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

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AmAs

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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