Toward Racial Equity and Justice in Human Papillomavirus (HPV) Vaccination: An Exploratory Study with Cape Verdean Parents

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PROJECT SUMMARY Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States (U.S.). HPV infection is linked to cancers of the cervix, vulva, vagina, penis, anus, and oropharynx, thus representing a significant public health concern. The HPV vaccine is the most efficient and cost-effective mechanism for combating HPV infection and its cancer- related consequences. Nonetheless, HPV vaccination rates for age-eligible adolescents remain suboptimal in the U.S. Scientific evidence underscores the critical influence of sociocultural and contextual factors on parents’ acceptability and uptake of the HPV vaccination. Sociocultural values, family expectations, health literacy, beliefs, attitudes, and knowledge influence parents’ behaviors and decisions, healthcare-seeking and utilization, and health outcomes. Black women are disproportionally affected by HPV-associated morbidity and mortality, with the second-highest cervical cancer incidence rate, the second highest after non-Hispanic Whites and the highest cancer mortality rate. However, there is a lack of data for African ethnic minority subgroups such as Cape Verdeans (CV) in the U.S, an ethnic minority group of mixed West African and Portuguese roots. The U.S. is home to the largest CV population outside the country of Cape Verde, with an estimated 265,000 CV immigrants and their descendants living in the U.S. CVs primarily reside (~90%) in Massachusetts and Rhode Island. Understanding HPV and HPV vaccination knowledge, attitudes, and behaviors (KAB) of specific ethnic minoritized and immigrant subgroups, such as CV, will make it possible to meet particular subgroup needs and improve knowledge and practices, thereby improving health status and outcomes by decreasing cancer risk. Though recent research has shown an increase in HPV uptake, but not necessarily HPV vaccine completion, among minority populations including African Americans and Blacks, no data exist to show that this is the case for CV adolescents living in the U.S. Also, there remains a paucity of data regarding HPV knowledge, attitudes, and behaviors of CV parents living in the U.S. Therefore, the proposed study will focus on Cape Verdeans, a population group currently underrepresented in cancer health disparity research, and seeks to: 1) explore the KAB regarding HPV and HPV vaccination (intention, hesitancy, barriers, initiation, and completion) among CV mothers and fathers (Phase 1: Focus Groups); and 2) explore CV parents’ HPV KAB, health communication, sociocultural factors, their intention to have their sons and daughters undergo HPV vaccination, HPV vaccine hesitancy, barriers to HPV vaccination, and parent-reported receipt of HPV vaccine or refusal of the vaccine (Phase 2: Survey Administration). The proposed community-engaged research is innovative in that it will: 1) engage CVs, an understudied ethnic minority and immigrant subpopulation currently underrepresented in HPV research, 2) include fathers who are under-represented in HPV research, and 3) establish a partnership with Catholic and Protestant churches to further assist with the important goal of addressing HPV vaccine myths and disseminating accurate HPV vaccine information to CV communities. Moreover, it will provide a solid basis for the design of future linguistically and culturally tailored education interventions to promote the HPV vaccine among CVs in the U.S. Moreover, this research will build further research capacity to engage underserved, minority CV parents in future HPV and cancer prevention interventions.