Latina women, particularly Mexican Americans, have the highest incidence rates of cervical cancer compared to other racial and ethnic groups. Cervical cancer is preventable through HPV vaccination, but vaccination rates remain suboptimal, particularly among young adult Latina women. Additionally, foreign-born Latina women have lower cervical screening and HPV vaccination rates and often no access to preventive care prior to coming to the United States. Population studies have found significant differences in HPV vaccine completion among Latina foreign-born and U.S.-born young adults (18?26 years old), with foreign-born women less likely to vaccinate (7.2% vs 18.5%). Studies exploring HPV vaccine hesitancy are needed to inform scalable interventions to prevent infection and improve health outcomes that disproportionately burden Latina Mexican American women. The literature has not identified key multilevel mechanisms contributing to differences among Mexican American women in understanding their vaccine hesitancy. Studies on HPV vaccination differences among foreign-born and U.S.-born women are scarce. The goal of this mixed-methods study is to identify key factors contributing to HPV vaccine hesitancy among young adult Mexican American women that will inform effective public health vaccine interventions tailored for Latina subgroups in a future K- award. Previous qualitative studies have uncovered important differences in HPV vaccine decision-making among Latina young adults compared to other racial and ethnic groups. This study will build on past work by investigating hesitancy toward the HPV vaccine and the influence of individual, interpersonal, and community factors on vaccine hesitancy. The proposed study will explore two aims: (1) investigate what HPV messages Latinas receive and relay to others at the individual, interpersonal, and community levels and what meaning Latina women ascribe to the messages they receive; and (2) identify how mother-daughter communication is associated with HPV vaccine hesitancy in the context of important individual-, interpersonal-, and community- level factors. The unique strengths of this proposal include its focus on understanding multilevel influences explaining HPV vaccine hesitancy among at-risk Mexican American women. Additionally, a unique focus is studying differences between U.S.- and foreign-born Mexican American women. Finally, the applicant will benefit from a strong team of mentors and research environment with mentor specialties in health communication, health disparities, Latino health, and multilevel modeling. The proposed study is innovative in its proposed plan to understand how the effect of HPV messages may contribute to the vaccination gap between U.S.-born and foreign-born Latinas identified in the literature. Results of this study will inform HPV vaccine interventions tailored for Mexican American women and how community-based clinic interventions can be effectively implemented to reduce HPV-associated cancer by increasing HPV vaccination for this population.
The long-term goal of this study is to decrease the costs of HPV-associated cancers that disproportionately burden Latina Mexican American women by identifying contributors to HPV vaccine hesitancy in this population. Using a multilevel approach, this study will assess individual, interpersonal, and community factors associated with HPV vaccine hesitancy among foreign-born and U.S.-born Mexican American women. Guided by the National Institute on Minority Health and Health Disparities Research Framework, this study will use a health communication focus to identify HPV vaccine messages resonant among Mexican American women 18 to 26 years of age and that informs the development of a targeted communication intervention.
