HPV Vaccination among Low-Income Hispanic Adolescents

描述（由申请人提供）：人乳头瘤病毒（HPV）疫苗接种是宫颈癌和其他肛门生殖器癌症安全有效的一级预防策略，但疫苗接种率非常低。只有53%的青春期女性接种了疫苗（接种了1剂）。更重要的是，只有35%的人完成了对有效预防癌症至关重要的3剂系列治疗。此外，在HPV疫苗完成率方面存在越来越大的差异，西班牙裔女性完成一系列疫苗接种的可能性明显低于非西班牙裔白人。低疫苗完成率是受hpv相关疾病不成比例影响人群的关键问题，如拉丁裔，其宫颈癌发病率比非西班牙裔白人高60%。虽然研究已经检查了HPV疫苗启动的预测因素，但关于系列完成的预测因素在文献中存在根本差距。由于接受所有三剂疫苗对于最大限度地预防HPV至关重要，因此确定影响西班牙裔青少年是否完成该系列疫苗的因素对于告知未来的干预工作至关重要。本研究项目的长期目标是制定有效的策略，提高低收入西班牙裔青少年HPV疫苗的完成率，从而降低HPV相关疾病的发病率、死亡率和差异。本应用程序的目的是确定HPV疫苗完成的关键预测因素，特别强调确定与完成该系列相关的可改变的社会心理和文化因素。我们提出了两个具体目标：(1)确定接受了第一剂HPV疫苗的青少年的低收入拉丁裔母亲的HPV疫苗完成（接受所有3剂）的关键预测因素；(2)提供关于HPV疫苗完成的重要促进因素和障碍的补充定性信息。为了实现目标1，我们将对其青春期女儿/儿子开始接种HPV疫苗的低收入拉丁裔母亲进行为期一年的纵向研究。在基线时，母亲和她们的女儿/儿子（9-17岁）将完成一项调查，以评估来自主要健康行为理论（健康信念模型、计划行为理论）的文化（例如，文化适应）和社会心理因素（例如，感知到的完成障碍、完成系列的主观规范）。这些变量将用于预测我们的主要结局变量：HPV疫苗完成状态，由儿童的医疗记录验证。为了实现目标2，我们将对纵向研究中有目的的母亲样本进行深入的定性访谈。这些访谈的目的是更深入地了解与完成有关的文化/社会心理因素，确定与完成有关的因素没有反映在传统的健康行为理论中，并调查母亲完成基线评估后可能出现的因素。预计该项目的结果将通过推进制定有效战略以提高低收入西班牙裔青少年中HPV疫苗完成率所需的知识，产生重要的积极影响。

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) vaccination is a safe and effective primary prevention strategy for cervical cancer and other anogenital cancers, yet vaccination rates are remarkably low. Only 53% of adolescent females have initiated the vaccine (received �1 dose). More importantly, far fewer (35%) have completed the 3-dose series, which is vital for effective cancer prevention. Moreover, there are growing disparities in HPV vaccine completion rates, with Hispanic females significantly less likely to complete the series than non-Hispanic Whites. Low rates of vaccine completion are of crucial concern for populations disproportionally affected by HPV-related disease such as Latinas, whose cervical cancer incidence rates are 60% higher than in non- Hispanic Whites. Although studies have examined predictors of HPV vaccine initiation, there is a fundamental gap in the literature about predictors of series completion. Because receipt of all 3 doses is essential for maximum protection against HPV, identifying factors that influence whether Hispanic adolescents complete the series is critical for informing future intervention efforts. The long-term goal of ths research program is to develop effective strategies for increasing HPV vaccine completion among low-income Hispanic adolescents, thereby reducing morbidity, mortality, and disparities associated with HPV-related disease. The objective of this application is to determine key predictors of HPV vaccine completion, with special emphasis on identifying modifiable psychosocial and cultural factors associated with completion of the series. We propose two specific aims: (1) Determine key predictors of HPV vaccine completion (receipt of all 3 doses) among low-income Latina mothers of adolescents who have received the first dose of HPV vaccine and (2) Provide complementary qualitative information about facilitators and barriers that play an important role in HPV vaccine completion. To achieve Aim 1 we will conduct a yearlong longitudinal study of low-income Latina mothers whose adolescent daughter/son initiates the HPV vaccine. At baseline, both mothers and their daughter/son (aged 9-17) will complete a survey to assess cultural (e.g., acculturation) and psychosocial factors (e.g., perceived barriers to completion, subjective norms for completing the series) from major theories of health behavior (Health Belief Model, Theory of Planned Behavior). These variables will be used to predict our primary outcome variable: HPV vaccine completion status, as verified by the child's medical record. To achieve Aim 2 we will conduct in-depth qualitative interviews with a purposive sample of mothers from the longitudinal study. The goal of these interviews is to provide greater insight into cultural/psychosocial factors associated with completion, to identify factors related to completion not reflected in traditional theories of health behavior, an to investigate factors that may arise after mothers complete the baseline assessment. Outcomes from this project are expected to have an important positive impact by advancing knowledge needed to develop effective strategies for increasing HPV vaccine completion rates among low-income Hispanic adolescents.