The University of Texas at Austin Latino Research Initiative

Mothers, marketing, and policy: identifying the challenges to HPV vaccine uptake in U.S. Hispanic and Puerto Rican women

Mon, October 8, 2018
Mothers, marketing, and policy: identifying the challenges to HPV vaccine uptake in U.S. Hispanic and Puerto Rican women
"...in 2015, only 42% of U.S. Hispanic girls and 44% of island Puerto Rican girls received the vaccine."

Written by Jessie Temple

In a recently published study, Dr. Daisy Morales-Campos of the Latino Research Institute investigated a question with broad relevance for health equity: even given increased awareness of HPV and the HPV vaccine’s role in preventing cancers, why do so many girls fail to receive or finish the HPV vaccine series? The study examined data from two groups, U.S. Hispanic women and island Puerto Rican women, to identify the factors that might limit understanding and uptake of the HPV vaccine.

Existing HPV vaccines have been proven to reduce the incidence of cervical and other cancers in people who receive the vaccine in adolescence. Healthy People 2020, which lays out the U.S. Department of Health and Human Services’ 10-year goals and objectives for health promotion and disease prevention, set an HPV vaccination goal of 80% of girls aged 13–15. Meanwhile, both U.S. Hispanic and island Puerto Rican women have a higher incidence of cervical cancer compared to non-Hispanic U.S. white women. However, HPV vaccine uptake within these groups was significantly lower than the national target: in 2015, only 42% of U.S. Hispanic girls and 44% of island Puerto Rican girls received the vaccine.

Using previously collected data sets, Dr. Morales-Campos set out to compare similarities and differences in HPV awareness between the two groups of women. Women in both groups were knowledgeable about HPV (knowing, for instance, that HPV is a sexually transmitted infection and that HPV can cause cancer). Initially, island Puerto Rican women showed significantly higher HPV vaccine awareness (66.9% vs. 61.0%) and were more accepting of the HPV vaccine for a real or hypothetical daughter compared to U.S. Hispanic women (74.8% vs. 56.1%). However, after controlling for sociodemographic variables and survey group, there was no longer a difference between the two groups of women in HPV vaccine awareness. Moreover, after controlled analysis, island PR women were significantly less likely to have their hypothetical daughter get the HPV vaccine compared to U.S. Hispanic women.

The study identified several possible barriers to HPV uptake: a sexual stigma linking the HPV vaccine to sexual activity; differences in access to health care in the U.S. and Puerto Rico (for instance, the difficulties that undocumented immigrants in the U.S. might face in accessing health care); and the existence, or lack thereof, of health education, media coverage, and health policy targeted to specific cultural groups. 

But for Dr. Morales-Campos, an important finding of the study was not specifically related to the HPV vaccine. “We need specific data related to cultural subsets,” she noted. At present, much available data does not distinguish between different Hispanic cultural groups. For instance, researchers had no way to determine if the U.S. Hispanic women who provided data for the study were Mexican-American Latinas in South Texas or Dominican-American Latinas in New York City. “For health education programs and media messages to be effective, they have to be culturally appropriate,” says Morales-Campos. Future researchers, then, would do well to look at the category of “Hispanic” much more closely.  

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