Almost all cervical cancers are causally related to infections by human papillomavirus (HPV), with HPV types 16 and 18 responsible for ~70% of this malignancy. American Indian (Al) women have one of the highest incidences of cervical cancer among U.S. women, and this rate is increasing. Al women also have the poorest cervical cancer survival of any racial/ethnic group. Reasons for the high incidence, poor survival, and variation by tribe are unknown, but might be explained by lower rates of Papanicolaou (Pap) screening, a higher prevalence of oncogenic HPV infection,15 or a higher prevalence of particularly virulent HPV 16 or HPV 18 variant. We found that the prevalence of high-risk HPV types in Al women was over twice that in White women. After adjusting for age and abnormal Pap results, the odds ratio of high-risk HPV infection in Al versus White women was 2.9 and Al women were 4 times more likely to have an abnormal Pap test. In this Research Project, we propose to partner with the Hopi Tribe in Arizona to conduct 2 theoretically linked studies, designed to complement one another and cover the lifespan of HPV prevention and screening. The first study aims to increase HPV vaccination rates among girls aged 11-12 years by engaging motherdaughter dyads. The second study examines the presence of high-risk HPV types and variants, particularly HPV 16 and 18, in Hopi women.
Our specific aims i n Study 1 are to 1) Compare the number of Hopi girls ages 11-12 receiving HPV vaccination before and after a 2-year implementation of our mother-daughter educational intervention;and 2) Assess individual predictors of HPV vaccination. In Study 2 we aim to 2): compare the prevalence of high-risk HPV types in Hopi women adherent with cervical cancer screening guidelines to those who are non-adherent;and 4) Compare risk and protective factors for high-risk HPV infection among screening adherent and non-adherent Hopi women. We hypothesize that screening nonadherent women will have more high risk HPV types, more risk factors, and fewer protective factors than those who are adherent. This study fits into the multi-level health disparities model by examining how individual, family, and organizational variables influence cervical cancer prevention among Hopi women and young adolescents.

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