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

项目摘要/摘要 加勒比癌症污名调查及其对宫颈癌筛查和HPV疫苗接种的影响 此申请是针对标识为“NOT-CA-21-026”的特殊利益通知(NOSI)而提交的 癌症污名是寻求癌症治疗、早期诊断、筛查和其他预防的一个未被充分研究的障碍 练习。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 但是高度可预防的癌症。尽管有准确的筛查测试，CCA仍是世界上第四种最常见的癌症 和一种预防性HPV疫苗。人乳头瘤病毒(HPV)导致99%的宫颈，以及大部分肛门， 阴茎癌和口腔癌。CCA的负担持续存在，在黑人中CCA的发病率和死亡率甚至正在上升 全球资源匮乏国家的妇女。具体地说，CCA的发病率最高，是早产的主要原因 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 在加勒比地区的筛查和HPV疫苗接种(HPVV)中，CCA筛查和HPV疫苗接种都是 低到危险的程度。我们先前的初步研究表明，CCA耻辱与筛查不足有关， 确诊为晚期癌症，以及加勒比人口中HPV疫苗接种率较低，这两个地区 加勒比地区和美国(美国)。然而，我们的初步研究以及与CCA相关的文献都是如此 耻辱，是因为缺乏使用定性和定量方法来严格量化的人口研究 污名，并测量污名对CCA筛查和HPVV的影响。因此，为了进一步了解 癌症污名对CCA筛查和HPVV的影响对于加勒比海地区来说，我们的目标是1)从文化上改变 现有的用于人群适宜性的有效癌症污名量表(CASS)，2)评估非患者的癌症污名 牙买加和格林纳达使用文化转化的CASS的男性和女性的人口，3)评估这种联系 耻辱和a)妇女宫颈癌筛查和b)HPVV知识和实践-针对 符合HPVV条件的青少年。对于本文的研究，社会规范理论形成了理论，我们将采用混合的方法 设计，根植于社会参与的研究方法。在这两个地方都将任命一个社区咨询委员会 牙买加和格林纳达，为中国社科院的创新和这项研究的整体文化反应提供信息。这项研究 将与利益相关者一起使用定性方法来转换和修改中国社会科学院。改良后的研究性问卷调查 CASS将通过社交媒体和电子平台分发给人口样本(n=1240)。参与者将 使用纸质格式和研究电子数据采集系统(RedCap)完成调查。基于 根据我们的初步发现和统计，我们假设加勒比地区(格林纳达和牙买加)的污名得分相似， 与其他国家相比，加勒比海的污名分数会更高，并且与更高的污名分数相关 癌症筛查较少，HPV疫苗的知识、可接受性和接受度较低(针对年龄段的人 符合条件的儿童)。在全球癌症研究中必须强调加勒比地区，因为它非常接近 美国和加勒比海移民占美国黑人的12%。因此，结果将为干预措施提供信息 减少耻辱和加强癌症预防，例如在加勒比人口中进行CCA筛查和HPVV 加勒比地区和美国加勒比移民之间的差距最终减少了黑人癌症的差异。

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.