African American cervical cancer mortality rates for Missouri are higher than those observed in the general population; and mortality rates in St. Louis City and county exceed the African American mortality rates for the state. Human Papillomavirus (HPV) is one of the most common sexually transmitted infections among young people and it is associated with cervical cancer in women. The higher cervical cancer incidence and mortality rates observed among African Americans in St. Louis suggests the importance of HPV screening and vaccination for this community. While HPV consists of over 30 types of viruses that can be passed from one person to another through sexual contact, the HPV 16 virus accounts for approximately half of all cervical cancers in the world. Its prevalence in the US is highest among African American women (19.1 percent) compared to 12.5 percent among white women. There is now an approved prophylactic vaccine, Gardasil, available. The vaccine is recommended for girls 11 to12 years of age, but can be given to girls as young as nine and is also recommended for girls 13-18 year to catch up on or complete missed shots. Giving the vaccine to young girls is important because the vaccine is most effective when given to people prior to HPV infection. Surveys show that 68% of African American high school students are sexually active, which can result in HPV infection. St. Louis city is over 50% African American, with notable disparities in the teen pregnancy and sexually transmitted disease rates. These facts support the need for early vaccination if young African American girls are to be adequately protected from the effect of HPV. Historically, where there are no penalties or mandated vaccination requirements, immunization levels are consistently lower in the African American community compared to those of Whites or other minorities; a fact that suggests the need to assure that parents in the African American community are well-educated on HPV, HPV vaccination, and that we address barriers to vaccination. Working with our community partners, this project seeks to assess HPV knowledge, awareness of the vaccine, its benefits, and barriers to vaccination. We will conduct a cross sectional survey of 200 African American parents, and complete in depth interviews with 30 randomly selected parents to address three specific aims.
The specific aims of this research effort are to: 1) determine knowledge about HPV, HPV vaccination and its relationship to cancer among African American parents; 2) determine acceptability of and intent to vaccinate among parents of African American girls nine to 17; and 3) describe the individual characteristics, cultural attitudes, social and environmental factors that affect African American parents' intent to vaccinate girls, nine to 17, against HPV. These data will be used to develop and test a culturally sensitive intervention designed to reduce the likelihood that disparities in HPV vaccination will emerge in the St. Louis African American community. ? ? The Siteman Cancer Center (SCC) Program for the Elimination of Cancer Disparities (PECaD) is a multi- disciplinary community-focused program established to eliminate pervasive disparities of cancer education, prevention, and treatment. The SCC Senior Leadership made this program a top priority, and it subsequently developed a substantial infrastructure and scientific portfolio, which will be further strengthened by this proposal.
Specific aims for the first year are: 1) To further develop the core organizational infrastructure within the SCC to support community-based participatory activities to reduce cancer health disparities by establishing a staff of multidisciplinary professionals critical to implementing the program. 2) To enhance existing relationships and build new partnerships with communities that suffer cancer health disparities and with other organizations with an interest in reducing cancer health disparities among members of these communities. 3) To form or further develop at least four collaborations with other NCI programs (i.e., NCI Centers/Divisions/offices other than the NCI Center to Reduce Cancer Health Disparities) for the purpose of reducing cancer health disparities. 4) To increase utilization of beneficial interventions to reduce cancer health disparities. 5) To leverage Community Networks Program (CNP) activities by maintaining and obtaining new non- CRCHD funding for community-based participatory activities directed at reducing cancer health disparities. 6) To identify specific metrics to measure effectiveness of this project. 7) To increase community participation in primary and secondary prevention activities. 8) To identify specific barriers to proportional accrual in clinical research studies. 9) To plan training program activities for investigators, staff, and trainees with regard to overcoming disparities and disparities-focused research.
Aims i n years 2-5 will focus on developing, monitoring, and measuring effectiveness of these activities, and on building and leveraging funding to sustain program growth in the future. ? ? ? ?
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