Journal of Community Health

, Volume 41, Issue 3, pp 603–611 | Cite as

HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity

  • Raiza Beltran
  • Tina Simms
  • Hee Yun Lee
  • Melissa Kwon
Original Paper
First Online:

Abstract

Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study’s objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen’s Behavioral Model of Health Services Use was used as the study’s theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants’ level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study’s results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.

Keywords

Hmong Americans Asian Americans HPV literacy Health disparities Cervical cancer prevention 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

Funding for this research was provided by a research grant from the UCare Fund of the Minnesota Medical Foundation. The research team would like to extend their gratitude to the Hmong American immigrants who participated in this study, and dedicates this research to the memory of Andrew Park.

References

  1. 1.
    The Henry J. Kaiser Family Foundation. (2015). The HPV vaccine: Access and use in the US. www.kff.org. Retrieved 28 Feb 2015.
  2. 2.
    Centers for Disease Control and Prevention, Division of Cancer Prevention and Control. (2014). Cervical Cancer Statistic. http://www.cdc.gov/cancer/cervical/statistics/. Retrieved 28 Feb 2015.
  3. 3.
    Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. (2014). Cervical cancer rates by race and ethnicity. http://www.cdc.gov/cancer/cervical/statistics/race.htm. Retrieved 28 Feb 2015.
  4. 4.
    Yi, J. K., Anderson, K. O., Le, Y. C., Escobar-Chaves, S. L., & Reyes-Gibby, C. C. (2013). English proficiency, knowledge, and receipt of HPV vaccine in Vietnamese–American Women. Journal of Community Health, 38, 805–811. doi: 10.1007/s10900-013-9680-2.CrossRefPubMedGoogle Scholar
  5. 5.
    Do, H., Seng, P., Talbot, J., Acorda, E., Coronado, G. D., & Taylor, V. M. (2009). HPV vaccine knowledge and beliefs among Cambodian American parents and community leaders. Asian Pacific Journal of Cancer Prevention, 10(3), 339–344.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Zhao, N., Huh, J., Murphy, S. T., Chatterjee, J. S., & Baezconde-Garbanti, L. (2012). Self-construal as a predictor of Korean American women’s intention to vaccinate Daughters against HPV. Asian American Journal of Psychology, 29(2), 997–1003. doi: 10.1016/j.biotechadv.2011.08.021.Secreted.Google Scholar
  7. 7.
    Miller, B. A., Chu, K. C., Hankey, B. F., & Ries, L. A. G. (2008). Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S. Cancer Causes and Control, 19, 227–256. doi: 10.1007/s10552-007-9088-3.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ross, J. A., Xie, Y., Kiffmeyer, W. R., Bushhouse, S., & Robison, L. L. (2003). Cancer in the Minnesota Hmong population. Cancer, 97, 3076–3079. doi: 10.1002/cncr.11443.CrossRefPubMedGoogle Scholar
  9. 9.
    Taylor, V. M., Burke, N., Do, H., Liu, Q., Yasui, Y., & Bastani, R. (2012). HPV vaccination uptake among Cambodian mothers. Journal of Cancer Education, 29(1), 997–1003. doi: 10.1016/j.biotechadv.2011.08.021.Secreted.Google Scholar
  10. 10.
    Lee, H. Y., Roh, S., Vang, S., & Jin, S. W. (2011). The contribution of culture to Korean American women’s cervical cancer screening behavior: The critical role of prevention orientation. Ethnicity and Disease, 21(4), 399–405.PubMedGoogle Scholar
  11. 11.
    Lee, H. Y., & Vang, S. (2010). Barriers to cancer screening in Hmong Americans: The influence of health care accessibility, culture, and cancer literacy. Journal of Community Health, 35(3), 302–314. doi: 10.1007/s10900-010-9228-7.CrossRefPubMedGoogle Scholar
  12. 12.
    Yang, R. C., Mills, P. K., & Riordan, D. G. (2004). Cervical cancer among Hmong women in California, 1988 to 2000. American Journal of Preventive Medicine, 27(2), 132–138. doi: 10.1016/j.amepre.2004.04.003.CrossRefPubMedGoogle Scholar
  13. 13.
    Vang, C. Y. (2013). Hmong socioeconomic trends in the U.S.:The State of the Hmong American Community 2013. http://www.hndinc.org/cmsAdmin/uploads/dlc/HND-Census-Report-2013.pdf.
  14. 14.
    Constantine, N. A., & Jerman, P. (2007). Acceptance of human papillomavirus vaccination among californian parents of daughters: A representative statewide analysis. Journal of Adolescent Health, 40(2), 108–115. doi: 10.1016/j.jadohealth.2006.10.007.CrossRefPubMedGoogle Scholar
  15. 15.
    Kobetz, E., Mendoza, A. D., Menard, J., et al. (2010). One size does not fit all: Differences in HPV knowledge between Haitian and African American women. Cancer Epidemiology, Biomarkers and Prevention, 19(2), 366–370. doi: 10.1158/1055-9965.EPI-09-1180.CrossRefPubMedGoogle Scholar
  16. 16.
    Bastani, R., Glenn, B. A., Tsui, J., et al. (2011). Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiology, Biomarkers and Prevention, 20, 1463–1472. doi: 10.1158/1055-9965.EPI-11-0267.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tiro, J. A., Meissner, H. I., Kobrin, S., & Chollette, V. (2007). What do women in the U.S. know about human papillomavirus and cervical cancer? Cancer Epidemiology Biomarkers & Prevention, 16(2), 288–294. doi: 10.1158/1055-9965.EPI-06-0756.CrossRefGoogle Scholar
  18. 18.
    Licht, A. S., Murphy, J. M., Hyland, A. J., Fix, B. V., Hawk, L. W., & Mahoney, M. C. (2010). Is use of the human papillomavirus vaccine among female college students related to human papillomavirus knowledge and risk perception? Sexually Transmitted Infections, 86(1), 74–78. doi: 10.1136/sti.2009.037705.CrossRefPubMedGoogle Scholar
  19. 19.
    Marlow, L. A., Wardle, J., Forster, A. S., & Waller, J. (2009). Ethnic differences in human papillomavirus awareness and vaccine acceptability. Journal of Epidemiology and Community Health, 63, 1010–1015. doi: 10.1136/jech.2008.085886.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nomura, K., & Rahman, M. (2014). Letter to the editor: Human papillomavirus vaccine uptake among Asian American women aged 18 to 26 years—Behavioral Risk Factor Surveillance Study (BRFSS) 2008–2010. Ethnicity and Disease, 24(3), 77555.Google Scholar
  21. 21.
    Downs, L. S., Scarinci, I., Einstein, M. H., Collins, Y., & Flowers, L. (2010). Overcoming the barriers to HPV vaccination in high-risk populations in the US. Gynecologic Oncology, 117(3), 486–490. doi: 10.1016/j.ygyno.2010.02.011.CrossRefPubMedGoogle Scholar
  22. 22.
    Jeudin, P., Liveright, E., Del Carmen, M. G., & Perkins, R. B. (2014). Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clinical Therapeutics, 36(1), 24–37. doi: 10.1016/j.clinthera.2013.11.001.CrossRefPubMedGoogle Scholar
  23. 23.
    Gor, B. J., Chilton, J. A., Camingue, P. T., & Hajek, R. A. (2011). Young Asian Americans’ knowledge and perceptions of cervical cancer and the human papillomavirus. Journal of Immigrant and Minority Health, 13, 81–86. doi: 10.1007/s10903-010-9343-7.CrossRefPubMedGoogle Scholar
  24. 24.
    Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Nguyen, G. T., Chen, B., & Chan, M. (2012). Pap testing, awareness, and acceptability of a human papillomavirus (HPV) vaccine among Chinese American women. Journal of Immigrant and Minority Health, 14, 803–808. doi: 10.1007/s10903-012-9607-5.CrossRefPubMedGoogle Scholar
  26. 26.
    Yi, J. K., Lackey, S. C., Zahn, M. P., Castaneda, J., & Hwang, J. P. (2013). Human papillomavirus knowledge and awareness among vietnamese mothers. Journal of Community Health, 38, 1003–1009. doi: 10.1007/s10900-013-9709-6.CrossRefPubMedGoogle Scholar
  27. 27.
    Fang, D. M., & Baker, D. L. (2013). Barriers and facilitators of cervical cancer screening among women of Hmong origin. Journal of Health Care for the Poor and Underserved, 24(2), 540–555. doi: 10.1353/hpu.2013.0067.CrossRefPubMedGoogle Scholar
  28. 28.
    Lee, H. Y., & Lee, M. H. (2015). Health literacy in an underserved immigrant population: New implications toward achieving health equity. Asian American Journal of Psychology, 6(1), 97–105.CrossRefGoogle Scholar
  29. 29.
    Sparks, S. M. A. (2014). Considerations of culture and community in the production of Hmong health. Family and Consumer Sciences Research Journal, 42(3), 224–234. doi: 10.1111/fcsr.12057.CrossRefGoogle Scholar
  30. 30.
    McPartland, T. S., Weaver, B. A., Lee, S. K., & Koutsky, L. A. (2005). Men’s perceptions and knowledge of human papillomavirus (HPV) infection and cervical cancer. Journal of American College Health, 53(5), 225–230. doi: 10.3200/JACH.53.5.225-230.CrossRefPubMedGoogle Scholar
  31. 31.
    Kim, K., Kim, B., Choi, E., Song, Y., & Han, H. R. (2015). Knowledge, perceptions, and decision making about human papillomavirus vaccination among Korean American women: A focus group study. Women’s Health Issues, 25(2), 112–119. doi: 10.1016/j.whi.2014.11.005.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lee, H. Y., Kwon, M., Vang, S., et al. (2015). Disparities in HPV vaccine literacy and vaccine Completion among Asian American Pacific Islander undergraduates: Implications for cancer health equity. Journal of American College Health, (April), 316–322. doi: 10.1080/07448481.2015.1031237.
  33. 33.
    Garcini, L. M., Murray, K. E., Barnack-Tavlaris, J. L., Zhou, A. Q., Malcarne, V. L., & Klonoff, E. A. (2013). Awareness and knowledge of human papillomavirus (HPV) among ethnically diverse women varying in generation status. Journal of Immigrant and Minority Health, 17(1), 29–36. doi: 10.1007/s10903-013-9913-6.CrossRefGoogle Scholar
  34. 34.
    Williams, W. W., Lu, P. J., Saraiya, M., et al. (2013). Factors associated with human papillomavirus vaccination among young adult women in the United States. Vaccine, 31(28), 2937–2946. doi: 10.1016/j.vaccine.2013.04.041.CrossRefPubMedGoogle Scholar
  35. 35.
    Laz, T. H., Rahman, M., & Berenson, A. B. (2012). An update on human papillomavirus vaccine uptake among 11–17 year old girls in the United States: National Health Interview Survey, 2010. Vaccine, 30(24), 3534–3540. doi: 10.1016/j.vaccine.2012.03.067.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Taylor, V. M., Burke, N. J., Ko, L. K., et al. (2014). Understanding HPV vaccine uptake among Cambodian American girls. Journal of Community Health, 39(5), 857–862. doi: 10.1007/s10900-014-9844-8.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Lee, H. Y., Yang, P. N., Lee, D. K., & Ghebre, R. (2015). Cervical cancer screening behavior among Hmong American immigrant women. American Journal of Health Behavior, 39(1), 301–307.CrossRefPubMedGoogle Scholar
  38. 38.
    Johnson, S. K. (2002). Hmong health beliefs and experiences in the western health care system. Journal of Transcultural Nursing, 13(2), 126–132. doi: 10.1177/104365960201300205.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Raiza Beltran
    • 1
  • Tina Simms
    • 1
  • Hee Yun Lee
    • 1
  • Melissa Kwon
    • 2
  1. 1.School of Social WorkUniversity of Minnesota, Twin CitiesSt. PaulUSA
  2. 2.Asian American StudiesUniversity of Minnesota, Twin CitiesMinneapolisUSA

Personalised recommendations