HPV Vaccination among Daughters of Latina Immigrants

拉美裔是美国最大的少数族裔人口，预计到2050年，10岁至14岁的拉美裔女孩将有144%的变化，而白人的预期变化为39%。2010年美国人口普查显示，阿拉巴马州的拉美裔人口增长了145%，这是2000至2010年间美国仅次于南卡罗来纳州的第二大百分比增长。 拉丁裔女性的宫颈癌发病率和死亡率高于白人女性。除非这一人群大量采用HPV疫苗，否则在美国，评估异常巴氏涂片和/或治疗浸润性宫颈癌的经济负担可能会几十年来首次增加。我们提出了一项为期5年的小组随机对照试验(RCT)，以测试基于理论的文化相关干预措施在9至12岁的拉丁裔移民女儿中促进HPV疫苗接种的有效性，具体目标有四：(1)进行形成性评估，以开发基于理论的、与文化相关的干预措施，以促进9至12岁拉丁裔移民的女儿接受HPV疫苗；(2)根据目标1的结果和先前的试点数据，制定拟议的干预措施；(3)对320名9至12岁女儿的拉丁裔移民母亲实施干预；(4)通过团体随机对照试验评价干预效果。对照组将接受健康饮食和体育锻炼的教育。主要结果将是在9岁至12岁的拉丁裔移民的女儿中接种第一针HPV疫苗并完成所有三剂疫苗的接种。次要结果将包括：9岁至12岁女儿的拉丁裔移民母亲对HPV/宫颈癌和HPV疫苗的态度和信念的改变。拟议的研究解决了一个重要的科学知识缺口，因为对拉丁裔移民的女儿接种HPV疫苗知之甚少，拉丁裔移民是HPV感染和宫颈癌的高危群体。如果被证明成功，这种干预可能会传播给全美拉美裔移民的女儿，可能会对公共卫生产生重大影响。

Latinos are largest minority population in the U.S with a projected change of 144% of Latino girls between the ages of 10 and 14 in 2050 as compared to 39% projected change among whites. The 2010 U.S. Census indicated that the Latino population in Alabama grew 145%, which represents the second largest percentage growth between 2000 and 2010 in the U.S. after South Carolina. Cervical cancer incidence and mortality is higher among Latinas than among white women. Unless there is significant HPV vaccine uptake in this population the economic burden of evaluating abnormal Pap smears and/or treating invasive cervical cancer is likely to increase in the U.S. for the first time in decades. We propose a 5-year group randomized controlled trial (RCT) to test the efficacy of a theory-based culturally relevant intervention to promote HPV vaccine uptake among daughters of Latina immigrants between the ages of 9 and 12 with four specific aims: (1) To conduct a formative evaluation in order to develop theory-based, culturally relevant intervention to promote HPV vaccine uptake among daughters of Latina immigrants between the ages of 9 and 12; (2) To develop the proposed intervention based on the results of Aim 1 and previous pilot data; (3) To implement the intervention among 320 Latina immigrant mothers of daughters between 9 and 12; and (4) To evaluate the efficacy of such intervention through a group RCT. The comparison group will receive education on healthy eating and physical activity. The primary outcomes will be receipt of first dose as well as completion of all three doses of the HPV vaccine among daughters of Latina immigrants between the ages of 9 and 12. Secondary outcomes will include: changes in attitudes, and beliefs regarding HPV/cervical cancer and HPV vaccine among Latina immigrant mothers of daughters between the ages of 9 and 12. The proposed study addresses an important scientific knowledge gap since little is known about HPV vaccine uptake among daughters of Latina immigrants, a high risk group for HPV infection and cervical cancer. If proven successful, this intervention could be disseminated to daughters of Latina immigrants across the U.S. with the potential of having a major public health impact.