Abstract C87: Prevalence of HPV vaccine uptake in Hawai'i
Authors: Cruz May Rose Isnec Dela 
Published: May 2016

‘Imi Hale Native Hawaiian Cancer Network: he ‘Imi Hale Native Hawaiian Cancer Network (‘Imi Hale) is a program of Papa Ola Lōkahi. Launched in 2000, ‘Imi Hale collaborates with key local, state, national and international partners to reduce cancer incidence and mortality among Native Hawaiians and Pacific Islanders through the establishment of a core organizational infrastructure that:

Goal 1: Increase knowledge of, access to, an0d use of beneficial biomedical procedures in cancer prevention and control and co-morbid conditions of cancer patients.

Goal 2: Develop and conduct evidence-based intervention research to increase use of beneficial biomedical procedures to control cancer and co-morbid conditions.

Goal 3: Train and develop a critical mass of competitive researchers using community-based participatory research (CBPR) methods to reduce health disparities.

‘Imi Hale is a community-placed, community driven initiative that addresses cancer health disparities. It established the Ho'okele I'ke Ola Cancer Patient Navigation Training Program and has trained over 180 navigators since 2006. Our advocacy work involves serving on policy committees to prevent tobacco use and increase tobacco cessation. ‘Imi Hale programs and research incorporate community-based participatory principles, community leadership, capacity building and community participation.

A recent ‘Imi Hale study surveyed parents in Hawai'i to determine their knowledge of the human papillomavirus (HPV) vaccine, assessed their child's HPV vaccination status, and identified motivators and barriers to vaccinating their child with the HPV vaccine.

Prevalence of HPV vaccine uptake in Hawai'i: Along with other recommended vaccines, including tetanus, diptheria, and pertussis vaccine (Tdap) and meningococcal conjugate vaccine (MCV4), the HPV vaccine was integrated into the Adolescent Immunization Schedule. The HPV vaccine is a three-dose vaccine for children ages 11 to 12. Nationally, age-appropriate uptake of Tdap and MCV4 are at 88% and 79%, respectively. Unfortunately, completion of all three doses of the HPV vaccine is estimated at only 40% for 13 to 17-year-old females and 22% for 13 to17-year-old males. Hawai'i's 2014 HPV completion rates (receiving all three doses) were 38% for females and 31% for males. Although CDC's national survey (NIS-Teen Survey) shows vaccine uptake by state and ethnicity, data are not shown for Native Hawaiians, Filipinos, and Japanese, which are all major groups of interest in Hawai'i. The study's primary purpose was to determine the prevalence of the HPV vaccine uptake among youth ages 11-18 in four ethnic groups in Hawai'i, specifically Native Hawaiians, Filipinos, Japanese, and Caucasians, by surveying parents and identifying barriers and motivators to vaccinating their child(ren).

A population-based, cross-sectional telephone survey was administered in Hawai'i from October 2013 to January 2014 to parents of children 11 to 18 years old, who were the primary parent that takes the child(ren) to get vaccinated and were Native Hawaiian, Filipino, Japanese, or Caucasian, and reside in the state of Hawai'i. This survey included questions assessing parents' knowledge of HPV and the HPV vaccine, status of their child(ren)'s HPV vaccine uptake and barriers and motivators to uptake.

There were 799 parents who completed the survey, representing 492 with daughters and 466 with sons. The prevalence of HPV vaccination uptake was significantly higher in daughters than sons. More than half (55%) of parents with daughters had vaccinated their daughter with one or more shots and more than half of sons (59%) were not vaccinated. For both daughters and sons, the observed HPV vaccination was the highest with Japanese parents. After adjusting for important demographic variables, Japanese children still showed the highest percentage of HPV vaccination, while Caucasians children, both boys and girls, showed the lowest likelihood of having HPV vaccination. To assess the differences of HPV vaccination (at least one dose) among the four ethnic groups, adjusted ORs were derived using multivariable logistic regression models. In this analysis, Caucasian parents were significantly less likely to vaccinate their daughters and sons with the HPV vaccine, compared with Japanese parents. Hearing about the vaccine predicts that the parent is more likely to vaccinate their daughter and sons. In addition, the child's age is associated with receiving the vaccine and younger children were least likely to get vaccinated.

The main motivators to a daughter's HPV vaccination were a physician's recommendation and daughter's protection. The top motivator for parents of sons was to protect their sons and a doctor's recommendation followed. Barriers for daughters and sons were significant across ethnicities. For daughters, significantly more Filipino (45%) and Japanese (47%) parents said they did not know about the vaccine, compared to 29% Native Hawaiian and 15% Caucasian parents (p=0.016). For sons, not knowing about the HPV vaccine was a barrier for 53% of Filipino and 51% of Native Hawaiian parents, both significantly higher proportions than the other ethnic groups (p=0.004).

This study provides new information about the HPV vaccine uptake prevalence in Hawai'i. Its findings highlight higher vaccination frequencies than what was reported in CDC's annual national survey. Findings also reinforce the fact that parents are encouraged by a physician's recommendation and receipt of information about the vaccine were strong motivators for parents to vaccinate their children, especially for Native Hawaiians, Filipino and Japanese parents. A physician recommendation, supplemental HPV vaccine information, and further discussions may help Caucasian parents to alleviate hesitancy in vaccination. With culturally-tailored health education strategies along with a strong physician recommendation, uptake of the HPV vaccine can be increased among these four populations in Hawai'i.

Citation Format: May Rose Isnec Dela Cruz. Prevalence of HPV vaccine uptake in Hawai'i. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C87.