1. Patterns of HPV vaccination among Latinos: Key factors for consideration Rachel A. Reimer, PhD Chair Department of Public Health Director MPH program Associate Professor Des Moines University

2. Cervical Cancer Disparities Latinas more likely to contract HPV-associated cervical cancer than Whites Mortality rates disparate – Pap screening rates – Advanced stage of diagnosis

3. Patterns of HPV Vaccination 13-17 year olds, NIS-Teen 2014 Females – 60.0 > 1 dose – 39.7 > 3 doses Males – 33.6 > 1 dose – 13.4 > 3 doses

4. Patterns of HPV vaccination by race / ethnic group White non-HispanicBlack non-HispanicHispanic Females > 1 doses56.166.466.3 > 3 doses37.539.046.9 Males > 1 doses36.442.154.2 > 3 doses18.820.427.8

5. Study 1 Purpose – Examine HPV vaccine uptake among older adolescent girls and women and to examine influence of mother-daughter communication Participants – 972 ISU undergraduate students – Predominantly Caucasian – Typically from middle-class SES backgrounds Roberts, Gerrard, Reimer, & Gibbons. (2010). Mother Daughter communication and Human Papillomavirus Vaccine uptake by college students. Pediatrics,

6. Study 1 Findings: Logistic Regressions predicting vaccination status Unadjusted logistic regression Adjusted Logistic Regressions BOR (95% CI)B Risky Sexual Behavior.061.06 (.98 – 1.14)-- HPV knowledge.26*1.30 (1.11 – 1.52).091.09 (.92 -1.31) HPV risk perception.12*(1.22 (1.13 – 1.31).14*1.15 (1.06-1.25) Communication –sex.39*1.48 (1.25 – 1.75).28*1.32 (1.10 – 1.59) Communication –values.051.06 (.92-1.21)-- Mother approval.95*2.57 (2.11 -3.13).84*2.32 (1.90 – 2.83)

7. Study 2 Purpose – Examine ethnic differences in HPV-associated beliefs and practices Partners – PHC and Mercy family practice clinics Participants – 150 White non-Hispanic, and 159 Latina women

8. Study 2 Findings: Communication about sex & values

9. Study 2 Findings: Norms

10. Study 2 Findings Religiosity

11. Study 3 Purpose – Examine ethnic and gender differences in key vaccination predictors Participants – Community sample recruited from health care clinics – 507 15-30yr old male and female Hispanic and non-Hispanic Whites

12. Study 3 Findings HPV awareness – Whites and females reported more awareness HPV knowledge – Hispanics and Males reported lower knowledge Vaccine Status – No males had been vaccinated – White women more likely to be vaccinated Physician Recommendation – Hispanics less likely to receive recommendation – Males less likely to receive recommendation – Hispanic Males least likely to receive a recommendation

13. Future Practice Recommendations Practice – Consider key sociocultural factors that may affect racial and ethnic groups and genders differently – Collaborate with health care providers to increase awareness – Engage community stakeholders to change norms and perceptions