Journal of Community Health

, 36:903 | Cite as

HPV-Related Risk Perceptions and HPV Vaccine Uptake Among a Sample of Young Rural Women

  • Robin C. Vanderpool
  • Baretta R. Casey
  • Richard A. Crosby
Original Paper

Abstract

Appalachia Kentucky is recognized for increased cervical cancer incidence, morbidity and mortality and lower rates of Pap testing. Understanding the predictors of Human Papillomavirus (HPV) vaccine uptake is warranted among this population. The purpose of this exploratory research is to determine associations between HPV-related risk perceptions and uptake of free Gardasil offered to rural Appalachian women ages 18–26 attending regional health clinics. Young women (N = 247) were recruited from health clinics in Southeastern, Kentucky from March 2008 through September 2009. After completing a brief interview assessing seven HPV-related risk perceptions, women received a HPV vaccine voucher which provided the entire three-dose vaccine series free of charge. Whether women redeemed the voucher for dose one of Gardasil served as the study outcome variable. Hierarchical logistic regression was used to estimate the independent effects of each predictor variable on vaccine uptake. Less than 50% redeemed the voucher to receive dose one of the HPV vaccine. Five of the seven variables significantly predicted uptake. In a controlled analysis, only two predictors remained significant: “in general, vaccines are a good thing” (P = .02) and “I believe that getting the vaccine will be painful” (P = .03). The remaining three predictor variables (worry about having HPV [P = .07], HPV is serious enough for vaccination [P = .43], and not sure vaccine is safe [P = .22]) were not significant in the model. Health promotion programs designed for this population may enhance HPV vaccine uptake by creating more realistic perceptions about the inherent value of vaccines and by improving perceptions relative to injection pain.

Keywords

Appalachia Rural HPV vaccine Risk perceptions 

References

  1. 1.
    Croyle, R. T., & Lerman, C. (1999). Risk communication in genetic testing for cancer susceptibility. Journal of the National Cancer Institute Monographs, 25, 59–66.PubMedGoogle Scholar
  2. 2.
    McCaul, K. D., & Tulloch, H. E. (1999). Cancer screening decisions. Journal of the National Cancer Institute Monographs, 25, 52–58.PubMedGoogle Scholar
  3. 3.
    Vernon, S. W. (1999). Risk perception and risk communication for cancer screening behaviors: A review. Journal of the National Cancer Institute Monographs, 25, 101–119.PubMedGoogle Scholar
  4. 4.
    Markowitz, L., Dunne, E., Saraiya, M., Lawson, H., Chesson, H., & Unger, E. (2007). Quadrivalent human papillomavirus vaccine: Recommendations of the ACIP. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  5. 5.
    Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychology, 26(2), 136–145.PubMedCrossRefGoogle Scholar
  6. 6.
    Chapman, G. B., & Coups, E. J. (1999). Predictors of influenza vaccine acceptance among healthy adults. Preventive Medicine, 29, 249–262.PubMedCrossRefGoogle Scholar
  7. 7.
    Dunne, E. F., Unger, E. R., Sternberg, M., et al. (2007). Prevalence of HPV infection among females in the United States. JAMA, 297(8), 813–819.PubMedCrossRefGoogle Scholar
  8. 8.
    Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45(2–3), 107–114.PubMedCrossRefGoogle Scholar
  9. 9.
    Christian, W. J., Christian, A., & Hopenhayn, C. (2009). Acceptance of the HPV vaccine for adolescent girls: Analysis of state-addes questions from the BRFSS. The Journal of Adolescent Health, 44, 437–445.PubMedCrossRefGoogle Scholar
  10. 10.
    Esposito, S., Bosis, S., Pelucchi, C., et al. (2007). Pediatrician knowledge and attitudes regarding human papillomavirus disease and its prevention. Vaccine, 25(35), 6437–6446.PubMedCrossRefGoogle Scholar
  11. 11.
    Fazekas, K. I., Brewer, N. T., & Smith, J. S. (2008). HPV vaccine acceptability in a rural southern area. Journal of Women’s Health, 17(4), 539–548.PubMedCrossRefGoogle Scholar
  12. 12.
    Friedman, A. L., & Shepeard, H. (2007). Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: Findings from CDC focus group research and implications for practice. Health Education & Behavior, 34(3), 471–485.CrossRefGoogle Scholar
  13. 13.
    Ishibashi, K. L., Koopmans, J., Curlin, F. A., Alexander, K. A., & Friedman Ross, L. (2008). Paediatricians’ attitudes and practices towards HPV vaccination. Acta Paediatrica, 97(11), 1550–1556.PubMedCrossRefGoogle Scholar
  14. 14.
    Keating, K. M., Brewer, N. T., Gottlieb, S. L., Liddon, N., Ludema, C., & Smith, J. (2008). Potential barriers to HPV vaccine provision among medical practices in an area with high rates of cervical cancer. The Journal of Adolescent Health, 43, s61–s67.PubMedCrossRefGoogle Scholar
  15. 15.
    Raley, J. C., Followwill, K. A., Zimet, G. D., & Ault, K. A. (2004). Gynecologists’ attitudes regarding human papilloma virus vaccination: A survey of Fellows of the American College of Obstetricians and Gynecologists. Infectious Diseases in Obstetrics and Gynecology, 12(3–4), 127–133.PubMedCrossRefGoogle Scholar
  16. 16.
    Slomovitz, B. M., Sun, C. C., Frumovitz, M., et al. (2006). Are women ready for the HPV vaccine? Gynecologic Oncology, 103(1), 151–154.PubMedCrossRefGoogle Scholar
  17. 17.
    Zimet, G. D., Mays, R. M., Winston, Y., Kee, R., Dickes, J., & Su, L. (2000). Acceptability of human papillomavirus immunization. Journal of Women’s Health & Gender-Based Medicine, 9(1), 47–50.CrossRefGoogle Scholar
  18. 18.
    Chao, C., Slezak, J. M., Coleman, K. J., & Jacobsen, S. J. (2009). Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls. American Journal of Public Health, 99(6), 1137–1142.PubMedCrossRefGoogle Scholar
  19. 19.
    Chao, C., Velicer, C., Slezak, J. M., & Jacobsen, S. J. (2009). Correlates for completion of 3-dose regimen of HPV vaccine in female members of a managed care organization. Mayo Clinic Proceedings, 84(10), 864–870.PubMedCrossRefGoogle Scholar
  20. 20.
    Neubrand, T. P. L., Radecki Breitkopf, C., Rupp, R., Breitkopf, D., & Rosenthal, S. L. (2009). Factors associated with completion of the human papillomavirus vaccine series. Clinical Pediatrics, 48(9), 966–969.PubMedCrossRefGoogle Scholar
  21. 21.
    Kahn, J. A., Rosenthal, S. L., Jin, Y., Huang, B., Namakydoust, A., & Zimet, G. D. (2008). Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. Obstetrics and Gynecology, 111(5), 1103–1110.PubMedCrossRefGoogle Scholar
  22. 22.
    Baker, C. J., Pickering, L. K., Chilton, L., et al. (2010). Recommended adult immunization schedule: United States, 2010. Annals of Internal Medicine, 152(1), 36–38.Google Scholar
  23. 23.
    Jain, N., Euler, G. L., Shefer, A., Lu, P., Yankey, D., & Markowitz, L. (2009). Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007. Preventive Medicine, 48, 426–431.PubMedCrossRefGoogle Scholar
  24. 24.
    Amonkar, M. M., & Madhavan, S. (2002). Compliance rates and predictors of cancer screening recommendations among Appalachian women. Journal of Health Care for the Poor and Underserved, 13(4), 443–460.PubMedGoogle Scholar
  25. 25.
    Hall, H. I., Rogers, J. D., Weir, H. K., Miller, D. S., & Uhler, R. J. (2000). Breast and cervical carcinoma mortality among women in the Appalachian region of the US, 1976–1996. Cancer, 89(7), 1593–1602.PubMedCrossRefGoogle Scholar
  26. 26.
    Hall, H. I., Uhler, R. J., Coughlin, S. S., & Miller, D. S. (2002). Breast and cervical cancer screening among Appalachian women. Cancer Epidemiology, Biomarkers and Prevention, 11(1), 137–142.PubMedGoogle Scholar
  27. 27.
    Hopenhayn, C., Bush, H., Christian, A., & Shelton, B. (2005). Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states. Preventive Medicine, 41, 859–864.PubMedCrossRefGoogle Scholar
  28. 28.
    Hopenhayn, C., King, J. B., Christian, A., Huang, B., & Christian, W. J. (2008). Variability of cervical cancer rates across 5 Appalachian states, 1998–2003. Cancer, 113(10), 2974–2980.PubMedCrossRefGoogle Scholar
  29. 29.
    Huang, B., Wyatt, S., Tucker, T., Bottorff, D., Lengerich, E., & Hall, H. (2002). Cancer death rates–Appalachia, 1994–1998. Morbidity and Mortality Weekly Report, 51(24), 527–529.Google Scholar
  30. 30.
    Lengerich, E. J., Tucker, T. C., Powell, R. K., et al. (2005). Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia. The Journal of Rural Health, 21(1), 39–47.PubMedCrossRefGoogle Scholar
  31. 31.
    Wingo, P. A., Tucker, T. C., Jamison, P. M., et al. (2008). Cancer in Appalachia, 2001–2003. Cancer, 112(1), 181–192.PubMedCrossRefGoogle Scholar
  32. 32.
    Yabroff, K., Lawrence, W., King, J., et al. (2005). Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment? The Journal of Rural Health, 21(2), 149–157.PubMedCrossRefGoogle Scholar
  33. 33.
    Behringer, B., & Friedell, G. H. (2006). Appalachia: Where place matters in health. Preventing Chronic Disease, 3(4), A113.PubMedGoogle Scholar
  34. 34.
    Couto, R. A., Simpson, N. K., & Harris, G. (Eds.). (1994). Sowing seeds in the mountains community based coalitions for cancer prevention and control. Bethesda, MD: National Institutes of Health, National Cancer Institute.Google Scholar
  35. 35.
    Freeman, H. P., & Wingrove, B. K. (2005). Excess cervical cancer mortality: A marker for low access to health care in poor communities. Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities.Google Scholar
  36. 36.
    ARC. County economic status in Appalachia, FY 2011. Available at: http://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=54. Accessed May 4, 2010.
  37. 37.
    Census. Small area income and poverty estimates, state and county maps 2008. Available at: http://www.census.gov/did/www/saipe/data/statecounty/maps/2008.html. Accessed May 4, 2010.
  38. 38.
    Crosby, R., Schoenberg, N., Hopenhayn, C., Moore, G., & Melhan, W. (2007). Correlates of intent to be vaccinated against human papillomavirus: An exploratory study of college-aged women. Sexual Health, 4(1), 71–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Hopenhayn, C. R., Christian, A., Christian, W. J., & Schoenberg, N. E. (2007). Human papillomavirus vaccine: Knowledge and attitudes in two Appalachian Kentucky counties. Cancer Causes and Control, 16(6), 627–634.Google Scholar
  40. 40.
    May, T. (2005). Public communication, risk perception, and the viability of preventive vaccination against communicable diseases. Bioethics, 19(4), 407–421.PubMedCrossRefGoogle Scholar
  41. 41.
    Chang, Y., Brewer, N. T., Rinas, A. C., Schmitt, K., & Smith, J. S. (2009). Evaluating the impact of human papillomavirus vaccines. Vaccine, 27(32), 4355–4362.PubMedCrossRefGoogle Scholar
  42. 42.
    Insinga, R. P., Dasbach, E. J., & Elbasha, E. H. (2005). Assessing the annual economic burden of preventing and treating anogenital Human papillomavirus-related disease in the US: Analytic framework and review of the literature. PharmacoEconomics, 23(11), 1107–1122.PubMedCrossRefGoogle Scholar
  43. 43.
    Lehmann, C., & Benson, P. A. S. (2009). Vaccine adherence in adolescents. Clinica pediatrica, 48(8), 801–811.CrossRefGoogle Scholar
  44. 44.
    Begley S. Anatomy of a scare. Newsweek Available at: http://www.newsweek.com/id/185853. Accessed May 4, 2010.
  45. 45.
    Slonim, A. B., Roberto, A. J., Downing, C. R., et al. (2005). Adolescents’ knowledge, beliefs, and behaviors regarding hepatitis B: Insights and implications for programs targeting vaccine-preventable diseases. The Journal of Adolescent Health, 36(3), 178–186.PubMedCrossRefGoogle Scholar
  46. 46.
    Katz, M. L., Reiter, P. L., Heaner, S., Ruffin, M. T., Post, D. M., & Paskett, E. D. (2009). Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia. Vaccine, 27, 3945–3952.PubMedCrossRefGoogle Scholar
  47. 47.
    Associated Press. Cervical cancer vaccine called most painful shot. Available at: http://www.foxnews.com/story/0,2933,320132,00.html. Accessed April 15, 2010.
  48. 48.
    Doss JR, Habel MA, Liddon N. (2009). The HPV vaccine post-licensure: Have online news stories changed over time? A follow-up study. Centers for Disease Control and Prevention 43rd National Immunization Conference. Dallas, TX.Google Scholar
  49. 49.
    Kotz D. (2010). 5 Things to consider before getting the HPV vaccine How to weigh the risks, benefits, and cost of the cancer preventing shot. Available at: http://health.usnews.com/health-news/managing-your-healthcare/cancer/articles/2008/09/02/5-things-to-consider-before-getting-the-hpv-vaccine.html. Accessed April 15, 2010.
  50. 50.
    Elnicki, D. M., Morris, D. K., & Shockcor, W. T. (1995). Patient-perceived barriers to preventive health care among indigent, rural Appalachian patients. Archives of Internal Medicine, 155(4), 421–424.PubMedCrossRefGoogle Scholar
  51. 51.
    Shell, R., & Tudiver, F. (2004). Barriers to cancer screening by rural Appalachian primary care providers. The Journal of Rural Health, 20(4), 368–373.PubMedCrossRefGoogle Scholar
  52. 52.
    Denham, S. A., Meyer, M. G., Toborg, M. A., & Mande, M. J. (2004). Providing health education to Appalachia populations. Holistic Nursing Practice, 18(6), 293–301.PubMedGoogle Scholar
  53. 53.
    Hutson, S. P., Dorgan, K. A., Phillips, A. N., & Behringer, B. (2007). The mountains hold things in: The use of community research review work groups to address cancer disparities in Appalachia. Oncology Nursing Forum, 34(6), 1133–1139.PubMedCrossRefGoogle Scholar
  54. 54.
    Lyttle, N. L., & Stadelman, K. (2006). Assessing awareness and knowledge of breast and cervical cancer among Appalachian women. Preventing Chronic Disease, 3(4), A125.PubMedGoogle Scholar
  55. 55.
    Schoenberg, N. E., Hopenhayn, C., Christian, A., Knight, E., & Rubio, A. (2006). An in-depth and updated perspective on determinants of cervical cancer screening among central Appalachian women. Journal of Women and Health, 42(2), 29–105.Google Scholar
  56. 56.
    Coyne, C. A., Demian-Popescu, C., & Friend, D. (2006). Social and cultural factors influencing health in southern West Virginia: A qualitative study. Preventing Chronic Disease, 3(4), A124.PubMedGoogle Scholar
  57. 57.
    Friedell, G. H., Linville, L. H., & Hullet, S. (1998). Cancer control in rural Appalachia. Cancer, 83(S8), 1868–1871.CrossRefGoogle Scholar
  58. 58.
    Halverson, J. A., & Bischak, G. (2008). Underlying socioeconomic factors influencing health disparities in the appalachian region. Washington, DC: Appalachian Regional Commission.Google Scholar
  59. 59.
    Kang, S., Kim, K. H., Kim, Y. T., et al. (2008). Safety and immunogenicity of a vaccine targeting human papillomavirus types 6, 11, 16 and 18: A randomized, placebo-controlled trial in 176 Korean subjects. International Journal of Gynecological Cancer, 18(5), 1013–1019.PubMedCrossRefGoogle Scholar
  60. 60.
    Merck & Co. I. Gardasil. Available at: https://www.merckvaccines.com/gardasilProductPage_frmst.html.
  61. 61.
    Perez, G., Lazcano-Ponce, E., Hernandez-Avila, M., et al. (2008). Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus-like-particle vaccine in Latin American women. International Journal of Cancer, 122(6), 1311–1318.CrossRefGoogle Scholar
  62. 62.
    Dempsey, A. F., & Davis, M. M. (2006). Overcoming barriers to adherence to HPV vaccination recommendations. The American Journal of Managed Care, 12(17), 484–491.Google Scholar
  63. 63.
    Reiter, P. L., Brewer, N. T., Gottlieb, S. L., McRee, A.-L., & Smith, J. S. (2009). How much will it hurt? HPV vaccine side effects and influence on completion of the three-dose regimen. Vaccine, 27(49), 6840–6844.PubMedCrossRefGoogle Scholar
  64. 64.
    Katz, M. L., Wewers, M. E., Single, N., & Paskett, E. D. (2007). Key informants’ perspectives prior to beginning a cervical cancer study in Ohio Appalachia. Qualitative Health Research, 17(1), 131–141.PubMedCrossRefGoogle Scholar
  65. 65.
    Haynes, M., & Smedley, B. (Eds.). (1999). The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington, DC: The National Academies Press.Google Scholar
  66. 66.
    Tripp-Reimer, T., & Friedl, M. C. (1977). Appalachians: A neglected minority. The Nursing Clinics of North America, 12(1), 41–54.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Robin C. Vanderpool
    • 1
  • Baretta R. Casey
    • 2
  • Richard A. Crosby
    • 1
  1. 1.Department of Health BehaviorUniversity of Kentucky College of Public HealthLexingtonUSA
  2. 2.Department of Health BehaviorUniversity of Kentucky College of Public HealthLexingtonUSA

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