HPV Vaccination among Low-Income Hispanic Adolescents

描述(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道癌的安全和有效的一级预防策略，但疫苗接种率非常低。只有53%的青春期女性启动了疫苗接种(接种了1剂)。更重要的是，更少的人(35%)完成了3剂系列，这对有效的癌症预防至关重要。此外，HPV疫苗完成率方面的差距越来越大，西班牙裔女性完成该系列疫苗的可能性明显低于非西班牙裔白人。疫苗完成率低是受HPV相关疾病不成比例影响的人群的关键问题，如拉丁裔，其宫颈癌发病率比非西班牙裔白人高60%。尽管研究已经检验了HPV疫苗启动的预测因素，但关于系列完成的预测因素，文献中存在着根本的差距。因为接受所有3剂疫苗对于最大限度地预防HPV至关重要，确定影响西班牙裔青少年是否完成这一系列接种的因素对于指导未来的干预工作至关重要。该研究计划的长期目标是制定有效的战略，提高低收入拉美裔青少年的HPV疫苗完成率，从而降低与HPV相关疾病的发病率、死亡率和差异。这项应用的目的是确定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心理社会和文化因素。我们提出了两个具体目标：(1)确定在接种了第一剂HPV疫苗的青少年的低收入拉丁裔母亲中完成HPV疫苗接种的关键预测因素(收到所有3剂疫苗)，以及(2)提供有关在HPV疫苗完成过程中发挥重要作用的促进剂和障碍的补充定性信息。为了实现目标1，我们将对低收入拉丁裔母亲进行为期一年的纵向研究，这些母亲的青春期女儿/儿子开始接种HPV疫苗。在基线阶段，母亲和她们的女儿/儿子(9-17岁)将完成一项调查，以评估主要健康行为理论(健康信念模式、计划行为理论)中的文化因素(例如，文化适应)和心理社会因素(例如，感知到的完成障碍，完成系列活动的主观规范)。这些变量将被用来预测我们的主要结果变量：HPV疫苗接种完成情况，正如儿童的医疗记录所证实的那样。为了达到目标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/心理社会因素，找出传统健康行为理论中没有反映的与完成有关的因素，并调查母亲完成基线评估后可能出现的因素。该项目的成果预计将产生重要的积极影响，因为它促进了制定有效战略以提高低收入西班牙裔青少年的HPV疫苗完成率所需的知识。

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.