Tailoring an Intervention with Parents in Rural Areas to Reduce HPV Transmission Women who live in rural areas are dying at higher rates from cervical cancer related to Human Papillomavirus (HPV) Infection than their urban counterparts, and yet 3.7 billion healthcare dollars are spent each year for the treatment of HPV infection, genital warts, and cervical cancer.1-4 These human and fiscal costs could be markedly reduced if the HPV vaccine, a series of three shots over six months, is given prior to first sexual contact.4-6 However, for children to be protected against HPV infection, parents must give consent.6 Unfortunately in rural areas, rates of HPV vaccination are very low, less than 20% in some counties.4 The HPV vaccine was approved in 2006 for girls and in December 2009 for males ages 9 to 26 though there are no statistics available for male vaccination yet.7-10 National incidence rates of cervical cancer and other HPV related cancers are disproportionately higher for women living in the rural areas where geographic disparities emerge from large distances traveled to access healthcare resources.9-11 The health disparities affecting families living in rural areas of Georgia are well documented, providing a compelling reason to choose this population for study.11-15 Past research studies have focused on parents and HPV vaccination but many of these were completed prior to vaccine availability, relied on self-report, and focused predominantly on women living in urban areas seeking clinical services.16-23 These studies provided valuable information though they cannot be generalized to parents living in rural areas. In addition, there are no qualitative studies that address low HP vaccination rates in rural areas of Georgia. Any intervention developed to reduce HPV transmission and HPV-related cancers, such as cervical cancer, must include parental input as only the parent/caregiver (P/C) can provide consent for HPV vaccination.24-26 Since there is evidence that mistrust of healthcare interventions persists, particularly among African Americans, the proposed study will use an anonymous focus group approach to provide narrative data to explicate a better understanding of why parents choose to vaccinate their children ages 9 to 13 with the HPV vaccine.27-29 Results from a completed quantitative pilot form the basis of the questions to be asked in this proposed focus group study;these questions will be posed by focus group leaders who are trained by the Principal Investigator (PI). We expect to collect greater amounts of in-depth, culturally rich information using this qualitative method and then develop a tailored intervention that will emerge from the focus group data to increase HPV vaccine rates thereby reducing HPV transmission.

Public Health Relevance

Project Narrative Almost 4 billion healthcare dollars are spent each year for the treatment of HPV infection including genital warts, cervical cancer and other HPV-related cancers. These human and fiscal costs can be reduced if the HPV vaccine is given prior to first sexual contact. However, for children to be protected against HPV infection, parents must give consent. This study will collect focus group data from parents with children ages 9 to 13 who reside in rural Georgia to identify the reasons why they do or do not vaccinate their children with the HPV Vaccine.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Small Research Grants (R03)
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Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Hardy, Lynda R
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Emory University
Schools of Nursing
United States
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Thomas, Tami L (2016) Cancer Prevention: HPV Vaccination. Semin Oncol Nurs 32:273-80
Thomas, Tami; Blumling, Amy; Delaney, Augustina (2015) The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices. ANS Adv Nurs Sci 38:E1-E12
Thomas, Tami L; Snell, Samuel (2013) Vaccinate boys with the HPV vaccine? Really? J Spec Pediatr Nurs 18:165-9