For low-income women, hurdles to the HPV vaccine

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Low-income women may have too little information about the human papillomavirus (HPV) vaccine to make informed decisions about it, and, due to low rates of follow through with the three-shot series, even those who begin the vaccination process may not be reaping the full protective benefits, according to two studies presented this week at a meeting of the American Association for Cancer Research in Houston.

Fifty-four percent of the participants were Latina, 20 percent were Chinese, 13 percent were Korean, 8 percent were black and 6 percent were of other ethnic origin.

One study surveyed 390 low-income minority women with daughters between the ages of 9 to 18 living in Los Angeles. (54% of the study population was Latina, 20% Chinese, 13% Korean, 8% black and 6% of a different ethnic background.) Researchers found that reported HPV vaccination rates among the daughters were comparable to those at national and state levels, but that information about the vaccine was lacking in different communities. (Nationwide, HPV vaccination rates among girls ages 11 and 12 are between 6% and 25%.) On average, 64% of mothers said they’d heard of the vaccine and 28% reported knowing where they could bring their daughters to get vaccinated, but when the data was broken down by ethnic group, it became clear that that knowledge was not evenly distributed. Only 42% of Korean mothers said they’d heard of the vaccine, and while more than a third (35%) of Latina women and 29% of black women knew where to find the vaccine for their daughters, only 19% of Chinese and 16% of Korean mothers did.

Additionally, many study participants reported having too little information about the vaccine to make an informed decision about the possible benefits for their daughters’ health. Again, this varied dramatically across ethnic groups. While 56% of black women and 31% of Latinas believed they had ample information to decide about the vaccine’s value, only 17% of Chinese mothers and 14% of Korean mothers felt as comfortable with the information they had. Across ethnic groups, women whose daughters were unvaccinated said that cost, concern about side effects and lack of information were reasons they had not pursued the vaccine.

These findings, the researchers say, suggest that HPV vaccine education efforts may not only need to be increased, but also need to be more specifically tailored to different ethnic communities to ensure that more young women are given the opportunity for vaccination. The Centers for Disease Control currently recommend the HPV vaccine for 11 and 12-year-old girls, as well as for 13- to 26-year-old females who have either not yet been vaccinated or not yet completed the series of shots. According to the guidelines, vaccination can begin as early as age 9.

Having enough information about the vaccine is not the only hurdle for many low-income women, however. In a second study, which examined the medical records of 353 girls between the ages of 11 and 18 who were treated at neighborhood clinics in areas where the vaccine was readily available, researchers found that few young women who began the vaccine series completed it. Of the patients eligible for the shots, only 40% were advised by a care provider to get vaccinated. Of those, nearly a quarter refused the vaccine. In total, 30% of the patients included in the study were given the first dose of the vaccine, but only 6.5% followed through with all three shots.

Researchers say that the low rate of completion demonstrates the need for both more education about the vaccine—particularly the fact that it is delivered in a three part series—and better follow-up on the part of care providers. The clinics included in the study have changed follow-up practices, introducing an automatic phone system that reminds patients of their subsequent appointments. And, to ensure that the doctors remember too, they’ve introduced automatic alerts that remind care providers to inform patients who are eligible for the vaccine.