Skip to main content

Advertisement

SpringerLink
Log in

Barriers to Human Papillomavirus Vaccine Uptake Among Racial/Ethnic Minorities: a Systematic Review

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Human papillomavirus (HPV) is associated with poor health outcomes, including cervical cancer. Racial/ethnic minority populations experience poor health outcomes associated with HPV at higher rates. A vaccine is available to protect against HPV infections and prevent HPV-related sequelae; however, vaccination rates have remained low in the United States (U.S.) population. Thus, there is an urgent need to increase the HPV vaccination rate. Moreover, little is known about barriers to HPV vaccination in racial/ethnic minority groups. This paper highlights the most recent findings on barriers experienced by these groups.

Methods

The PubMed database was searched on July 30, 2020, for peer-reviewed articles and abstracts that had been published in English from July 2010 to July 2020 and covered racial/ethnic disparities in HPV vaccination.

Results

Similar findings were observed among the articles reviewed. The low HPV vaccination initiation and completion rates among racial/ethnic minority populations were found to be associated with lack of provider recommendations, inadequate knowledge and awareness of HPV and HPV vaccination, medical mistrust, and safety concerns.

Conclusions

Provider recommendations and accurate distribution of information must be increased and targeted to racial/ethnic minority populations in order to bolster the rate of vaccine uptake. To effectively target these communities, multi-level interventions need to be established. Further, research to understand the barriers that may affect unvaccinated adults in the catch-up age range, including males, may be beneficial, as majority of the previous studies focused on either parents of adolescents or women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CDC. Genital HPV infection – fact sheet. Division of STD Prevention, Center for Disease Control and Prevention. 2017. Accessed 26 Nov 2018. Retrieved from: https://www.cdc.gov/std/hpv/stdfact-hpv.htm.

  2. CDC. Human papillomavirus. National Center of Immunization and Respiration Diseases. 2018. Accessed 26 Nov 2018. Retrieved from https://www.cdc.gov/hpv/parents/vaccine.html.

  3. U.S. Food & Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. FDA News Release, October 5, 2018. Retrieved from: https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old.

  4. CDC. Sexually Transmitted Disease Surveillance 2017. Division of STD prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Center for Disease Control and Prevention 2018. . Retrieved from: https://www.cdc.gov/std/stats17/other.htm#hpv.

  5. Spencer et al. Disparities and reverse disparities in HPV vaccination: a systematic review and meta-analysis. Prev Med. 2019;123:197–203. doi: https://doi.org/10.1016/j.ypmed.2019.03.037. Epub 2019 Mar 29.

  6. Gallagher, et al. Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review. BMC Public Health. 2016;16:172. https://doi.org/10.1186/s12889-016-2845-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sledge JA. The male factor: human papillomavirus (HPV) and HPV4 vaccine acceptance among African American young men. J Community Health. 2015 Aug;40(4):834–42. https://doi.org/10.1007/s10900-015-0007-3.

    Article  PubMed  Google Scholar 

  8. Miller, et al. Views on human papillomavirus vaccination: a mixed-methods study of urban youth. J Community Health. 2014 Oct;39(5):835–41. https://doi.org/10.1007/s10900-014-9858-2.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Joseph P, et al. Ethnic differences in perceived benefits and barriers to HPV vaccine acceptance: a qualitative analysis of young African American, Haitian, Caucasian, and Latino men. Clin Pediatr (Phila). 2014;53(2):177–85. https://doi.org/10.1177/0009922813515944.

    Article  Google Scholar 

  10. Warner et al. Latino parents’ perceptions of the HPV vaccine for sons and daughters. J Community Health 2015;40(3):387–394. doi: https://doi.org/10.1007/s10900-014-9949-0.

  11. Davlin, et al. Correlates of HPV knowledge among low-income minority mothers with a child 9-17 years of age. J Pediatr Adolesc Gynecol. 2015;28(1):19–23. https://doi.org/10.1016/j.jpag.2014.01.109.

    Article  CAS  PubMed  Google Scholar 

  12. Kepka, et al. Low human papillomavirus (HPV) vaccine knowledge among Latino parents in Utah. J Immigr Minor Health. 2015;17(1):125–31. https://doi.org/10.1007/s10903-014-0003-1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Btoush, et al. Knowledge and attitudes toward human papillomavirus vaccination among Latina mothers of South American and Caribbean descent in the Eastern US. Health Equity. 2019;3(1):219–30. https://doi.org/10.1089/heq.2018.0058 eCollection 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bastani, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomark Prev. 2011;20(7):1463–72. https://doi.org/10.1158/1055-9965.EPI-11-0267.

    Article  Google Scholar 

  15. Kepka, et al. Factors associated with human papillomavirus vaccination among diverse adolescents in a region with low human papillomavirus vaccination rates. Health Equity. 2018;2(1):223–32. https://doi.org/10.1089/heq.2018.0028.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cruz D, et al. Human papillomavirus (HPV) vaccination motivators, barriers, and brochure preferences among parents in multicultural Hawai'i: a qualitative study. J Cancer Educ. 2017;32(3):613–21. https://doi.org/10.1007/s13187-016-1009-2.

    Article  Google Scholar 

  17. Mehta, et al. Human papillomavirus vaccination history among women with precancerous cervical lesions: disparities and barriers. Obstet Gynecol. 2012;119(3):575–81. https://doi.org/10.1097/AOG.0b013e3182460d9f.

    Article  PubMed  Google Scholar 

  18. Taylor, et al. Understanding HPV vaccine uptake among Cambodian American girls. J Community Health. 2014;39(5):857–62. https://doi.org/10.1007/s10900-014-9844-8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim, et al. Knowledge, perceptions, and decision-making about human papillomavirus vaccination among Korean American women: a focus group study. Womens Health Issues. 2015;25(2):112–9. https://doi.org/10.1016/j.whi.2014.11.005.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kobetz, et al. Perceptions of HPV and cervical cancer among Haitian immigrant women: implications for vaccine acceptability. Educ Health (Abingdon). 2011;24(3):479.

    CAS  Google Scholar 

  21. Allen, et al. Parental decision making about the HPV vaccine. Cancer Epidemiol Biomark Prev. 2010;19(9):2187–98. https://doi.org/10.1158/1055-9965.EPI-10-0217.

    Article  Google Scholar 

  22. Strohl, et al. Barriers to prevention: knowledge of HPV, cervical cancer, and HPV vaccinations among African American women. Am J Obstet Gynecol. 2015;212(1):65.e1–5. https://doi.org/10.1016/j.ajog.2014.06.059.

    Article  Google Scholar 

  23. Ford JL. Racial and ethnic disparities in human papillomavirus awareness and vaccination among young adult women. Public Health Nurs. 2011;28(6):485–93. https://doi.org/10.1111/j.1525-1446.2011.00958.x.

    Article  PubMed  Google Scholar 

  24. Jones et al. Minority college students’ HPV knowledge, awareness, and vaccination history. J Assoc Nurses AIDS Care. 2017 28(5):675–679. doi: https://doi.org/10.1016/j.jana.2017.04.008. Epub 2017 Apr 26.

  25. O’Leary, et al. Exploring Facilitators and Barriers to Initiation and Completion of the Human Papillomavirus (HPV) Vaccine Series among Parents of Girls in a Safety Net System. Int J Environ Res Public Health. 2018;15(2):E185. https://doi.org/10.3390/ijerph15020185.

    Article  PubMed  Google Scholar 

  26. Lechuga, et al. HPV vaccine awareness, barriers, intentions, and uptake in Latina women. J Immigr Minor Health. 2016;18(1):173–8. https://doi.org/10.1007/s10903-014-0139-z.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Romaguera, et al. Factors associated with HPV vaccine awareness in a population-based sample of Hispanic women in Puerto Rico. J Racial Ethn Health Disparities. 2016;3(2):281–90. https://doi.org/10.1007/s40615-015-0144-5.

    Article  CAS  PubMed  Google Scholar 

  28. Blake, et al. Predictors of human papillomavirus awareness and knowledge in 2013: gaps and opportunities for targeted communication strategies. Am J Prev Med. 2015. 2015;48(4):402–10. https://doi.org/10.1016/j.amepre.2014.10.024.

    Article  Google Scholar 

  29. Boakye, et al. Approaching a decade since HPV vaccine licensure: racial and gender disparities in knowledge and awareness of HPV and HPV vaccine. Hum Vaccin Immunother. 2017;13(11):2713–22. https://doi.org/10.1080/21645515.2017.1363133.

    Article  Google Scholar 

  30. McBride K, Singh S. Predictors of adults’ knowledge and awareness of HPV, HPV-associated cancers, and the HPV vaccine: implications for health education. Health Educ Behav. 2018;45(1):68–77. https://doi.org/10.1177/1090198117709318.

    Article  PubMed  Google Scholar 

  31. Kashani, et al. Human papillomavirus vaccination trends, barriers, and promotion methods among American Indian/Alaska native and non-Hispanic white adolescents in Michigan 2006-2015. J Community Health. 2019;44(3):436–43. https://doi.org/10.1007/s10900-018-00615-4.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pierce, et al. Post approval human papillomavirus vaccine uptake is higher in minorities compared to whites in girls presenting for well-child care. Vaccines (Basel). 2013;1(3):250–61. https://doi.org/10.3390/vaccines1030250.

    Article  Google Scholar 

  33. Sriram S, Ranganathan R. Why human papilloma virus vaccination coverage is low among adolescents in the US? A study of barriers for vaccination uptake. J Family Med Prim Care. 2019;8(3):866–70. https://doi.org/10.4103/jfmpc.jfmpc_107_19.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cheruvu, et al. Factors associated with parental reasons for “no-intent” to vaccinate female adolescents with human papillomavirus vaccine: National Immunization Survey - Teen 2008–2012. BMC Pediatr. 2017;17(1):52. https://doi.org/10.1186/s12887-017-0804-1.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dela Cruz et al. HPV vaccination prevalence, parental barriers and motivators to vaccinating children in Hawai’i. Ethn Health. 2018 10:1-13. doi: https://doi.org/10.1080/13557858.2018.1473556. Online ahead of print.

  36. Liddon, et al. Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: findings from the 2006-2008 National Survey of Family Growth. Vaccine. 2012;30(16):2676–82. https://doi.org/10.1016/j.vaccine.2012.02.007.

    Article  PubMed  Google Scholar 

  37. Otanez S, Torr BM. Ethnic and racial disparities in HPV vaccination attitudes. J Immigr Minor Health. 2018;20(6):1476–82. https://doi.org/10.1007/s10903-017-0685-2.

    Article  PubMed  Google Scholar 

  38. Hennebery, et al. Factors associated with initiation of HPV vaccination among young women and girls in urban and suburban New Orleans. J Community Health. 2020;45(4):775–84. https://doi.org/10.1007/s10900-020-00793-0.

    Article  PubMed  Google Scholar 

  39. Glenn, et al. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine. 2015;33(2):289–93. https://doi.org/10.1016/j.vaccine.2014.11.032.

    Article  PubMed  Google Scholar 

  40. Reiter, et al. Provider-verified HPV vaccine coverage among a national sample of Hispanic adolescent females. Cancer Epidemiol Biomark Prev. 2014;23(5):742–54. https://doi.org/10.1158/1055-9965.EPI-13-0979.

    Article  Google Scholar 

  41. Chando, et al. Effects of socioeconomic status and health care access on low levels of human papillomavirus vaccination among Spanish-speaking Hispanics in California. Am J Public Health. 2013;103(2):270–2. https://doi.org/10.2105/AJPH.2012.300920 Epub 2012 Dec 13.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Guerry, et al. Human papillomavirus vaccine initiation among adolescent girls in high-risk communities. Vaccine. 2011;29(12):2235–41. https://doi.org/10.1016/j.vaccine.2011.01.052.

    Article  PubMed  Google Scholar 

  43. Cunningham-Erves, et al. Black mother’s intention to vaccinate daughters against HPV: a mixed methods approach to identify opportunities for targeted communication. Gynecol Oncol. 2018;149(3):506–12. https://doi.org/10.1016/j.ygyno.2018.03.047.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Sanders, et al. African American parents’ HPV vaccination intent and concerns. J Health Care Poor Underserved. 2012;23(1):290–301. https://doi.org/10.1353/hpu.2012.0007.

    Article  Google Scholar 

  45. Victory, et al. Parental knowledge gaps and barriers for children receiving human papillomavirus vaccine in the Rio Grande Valley of Texas. Hum Vaccin Immunother. 2019;15(7–8):1678–87. https://doi.org/10.1080/21645515.2019.1628551.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pierre-Victor, et al. Barriers to HPV vaccination among unvaccinated. Haitian American College Women Health Equity. 2018;2(1):90–7. https://doi.org/10.1089/heq.2017.0028 eCollection 2018.

    Article  PubMed  Google Scholar 

  47. Niccolai, et al. Parents’ recall and reflections on experiences related to HPV vaccination for their children. Qual Health Res. 2016;26(6):842–50. https://doi.org/10.1177/1049732315575712.

    Article  PubMed  Google Scholar 

  48. Galbraith, et al. African-American parents’ and daughters’ beliefs about HPV infection and the HPV vaccine. Public Health Nurs. 2019;36(2):134–43. https://doi.org/10.1111/phn.12565.

    Article  Google Scholar 

  49. Ramirez, et al. Acceptability of the human papillomavirus vaccine among diverse Hispanic mothers and grandmothers. Hisp Health Care Int. 2014;12(1):24–33. https://doi.org/10.1891/1540-4153.12.1.24.

    Article  PubMed  Google Scholar 

  50. Hernandez, et al. HPV vaccine recommendations: does a health care provider’s gender and ethnicity matter to unvaccinated Latina college women? Ethn Health. 2019;24(6):645–61. https://doi.org/10.1080/13557858.2017.1367761.

    Article  PubMed  Google Scholar 

  51. Kolar, et al. Human papillomavirus vaccine knowledge and attitudes, preventative health behaviors, and medical mistrust among a racially and ethnically diverse sample of college women. J Racial Ethn Health Disparities. 2015;2(1):77–85. https://doi.org/10.1007/s40615-014-0050-2.

    Article  PubMed  Google Scholar 

  52. Ashing, et al. Examining HPV- and HPV vaccine-related cognitions and acceptability among US-born and immigrant Hispanics and US-born and immigrant non-Hispanic Blacks: a preliminary catchment area study. Cancer Causes Control. 2017;28(11):1341–7. https://doi.org/10.1007/s10552-017-0973-0 Epub 2017 Nov 2.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Daley, et al. Ethnic and racial differences in HPV knowledge and vaccine intentions among men receiving HPV test results. Vaccine. 2011;29(23):4013–8. https://doi.org/10.1016/j.vaccine.2011.03.060.

    Article  PubMed  PubMed Central  Google Scholar 

  54. American Academy of Pediatrics. HPV vaccine is cancer prevention: teaching tools. 2020. Accessed on 10 Aug 2020. Retrieved from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/HPV-Champion-Toolkit/Pages/Grand-Rounds.aspx

  55. Castellsague, et al. End-of-study safety, immunogenicity, and efficacy of quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine in adult women 24–45 years of age. Br J Cancer. 2011;105:28–37 2011 Cancer Research UK All rights reserved 0007–0920/11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Luna, et al. Long-term follow-up observation of the safety, immunogenicity, and effectiveness of Gardasil in adult women. PLoS One. 2013;8(12):e83431. https://doi.org/10.1371/journal.pone.0083431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Vu, et al. A multilevel analysis of factors influencing the inaccuracy of parental reports of adolescent HPV vaccination status. Vaccine. 2019;37(6):869–76. https://doi.org/10.1016/j.vaccine.2018.12.032.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This work was supported in part by NIH R01 Grant number R01AI116914 from the NIH Institute of Allergy and Infectious Diseases.

Availability of Data and Material

Not applicable.

Code Availability

Not applicable.

Funding

This work was supported in part by NIH R01 Grant number R01AI116914 from the NIH Institute of Allergy and Infectious Diseases.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Diseases, University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Street, Room E715, Houston, TX, 77030, USA

    Trisha L. Amboree & Charles Darkoh

  2. Microbiology and Infectious Diseases Program, University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA

    Charles Darkoh

Authors
  1. Trisha L. Amboree
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles Darkoh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors contributed to the study idea. Review of the literature was performed by Trisha Amboree. Synthesis of review findings was performed by Trisha Amboree and Charles Darkoh. The first draft of the manuscript was written by Trisha Amboree and both authors commented on previous versions of the manuscript. Charles Darkoh critically revised the work. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Charles Darkoh.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1

Table 4 Summary of main qualitative findings related to barriers to HPV vaccine uptake among racial/ethnic minorities
Full size table

Appendix 2. Search strategy (PubMed)—MeSH terms

  • (((“papillomaviridae”[MeSH Terms] OR “papillomaviridae”[All Fields]) OR ((“human”[All Fields] AND “papillomavirus”[All Fields]) AND “hpv”[All Fields])) OR “human papillomavirus hpv”[All Fields]) AND (((((((((((((((((((“vaccin”[Supplementary Concept] OR “vaccin”[All Fields]) OR “vaccination”[MeSH Terms]) OR “vaccination”[All Fields]) OR “vaccinable”[All Fields]) OR “vaccinal”[All Fields]) OR “vaccinate”[All Fields]) OR “vaccinated”[All Fields]) OR “vaccinates”[All Fields]) OR “vaccinating”[All Fields]) OR “vaccinations”[All Fields]) OR “vaccination s”[All Fields]) OR “vaccinator”[All Fields]) OR “vaccinators”[All Fields]) OR “vaccine s”[All Fields]) OR “vaccined”[All Fields]) OR “vaccines”[MeSH Terms]) OR “vaccines”[All Fields]) OR “vaccine”[All Fields]) OR “vaccins”[All Fields]) AND ((“barrier”[All Fields] OR “barrier s”[All Fields]) OR “barriers”[All Fields])

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amboree, T.L., Darkoh, C. Barriers to Human Papillomavirus Vaccine Uptake Among Racial/Ethnic Minorities: a Systematic Review. J. Racial and Ethnic Health Disparities 8, 1192–1207 (2021). https://doi.org/10.1007/s40615-020-00877-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-020-00877-6

Keywords

Search

Navigation