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

项目摘要 人乳头瘤病毒（HPV）是美国最常见的性传播病毒。HPV感染是 与宫颈癌、外阴癌、阴道癌、阴茎癌、肛门癌和口咽癌有关，因此代表了一个重要的公共卫生问题。 关心HPV疫苗是对抗HPV感染及其癌症的最有效和最具成本效益的机制- 相关后果。尽管如此，美国适龄青少年的HPV疫苗接种率仍然不理想。 科学证据强调，社会文化和背景因素对父母的接受程度具有重要影响， 接种HPV疫苗。社会文化价值观、家庭期望、卫生知识、信仰、态度和知识 影响父母的行为和决定，寻求和利用医疗保健，以及健康结果。黑人女性 受HPV相关发病率和死亡率的影响，宫颈癌发病率第二高 这是仅次于非西班牙裔白人的第二高，也是最高的癌症死亡率。然而，缺乏数据 对于非洲少数民族亚群体，如美国的佛得角人（CV），一个混合西方的少数民族群体， 非洲和葡萄牙血统。美国是佛得角以外最大的CV人口所在地， 估计有265，000名CV移民及其后代居住在美国。CV主要居住在（约90%）马萨诸塞州 和罗得岛。了解特定种族的HPV和HPV疫苗接种知识、态度和行为（KAB） 少数民族和移民亚群体，如CV，将有可能满足特定的亚群体需求，并提高 知识和实践，从而通过降低癌症风险改善健康状况和结果。虽然最近的研究 在少数人群中，HPV摄取增加，但不一定完成HPV疫苗接种，包括 非洲裔美国人和黑人，没有数据表明这是生活在美国的CV青少年的情况。 仍然缺乏关于生活在美国的CV父母的HPV知识、态度和行为的数据。因此， 拟议的研究将侧重于佛得角人，这是一个目前在癌症健康差异方面代表性不足的人口群体 研究，并寻求：1）探索关于HPV和HPV疫苗接种的KAB（意图，犹豫，障碍，启动， 和完成）（第1阶段：焦点小组）;和2）探索CV父母的HPV KAB，健康 沟通，社会文化因素，他们让儿子和女儿接受HPV疫苗接种的意图，HPV 疫苗犹豫、HPV疫苗接种障碍以及父母报告接受HPV疫苗或拒绝接种（阶段 2：调查管理）。拟议的社区参与研究是创新的，因为它将：1）参与简历， 研究不足的少数民族和移民亚群目前在HPV研究中代表性不足，2）包括父亲 在HPV研究中代表性不足的人，以及3）与天主教和新教教会建立伙伴关系， 帮助实现解决HPV疫苗神话和传播准确的HPV疫苗信息的重要目标， CV社区此外，它将为未来的语言和文化定制设计提供坚实的基础 教育干预，以促进HPV疫苗在美国的简历，此外，这项研究将进一步建立 研究能力，使服务不足，少数CV父母在未来的HPV和癌症预防干预措施。

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.