Abstract B048: HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study
Authors: Xiong Serena , Kashouaher Maiyia Y , Vue Bai , Culhane-Pera Kathleen A , Pergament Shannon L , Desai Jay , Lee Hee Yun 
Published: September 2020

Abstract
Background: Rates of human papillomavirus (HPV) vaccine uptake in Hmong-Americans, an Asian American and Pacific Islander (AAPI) minority group, are substantially lower than the majority of Americans. In 2015, a community health center (CHC) in Minnesota found that HPV vaccine rates for Hmong children ages 9-17 were 32% in girls and 20% in boys, much lower than nationally published HPV coverage rates in 2017 (47% and 53%, respectively). This qualitative study identified barriers, facilitators, and decision-making processes about HPV vaccinations among Hmong adolescents and parents. Methods: Hmong adolescents (14-17 years old) and their parents were recruited from a local CHC to participate in focus group sessions. Using a community-based participatory action research approach, bilingual community researchers conducted eight focus groups with adolescents and parents. Prior to focus groups, participants provided demographic information and completed a survey about HPV and HPV vaccination. Focus group transcripts were analyzed using participatory thematic analysis. Themes were codified using a socioecological model (multilevel) framework combined with an assets lens. Results: A total of 12 adolescents and 13 parents participated in the focus groups (N = 25). Both survey and focus group results showed that Hmong adolescents and parents had low levels of awareness regarding HPV or the HPV vaccine. At the individual-level, both adolescents and parents reported concerns about side effects and costs as potential reasons for not getting vaccinated. Whereas, an individual-level facilitator for both adolescents and parents included personal agency (i.e., individual desire to want to learn more about HPV and the HPV vaccine). At the community-level, barriers included community narratives around traumatic experiences with vaccine, and facilitators included strong community connections and communications. At the institutional-level, barriers included lack of a school policy requiring HPV vaccinations and structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision making. Finally, there was a range of decision-making processes between parents and adolescents and parents and providers. Conclusion: A culturally-appropriate HPV educational program for Hmong adolescents and parents could address barriers and build on facilitators and assets to promote HPV vaccine uptake. These findings have been used in the development of an eHealth application to increase HPV vaccinations in Hmong adolescents. Future research studies that test the feasibility, acceptability, and efficacy of culturally-tailored, multilevel HPV vaccination interventions may provide evidence about the efficacy of culturally-appropriate education in comprehensive vaccine strategies.
Citation Format: Serena Xiong, Maiyia Y Kashouaher, Bai Vue, Kathleen A Culhane-Pera, Shannon L Pergament, Jay Desai, Hee Yun Lee. HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B048.