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Am J Health Behav. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Am J Health Behav. 2016 November ; 40(6): 771–778. doi:10.5993/AJHB.40.6.9.

HPV Awareness, Knowledge and Vaccination Attitudes among Church-going African-American Women Sarah B. Maness, PhD, MPH [Assistant Professor], The University of Oklahoma, Department of Health and Exercise Science, Norman, OK.

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Lorraine R. Reitzel, PhD [Associate Professor], The University of Houston, Department of Psychological, Health, & Learning Sciences, Social Determinants/ Health Disparities Lab, Houston, TX. Kellie L. Watkins, MS [Graduate Student], and The University of Texas School of Public Health, Department of Epidemiology, Houston, TX. Lorna H. McNeill, PhD, MPH [Associate Professor] The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX.

Abstract

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Objectives—The purpose of this exploratory study was to better understand sociodemographic correlates of human papillomavirus (HPV) awareness, knowledge, and vaccination attitudes among a convenience sample of church-going, African-American women and how knowledge about HPV-related cancers relates to vaccination attitudes for girls and boys. Methods—Participants (N = 308) answered survey questions about HPV awareness, knowledge, and vaccination attitudes. Associations between variables were assessed using Bonferroni-adjusted chi-square tests and regression analyses. Results—Younger age was associated with having heard of HPV and willingness to vaccinate a daughter or son in covariate-adjusted analyses. Younger age and greater education were associated with knowledge that HPV causes cervical cancer. A positive association existed between willingness to vaccinate a daughter or son based on knowledge of the number of cancers associated with HPV. Knowledge that HPV was related to non-cervical cancers was significantly associated with greater willingness to vaccinate sons.

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Conclusions—Knowledge that HPV causes multiple cancers is important to willingness to vaccinate a child. Education campaigns should emphasize that HPV is also related to non-cervical

Correspondence Dr Reitzel; [email protected]. Lorraine R. Reitzel and Lorna H. McNeill are the joint senior scientists on this work. Human Subjects Statement The Institutional Review Board at The University of Texas MD Anderson Cancer Center and the University of Houston approved this study. Written informed consent for all study procedures was obtained before data collection. Conflict of Interest Statement Authors have no competing interests pertaining to this research.

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cancers. African-American women of older age and less education might benefit from churchbased HPV educational campaigns. Keywords HPV; vaccination; African-American women; church

INTRODUCTION

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The Human papillomavirus (HPV) is associated with a number of cancers including cervical, oropharyngeal, penile and anal.1 Between 2008 and 2012, 23,000 HPV-related cancers were diagnosed among women and 15,793 were diagnosed among men.2 Vaccination is available to prevent infection with HPV and is recommended for pre-teens to young adults. Originally approved in 2006 for girls and women aged 9–26, the HPV vaccine was approved for use with boys in 2009.3 However, since arriving on the market in 2006, uptake of the HPV vaccination is lower than that of other adolescent vaccines,4 at about 30% uptake for girls and 5% for boys.5,6 HPV vaccination provides an opportunity to reduce multiple HPV-related cancers; therefore, increasing uptake of the vaccine among youth of both sexes is a vital public health issue.

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HPV vaccination was originally marketed as a preventive measure for cervical cancer, and many previous studies have specifically addressed knowledge of the link between HPV and cervical cancer to HPV vaccination attitudes and uptake.7–9 However, the HPV vaccine has the added benefit of reducing the burden of other HPV-related cancers for both men and women.10,11 Despite this, few studies address how knowledge of HPV and the incidence of non-cervical cancers might relate to attitudes about vaccination, especially as related to the vaccination of boys. Presumably, a lack of knowledge of the connection between HPV and the types of cancers that affect men might be associated with less willingness to vaccinate sons than daughters, or to support vaccination of boys within the family.

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Acceptance of HPV vaccine among parents/guardians and rates of vaccination among adolescent girls may be lower among some religious communities, potentially due to perceptions of the link between HPV transmission and early/premarital sexual activity.12 Racial and ethnic disparities in HPV vaccination have also been documented among African-American populations, with lower rates of uptake found among African-American girls and women relative to non-Hispanic White girls and women (18.2% vs. 33.1%).13 Currently, there is a lack of research regarding racial and ethnic disparities in relation to the vaccination of boys. In addition, research has not adequately addressed knowledge about HPV and attitudes regarding vaccination of both African-American girls and boys in the context of a religious community. Approximately 53% of African-American adults report attending religious services once a week in comparison with 39% of all American adults.14 The African-American church represents an important part of the African-American community and provides an opportunity to examine links between HPV awareness, knowledge, and vaccination attitudes among church-going, African-American women. A recent publication using data from the larger, longitudinal parent study examined older church-going African-American women’s views on HPV vaccination from the standpoint Am J Health Behav. Author manuscript; available in PMC 2017 November 01.

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that the family structure of African-American families is often intergenerational in terms of care-giving for children.15 Results supported associations between HPV knowledge and higher education, as well as between HPV awareness and younger age, higher education, a family history of cancer, and less endorsed spirituality. This study concluded that older African-American women with less education and no family history of cancer may benefit from HPV education. However, this study was only able to examine willingness to vaccinate daughters, with no attention to sons, and focused only on older African-American women (aged 40 and above).

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The current, exploratory study seeks to understand the sociodemographic correlates of HPV awareness, knowledge, and attitudes among a convenience sample of church-going AfricanAmerican women and how knowledge about HPV-related cancers relates to vaccination attitudes for both girls and boys. It expands the literature in this area by examining HPV knowledge of links with non-cervical cancers and vaccination attitudes. In addition, it captures vaccination attitudes regarding both girls and boys across a broader age range of church-going African-American women. It also expands on the previous study by collecting data from a different church of an alternate denomination (Baptist vs. Methodist) located in the same urban area. This research is an important next step in understanding how to best focus health promotion efforts to increase vaccination rates among African-American girls and boys.

METHODS Design

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Data were gathered from a Baptist church in Houston, Texas, that comprises predominately African-American attendees, with an overall membership of approximately 2000 parishioners. Previous publications detail the parent study design, which was replicated within the current setting.15–23 Specifically, recruitment was accomplished via televised media and in-person solicitation for a study about African-American adults and cancer risk. Inclusion criteria were age ≥18 years old, resident of the Houston area with a functional telephone number, able to read and speak English, and an attendee of the church where data were gathered (membership was not a requirement). A convenience sampling method was used to achieve the targeted sample size of >/=400 men and women (actual N = 417). Surveys were completed in person at the church using a computerized questionnaire format administered at private stations. Participants were compensated with a $30 gift card following survey completion. Data were collected between September 2013 and February 2014. The current study reports on one of several diverse project aims. Study procedures were approved by the Institutional Review Boards at the primary (The University of Texas MD Anderson Cancer Center) and affiliated (University of Houston) institutions and written informed consent was obtained from all participants.

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Sample Due to a skip pattern structure for men, data relevant to HPV were only asked among women (N = 308; 73.9% of those included in the study). Consequently, the current sample comprised 308 African-American women.

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Measures

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Participant characteristics—Participant characteristics included age (assessed continuously; categorized as 18–39, 40–59, ≥60). Other characteristics included education (/= Bachelor's degree

144

46.8

< $40,000

97

33.4

>/= $40,000

193

66.6

unemployed

128

41.6

employed

180

58.4

partnered

131

42.7

not partnered

176

57.3

not parent

61

19.9

parent

246

80.1

none

222

72.1

>/= 1

86

27.9

no

240

77.9

yes

68

22.1

Age

Education

Annual Household Income

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Employment Status

Partner Status

Parental Status

Minors in Household

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Family History of Cancer

Personal History of Cancer no

255

96.2

yes

10

3.8

Strongly agree

215

69.8

agree

90

29.2

disagree

3

1.0

Spirituality

Note: Family history of cancer was over the last 12 months, whereas personal history of cancer was in reference to the lifetime. Some questions contain missing data and do not represent all 308 participants.

Author Manuscript Am J Health Behav. Author manuscript; available in PMC 2017 November 01.

HPV Awareness, Knowledge and Vaccination Attitudes among Church-going African-American Women.

The purpose of this exploratory study was to improve understanding of the sociodemographic correlates of human papillomavirus (HPV) awareness, knowled...
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