Background The introduction of HPV vaccines represents a breakthrough in the primary prevention of cervical cancer. However, little is known about vaccination uptake and correlates among U.S. low-income, ethnic minority and immigrant populations who may benefit most from the vaccine. Methods Telephone interviews (N=490) were conducted in six languages between January and November 2009 among mothers of vaccine-eligible girls (ages 9–18) using the Los Angeles County Department of Public Health, Office of Women’s Health service referral hotline. HPV and vaccine awareness, knowledge, beliefs, barriers, and daughter’s vaccine receipt were assessed. Results The sample consisted of low-income, uninsured, ethnic minority and immigrant women. Only 29% of daughters initiated the vaccine and 11% received all three doses. No ethnic differences were observed in initiation or completion rates. Ethnic differences were observed in HPV awareness, perceived risk, and other immunization related beliefs. The strongest predictor of initiation was vaccine awareness (OR=12.00). Daughter’s age and reporting a younger acceptable age for vaccination were positively associated with initiation. Mothers of unvaccinated girls reported lacking information about the vaccine to make a decision (66%) and not knowing where they could obtain the vaccine (74%). Conclusion Vaccination rates in this sample were lower than state and national estimates, and were associated with low levels of vaccine awareness. Interventions, including culturally targeted messaging, may be helpful for enhancing HPV vaccine knowledge, modifying vaccine-related beliefs and increasing uptake. Impact Our findings provide valuable guidance for developing interventions to address sub-optimal HPV vaccination in high risk groups.

Background Little is known about whether neighborhood factors are associated with HPV vaccine uptake, especially among disadvantaged groups that can benefit most from the vaccine. Methods We used data collected from immigrant, low-income mothers of adolescent girls and data from the 2005–2009 American Community Survey to investigate the relationship between HPV vaccine initiation and neighborhood characteristics. We compared initiation rates across levels of neighborhood disadvantage and employed multilevel logistic regression models to examine contextual effects on uptake. Results Overall, 27% of girls (n=479) initiated the vaccine. Initiation rates were highest among girls from the most disadvantaged neighborhoods (30%), however, neighborhood factors were not independently associated with vaccine initiation after adjusting for individual factors. Mother’s awareness of HPV, age, and insurance status were strong predictors for initiation. Conclusions Future interventions should focus on improving awareness among low-income mothers as well as targeting vulnerable families outside the catchment area of public programs.

Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women’s Health’s hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.