HPV Latino Survey Workgroup:
Update & Future DirectionsCPCRN National Meeting
Seattle, WAOctober 5, 2011
Presenters: Roshan Bastani, Beth Glenn, Gloria Coronado
Discussants: Jennifer Allen, Roshan Bastani, Vicky Taylor
Background
• Collaboration among 3 CPCRN sites:
• University of California, Los Angeles
• University of Texas, Houston
• University of Washington, Seattle
• Initiated in November in 2008
• Used the Health Behavior Framework to develop a set of 24 core HPV vaccine survey items
• Surveyed Latino parents of girls ages 9–18 in Los Angeles (N=274), Seattle area-Yakima Valley (N=90), Houston (N=83),
• Data collection and descriptive analysis are complete
• Drafted a collaborative manuscript based on data collected
• Identifying next steps based on study results
Summary of Progress
DemographicsLos
Angeles(n=274)
Seattle
YV(n=90
)
Houston 211
(n=44)
Houston Lower Rio
Grande Valley (n=39)
Parents/Caregivers
Age (mean) 42.8 38.2 N/A 54.9
Female 100% 100% 88% 47%
Spanish Interview 89% 78% 45% 100%
Foreign-born 94% 82% N/A N/A
Uninsured 87% 46% 52% 79%
Household income: < $25,000/year 87% 74% N/A 87%
Adolescent Girl
Age (mean) 13.9 13.3 N/A 13.9
Los Angeles(n=274)
Seattle
YV (n=90
)
Houston 211
(n=44)
Houston Lower Rio
Grande Valley (n=39)
HPV
Awareness: Heard of HPV 64% 74% 69% 34%
Knowledge (among aware): HPV spread via sexual contact 70% 68% 38% 71%
HPV can cause cervical cancer 75% 68% 41% 74%HPV Vaccine
Awareness: Heard of HPV vaccine 63% 73% 69% 57%
Knowledge (among aware): HPV vaccine most effective when given before a girl starts having sex
75% 84% 36% n/a
Receipt: Initiated HPV Vaccine (received ≥ 1 dose) 29% 37% 31% 25%
Acceptability/Intention:Very likely daughter will get the HPV vaccine in next 12 months
30% 33% 21% 58%
Awareness, Knowledge, Uptake
Los Angeles(n=274)
Seattle
YV (n=90
)
Houston 211
(n=44)
Houston Lower Rio
Grande Valley (n=39)
HPV
Perceived Susceptibility Agree daughter has more chance of getting HPV compared to other girls
8% 30% 5% 5%
Perceived SeverityAgree daughter getting HPV would be a serious problem
87% 61% 79% 74%
HPV Vaccine
BarriersAgree daughter may be more likely to think it’s okay to have sex if vaccinated
11% 60% 21% 18%
Agree getting the HPV vaccine may cause problems getting pregnant later 17% 32% 14% 3%
Agree if daughter gets the HPV vaccine it may cause future health problems
11% 31% 14% 11%
Perceived Efficacy Thinks HPV vaccine is very effective in preventing cervical cancer
41% 67% 7% 63%
Attitudes, Beliefs, Barriers
Los Angele
s(n=274
)
Seattle
YV (n=90
)
Houston 211
(n=44)
Houston Lower Rio
Grande Valley (n=39)
Need more InformationDoes not have enough information to make a decision to get the HPV vaccine
70% 40% 26% n/a
Health care provider:Would have daughter get the vaccine if your doctor recommended it
79% 87% 48% 90%
Discussed HPV vaccine w/ daughter’s MD 58% 47% 24% 32%
Daughter has ever been offered the HPV Vaccine by her doctor or nurse 63% 46% 29% 37%
Social Norms/Influences Agree other parents in the community are getting their daughters the HPV vaccine
23% 67% 36% 42%
Self-EfficacyVery sure they could get the HPV vaccine for daughter if they wanted
36% 58% 21% 63%
Decision Role PreferenceThe decision to about vaccination should be made by my daughter’s MD/MD and me
82% 77% 81% n/a
Decision Factors (among unvaccinated)
• Moderate rates of vaccine awareness, but low rates of uptake and intent to vaccinate across samples
• Attitudinal barriers were not frequently endorsed• Areas to target in interventions:
• Increase awareness, enhance beliefs about vaccine’s efficacy and safety
• Provide information on where to get vaccine (e.g., VFC providers)
• Likely important to engage health care providers in the process
Summary of Key Findings
• University of Washington, Seattle
• Receipt of a R21, 2011-2013
• University of Texas, Houston
• CPRIT-funded HPV Research Project, 2010-2013
• CPRIT-funded , 2-1-1 Cancer Prevention Project, 2010-2012
• Cervical Cancer Free America: GSK funded project, 2011-2013
• University of California, Los Angeles
• Submission of R01 that has received a fundable score, 2011-2016
Recently Funded HPV Grants
• NCI R21 proposal funded July 2011 (w/UCLA site)• Collaboration with an established Cambodian Community
Coalition
• Primary goal:• To conduct mixed-methods research that could be used to
inform the development, implementation, and evaluation of culturally appropriate HPV vaccination interventions targeting Cambodian women with daughters in the 9–17 age group
• Components:
• 25 qualitative interviews
• Community-based survey of 200 mothers
• Retest survey with 50 quantitative survey participants
UW: HPV Vaccination in the Cambodian Community
• Cancer Prevention Research Institute of Texas (CPRIT) funded Research Project
• Primary Goal• To evaluate, in a group randomized control trial, the
effectiveness and cost effectiveness of two lay health worker-delivered programs to increase vaccine uptake among Hispanic girls ages 11-17
• Recruiting 1,809 parents in 27 clinics in Houston
• Intervention components (targeting parents):• Print fotonovelas • A self directed, tailored interactive (TIV) program that
runs on iPads; Now known as “For Our Daughters”
Houston: HPV Vaccination in the Hispanic Community
• CPRIT-funded Research Project to develop, deliver and determine the effectiveness and cost effectiveness of a Cancer Control Navigator program implemented within the Gulf Coast & Weslaco 2-1-1 Help Line Programs
• Increase cervical cancer screening with the Pap test and the initiation and completion of the HPV vaccine series, thereby reducing or eliminating cervical cancer in Texas
• Form a statewide coalition of key partners (investigators, healthcare systems, cancer centers, providers, community groups, agencies, and policymakers)
• Implement educational interventions and activities in identified areas
Increasing Breast, Cervical, and Colorectal Cancer Screening & HPV Vaccinations among Underserved Texans: A Collaboration with the 2-1-1 Program
Cervical Cancer Free America: GlaxoSmithKline
UCLA: Increasing HPV Vaccine Uptake in a
Low Income Ethnic Minority Population
• NCI R01 Proposal Submitted March 2011, with Seattle site, based on CPCRN survey findings
• Collaboration with the Los Angeles County Department of Public Health (LADPH), Office of Women's Health
• Primary goal: Randomized trial to test a theoretically driven intervention to increase HPV vaccine receipt among underserved, high risk girls in LA• Will assess implementation outcomes (i.e., reach, etc)
• Intervention delivered by LADPH staff through their telephone hotline in English, Spanish, Cantonese, Mandarin, Korean, Armenian. Targets caregivers of 9-18 yr old girls
• Brief telephone intervention and companion print materials
• Referral to a convenient clinic offering low cost/free vaccine
• Intervention designed to be feasible for delivery by a county health department, and integrated into their infrastructure. Will facilitate sustainability and dissemination. Can be adapted for other outcomes.
Recent HPV Vaccine News
Sept 13, 2011New York
Timesarticle on HPV legislation
Recent HPV Vaccine News• September 19, 2011, New York
Times article commenting on the potential negative influence of Michele Bachmann’s criticism of the vaccine on uptake rates
Latest national data show rates of initiation remain low among adolescent girls (49%), growing socioeconomic/racial/ethnic disparities in vaccine completion MMWR, 2011
Whi
te
Latin
oA
AmAs
ian
0
50
100
HPV Vaccine Initi-ation
Proposed Ideas for Cross-site Projects• Implement the survey in additional populations
• i.e. Asian subgroups, African Americans
• Adapt evidence-based interventions for other vaccines or preventive health services to promote uptake of the HPV vaccine among Latinos or other groups
• System/Provider-based Interventions• Include HPV vaccine promotion in work with FQHCs• Use of 2-1-1 for HPV vaccine education (similar to Texas)• Deliver HPV vaccine and testing education to women
seeking cancer screening, particularly women with vaccine-eligible daughters