Objective. To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. Methods. A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. Results. General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30–0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40–0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents. Conclusions. Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean. 1. Introduction Cervical cancer (CC) is listed among the top five cancers that affect women globally. According to the International Agency for Research on Cancer (IARC), in 2008 there were 530,000 new cases of cervical cancer worldwide, with 85% of the disease burden occurring in developing countries. Caribbean women are at an increased risk of dying from CC, which is the second most frequent cancer among women and also ranks as the third most frequently diagnosed cancer in both sexes [1]. In the United States (US), CC has decreased in incidence and mortality since the mid 19th century, primarily because of screening [2]. Even with the introduction and widespread use of the Pap test, CC still ranks among the top ten cancers diagnosed in the US among minority populations, which includes Blacks, American Indians, and Hispanics [3]. Persistent high-risk (HR) human papillomavirus (HPV) infection, specifically HPV types 16 and 18, has been linked to the development of CC, anogenital cancers, and oropharyngeal cancers [4, 5]. In 2006, the FDA approved the HPV vaccine Gardasil (against HR HPV types 16 and 18 as well as low-risk types 6 and 11) for all females aged 9 through 26. In 2009, the FDA
References
[1]
J. Ferlay, H. R. Shin, F. Bray, D. Forman, C. Mathers, and D. M. Parkin, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet], International Agency for Research on Cancer, 2010.
[2]
S. J. Henley, J. B. King, R. R. German, L. C. Richardson, and M. Plescia, “Surveillance of screening-detected cancers (Colon and Rectum, Breast, and Cervix)—United States, 2004–2006,” Morbidity and Mortality Weekly Report, vol. 59, no. 9, pp. 1–25, 2010.
[3]
B. K. Edwards, E. Ward, B. A. Kohler et al., “Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates,” Cancer, vol. 116, no. 3, pp. 544–573, 2010.
[4]
J. R. Carter, Z. Ding, and B. R. Rose, “HPV infection and cervical disease: a review,” Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 51, no. 2, pp. 103–108, 2011.
[5]
C. C. R. Ragin, E. Taioli, J. L. Weissfeld et al., “11q13 amplification status and human papillomavirus in relation to p16 expression defines two distinct etiologies of head and neck tumours,” British Journal of Cancer, vol. 95, no. 10, pp. 1432–1438, 2006.
[6]
FDA, “FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys,” Bethesda, Md, USA, 2009, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm187003.htm.
[7]
FDA, “FDA Approves New Vaccine for Prevention of Cervical Cancer,” Bethesda, Md, USA, 2009, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm187048.htm.
[8]
CDC, Centers for Disease Control and Prevention, “2013 Recommended Immunizations for Children from 7 Through 18 Years Old,” 2010, http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf.
[9]
S. A. Bynum, H. M. Brandt, P. A. Sharpe, M. S. Williams, and J. C. Kerr, “Working to close the gap: identifying predictors of HPV vaccine uptake among young African American women,” Journal of Health Care for the Poor and Underserved, vol. 22, no. 2, pp. 549–561, 2011.
[10]
L. M. Niccolai, N. R. Mehta, and J. L. Hadler, “Racial/ethnic and poverty disparities in human papillomavirus vaccination completion,” American Journal of Preventive Medicine, vol. 41, no. 4, pp. 428–433, 2011.
[11]
R. B. Perkins, S. M. Langrish, D. J. Cotton, and C. J. Simon, “Maternal support for human papillomavirus vaccination in honduras,” Journal of Women's Health, vol. 20, no. 1, pp. 85–90, 2011.
[12]
L. Gillespie, C. W. Hicks, M. Santana et al., “The acceptability of human papillomavirus vaccine among parents and guardians of newborn to 10-year-old children,” Journal of Pediatric and Adolescent Gynecology, vol. 24, no. 2, pp. 66–70, 2011.
[13]
C. C. Ragin, R. P. Edwards, J. Jones et al., “Knowledge about human papillomavirus and the HPV vaccine—a survey of the general population,” Infectious Agents and Cancer, vol. 4, no. 1, article S10, 2009.
[14]
C. K. Gwede, E. Jean-Francois, G. P. Quinn et al., “Perceptions of colorectal cancer among three ethnic subgroups of US blacks: a qualitative study,” Journal of the National Medical Association, vol. 103, no. 8, pp. 669–680, 2011.
[15]
F. T. Odedina, G. Dagne, M. Larose-Pierre et al., “Within-group differences between native-born and foreign-born black men on prostate cancer risk reduction and early detection practices,” Journal of Immigrant and Minority Health, vol. 13, no. 6, pp. 996–1004, 2011.
[16]
K. L. Taylor, J. F. Kerner, K. F. Gold, and J. S. Mandelblatt, “Ever vs never smoking among an urban, multiethnic sample of Haitian-, Caribbean-, and U.S.-born blacks,” Preventive Medicine, vol. 26, no. 6, pp. 855–865, 1997.
[17]
C. Giambi, S. Donati, S. Declich et al., “Estimated acceptance of HPV vaccination among Italian women aged 18–26 years,” Vaccine, vol. 29, no. 46, pp. 8373–8380, 2011.
[18]
G. D. Bakogianni, K. M. Nikolakopoulos, and N. M. Nikolakopoulou, “HPV vaccine acceptance among female Greek students,” International Journal of Adolescent Medicine and Health, vol. 22, no. 2, pp. 271–273, 2010.
[19]
P. Basu and S. Mittal, “Acceptability of human papillomavirus vaccine among the urban, affluent and educated parents of young girls residing in Kolkata, Eastern India,” Journal of Obstetrics and Gynaecology Research, vol. 37, no. 5, pp. 393–401, 2011.
[20]
C. Charakorn, S. Rattanasiri, A.-A. Lertkhachonsuk, D. Thanapprapasr, S. Chittithaworn, and S. Wilailak, “Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women,” Asia-Pacific Journal of Clinical Oncology, vol. 7, no. 2, pp. 160–167, 2011.
[21]
M. A. Coleman, J. Levison, and H. Sangi-Haghpeykar, “HPV vaccine acceptability in Ghana, West Africa,” Vaccine, vol. 29, no. 23, pp. 3945–3950, 2011.
[22]
S. A. Francis, M. Battle-Fisher, J. Liverpool et al., “A qualitative analysis of South African women's knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health,” Vaccine, vol. 29, no. 47, pp. 8760–8765, 2011.
[23]
Z. Iliyasu, I. S. Abubakar, M. H. Aliyu, and H. S. Galadanci, “Cervical cancer risk perception and predictors of human papilloma virus vaccine acceptance among female university students in northern Nigeria,” Journal of Obstetrics and Gynaecology, vol. 30, no. 8, pp. 857–862, 2010.
[24]
S. A. Bynum, H. M. Brandt, D. B. Friedman, L. Annang, and A. Tanner, “Knowledge, beliefs, and behaviors: examining human papillomavirus-related gender differences among african American College Students,” Journal of American College Health, vol. 59, no. 4, pp. 296–302, 2011.
[25]
Y. Cui, S. B. Baldwin, D. J. Wiley, and J. E. Fielding, “Human papillomavirus vaccine among adult women: disparities in awareness and acceptance,” American Journal of Preventive Medicine, vol. 39, no. 6, pp. 559–563, 2010.
[26]
L. A. V. Marlow, J. Wardle, A. S. Forster, and J. Waller, “Ethnic differences in human papillomavirus awareness and vaccine acceptability,” Journal of Epidemiology and Community Health, vol. 63, no. 12, pp. 1010–1015, 2009.
[27]
E. Kobetz, J. Kornfeld, R. C. Vanderpool et al., “Knowledge of HPV among United States Hispanic Women: opportunities and challenges for cancer prevention,” Journal of Health Communication, vol. 15, no. 3, pp. 22–29, 2010.
[28]
L. Jaspers, S. Budiningsih, R. Wolterbeek, F. C. Henderson, and A. A. W. Peters, “Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: a cross-sectional study,” Vaccine, vol. 29, no. 44, pp. 7785–7793, 2011.
[29]
C. C. Hughes, A. L. Jones, K. A. Feemster, and A. G. Fiks, “HPV vaccine decision making in pediatric primary care: a semi-structured interview study,” BMC Pediatrics, vol. 11, article 74, 2011.
[30]
G. R. Dudley-Grant, “Eastern Caribbean family psychology with conduct-disordered adolescents from the Virgin Islands,” American Psychologist, vol. 56, no. 1, pp. 47–57, 2001.
