Abstract B62: HPV vaccine initiation among Hispanic adolescent males in Puerto Rico: A mixed-method study
Authors: Toro-Mejias Lizbeth M. Del , Conde-Toro Alexandra , Serra-Rivera Michelle , Martinez Tania M. , Rodriguez Veronica , Villanueva Hector , Berdiel Luis , Colon-Lopez Vivian 
Published: May 2015

Abstract
Background: A quadrivalent Human Papillomavirus (HPV) vaccine was licensed in 2009 for boys and young males aged 9-26 years for the prevention of genital warts. In 2011, new recommendations to routine vaccination were given for prevention of genital warts and anal cancer in males. Given that HPV vaccine is most effective if administered prior to HPV exposure through sexual contact, vaccination promotion strategies on male adolescents younger than 17 years old are essential.
Objectives: The purpose of this study was to describe the profile of parents of boys 9-17 years old, identify correlates associated with HPV vaccine initiation, and have a better understanding of the educational messages that might influence the HPV vaccine administration.
Methods: A mixed-method study was conducted in HealthproMed, a Federally Qualified Health Center (FQHC) in Santurce, Puerto Rico. A self-administered questionnaire containing sociodemographic information as well as a module on HPV vaccine was collected among 200 parents. Also, two separate focus group sessions were held among parents of vaccinated and unvaccinated boys.
Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess HPV vaccine initiation (received ≤ 1 dose) as the dependent variable, and other parents and sons' characteristics as independent variables. Those variables who achieved statistical significance (p &lt;0.05) in the bivariate analysis were then included in a multivariate logistic regression model.
Results: The mean age of the recruited parents was 37.7 ± 7.2 years old. The vast majority were females (88.5%), born in Puerto Rico (65.3%), and reported a high school degree or lower (57.4%). Regarding sons' characteristics, their mean age was 12.5 ± 2.6 years old. Most of the parents reported that their sons had visited a healthcare provider in the last year (78.1%) and that they had a healthcare coverage (75.0%). Approximately a third of the parents reported that their sons had initiated the HPV vaccination (29.3%). Most of the interviewed parents have heard about HPV infection (88.1%), and the administration of the vaccine among males (62.4%). In multivariate analysis, parents who had asked a health provider (OR= 6.5; 95% CI= 1.2-34.4) and received a health provider recommendation (OR= 13.0; 95% CI= 2.1-82.7) to get their sons the HPV vaccine, as well as having a daughter who had received the HPV vaccine (OR= 4.9; 95% CI= 1.1-22.4), were more likely to have initiated the HPV vaccine administration. Focus groups supported our quantitative analysis in recommending health care providers for HPV vaccination. Presentations of clinical images to document the health consequences of HPV infection were suggested by parents. Interest topics among parents in order to increase HPV vaccination includes: (1) understanding of the risk factors for HPV infection; (2) vaccine costs; (3) places where the vaccine can be administered; and (4) understanding the importance of administer the vaccine in a timely schedule.
Conclusions: Quantitative data shows that health care provider recommendation is associated with HPV vaccine initiation. Qualitative data, on the other hand, highlighted the topics and messages that should be included as part of educational campaigns targeting parents and young men for HPV vaccination. Since a high percentage of unvaccinated parents indicated that they have not received recommendation from healthcare providers, efforts in HPV vaccine promotion should include capacity building strategies for healthcare providers to then educate parents and their sons about the benefits of the HPV vaccination.
Citation Format: Lizbeth M. Del Toro-Mejias, Alexandra Conde-Toro, Michelle Serra-Rivera, Tania M. Martinez, Veronica Rodriguez, Hector Villanueva, Luis Berdiel, Vivian Colon-Lopez. HPV vaccine initiation among Hispanic adolescent males in Puerto Rico: A mixed-method study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B62. doi:10.1158/1538-7755.DISP13-B62