Caribbean Investigation of Cancer Stigma and its effect on Cervical Cancer Screening and HPV Vaccination

项目总结/摘要 标题：加勒比地区癌症污名调查及其对宫颈癌筛查和HPV疫苗接种的影响 本申请是根据特别关注通知（NOSI）（编号为“NOT-CA-21-026”）提交的 癌症耻辱感是一个未充分研究的癌症治疗寻求，早期诊断，筛查和其他预防的障碍 实践特别是，宫颈癌（CCA）的耻辱必须优先进行研究，因为CCA是最致命的疾病之一 但是高度可预防的癌症。CCA是世界上第四大最常见的癌症，尽管有准确的筛查测试 预防性HPV疫苗。人乳头瘤病毒（HPV）引起99%的宫颈癌，以及大部分的肛门癌， 阴茎癌和口腔癌CCA的负担持续存在，CCA的发病率和死亡率在黑人中甚至有所增加 全球低资源国家的妇女。具体来说，CCA发病率最高，是早产儿的主要原因。 加勒比妇女的死亡率。尽管HPV相关癌症的风险增加，而且容易获得，成本低 筛查和HPV疫苗接种（HPVV），加勒比地区的CCA筛查和HPV疫苗接种， 危险的低。我们之前的初步研究表明，CCA的耻辱与筛查不足有关， 诊断时癌症处于晚期，加勒比人口中HPV疫苗的摄取率低， 加勒比地区和美国（US）。然而，我们的初步研究以及关于CCA相关的文献， 由于缺乏采用定性和定量方法严格量化 并测量污名对CCA筛查和HPVV的影响。因此，为了进一步了解 在加勒比地区，癌症耻辱感对CCA筛查和HPVV的影响，我们的目标是1）在文化上翻译 现有经验证的癌症耻辱量表（卡斯）用于人群适当性，2）评估非患者的癌症耻辱 在牙买加和格林纳达使用文化上跨创的卡斯的男性和女性人口，3）评估 和a）妇女宫颈癌筛查和B）HPV知识和实践-对于参与者， HPVV合格青少年。对于本文的研究，社会规范理论形成了理论基础，并且我们将采用混合的研究方法 设计，植根于社区参与的研究方法。将在这两个地区任命一个社区咨询理事会。 牙买加和格林纳达，为卡斯的翻译和研究的总体文化响应提供信息。研究 将与利益相关者一起使用定性方法来翻译和修改卡斯。研究调查与修改 卡斯将通过社交媒体和电子平台分发给人群样本（n= 1，240）。参与者将 使用纸质格式和研究电子数据捕获系统（REDCap）完成调查。基于 根据我们的初步发现和文献，我们假设加勒比海地区（格林纳达和牙买加）的耻辱感评分相似， 与其他国家相比，加勒比地区的耻辱得分将更高， 癌症筛查较少，HPV疫苗的知识、可接受性和摄取率较低（对于年龄较大的人）， 符合条件的儿童）。在全球癌症研究中必须强调加勒比地区，因为它靠近 美国和加勒比海移民占美国黑人的12%。因此，研究结果将为干预措施提供信息， 减少耻辱感并加强癌症预防，例如，加勒比地区人群中的CCA筛查和HPVV， 加勒比地区和美国加勒比移民之间，最终减少黑人癌症的差距。

Project Summary/Abstract Title: Caribbean Investigation of Cancer Stigma and its effect on Cervical Cancer Screening and HPV Vaccination This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT-CA-21-026 Cancer stigma is an understudied barrier to cancer treatment seeking, early diagnosis, screening and other prevention practices. In particular, cervical cancer (CCA) stigma must be prioritized for research as CCA is among the most deadly but highly preventable cancers. CCA is the fourth most common cancer in the world despite an accurate screening test and a preventive HPV vaccine. The Human papilloma Virus (HPV) causes 99% of cervical, as well as much of anal, penile and oral cancers. The burden of CCA persists, and CCA incidence and mortality are even increasing among Black women in low resourced countries globally. Specifically, CCA incidence is highest, and is the leading cause of premature mortality among Caribbean women. Despite heightened risk for HPV-related cancer, and readily available, low cost screening and HPV vaccination (HPVV), both CCA screening and HPV vaccine uptake in the Caribbean region is perilously low. Our prior, preliminary research suggest that CCA stigma is associated with inadequate screening, advanced cancer stage at diagnosis, and low uptake of the HPV vaccine among Caribbean populations, both in the Caribbean region and United States (US). However, both our preliminary studies as well as the literature on CCA-related stigma, suffer from a lack of population studies that employs qualitative and quantitative methods to rigorously quantify stigma, and measure stigma’s impact on CCA screening and HPVV. Therefore in an effort to further understand the impact of cancer stigma on CCA screening and HPVV for the Caribbean context, we aim to 1) culturally transcreate the existing validated Cancer Stigma Scale (CASS) for population appropriateness, 2) assess cancer stigma in a non-patient population of men and women using the culturally transcreated CASS in Jamaica and Grenada, 3) assess the association of stigma and a) cervical cancer screening among women and b) HPVV knowledge and practice --- for participants with HPVV eligible adolescents. For this study, social norms theory formed the theory, and we will use a mixed-methods design, rooted in the community engaged research approach. A community advisory council will be appointed in both Jamaica and Grenada, to inform the transcreation of CASS and overall cultural responsiveness of the study. The study will use qualitative methods with stakeholders to transcreate and modify CASS. The study survey with the modified CASS will be distributed via social media and electronic platforms to a population sample (n=1,240). Participants will complete the survey using a paper-based format and the Research Electronic Data Capture System (REDCap). Based on our preliminary findings and the lierature, we hypothesize similar stigma scores in the Caribbean (Grenada and Jamaica), and that Caribbean stigma scores will be higher compared to other countries, and higher stigma scores will be associated with less cancer screening and lower knowledge, acceptability, and uptake of the HPV vaccine (for those with age eligible children). The Caribbean region must be emphasized in global cancer research because of its close proximity to the US and Caribbean immigrants account for 12% of US Blacks. Therefore, the results will inform interventions to reduce stigma and increase cancer prevention e.g., CCA screening and HPVV among Caribbean populations both in the Caribbean region and among US Caribbean immigrants to ultimately reduce Black cancer disparities.