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The human papillomavirus (HPV) vaccination literature supports the role of culture on African-Americans’ HPV vaccination acceptance. However, the evidence supporting the role of culture on this health behavior is limited. Few studies examine the influence of culture on HPV vaccination acceptance among African-Americans using theoretical frameworks grounded in culture, and few studies examine the influence of culture from the perspective of adolescent females. Therefore, using a dyadic approach, this dissertation explored the role of culture on African-American parents’ and their adolescent daughters’ (12 to 17 years old) HPV vaccination acceptance using both the PEN-3 cultural model and the Health Belief Model. Grounded theory techniques and quantitative descriptive statistics were used to explore the cultural factors that influence the HPV vaccine acceptance of 29 African-American parent-daughter dyads (n = 30 parents; n = 34 daughters) residing in the Southeastern and Northeastern United States. This dissertation’s findings provide evidence of the role of culture on African-American parents’ and their adolescent daughters’ HPV vaccine acceptance, and suggest the need for future research to use a culturally empowering lens to better understand African-American parents’ and adolescent daughters’ cervical cancer prevention health behaviors. Additionally, the findings support the usefulness of using a culture-centered theory to explore culture-related factors that influence the HPV vaccine acceptance of African-American parents and daughters. Incorporating a dyadic approach was also useful for understanding how cultural factors that influence African-American parents’ and daughters’ perceptions and health behaviors may be transmitted among families, kinship networks, and the community. The findings from this dissertation elucidate new areas that may potentially inform the development of culturally appropriate interventions to advance the field of cervical cancer prevention research.

To determine whether psychosocial factors predict depression among older African American patients with cancer.A descriptive correlational study.Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States.African American patients with cancer aged 50-88 years.Fisher's exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates.Religiosity, emotional support, collectivism, perceived stigma, and depression.Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model.Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk.Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs.Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.