Ethnic and racial differences in HPV knowledge and vaccine intentions among men receiving HPV test results
Introduction
Human papillomavirus (HPV), the most common sexually transmitted virus in the United States (U.S.), remains a considerable public health problem [1]. Although most attention has been directed to cervical cancer, the most common HPV-related cancer, HPV has been indicated in 40% of vulvar and vaginal cancers, 40% of penile cancers, 90% of anal cancers [2], [3], [4] and 25–63% of head and neck cancers in the U.S. [2], [3], [4], [5], [6], [7]. Racial/ethnic minorities account for a disproportionate number of HPV-related cancers [8]. Greater proportions of Black and Hispanic men and women are diagnosed with HPV-related cancers and are diagnosed at later stages of the disease than men and women of other races or ethnicities [9], [10], [11], [12], [13], [14]. Thus, race and ethnicity, or associated factors, play a fundamental role in the epidemiology of HPV-related cancer in the U.S.
In 2006, the Food and Drug Administration (FDA) approved a prophylactic quadrivalent HPV vaccine for women (9–26 years) [15] and recently in 2009, the FDA approved the quadrivalent HPV vaccine for use in preventing HPV 6 and 11 related to genital warts in males ages 9–26 years [16]. Numerous studies evaluating the acceptability of and the attitudes towards the HPV vaccine have been conducted, but few have examined acceptability among racial and ethnic minority men [17]. Across racial/ethnic groups, factors associated with vaccine acceptance among men include knowledge of HPV, perceived threat, and perceived barriers to HPV vaccine [17], [18], [19], [20]. Previous research conducted with men found low levels of awareness and knowledge about HPV [21], [22], [23]. Acceptability of the HPV vaccine was on average higher in studies conducted with gay and bi-sexual men (47–74%) than studies conducted with heterosexual men (37–78%) [17], [21], [22], [23], [24]. These rates also varied based on how the vaccine was framed, and there was a general preference for a vaccine that protected against more types of HPV and that provided some direct protection for males [24], [25]. Vaccine acceptance is generally higher among men who perceive themselves to be at risk for HPV infection, those with higher lifetime partners and those with greater anticipated regret if they did not get vaccinated and later had an HPV infection [21], [22], [25], [26]. Perceived barriers to vaccination often include concerns about vaccine safety, side effects, costs, and fear of shots [18], [19], [23], [26]. Additionally, it is well documented that a physician's recommendation plays a significant role in the decision to be vaccinated [21], [27], [28], [29], [30], [31], and physicians who currently vaccinate women support vaccinating men [31]. Understanding factors related to vaccine intentions among racial and ethnic minority populations is critical, because disparities in other types of immunization and vaccinations remain an important public health concern, and addressing potential disparities now may be key to preventing major disparities [32].
The purpose of this current investigation is to examine whether there are racial and ethnic differences among men in: (a) factors associated with vaccine uptake, including knowledge of HPV and other demographic factors; (b) barriers to HPV vaccination; (c) importance of provider recommendation; and (d) vaccine intentions. Results from this study will inform future HPV vaccine interventions among racial and ethnic minority men at high risk for HPV-related cancers.
Section snippets
Study design and population
The Cognitive and Emotional Responses to HPV in Men (CER) Study is the behavioral arm of a Natural History Study of HPV Infection in Men (the HIM study) [33]. The CER survey was developed as a computer-assisted survey instrument (CASI) that measures theoretically-based constructs related to cognitive and emotional responses to an HPV test result. The constructs in the survey were derived from the Parallel Processing Model and Common Sense Model (Leventhal), the Extended Parallel Processing
Sample characteristics
Of 477 respondents, 307 (64%) identified as non-Hispanic White, 78 (16%) as non-Hispanic Black, and 90 (19%) as Hispanic. Self-reported HPV status did not differ among these 3 groups. The mean age of participants was 31 years (range 18–69). Overall, men in this sample had high scores on the HPV knowledge scale (mean = 15, SD = 3) and reported having at least some college education (87%). Compared to non-Hispanic White men, a greater proportion of non-Hispanic Black men reported ever having had
Discussion
One of the four goals outlined in Healthy People 2020 is “achieve health equity, eliminate disparities, and improve the health of all groups [36].” Strategies of this initiative to avert vaccine-preventable diseases include: improved quality and quantity of vaccination services; minimization of financial burden for disadvantaged persons; increased community participation, education, and leadership; improved disease monitoring and vaccine coverage; and development of new or improved vaccines.
Acknowledgement
This study is funded by the National Institutes of Health, National Cancer Institute (Grant# 1R01 CA123346).
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