HPV vaccination coverage and factors among American Indians in Cherokee Nation

Abstract

Purpose We estimated human papillomavirus (HPV) vaccine initiation coverage among American Indian adolescents and identified factors associated with HPV vaccination among parents of these adolescents. Methods We developed, tested, and disseminated a survey to a random sample of 2,000 parents of American Indian adolescents aged 9–17 years who had accessed Cherokee Nation Health Services from January 2019 to August 2020. We used log-binomial regression to estimate the unadjusted and adjusted weighted prevalence proportion ratios (PPR) and 95% confidence intervals (CI) for adolescent HPV vaccine initiation. Results HPV vaccine initiation coverage (≥ 1 dose) was 70.7% among adolescents aged 13–17 years. The prevalence of HPV vaccine initiation was higher among American Indian adolescents whose parents were aware of the HPV vaccine (adjusted weighted PPR 3.41; 95% CI 2.80, 4.15) and whose parents received a recommendation from their provider (adjusted weighted PPR 2.70; 95% CI 2.56, 2.84). The most common reasons reported by parents to vaccinate their children were to protect them against HPV-associated cancers (25.7%) and receiving a recommendation from a healthcare provider (25.0%). Parents cited vaccine safety concerns as the main reason for not getting their children vaccinated (33.2%). Conclusions HPV vaccine initiation coverage among American Indian adolescents in Cherokee Nation was consistent with the national survey estimates. However, allaying parental concerns about vaccine safety and encouraging providers to recommend the HPV vaccine could improve coverage. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-022-01662-y.

Factors Related to Parents’ Intention in Vaccination of Human Papillomavirus for their Daughter Aged 11-12 Years

“…The results of this study indicate that the reason parents are intentioned to vaccinate was to avoid their child's cancer in the future and to participate in the school program, this is in line with the results of other researchers who found the most common reason reported by parents to vaccinate their children is to protect them from cancerrelated to HPV and to get recommendations from healthcare providers (10). This reason is the most important thing for parents because they don't want their children to get cervical cancer in the future.…”

Perception of Barriers to and Factors Associated with HPV Vaccination Among Parents of American Indian Adolescents in the Cherokee Nation

“…The main reason described by parents for HPV vaccination was preventing cancer in their children. This finding of cancer prevention being the most compelling reason for HPV vaccination was also reported in a survey of Cherokee Nation parents [ 16 ] and in a national study of over 1000 parents [ 17 ]. Our finding that parental concerns about safety being a major barrier to HPV vaccination is also consistent with the findings from a systematic review among American Indian and Alaska Native persons [ 18 ] and reviews among other US populations [ 19 – 21 ].…”

Knowledge and Awareness of HPV, the HPV Vaccine and Cancer-Related HPV Types among Indigenous Australians

“…It is well understood that lack of information contributes to vaccine reluctance, with many studies suggesting that increasing awareness of HPV, its vaccine and its association with cancer can contribute to better vaccine uptake and infection prevention [ 18 , 21 , 23 , 24 , 25 , 26 , 27 ]. A study involving American Indian adolescents found that HPV vaccine initiation was higher among those whose parents were aware of the vaccine and had received a recommendation from their medical practitioner for their child to receive it [ 28 ]. Researchers have suggested that Indigenous participants have “little” knowledge about HPV, its mode of transmission, the HPV vaccine or its oncogenic potential [ 28 ].…”

“…A study involving American Indian adolescents found that HPV vaccine initiation was higher among those whose parents were aware of the vaccine and had received a recommendation from their medical practitioner for their child to receive it [ 28 ]. Researchers have suggested that Indigenous participants have “little” knowledge about HPV, its mode of transmission, the HPV vaccine or its oncogenic potential [ 28 ]. However, there was no evidence quantifying knowledge of HPV, its vaccine and related cancers among Indigenous Australians, or the individual factors associated with poorer knowledge.…”