Black, Hispanic and low-income women are more likely to develop and die from cervical cancer than White women. With the introduction of HPV vaccine, clinicians have a remarkable opportunity to reduce these disparities. Unfortunately, minority and low-income women are also less likely to complete the HPV vaccine series. While HPV vaccine uptake is expected to reduce incidence and prevalence of cervical cancer over time, poor uptake of the vaccine by underserved women could actual increase disparities in cervical cancer rates The long-term objective of the proposed study, Clarifying the Effects of Race and Socioeconomic Status on Disparities in HPV Vaccination Rates, is to generate knowledge on which to base interventions to increase uptake of the vaccine among underserved women. The study has three aims:1) to characterize how perceptions of HPV vaccination differ by race and socioeconomic status among White, Black, and Hispanic parents of 11-18 year old girls attending public and private clinics;2) to characterize providers'perceptions of barriers and facilitators to initiating and completing the HPV vaccine series, specifically focusing on the distinct contributions of race and socioeconomic status;and 3) to use the information gathered in Aims 1 and 2 to develop strategies for improving HPV vaccine initiation and completion overall, with a specific focus on reducing race and income-based disparities in complete vaccination rates. An innovative conceptual model, incorporating the Health Belief Model, the Transtheoretical Model, and the Theory of Planned Behavior will be used. To address the first aim, the investigators will conduct 30-45 minute qualitative interviews with 120 parents of adolescent girls to identify the barriers and facilitators to vaccine series completion. This study will sample Black, Hispanic, and White parents at public and private sites at each of three stages of vaccination: not initiated, incomplete, and complete. To achieve the second aim, 45-90 minute qualitative interviews will be conducted with 20 providers at public and private clinics to characterize knowledge, perceptions and beliefs of providers that serve as facilitators and barriers to HPV vaccine completion. Content analysis based in grounded theory will be used to identify common health beliefs, parental concerns and attitudes about HPV vaccination, social norms, barriers and other factors that influence series initiation and completion. To address the third aim, the investigators will solicit ideas from parents and providers, explore their receptiveness toward school-based solutions that have proved effective in other countries, and convene a meeting of key community stakeholders to discuss implementation of targeted solutions to improve HPV vaccine uptake among diverse groups.

Public Health Relevance

Black, Hispanic and low-income women are less likely to complete the HPV vaccine series, which could worsen disparities in cervical cancer rates. The proposed project is relevant to public health because it will allow us to explore the independent and additive effects of race and socioeconomic status on HPV vaccination in the adolescent daughters of minority women. We will use qualitative interviews with parents and providers, which allow a deep understanding of the interplay of factors, to identify targets and methodology for successful interventions.

National Institute of Health (NIH)
National Center for Immunication and Respiratory Diseases (NCIRD)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZIP1-GCA (26))
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Boston Medical Center
United States
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Vercruysse, Jessica; Chigurupati, Nagasudha L; Fung, Leslie et al. (2016) Parents' and providers' attitudes toward school-located provision and school-entry requirements for HPV vaccines. Hum Vaccin Immunother 12:1606-14
Perkins, Rebecca B; Chigurupati, Nagasudha L; Apte, Gauri et al. (2016) Why don't adolescents finish the HPV vaccine series? A qualitative study of parents and providers. Hum Vaccin Immunother 12:1528-35
Apte, Gauri; Pierre-Joseph, Natalie; Vercruysse, Jessica L et al. (2015) Could Poor Parental Recall of HPV Vaccination Contribute to Low Vaccination Rates? Clin Pediatr (Phila) 54:987-91
Perkins, Rebecca B; Clark, Jack A; Apte, Gauri et al. (2014) Missed opportunities for HPV vaccination in adolescent girls: a qualitative study. Pediatrics 134:e666-74