of HPV (76%, 72-80%) and the HPV vaccine (73%, 69-77%); had higher HPV knowledge scores (2.6±0.01); and were less ambivalent about whether or not the HPV vaccine was effective at preventing cervical cancer (62%, 59-66%). Increasing HPV-related awareness and knowledge, promoting positive beliefs about the HPV vaccine, and reducing modifiable HPV-related cancer risk factors (i.e., cigarette smoking) will be necessary first steps to increasing HPV vaccination among Veterans ages 27 years when/if clinical practice guidelines change in the future as a result of the FDA approval for HPV vaccine use among adults ages 27-45 years.

Citation Format: Lisa T Wigfall, Susana Ramirez, Yamile Molina, Nynikka Palmer, Angelica M Roncancio, Daisy Y Morales-Campos. What do veterans ages 27 years and older know and think about the HPV vaccine? [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 D029.

Abstract C53: Human papillomavirus (HPV) and cervical cancer: Exploring knowledge, attitudes, and cultural taboos among Mexican American families along the Texas-Mexico border

Background: Hispanic women living along the Texas-Mexico border have higher cervical cancer mortality and incidence rates compared to other Hispanic women in the U.S. The human papillomavirus (HPV) causes the majority of cervical cancers. Although cervical cancer can be prevented through HPV vaccination and prevented or detected early through Pap test screening and follow-up treatment, they are all underutilized by Hispanic females. Research indicates that beliefs, misconceptions, and taboos regarding sexuality may contribute to the low perceived risk for HPV and cervical cancer, thus contributing to the underutilization of vaccination and Pap test screening. Since beliefs are often transmitted through parents, it is critical to elucidate parents' and young women's (aged 18-26 years) beliefs about HPV and cervical cancer. In this study, we explored knowledge, attitudes, and perceptions about HPV and cervical cancer among Hispanic parents and young women living along the Texas-Mexico border.

Methods: We conducted eight focus groups in two counties along the Texas-Mexico border. Research staff recruited family members - fathers, mothers, and young women (aged 18-26 years) who were eligible for HPV catch-up vaccination - from local community centers, health centers, and colleges. Research staff audio-recorded focus groups for accuracy, transcribed recordings word-for-word, and uploaded transcripts into Atlas(ti) 5.0 for analysis. After open and axial coding, the research team analyzed the data for content, meaning, patterns, frequency, and themes by applying the constant comparison method to guide analysis and generation of themes.

Results: Although misconceptions existed across all participant groups, the type of misconception varied. Mothers, fathers, and young women held different beliefs. Misconceptions among parents centered heavily on sexual risk with fathers linking HPV risk to promiscuity. On the other hand, mothers linked HPV risk to adultery and indiscretion of male partners. Young women's beliefs were about transmission of the virus via unclean surfaces and beliefs that medications can cure HPV.

Conclusions: Results uncovered important differences in knowledge and risk beliefs concerning HPV and cervical cancer among Hispanic parents and young women living along the Texas Mexico border. Our findings highlight critical knowledge areas that can be addressed through interventions to overcome barriers to HPV prevention in Hispanic women, as well as to create culturally appropriate prevention messages that may ultimately help reduce disparities in HPV and cervical cancer among Hispanic women along the Texas-Mexico border.

Citation Format: Daisy Y. Morales-Campos, Shedra Amy Snipes, Maria E. Fernandez. Human papillomavirus (HPV) and cervical cancer: Exploring knowledge, attitudes, and cultural taboos among Mexican American families along the Texas-Mexico border. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C53.

Examining differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between U.S. Hispanic and island Puerto Rican women

BACKGROUND

In 2015, only 42% of Puerto Rican (PR) girls aged 13-17 and 44% of U.S. Hispanic girls aged 13-17 were vaccinated with all three Human Papillomavirus (HPV) vaccine doses; These percentages were far lower than the Healthy People 2020 goal of 80% of girls aged 13-15 the Healthy People 2020 goal of 80%. The purpose of this study was to examine potential differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between a population-based sample of U.S. Hispanic and island Puerto Rican women.

METHODS

We restricted our analyses to female respondents from the Health Information National Trends Survey (HINTS) 2007 (n=375; U.S. Hispanic) and HINTS Puerto Rico 2009 (n=417; PR). Using the Wald chi-square test, we assessed if there were significant differences in HPV awareness and knowledge and HPV vaccine awareness and acceptability between U.S. Hispanic and island PR women. We then utilized logistic or multinomial regression to control for covariates on significant outcomes.

RESULTS

Both groups of Hispanic women were highly knowledgeable that HPV causes cancer (89.2% in both samples) and that HPV is a sexually transmitted infection (78.1% [U.S. Hispanics] and 84.7% [PR]). Less than 10% of both groups recognized that HPV can clear on its own without treatment. Island PR women had significantly higher HPV vaccine awareness (66.9% vs. 61.0%; Wald X² F(1, 97) = 16.03, p < .001) and were more accepting of the HPV vaccine for a real or hypothetical daughter, compared to U.S. Hispanic women (74.8% vs. 56.1%; Wald X² F(2, 96) = 7.18, p < .001). However, after controlling for sociodemographic variables and survey group, there was no longer a difference between the two groups of women and HPV vaccine awareness (AOR = .53; 95% CI = .23, 1.24). Moreover, after controlled analysis, island PR women were significantly less likely to have their hypothetical daughter get the HPV vaccine, compared to U.S. Hispanic women (AOR = 0.26; 95% CI = .08, .81).

CONCLUSIONS

Future research focused on factors contributing to differences and similarities in HPV knowledge and awareness and HPV vaccine awareness and acceptability between these two groups of Hispanic women is warranted. Findings may assist in developing health education programs and media to promote HPV vaccination among both groups.

Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border

Few Texas Latino girls initiate and complete the human papillomavirus (HPV) vaccine series, but few studies have examined predictors of initiation and completion in this group. Mothers are crucial to vaccine uptake. Using self-reported data from mothers of unvaccinated girls (n = 317), we examined the association between predictors (HPV and HPV vaccine knowledge, vaccine self-efficacy) and outcomes (initiation and completion). Despite an increase in HPV and HPV vaccine knowledge from baseline to follow-up (n = 195), we found no association between the predictors and the outcomes. Findings showed that health insurance status and study group participation (Entre Madre e Hija program or brochure only) were associated with initiation and completion.

Abstract B90: Predictors of HPV vaccine initiation and completion among Hispanic mothers of 11-17 year old daughters living along the Texas-Mexico border

Background: Cervical cancer incidence and mortality are higher for Hispanic women along the Texas-Mexico border than for other female population groups. Incidence could be reduced if teenaged Hispanic girls received the HPV vaccine before they became sexually active. However, few Hispanic girls compared to U.S. girls receive all three HPV vaccine doses (31% vs 36%), which prevent cervical cancer. Mothers are crucial to the success of HPV vaccine uptake efforts, but few studies have examined predictors of vaccine initiation and completion. The purpose of this study is to assess predictors (socio-demographics, HPV and vaccine knowledge, and vaccine self-efficacy) of vaccine initiation and completion.

Methods: We utilized baseline data from an outreach and education program utilizing promotoras and peer educators to deliver health education to mothers and daughters to increase HPV knowledge and promote HPV immunization. Our analyses utilized data from mothers of never vaccinated girls (n=371) to examine the association between the predictors and vaccine initiation and completion. To control for potential confounders, we conducted multivariable logistic regression analyses.

Results: Findings showed both health insurance (Initiators AOR: 0.27; 95% CI= .09, .79; Completers AOR: 0.29; 95% CI= .10, .83) and program status (Initiators AOR: 3.04; 95% CI= 1.76, 5.26; Completers AOR: 2.21; 95% CI= 1.27, 3.58) were associated with HPV vaccine initiation and completion among mothers. Results also showed preferred language (AOR: 0.15; 95% CI= .04, .53) and health status (AOR: 0.52; 95% CI= .29, .92) were associated with series initiation.

Conclusions: Findings suggest mothers who spoke English, had health insurance, and reported having good health were at lower odds of vaccine initiation. Also, mothers with health insurance also had lower odds of series completion. Mothers who participated in the program compared to the brochure only group were more likely to initiate and complete the vaccine series. These findings assist in identifying appropriate intervention strategies to enhance vaccine initiation in border communities at risk for cervical cancer.

Citation Format: Daisy Y. Morales-Campos, Deborah A. Parra-Medina. Predictors of HPV vaccine initiation and completion among Hispanic mothers of 11-17 year old daughters living along the Texas-Mexico border. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B90.

Abstract B88: Examining differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanic and island Puerto Rican women

Background: Despite having guidelines recommending vaccination against the human papillomavirus (HPV) and widespread coverage for the vaccine, HPV vaccination rates among U.S. Hispanic and island Puerto Rican (PR) girls are low. In 2012, only 16% of PR girls aged 11–18 and 42% of U.S. Hispanic girls aged 13-17 were vaccinated with all three HPV vaccine doses; far fewer than the Healthy People 2020 goal of 80%. Parents are crucial to the success of HPV vaccine uptake efforts. Few studies focusing on parents have examined possible differences in HPV knowledge and vaccine acceptability within ethnic groups. The purpose of the study is to assess potential differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanic and island PR women.

Methods: We utilized data from the Health Information National Trends Survey (HINTS) 2007 and HINTS Puerto Rico 2009. For the current study, we restricted our analyses to female respondents in both surveys for a total sample of 792 women (n = 375; U.S. Hispanic HINTS 2007 and n = 417; Puerto Rican HINTS-PR 2009). Using the Wald chi-square test, we assessed if there were significant differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanics and island PR women.

Results: Island PR women had significantly higher HPV vaccine awareness (66.9% vs. 61.0%; Wald X2 F(1, 97) = 16.03, p &lt; .001) and were more accepting of the HPV vaccine for a real or hypothetical daughter (74.8% vs. 56.1%; Wald X2 F(2, 96) = 7.18, p &lt; .001) compared to U.S. Hispanic women. Both groups were highly knowledgeable that HPV causes cancer (89.2% in both samples) and HPV is a sexually transmitted infection (78.1% [U.S. Hispanics] and 84.7% [PR]). Less than 10% of both groups recognized that HPV can go away on its own without treatment.

Conclusions: Our study found that island PR women were more aware of and accepting of the HPV vaccine when compared to U.S. Hispanic women. Future research should further explore these in-group differences to determine what in the PR socio-cultural context or environment may have led to higher HPV vaccine awareness and acceptability. Findings may also assist in developing culturally appropriate health education programs and media to promote HPV vaccination among both groups.

Citation Format: Daisy Y. Morales-Campos, Robin C. Vanderpool. Examining differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanic and island Puerto Rican women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B88.

Breast, Cervical, and Colorectal Cancer Education and Navigation

Now that cancer has surpassed heart disease as the top cause of death for Hispanics in the United States, it is even more critical to focus on early detection of cancer in this population. We report the results of a theory-driven education-plus-navigation pilot intervention delivered by bilingual, bicultural community health workers (CHWs) with the goal of increasing cancer screening rates and knowledge among low-income Latinas. CHWs enrolled 691 eligible women, ages 18 to 75 years, considered rarely or never screened for breast, cervical, and colorectal cancer. Eligible women were scheduled for an education session and offered health care navigation support with appointment scheduling and reminder/follow-up calls. CHWs provided education to 535 (77%) eligible women, and arranged mammograms, Pap tests, or stool blood tests for 174 (25%) participants, with another 94 (14%) placed on a waiting list at a local health center. Statistically significant positive changes on knowledge of screening guidelines for breast, cervical, and colorectal cancer, and beliefs/attitudes regarding early detection were observed from pre- to posttest among eligible women who attended an educational session. Results highlight the effectiveness of CHW-directed interventions in recruiting individuals for programs, educating them, and influencing cancer knowledge and screening behavior.

Promotora Outreach, Education and Navigation Support for HPV Vaccination to Hispanic Women with Unvaccinated Daughters

Cervical cancer disparities persist in the predominantly Hispanic population of South Texas, and Hispanic girls are less likely to initiate and complete the three-dose human papillomavirus (HPV) vaccine series. Culturally relevant interventions are needed to eliminate these disparities and improve HPV vaccine initiation and completion. We enrolled 372 Hispanic women from South Texas' Cameron and Hidalgo counties with a daughter, aged 11-17, who had not received HPV vaccine. All participants received an HPV vaccine educational brochure in their preferred language (English or Spanish) and were invited to participate in the Entre Madre e Hija (EMH) program, a culturally relevant cervical cancer prevention program. EMH participants (n = 257) received group health education, referral and navigation support from a promotora (a trained, culturally competent community health worker). Those who declined participation in EMH received the brochure only (n = 115). Eighty-four percent of enrolled participants initiated the HPV vaccine, and no differences were observed between EMH program and brochure-only participants. Compared to brochure-only participants, EMH participants were more likely to complete the vaccine series [adjusted odds ratio (adj. OR) = 2.24, 95% CI (1.25, 4.02)]. In addition, participants who were employed and insured had lower odds of completing the vaccine series [adj. OR = 0.45, 95% CI (0.21-0.96); adj. OR = 0.36, 95% CI (0.13-0.98), respectively]. All enrolled participants had high vaccine initiation rates (>80%); however, EMH program participants were more likely to complete the vaccine series. HPV vaccine promotion efforts that include referral and navigation support in addition to education show promise.

Picture this!: using participatory photo mapping with Hispanic girls

Hispanic girls are burdened with high levels of obesity and are less active than the general adolescent population, highlighting the need for creative strategies developed with community input to improve physical activity behaviors. Involving girls, parents, and the community in the intervention planning process may improve uptake and maintenance of physical activity. The purpose of this article was to describe how we engaged adolescent girls as partners in community-based intervention planning research. We begin with an overview of the research project and then describe how we used Participatory Photo Mapping to engage girls in critical reflection and problems solving.

Hispanic mothers' and high school girls' perceptions of cervical cancer, human papilloma virus, and the human papilloma virus vaccine

PURPOSE

Cervical cancer incidence and mortality are higher for Hispanic women than for women in other population groups. However, the incidence could be reduced if teenaged Hispanic girls received the human papillomavirus (HPV) vaccine before they become sexually active. Unfortunately, few Hispanic girls receive this vaccine, which prevents cervical cancer. This study assessed Hispanic mothers' and girls' perceptions about cervical cancer, HPV, and the HPV vaccine. Results show factors that affect whether Hispanic high school girls receive the vaccine.

METHODS

Twenty-four Hispanic mothers and 28 Hispanic girls from an urban school district in southeast Texas each participated in one of eight focus groups. Bilingual moderators facilitated the mothers' groups in English and Spanish and the girls' groups in English. We analyzed transcripts of the discussions and identified themes using the grounded theory approach.

RESULTS

Our analysis found several themes that affect whether Hispanic girls get the HPV vaccine: gaps in knowledge; fears and concerns about the vaccine; sociocultural communication practices; and decision-making about HPV vaccination. Both mothers and girls had limited knowledge about cervical cancer, HPV, and the vaccine. Some girls who received the vaccine said they wished their mothers had involved them in making the decision.

CONCLUSIONS

Findings may help in developing school or community-based educational programs for Hispanic families. Such programs should provide information on the HPV vaccine and the link between HPV and cervical cancer, and they should assist mothers and girls in communicating to make informed decisions about the vaccine.

Sexual initiation, parent practices, and acculturation in Hispanic seventh graders

BACKGROUND

Hispanic youths have high rates of sexually transmitted infections and pregnancies, yet little research has targeted multiple protective/risk factors for early sexual initiation in this group. This study examined two main factors--parenting practices and acculturation--on early sexual initiation among Hispanic middle school students in Texas.

METHODS

Using data from Hispanic seventh graders (N = 655) in 15 urban middle schools in southeast Texas, we examined the association between parental monitoring/parent-child communication about sexual health and sexual initiation.

RESULTS

After controlling for age, gender, parent/guardian education, family structure, acculturation level, and intervention status, the likelihood of ever having sex decreased 50% for every 1-point increase in the parental monitoring score (AOR = 0.50;95%CI = 0.34,0.75). No association was found between ever having sex and parent-child communication scores (AOR = 1.29;95%CI = 0.76,2.18). Furthermore, parental monitoring differed significantly between acculturation levels, 1-way analysis of variance F(2,652) = 5.07, p < 0.007. This finding was unrelated to the parental monitoring-initiation association in the multivariable model.

CONCLUSION

Parental monitoring may delay sexual initiation among Hispanic middle school students. Parental monitoring differs by acculturation levels, warranting further investigation. These findings can inform school-based, parent-involved interventions designed to delay sexual initiation among Hispanic youth.

Development and validation of a cervical cancer screening self-efficacy scale for low-income Mexican American women

Although self-efficacy, a construct from social cognitive theory, has been shown to influence other screening behaviors, few measures currently exist for measuring Papanicolaou test self-efficacy. This article describes the development and psychometric testing of such a measure for Mexican American women. Data from two separate samples of Mexican American women ages>or=50 years, obtained as part of a study to develop and evaluate a breast and cervical cancer screening educational program, were used in the current study. Exploratory factor analysis indicated a single-factor solution and all item loadings were >0.73. Confirmatory analysis confirmed a single-factor structure with all standardized loadings>0.40 as hypothesized. The eight-item self-efficacy scale showed high internal consistency (Cronbach's alpha=0.95). As hypothesized, self-efficacy was correlated with knowledge, prior experience, and screening intention. Logistic regression supported the theoretical relationship that women with higher self-efficacy were more likely to have had a recent Papanicolaou test. Findings showed a significant increase in self-efficacy following the intervention, indicating that the measure has good sensitivity to change over time.

From isolation to connection: understanding a support group for Hispanic women living with gender-based violence in Houston, Texas

Little is known about the benefits of support groups to prevent gender-based violence in Hispanics. The article describes a Houston area community-based organization that assists immigrant Hispanic women exposed to gender-based violence and/or abuse. Internal documents, participant observation, and in-depth interviews were used to examine the support group. Thirty interviews were conducted with support group participants. Interviews were analyzed to identify common themes relating to the women's experiences. Overall, the women enjoyed the benefits of the support group and its offerings. Women were taught to manage situations and emotions, as well as to become less dependent on the abuser. The women also became aware of their selfworth and value, and most are making progress toward achieving self-sufficiency. Given the positive response from the women, this and other programs should continue to reach out into the community and offer a safe haven for immigrant Hispanic women living with gender-based violence and/or abuse.