Knowledge, Attitudes, Beliefs, Practices Regarding Human Papillomavirus (HPV), and Barriers to Vaccination Against HPV Infection: A Cross-Sectional Survey of Guam Residents.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is linked to several cancers. In Guam, the HPV vaccination rate falls short of the National Healthy People 2030 goal. Only half of eligible Guam teens have received the HPV vaccination series. Additionally, research on Guam HPV vaccination is limited. A cross-sectional survey was conducted, and a representative sample of Guam residents (n=775) was surveyed to examine their knowledge, attitudes, beliefs, practices regarding HPV, and barriers to HPV vaccination. Aggregated scores were calculated for these scale items: attitude, knowledge, subjective norms, and perceived behavioral control regarding HPV. One-way Analysis of Variance (ANOVA) was used to compare the means of the scores and check for significant differences. Binary logistic regression helped to identify significant predictors of HPV vaccination among respondents with children. Significant differences were found for sex, education, income, and ethnicity. Women and those with higher education and income demonstrated higher positive attitudes and knowledge about HPV vaccination. Also, those with health insurance and those who were advised by their physician were more likely to get their children vaccinated. These results will guide the implementation of effective strategies for developing targeted behavioral and other appropriate interventions to increase HPV vaccination in Guam.

Utilizing Filipino key informants to guide community outreach for cancer prevention in Hawai'i.

OBJECTIVE/DESIGN: The University of Hawai'i Cancer Center works with academic and community partners to examine health disparities and inequities that persist among Pacific Island Populations through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Partnership's Community Outreach Core (COC) assists and promotes cancer research and helps to ensure the integration of historically excluded community perspectives by utilizing community-engaged and culturally-grounded approaches to reduce cancer burdens. However, cancer health disparities among Filipinos demonstrate a need for cancer-control initiatives within this community. SAMPLE/MEASUREMENTS: COC staff conducted five semi-structured key informant interviews with Filipino nurse and healthcare leaders in Hawai'i to establishpartnerships with the community, as well as provide community-driven guidance for future cancer prevention and control efforts. RESULTS: The informants provided recommendations for COC community engagement, relationship building, and future areas of directed cancer focus. The interviews also initiated relationship-building and community collaborations for directed cancer education and resources within Filipino communities. CONCLUSION: The themes uncovered from the interviews provided guidance on how to begin addressing cancer concerns, and led to the informants' subsequent membership in our Outreach Advisory Council to engage in future collaboration with the Filipino community and a framework for future community-engaged cancer prevention efforts.

Cervical Cancer and HPV Knowledge and Awareness: An Educational Intervention among College Students in Guam.

BACKGROUND: Compared to the U.S. population, cervical cancer (CC) incidence is significantly higher among the CHamoru, Micronesian, and Caucasian populations in Guam. From 2008-2012, CC was the fifth most common cancer diagnosed on the island. Despite the prevalence of CC and low HPV vaccine uptake, there is a concerning lack of awareness and preventative behavior among young adults.  This study was aimed at influencing college students' knowledge and awareness of CC, CC screening, HPV, and the HPV vaccination. METHODS: We delivered a 30-minute educational intervention to a sample of 108 university students in a classroom setting. The effect of the educational intervention was measured through a pre-and post-test on CC and HPV health behaviors, knowledge, and awareness. Results were analyzed using SPSS and an exact McNemar's test was used to examine the difference in the proportion of correct answers to the tests. Two-way mixed ANOVA was used to examine between (gender, ethnicity, and class level) and within subjects (pre-and post-test) program effects. RESULTS: Of the 108 participants, only 39 (36.1%) reported being vaccinated for HPV, 23 (21.3%) had not been vaccinated, and 46 (42.6%) did not know if they had been vaccinated for HPV.  Only forty-one (60.3%) female participants had had a Pap smear. When comparing the pre-to-posttest responses, most questions had an increase in correct responses. Time also influenced CCA and HPV knowledge and awareness scores as there was a significant increase in scores from the pre- to post-test. CONCLUSION: The educational intervention was an effective tool for increasing knowledge and awareness of CC, HPV, and HPV vaccination among college students. While study results demonstrate the educational intervention's success as a baseline measure of knowledge, the inclusion of behavioral outcome measures, such as intent to get vaccinated or screened, could result in more robust future studies.

Acculturation and Cancer Risk Behaviors among Pacific Islanders in Hawaii.

Background: To communicate research to the public, the National Cancer Institute developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance, including the Behavioral Risk Factor Surveillance System, HINTS data are not sufficient to address unique demographic subpopulations such as US Pacific Islanders (PIs). National sampling methods do not adequately reach participants from small, medically underserved populations. Aim: This study aims to document the cancer-relevant knowledge, attitudes, behaviors, and information-seeking practices of PIs in Hawaii (HI). Methods: We conducted a cross-sectional survey during 2017-2018 of Native Hawaiians, Chuukese, and Marshallese in HI using Respondent Driven Sampling (RDS) to recruit these geographically diffuse groups. The modified HINTS survey included questions about cancer knowledge, attitudes and behaviors, health communications, and cultural practices. Results: A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer-related attitudes, knowledge, and behaviors. These groups also differed regarding acculturation, health locus of control, and trust in medical professionals. Native Hawaiians were significantly more acculturated (P=.0001) than Chuukese or Marshallese and more likely to smoke cigarettes (P=.0001). Among participants aged >50 years, we found no significant differences across ethnic groups (P=.30) for those completing a colon cancer screening (37%). However, only 27% were referred to screening by a physician. Conclusions: Cancer prevention programs are greatly needed for PIs in HI. This study provides knowledge concerning the efficiency of RDS to recruit participants, and the role of culture in communications influencing cancer risk behaviors, which may be generalizable to migrant PIs in the United States.

Using a Short Message System to Increase Cervical Cancer Screening Uptake among Chuukese Women in Guam: Lessons Learned from Linking Distance Technology Between Carriers and Using Telehealth Communication in a Cross-Cultural Context.

This paper reports on a project aimed at using a short message system (SMS) to increase cervical cancer screening uptake among Chuukese women in Guam. It documents the process and identifies the unexpected challenges which led to the early termination of the study. Although the original aims of the project were not met, there were some lessons learned about technology incompatibility in the context of Guam's and the United States' cell phone technology interface, the cultural nuances of cell phone use in the study population, and the necessity to follow a protocol for the termination of a project.

Cultural Considerations for Conducting the Health Information National Trends Survey with Micronesian Communities: Lessons from a Qualitative Study.

A critical barrier to addressing health disparities among minorities is the lack of data, particularly on Pacific Islanders. Typically, national health surveillance systems do not have the resources to ensure proper representation of these small population groups. This study reports factors that guided the cultural adaptation and administration of the National Cancer Institute's Health Information Trends National Survey (HINTS) for a United States-dwelling Pacific Islander population in Hawai'i. To adapt the survey, four focus groups were conducted with 32 purposively-selected Micronesian migrants. Themes on health, healthcare barriers, cancer and methods to implement the survey were extracted from the analyses of the focus group narratives. Key cultural factors were identified that impact health practices, including religious and cancer fatalism, racism, health locus of control and other barriers. Using information from the focus group participants, the HINTS questionnaire was modified and the survey was implemented. The survey data provided will inform the future delivery of health promotion strategies for this unique medically underserved population.

Protective Effect of Biculturalism for Health Amongst Minority Youth: The Case of Pacific Islander Migrant Youths in Hawai'i.

This study investigates the mechanisms by which biculturalism impacts various health outcomes amongst youth migrants to Hawai'i who are from the US-Affiliated Pacific Islands jurisdictions. Using purposive sampling, 284 males and females (twelve to nineteen years old) of Pacific Islander ethnicities in Hawai'i completed a survey. Results from path analysis showed that biculturalism significantly and positively affected self-esteem that, in turn, improved eating attitude, body satisfaction and perceived well-being. Further, eating attitude increased healthy eating behaviour and body satisfaction that, in turn, positively affected general health perception and body satisfaction. Positive smoking attitudes increased smoking activities, which negatively affect general health perception. The study demonstrated that self-esteem impacted overall health through its influence on enhancing positive perceptions about the importance of healthy eating, body satisfaction and well-being. Biculturalism indirectly led to increased self-esteem, which in turn directly influenced attitudes about healthy eating, body satisfaction and perceived well-being. Our study provides strong evidence that addressing the problem of health disparities for minority populations in the USA has to start with reaffirming the value of diversity and multiculturalism and embracing an individual's historic cultural identity. Specific implications for funding agencies and researchers of minority health programs are discussed.

The efficacy of respondent-driven sampling for the health assessment of minority populations.

BACKGROUND: Respondent driven sampling (RDS) is a relatively new network sampling technique typically employed for hard-to-reach populations. Like snowball sampling, initial respondents or "seeds" recruit additional respondents from their network of friends. Under certain assumptions, the method promises to produce a sample independent from the biases that may have been introduced by the non-random choice of "seeds." We conducted a survey on health communication in Guam's general population using the RDS method, the first survey that has utilized this methodology in Guam. It was conducted in hopes of identifying a cost-efficient non-probability sampling strategy that could generate reasonable population estimates for both minority and general populations. METHODS: RDS data was collected in Guam in 2013 (n=511) and population estimates were compared with 2012 BRFSS data (n=2031) and the 2010 census data. The estimates were calculated using the unweighted RDS sample and the weighted sample using RDS inference methods and compared with known population characteristics. RESULTS: The sample size was reached in 23days, providing evidence that the RDS method is a viable, cost-effective data collection method, which can provide reasonable population estimates. However, the results also suggest that the RDS inference methods used to reduce bias, based on self-reported estimates of network sizes, may not always work. Caution is needed when interpreting RDS study findings. CONCLUSIONS: For a more diverse sample, data collection should not be conducted in just one location. Fewer questions about network estimates should be asked, and more careful consideration should be given to the kind of incentives offered to participants.

Health Information Seeking, Source Trust, and Culture: A Comparative Analysis of Health Information Trends and Needs Between Guam and the United States.

UNLABELLED: The Guam population offers a unique glimpse into Americans of Pacific Island ancestry and their communication and information-seeking behaviors, experiences, and needs relevant to cancer. National surveys do not typically include the U.S. territories, so there are limited data on the health and cancer information-seeking behaviors of these populations, in which health disparities persist. To fill this information gap, we conducted a survey on health communication in Guam using a modified version of the Health Information National Trends Survey instrument supplemented with items measuring specific cultural factors and communication practices. The results of the survey (N = 511) revealed some differences in health and cancer information-seeking patterns in Guam and the mainland United States. Sociodemographic variables, including sex, age, education, income, and employment, were significantly associated with health and cancer information seeking and Internet use. Levels of trust in various information sources were differentiated in the Guam and mainland U.S. SAMPLES: Logistic regression models revealed differences in factors predicting health and cancer information seeking and Internet use. The results suggest that these health information-seeking patterns and factors should be taken into account when developing communication strategies for more effective prevention and control programs.

Intergenerational communication across cultures: young people's perceptions of conversations with family elders, non-family elders and same-age peers.

Young adults from three Western (Canada, U.S.A., and New Zealand) and three East Asian (The Philippines, South Korea and Japan) nations completed a questionnaire regarding their perceptions of interactions with family elders, non-family elders, and same-age peers. Results showed that East Asians perceived family elders to be as accommodating as same-age peers, whereas Westerners perceived family elders as more accommodating than their same-age peers. Participants in both cultural blocks indicated an obligation to be most deferential towards non-family elders, followed by family elders, followed by same-age peers. Whereas both groups perceived interactions with same-age peers more positively than with the two older groups, the Western group perceived the older age groups more positively than did East Asians. Intergenerational communication is reportedly be more problematic than intragenerational communication and, consistent with previous findings, this pattern is more evident in East Asian nations on some variables.