Brief Client-Centered Motivational and Behavioral Intervention to Promote HPV Vaccination in a Hard-to-Reach Population: A Pilot Randomized Controlled Trial.

Objective To evaluate the impact of a client-centered behavioral intervention (Brief Negotiated Interviewing) on mothers' human papillomavirus (HPV) vaccine knowledge and vaccination initiation for their adolescent daughters. Methods We randomized mothers to intervention (n = 100) and control (n = 100) groups, and followed them over 12 months. Electronic medical records were reviewed to determine vaccination status. The primary outcome was receipt of the first vaccine. The secondary outcome was HPV vaccine knowledge among mothers. Results Brief Negotiated Interviewing intervention mothers demonstrated increased knowledge about HPV (pre/post mean score of 5 to 10 out of a possible 11; P < .001) and significantly higher mean knowledge scores (10 vs 6, P < .001) than control mothers. However, initiation and completion rates of the vaccine were not significantly different between groups. Conclusions Increasing HPV vaccine knowledge did not translate into increased vaccine uptake or completion of vaccination series. Future intervention must explore vaccine reminders to increase HPV vaccination rates.

Factors Associated with Human Papillomavirus Vaccine Acceptance Among Haitian and African-American parents of Adolescent Sons.

ACKNOWLEDGEMENTS: The authors would like to thank Cecilia Marquez, Justine Lavoye, Elaine Shu and Hailey Tipton for their efforts with participant recruitment and data collection. OBJECTIVE: To assess knowledge, attitudes, beliefs and practices related to HPV vaccination among African-Americans and Haitian immigrant parents, and to compare vaccination rates of their sons. STUDY DESIGN: We performed semi-structured interviews with parents of boys aged 11-17 who had not yet received the HPV vaccine. We used validated surveys of HPV knowledge, trust in physicians, and intention to vaccinate. We probed participants' thought processes about HPV vaccination, and examined parental attitudes, beliefs, and practices toward HPV vaccination using open-ended questions. We then reviewed medical records to determine whether sons were subsequently vaccinated. RESULTS: 25 African-American and 30 Haitian immigrant parents and legal guardians participated in the study. Haitian immigrants were more likely to be married and to practice a religion than African-Americans. Both groups had limited knowledge of HPV (32% of questions were answered correctly by Haitian immigrants vs. 31% by African-Americans). Sixty-four percent of African-Americans and 79% of Haitians intended to vaccinate their sons, however only 24% of African-American and 20% of Haitian sons received vaccination within 12 months of the interview. Open-ended questions revealed that most African-Americans felt that vaccination fell within the parental role, while some Haitian immigrants felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both groups wanted more information about HPV vaccines. CONCLUSIONS: Improving HPV vaccine rates in Haitian and African-American boys may require culturally competent approaches that address ethnic-specific barriers among their parents.

Knowledge, attitudes, and beliefs regarding HPV vaccination: ethnic and cultural differences between African-American and Haitian immigrant women.

BACKGROUND: Black women have higher rates of cervical cancer and lower rates of HPV vaccination than White women in the United States, and Haitians may be an especially vulnerable subgroup of Black women. To reduce these disparities, understanding differences among subgroups of Black women is crucial. METHODS: The objective of our study was to assess similarities and differences in the knowledge, attitudes, beliefs, and practices toward HPV vaccination and actual vaccination rates among African-American and Haitian immigrant women and their daughters. We used validated surveys of HPV knowledge, trust in physicians, acculturation, and constructs of the health belief model: Perceived susceptibility, severity, and barriers. We probed women's thought processes about vaccination using open-ended questions. We then reviewed medical records to determine vaccination rates. RESULTS: Nineteen African Americans and 51 Haitians participated. Although 75% of Haitians and 63% of African Americans intended to vaccinate their daughters, only 47% of African-American and 31% of Haitian daughters were vaccinated. African Americans were more knowledgeable than Haitians and had more prior experience with HPV disease. Most African Americans felt that vaccination fell within the parental role, whereas many Haitians felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both ethnic groups wanted more information about HPV vaccines. CONCLUSION: Cultural differences between African-American and Haitian immigrant mothers revealed distinct barriers for vaccine acceptance. Improving HPV vaccine rates in Black women may require culturally competent and sensitive approaches that address ethnic-specific barriers.

Depression, parenting attributes, and social support among adolescent mothers attending a teen tot program.

OBJECTIVE: To investigate the associations between depressive symptoms in adolescent mothers and their perceived maternal caretaking ability and social support. PATIENTS AND METHODS: Subjects were participants enrolled in a parenting program that provided comprehensive multidisciplinary medical care to teen mothers and their children. Baseline data of a prospective cohort study were collected by interview at 2 weeks postpartum and follow-up, and standardized measures on entry into postnatal parenting groups. Demographic data included education, social supports, psychological history, family history and adverse life events. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale for Children short version (CES-DC). The Maternal Self-report Inventory (MSRI) measured perceived maternal self-esteem, and Duke-UNC Functional Social Support Questionnaire measured social support. Data were analyzed with bivariate analyses and linear regression modeling focusing on depressive symptoms as the outcome variable. RESULTS: In the 168 teen mothers, mean age 17.6 +/- 1.2 years, African American (50%), Latina (31%) or Biracial (13%), the prevalence of depressive symptoms was 53.6%. In the linear model, controlling for baby's age, teen's age, ethnicity, Temporary Aid for Families with Dependent Children (TAFDC), and previous suicidal gesture, increased depressive symptoms were associated with decreased perceived maternal caretaking ability (P = 0.003) and lower social support (P < 0.001). In a linear model controlling for the same variables, MSRI total score (P = 0.001) and social support (P < 0.001) contributed significantly to the model as did the interaction term (MSRI x Social Support, P = 0.044). CONCLUSIONS: Depression is associated with decreased maternal confidence in their ability to parent and decreased perceived maternal social support, with a possible moderating effect of social support on the relationship of maternal self-esteem and depression.

Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term post partum weight retention.

STUDY OBJECTIVE: To determine the relationship between adolescents' pre-pregnancy body mass index (BMI), and gestational weight gain and postpartum weight retention. DESIGN: We review the medical records of adolescents participating in a prospective cohort study on comprehensive health care and parenting education to determine pre-pregnancy BMI, gestational weight gain, and postpartum weight retention at one year. SETTING: Urban academic hospital clinic. PARTICIPANTS: 102 pregnant adolescents aged 15-21 years. MAIN OUTCOMES: Gestational weight gain and weight retention at one year postpartum. RESULTS AND CONCLUSIONS: Fifty-two (51%) adolescent women had normal pre-pregnancy BMI according to the Institute of Medicine classification. Adolescent women with normal (36.5%) and high pre-pregnancy BMI (66.5%) were more likely than women with low pre-pregnancy BMI (26.5%) to exceed recommended gestational weight gain. Adolescent women who exceeded recommended weight gain retained significantly more weight at 1 year postpartum than women with weight gain within or below the recommendation. In a linear regression model that controlled for age, smoking, pregnancy complication, and post partum contraceptive use, pre-pregnancy BMI and gestational weight gain were the strongest predictors of postpartum weight retention at 1 year. A normal to high pre-pregnancy BMI and excessive gestational weight gain are important predictors of postpartum weight retention in adolescents. These two predictors must be monitored systematically with the aim of preventing postpartum obesity and its associated diseases among this population.

Preadolescents' report of exposure to violence: association with friends' and own substance use.

PURPOSE: To evaluate whether children's Exposure to Violence (EV) is associated with their own or their friends' use of alcohol, tobacco, and other drugs (ATOD). METHODS: The Violence Exposure Scale for Children-Revised (VEX-R) and the Substance Exposure Assessment (SXA) were given to 104 children participating in a longitudinal study of in-utero cocaine exposure (IUCE) at age 8.5, 9.5, and 11 years. Survival analyses evaluated the association of the quartile of VEX total score (higher scores indicating more violence exposure) at age 8.5 years, with time to first report of their own and their friends' use of ATOD from age 8.5-11 years. RESULTS: The sample consisted of 90% African-American/Caribbean children (mean age 8.5 years, SD 3 years), 53% males, and 49% with IUCE. The percentage of children who reported having substance-using friends was 12% at 8.5 years, 25% by 9.5 years, and 45% by 11 years. In multivariate survival analyses controlling for caregiver type, IUCE category, and child gender, children in the upper quartile of VEX-R total score at age 8.5 years were at significantly greater risk of having reported friends' use of ATOD by age 11 compared to those in the first through third quartiles (hazard ratio = 2.2; 95% CI = 1.14, 4.23; p = .02). Quartiles of the VEX score, however, were not significantly associated with children's acknowledgment of their own use (p = .85). CONCLUSIONS: Our findings suggest an association between EV in childhood and report of peer ATOD use at school age. Campaigns to prevent ATOD use should address the impact of childhood exposure to violence.