Race and sexual behavior predict uptake of the human papillomavirus vaccine.

Human papillomavirus (HPV) is a common sexually transmitted infection that is associated with cervical cancer (Bosch, Lorincz, Munoz, Meijer, & Shah, 2002). More than 25% of women 14–59 years old are infected with HPV (Dunne et al., 2007). In 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine developed to prevent genital warts, precancerous lesions, and cervical cancer caused by four types of HPV, which was heralded as a significant advance in preventive health care for females. The current U.S. guidelines for the HPV vaccination are to target girls 11–12 years old and previously unvaccinated girls 13–26 years old regardless of sexual experience (Markowitz et al., 2007). Sociodemographic factors are associated with HPV infection and cervical cancer. African-American women are at greater risk for HPV infection (Shikary et al., 2009), incidence of cervical cancer (Schairer, Brinton, Devesa, Ziegler, & Fraumeni, 1991), and morbidity resulting from cervical cancer (Hebert et al., 2009). Lower income is also associated with HPV infection and cervical cancer (Shikary et al., 2009). Efforts, therefore, to investigate uptake of the HPV vaccine in populations at high risk for HPV infection and cervical cancer are critical to addressing disparities in health outcomes for members of racial minorities and those living in poverty. To date, several studies have been conducted on vaccine acceptability and a few on correlates of initiation or uptake. Using a convenience sample of Caribbean-American and African-American adolescents attending a medical clinic and their parents, Read, Joseph, Polishchuk, and Suss (2010) reported that interest in the HPV vaccine was twice as high among sexually active compared to nonsexually active adolescents. Beliefs about health and sexuality, and African-American race are also correlates of low acceptability (Scarinci, Garces-Palacio, & Partridge, 2007). Among the recent studies testing correlates of vaccination initiation, perceived barriers to vaccination (Reiter, Brewer, Gottlieb, McRee, & Smith, 2009), and area and family level poverty (Pruitt & Schootman, 2010) decreased the likelihood of initiation. Few investigators have had sufficient representation of African-American adolescents in nonclinical settings, or representative populations with adequate response rates to test hypotheses about race effects. In addition, many of the factors identified in the existing literature, such as race and poverty, and age, puberty, and sexual activity, may share explained variance in vaccine initiation. Thus, adequately powered studies are needed to parse the unique effects of hypothesized correlates of HPV vaccine initiation. The present study addresses these gaps in the literature. Two years after FDA approval of the first HPV vaccine, caregivers of girls in the Pittsburgh Girls Study (PGS; Keenan et al., 2010), a longitudinal study funded by the National Institutes of Health on the development of behavioral and emotional problems, were administered questions about vaccine initiation. Approximately half of the girls in the PGS are African American and the sample was selected to overrepresent families living in low-income neighborhoods. Because data have been collected annually, predictors of vaccine initiation could be identified. Thus, the PGS provides a unique opportunity to generate information critical to evaluating the successful delivery of a preventive intervention for an illness that disproportionately affects minority populations.