Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial.

OBJECTIVES: Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects. METHODS: Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity. RESULTS: Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45). CONCLUSIONS: Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms).

Does language moderate the influence of information scanning and seeking on HPV knowledge and vaccine awareness and initiation among Hispanics?

OBJECTIVE: To examine whether language moderates associations between three communication variables: media use, information scanning (attending to and remembering information) and seeking (actively looking for information), and three HPV outcomes: knowledge, vaccine awareness and vaccine initiation among Hispanics. PARTICIPANTS: Hispanic mothers of females aged 8-22 years (N=288) were surveyed. METHODS: Univariate and multivariate logistic regressions investigated associations between communication variables and HPV outcomes. To examine moderation by language, we compared main effects and interaction models using the likelihood ratio test. RESULTS: For English- and Spanish-speakers, Internet use was associated with more HPV knowledge and vaccine awareness, but not initiation. Scanning and seeking were associated with more knowledge, vaccine awareness, and initiation. Language moderated effects of scanning and seeking only on vaccine awareness. Spanish speakers who scanned for information were more likely to be aware of the vaccine than those who did not (80% vs 26%); Spanish speakers who sought information were also more likely to be aware (95% vs 55%). For English speakers, vaccine awareness did not differ between those who scanned and sought and those who did not. CONCLUSIONS: Effects of information scanning and seeking on HPV vaccine awareness were much greater for Spanish than for English speakers. Providers, therefore, should not assume that Spanish-speaking mothers are already aware of the vaccine. Our findings call attention to heterogeneity within Hispanics which could be particularly important when examining health communication and cancer prevention behaviors.