Culturally Tailored Messages Increase HPV Vaccination of Asian American Adolescents

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Results from a pilot study supported by the National Cancer Institute’s Center to Reduce Cancer Health Disparities and presented at the 11th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held November 2-5, 2018 in the Sheraton New Orleans Hotel, New Orleans, Louisiana, USA, showed the effects of specifically designed culturally tailored messages aimed at removing barriers to human papillomavirus or HPV vaccination among low-income, mostly Chinese-American adolescent girls and boys.

The AACR’s Science of Cancer Health Disparities conferences is designed to help advance the understanding of, and ultimately help to eliminate, cancer health disparities which represent a major public health problem in our country.

The culturally tailored multilevel strategy significantly increased vaccine uptake, according the researchers.

Human papillomavirus or HPV is a group of more than 200 related viruses. Of these different viruses, more than 40 are spread through direct sexual contact. This includes several HPV types cause genital warts, and about a dozen HPV types can cause certain types of cancer such as cervical cancer, anal cancer, oropharyngeal cancer, penile cancer, vulvar cancer, and vaginal cancer.[1]

HPV vaccination could prevent more than 90% of the estimated 33,700 cases of cancer attributable to HPV infection that are diagnosed each year in the United States, according to the Centers for Disease Control and Prevention (CDC).


A culturally tailored intervention to engage pediatricians and physicians in educating low-income Asian American parents about the importance of HPV vaccination … has great potential to increase HPV vaccination rates in diverse Asian American communities…


The CDC therefore, recommends that all adolescents ages 11 and 12 receive two doses of HPV vaccine.

Amazing cancer prevention tool
“HPV vaccination is an amazing cancer prevention tool, but only 66% of all U.S. adolescents ages 13 to 17 have received one or more dose of the vaccine,” said Grace X. Ma, Ph.D, associate dean for health disparities, director of the Center for Asian Health, Laura H. Carnell professor, and professor in clinical sciences in the Lewis Katz School of Medicine at Temple University, Philadelphia.

“Overall, HPV vaccine uptake among Asian American adolescents is similar to uptake among adolescents from other racial and ethnic groups, but there are certain subgroups, such as Chinese Americans whose parents are low-income and have limited English proficiency, for whom uptake is much lower,” Ma noted.

“We know that there is a low level of awareness and knowledge about HPV vaccination among Asian American parents who are low-income and have limited English proficiency,” continued Ma. “However, they have strong trust in pediatricians/physicians, so we designed a culturally tailored intervention to engage pediatricians/physicians in educating low-income Asian American parents about the importance of HPV vaccination in the clinical setting using written materials, videos, verbal recommendations, and mobile communication,” she added.

Photo 1.0: Grace X. Ma, Ph.D is Associate Dean for Health Disparities, Founding Director of Center for Asian Health, Laura H. Carnell Professor and Professor in Clinical Sciences at Lewis Katz School of Medicine, Temple University. Ma is a nationally recognized behavioral health scientist and leader in health disparities research. Her community-based participatory research (CBPR) and patient-centered outcomes research (PCOR) focus on early detection, patient navigation, cancer prevention and control (Hepatitis liver cancer, cervical, breast, lung and colorectal cancers), chronic diseases (Hypertension and Diabetes), smoking cessation, and access/quality of healthcare in underserved Asian Pacific Americans and other diverse health disparity populations.

Culturally tailored messages
Ma and colleagues designed culturally tailored messages for pediatricians, community health workers, parents, and adolescents. The researchers intervened on multiple levels by developing messages for all these different groups of people, explained Ma.

The researchers provided the culturally tailored messages to Asian American pediatricians in primary care community health centers serving low-income Asian communities comprised mainly of Chinese Americans in Philadelphia and New York. The messages were delivered in Asian languages concordant with the language spoken by the parents.

Pilot study
The pilot study included 180 low-income mostly Chinese American parents with low English proficiency; 110 received the intervention and 70 did not. These parents had 290 adolescents ages 11–17; parents of 170 adolescents received the intervention.

Among those adolescents whose parents received the intervention, 76.36% had at least one dose of HPV vaccine, compared with 10 percent of adolescents whose parents did not receive the intervention.

Pediatrician engagement and pediatrician recommendation were the most important factors that led to parents choosing to have their children vaccinated, explained Ma. Having a peer or spouse who supported vaccination was another important factor.

Study Limitations
“Despite the study limitation in small sample size, these pilot data are extremely encouraging and promising,” said Ma.

“We need to test this intervention in larger, more rigorous clinical trials, but I believe that this multilevel and technology-based intervention has great potential to increase HPV vaccination rates in diverse Asian American communities, as well as can be adapted by other ethnic populations,” she concluded.

The U.S. Food and Drug Administration (FDA) has approved three vaccines that prevent infection with disease-causing HPV types. Today only one of these vaccines, Human Papillomavirus 9-valent Vaccine, Recombinant (Gardasil® 9; Merck & Co), an is the only HPV vaccine available for use in the United States. Other approved vaccines are still used in other countries.

Also read:

References
[1] Human Papillomavirus (HPV) Vaccines. National Cancer Institute (NCI). Online. Last accessed November 3, 2018


Last Editorial Review: November 3, 2018

Featured Image: Children receiving vaccine at shoulder. Children vaccine. Courtesy: © 2018 Fotolia. Used with permission. Photo 1.0: Grace X. Ma, Ph.D is Associate Dean for Health Disparities, Founding Director of Center for Asian Health, Laura H. Carnell Professor and Professor in Clinical Sciences at Lewis Katz School of Medicine, Temple University. Ma is a nationally recognized behavioral health scientist and leader in health disparities research. Her community-based participatory research (CBPR) and patient-centered outcomes research (PCOR) focus on early detection, patient navigation, cancer prevention and control (Hepatitis liver cancer, cervical, breast, lung and colorectal cancers), chronic diseases (Hypertension and Diabetes), smoking cessation, and access/quality of healthcare in underserved Asian Pacific Americans and other diverse health disparity populations. Courtesy: © 2018 Fotolia. Used with permission.

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