HPV Latino Survey Workgroup: Update & Future Directions CPCRN National Meeting Seattle, WA October 5, 2011 Presenters: Roshan Bastani, Beth Glenn, Gloria Coronado Discussants: Jennifer Allen, Roshan Bastani, Vicky Taylor

Background Collaboration among 3 CPCRN sites: University of California, Los Angeles University of Texas, Houston University of Washington, Seattle Initiated in November in 2008 Used the Health Behavior Framework to develop a set of 24 core HPV vaccine survey items

Surveyed Latino parents of girls ages 9–18 in Los Angeles (N=274), Seattle area-Yakima Valley (N=90), Houston (N=83), Data collection and descriptive analysis are complete Drafted a collaborative manuscript based on data collected Identifying next steps based on study results Summary of Progress

Demographics Los Angeles (n=274) Seattle YV (n=90) Houston 211 (n=44) Houston Lower Rio Grande Valley (n=39) Parents/Caregivers Age (mean) N/A54.9 Female100% 88%47% Spanish Interview89%78%45%100% Foreign-born94%82%N/A Uninsured87%46%52%79% Household income: < $25,000/year87%74%N/A87% Adolescent Girl Age (mean) N/A 13.9

Los Angeles (n=274) Seattle YV (n=90) Houston 211 (n=44) Houston Lower Rio Grande Valley (n=39) HPV Awareness: Heard of HPV 64%74%69%34% Knowledge (among aware): HPV spread via sexual contact 70%68%38%71% HPV can cause cervical cancer 75%68%41%74% HPV Vaccine Awareness: Heard of HPV vaccine63%73%69%57% Knowledge (among aware): HPV vaccine most effective when given before a girl starts having sex 75%84%36%n/a Receipt: Initiated HPV Vaccine (received ≥ 1 dose) 29%37%31%25% Acceptability/Intention: Very likely daughter will get the HPV vaccine in next 12 months 30%33%21%58% Awareness, Knowledge, Uptake

Los Angeles (n=274) Seattle YV (n=90) Houston 211 (n=44) Houston Lower Rio Grande Valley (n=39) HPV Perceived Susceptibility Agree daughter has more chance of getting HPV compared to other girls 8%30%5% Perceived Severity Agree daughter getting HPV would be a serious problem 87%61%79%74% HPV Vaccine Barriers Agree daughter may be more likely to think it’s okay to have sex if vaccinated 11%60%21%18% Agree getting the HPV vaccine may cause problems getting pregnant later 17%32%14%3% Agree if daughter gets the HPV vaccine it may cause future health problems 11%31%14%11% Perceived Efficacy Thinks HPV vaccine is very effective in preventing cervical cancer 41%67%7%63% Attitudes, Beliefs, Barriers

Los Angeles (n=274) Seattle YV (n=90) Houston 211 (n=44) Houston Lower Rio Grande Valley (n=39) Need more Information Does not have enough information to make a decision to get the HPV vaccine 70%40%26%n/a Health care provider: Would have daughter get the vaccine if your doctor recommended it 79%87%48%90% Discussed HPV vaccine w/ daughter’s MD 58%47%24%32% Daughter has ever been offered the HPV Vaccine by her doctor or nurse 63%46%29%37% Social Norms/Influences Agree other parents in the community are getting their daughters the HPV vaccine 23%67%36%42% Self-Efficacy Very sure they could get the HPV vaccine for daughter if they wanted 36%58%21%63% Decision Role Preference The decision to about vaccination should be made by my daughter’s MD/MD and me 82%77%81%n/a Decision Factors (among unvaccinated)

Moderate rates of vaccine awareness, but low rates of uptake and intent to vaccinate across samples Attitudinal barriers were not frequently endorsed Areas to target in interventions: Increase awareness, enhance beliefs about vaccine’s efficacy and safety Provide information on where to get vaccine (e.g., VFC providers) Likely important to engage health care providers in the process Summary of Key Findings

University of Washington, Seattle Receipt of a R21, University of Texas, Houston CPRIT-funded HPV Research Project, CPRIT-funded, Cancer Prevention Project, Cervical Cancer Free America: GSK funded project, University of California, Los Angeles Submission of R01 that has received a fundable score, Recently Funded HPV Grants

NCI R21 proposal funded July 2011 (w/UCLA site) Collaboration with an established Cambodian Community Coalition Primary goal: To conduct mixed-methods research that could be used to inform the development, implementation, and evaluation of culturally appropriate HPV vaccination interventions targeting Cambodian women with daughters in the 9–17 age group Components: 25 qualitative interviews Community-based survey of 200 mothers Retest survey with 50 quantitative survey participants UW: HPV Vaccination in the Cambodian Community

Cancer Prevention Research Institute of Texas (CPRIT) funded Research Project Primary Goal To evaluate, in a group randomized control trial, the effectiveness and cost effectiveness of two lay health worker-delivered programs to increase vaccine uptake among Hispanic girls ages Recruiting 1,809 parents in 27 clinics in Houston Intervention components (targeting parents): Print fotonovelas A self directed, tailored interactive (TIV) program that runs on iPads; Now known as “For Our Daughters” Houston: HPV Vaccination in the Hispanic Community

CPRIT-funded Research Project to develop, deliver and determine the effectiveness and cost effectiveness of a Cancer Control Navigator program implemented within the Gulf Coast & Weslaco Help Line Programs Increase cervical cancer screening with the Pap test and the initiation and completion of the HPV vaccine series, thereby reducing or eliminating cervical cancer in Texas Form a statewide coalition of key partners (investigators, healthcare systems, cancer centers, providers, community groups, agencies, and policymakers) Implement educational interventions and activities in identified areas Increasing Breast, Cervical, and Colorectal Cancer Screening & HPV Vaccinations among Underserved Texans: A Collaboration with the Program Cervical Cancer Free America: GlaxoSmithKline

UCLA: Increasing HPV Vaccine Uptake in a Low Income Ethnic Minority Population NCI R01 Proposal Submitted March 2011, with Seattle site, based on CPCRN survey findings Collaboration with the Los Angeles County Department of Public Health (LADPH), Office of Women's Health Primary goal: Randomized trial to test a theoretically driven intervention to increase HPV vaccine receipt among underserved, high risk girls in LA Will assess implementation outcomes (i.e., reach, etc) Intervention delivered by LADPH staff through their telephone hotline in English, Spanish, Cantonese, Mandarin, Korean, Armenian. Targets caregivers of 9-18 yr old girls Brief telephone intervention and companion print materials Referral to a convenient clinic offering low cost/free vaccine Intervention designed to be feasible for delivery by a county health department, and integrated into their infrastructure. Will facilitate sustainability and dissemination. Can be adapted for other outcomes.

Recent HPV Vaccine News Sept 13, 2011 New York Times article on HPV legislation

Recent HPV Vaccine News September 19, 2011, New York Times article commenting on the potential negative influence of Michele Bachmann’s criticism of the vaccine on uptake rates Latest national data show rates of initiation remain low among adolescent girls (49%), growing socioeconomic/racial/ethnic disparities in vaccine completion MMWR, 2011

Proposed Ideas for Cross-site Projects Implement the survey in additional populations i.e. Asian subgroups, African Americans Adapt evidence-based interventions for other vaccines or preventive health services to promote uptake of the HPV vaccine among Latinos or other groups System/Provider-based Interventions Include HPV vaccine promotion in work with FQHCs Use of for HPV vaccine education (similar to Texas) Deliver HPV vaccine and testing education to women seeking cancer screening, particularly women with vaccine-eligible daughters