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Background: Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet few mail-based HPV self-testing programs have been implemented in the United States. We report the results of a pilot study of a mail-based program, the Health Outcomes through Motivation and Education Project.Methods: In 2015 to 2016, we recruited 103 women from Appalachian Ohio who were aged 30 to 65 years and had not received a Papanicolaou (Pap) test in at least 3 years. Women were mailed an HPV self-test and randomized to receive either (a) self-test instructions developed by the device manufacturer and a standard information brochure about cervical cancer (control group) or (b) self-test instructions developed by the Health Outcomes through Motivation and Education Project and a photo story information brochure about cervical cancer (intervention group). Logistic regression compared study arms on HPV self-test return and receipt of a Pap test.Results: Overall, 80 (78%) women returned their HPV self-test. Return was similar among the intervention and control groups (78% vs. 77%; odds ratio, 1.09; 95% confidence interval, 0.43-2.76). Among returners, 26% had an oncogenic HPV type detected in their sample. Women who returned their self-test reported high levels of satisfaction and positive experiences with the self-testing process. Few women overall received a Pap test (11%), and Pap testing was similar among the intervention and control groups (14% vs. 8%; odds ratio, 1.91; 95% confidence interval, 0.52-6.97).Conclusions: Mail-based HPV self-testing programs are a potentially promising strategy for reaching underscreened women in Appalachia. Efforts are needed to better understand how to optimize the success of such programs. [ABSTRACT FROM AUTHOR]

Background: The concern that adolescent girls who receive human papillomavirus (HPV) vaccine may be more likely to have sex (ie, sexual disinhibition) has been commonplace in media coverage, but this belief is not held by many parents of adolescent girls. Because no studies have addressed this topic for adolescent boys, we examined parents' and their adolescent sons' beliefs in sexual disinhibition occurring after boys receive HPV vaccine. Methods: A national sample of parents of adolescent boys (n = 547) and their sons (aged 15-17 years; n = 176) completed online surveys in fall 2010. We used multi-item scales to measure parents' and sons' beliefs in sexual disinhibition after HPV vaccination. We used multivariate linear regression to identify correlates of beliefs in sexual disinhibition. Results: Less than a quarter of parents or sons agreed with statements suggesting that HPV vaccination leads to sexual disinhibition among adolescent boys (range, 20%-24%). Parents who had more liberal political affiliations (β = -0.11), had a daughter who had received HPV vaccine (β = -0.12), or had no daughter (β = -0.10) reported weaker beliefs in sexual disinhibition. Parents who reported higher anticipated regret if their sons got HPV vaccine and fainted (β = 0.18) indicated stronger beliefs in sexual disinhibition. Sons who perceived higher peer acceptance of HPV vaccination (β = 0.44) or were Hispanic (β = 0.21) had stronger beliefs in sexual disinhibition. Conclusions: Most parents and sons did not believe that HPV vaccination leads to sexual disinhibition among boys. Understanding the characteristics of parents and sons who hold these beliefs may help inform efforts to increase HPV vaccine uptake among boys. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a longitudinal study to examine human papillomavirus (HPV) vaccine uptake among male adolescents and to identify vaccination predictors. Methods. In fall 2010 and 2011, a national sample of parents with sons aged 11 to 17 years (n = 327) and their sons (n = 228) completed online surveys. We used logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up. Results. Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 8% by follow-up. About 55% of parents who had ever received a doctor's recommendation to get their sons HPV vaccine did vaccinate between baseline and follow-up, compared with only 1% of parents without a recommendation. Fathers (odds ratio = 0.29; 95% confidence interval = 0.09, 0.80) and non-Hispanic White parents (odds ratio = 0.29; 95% confidence interval = 0.11, 0.76) were less likely to have vaccinated sons. Willingness to get sons HPV vaccine decreased from baseline to follow-up among parents (P < .001) and sons (P = .003). Conclusions. Vaccination against HPV remained low in our study and willingness to vaccinate may be decreasing. Physician recommendation and education about HPV vaccine for males may be key strategies for improving vaccination. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer incidence and mortality rates are high among women from Appalachia, yet data do not exist on human papillomavirus (HPV) prevalence among these women. We examined the prevalence of genital HPV among Appalachian women and identified correlates of HPV detection. Methods: We report data from a case-control study conducted between January 2006 and December 2008 as part of the Community Awareness, Resources, and Education (CARE) Project. We examined HPV prevalence among 1116 women (278 women with abnormal Pap tests at study entry [cases], 838 women with normal Pap tests [controls]) from Appalachian Ohio. Analyses used multivariable logistic regression to identify correlates of HPV detection. Results: The prevalence of HPV was 43.1% for any HPV type, 33.5% for high-risk HPV types, 23.4% for low-risk HPV types, and 12.5% for vaccine-preventable HPV types. Detection of any HPV type was more common among women who were ages 18–26 (OR = 2.09, 95% CI: 1.26–3.50), current smokers (OR = 1.86, 95% CI: 1.26–2.73), had at least five male sexual partners during their lifetime (OR = 2.28, 95% CI: 1.56–3.33), or had multiple male sexual partners during the last year (OR = 1.98, 95% CI: 1.25–3.14). Similar correlates were identified for detection of a high-risk HPV type. Conclusions: HPV was prevalent among Appalachian women, with many women having a high-risk HPV type detected. Results may help explain the high cervical cancer rates observed among Appalachian women and can help inform future cervical cancer prevention efforts in this geographic region. [ABSTRACT FROM AUTHOR]

The article presents a study which characterizes the vaccination rate of hepatitis B virus (HBV) infection from a national sample group of bisexual and gay men. The study enrolled a random sample of bisexual or gay men with reported histories of HIV, HBV, and sexually transmitted infections (STI). Results derived from multivariate analyses indicate a 46% confidence interval of men who had received HBV vaccine with higher vaccination rate in 18-29 age group compared to 50-59 years.

The article presents a study on the statewide vaccine initiation for human papillomavirus (HPV) to adolescent girls in North Carolina, in order to reduce the incidence of cervical cancer. Based on results, vaccine initiation was higher for 13-15 year old girls and parents of unvaccinated non-Hispanic white daughters have lesser intentions to be vaccinated in 2011. It concludes that HPV vaccination in North Carolina shows significant response compared to other U.S. areas.

Objectives. We assessed the willingness of gay and bisexual men, who have high rates of anal cancer that might be prevented through regular screening, to receive anal Papanicolaou tests. Methods. We surveyed a national sample of men aged 18 to 59 years who self-identified as gay (n=236) or bisexual (n=70). Results. Most respondents were willing to accept free screening (83%), but fewer would pay for the test (31%; McNemar's c2=158.02; P<.001). Willingness to pay for screening was higher among men who reported greater worry about getting anal cancer (OR [odds ratio]=1.70; 95% confidence interval [CI]=1.06, 2.72), higher perceived likelihood of anal cancer (OR=1.88; 95% CI=1.18, 2.99), and higher income (OR=2.17; 95% CI=1.18, 3.98), in adjusted analyses. Only 33% (17 of 51) of HIV-positive respondents, who have the highest risk for anal cancer, had received anal Papanicolaou tests. Conclusions. Anal cancer screening was highly acceptable to gay and bisexual men, although cost was a major barrier. Efforts to reduce anal cancer disparities should target beliefs about anal cancer and barriers to anal Papanicolaou testing in this population. (Am J Public Health. 2010;100:1123-1129. doi:10.2105/AJPH.2009.176446) [ABSTRACT FROM AUTHOR]

The article presents a study to characterize the willingness of gays and bisexual men to get human papillomavirus (HPV) infection vaccine and identify correlates of vaccine acceptability. The study surveyed men aged 18 to 59 who self-identified as bisexual or gay. The results show that compared to men who believed their doctor would not recommend HPV vaccine, the vaccine acceptability was higher among men who believed their doctor would recommend getting the vaccine.

Extensive media coverage and potential controversy about COVID-19 vaccination during the pandemic may have affected people's general attitudes towards vaccination. We sought to describe key psychological antecedents related to vaccination and assess how these vary temporally in relationship to the pandemic and availability of COVID-19 vaccination. As part of an ongoing online study, we recruited a national (U.S.) sample of young gay, bisexual and other men who have sex with men (N = 1,227) between October 2019 and June 2021, and assessed the "4Cs" (antecedents of vaccination; range = 1–5). Overall, men had high levels of confidence (trust in vaccines; M = 4.13), calculation (deliberation; M = 3.97) and collective responsibility (protecting others; M = 4.05) and low levels of complacency (not perceiving disease risk; M = 1.72). In multivariable analyses, confidence and collective responsibility varied relative to the pandemic phase/vaccine availability, reflecting greater hesitancy during later stages of the pandemic. Antecedents also varied by demographic characteristics. Findings suggest negative effects of the COVID-19 pandemic on key antecedents of general vaccination and identify potential targets for interventions. [ABSTRACT FROM AUTHOR]

The authors comment on a study that showed the efficacy of human papillomavirus (HPV)-6/11/16/18 vaccine against all HPV-associated genital diseases in young women, such as vulvar and cervical intraepithelial neoplasia, adenocarcinoma in situ and genital warts. The study participants were treated with procedures known to be effective in cervical cancer prevention, which greatly reduced their chances of getting cervical cancer. The authors warn that most randomized controlled trials will not be able to show whether HPV vaccines prevent cervical cancer.

Background: The U.S. Food and Drug Administration (FDA) is working to introduce new graphic warning labels for cigarette packages, the first change in cigarette warnings in more than 25 years. We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age. Methods: A national sample of 386 non-smoking American males ages 11–17 participated in an online experiment during fall 2010. We randomly assigned participants to view warnings using a 2×2 between-subjects design. The warnings described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette package warnings. Analyses tested whether age moderated the warnings' impact on risk perceptions and smoking motivations. Results: The warnings discouraged most adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings did (60% vs. 34% were “very much” discouraged, p<.001). Including an image had no effect on discouragement. The warnings affected several beliefs about the harms from smoking, and age moderated these effects. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They also believed that their true likelihood of experiencing any harm was lower than what an expert would say. Conclusions: Our findings suggest that warnings focusing on lung cancer, rather than addiction, are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking. Including images on warnings had little effect on non-smoking male adolescents' discouragement or beliefs, though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels. [ABSTRACT FROM AUTHOR]

The article focuses on a study to determine the longitudinal predictors of human papillomavirus (HPV) vaccine uptake in populations that are at high risk for cervical cancer. Interviews were conducted on parents of 10 to 18 year-old girls in North Carolina particularly non-Hispanic white with 56% and black with 35%. Results show that 27% of the girls covered by the study had initiated HPV vaccine. It also recommends correlates of uptakes that provide opportunities for increased vaccine uptake.

The article presents a study which assesses the beliefs and attitudes of parents toward human papillomavirus (HPV) vaccination. The study develops the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) using collected information from 783 parents whose daughters have not received HPV vaccination yet. The study has found that the attitude of parents toward HPV vaccines are significant to their intentions to have their daughters vaccinated against HPV.

Objective: To support efforts to address parental hesitancy towards early childhood vaccination, we sought to validate the Vaccination Confidence Scale using data from a large, population-based sample of U.S. parents. Methods: We used weighted data from 9,354 parents who completed the 2011 National Immunization Survey. Parents reported on the immunization history of a 19- to 35-month-old child in their households. Healthcare providers then verified children’s vaccination status for vaccines including measles, mumps, and rubella (MMR), varicella, and seasonal flu. We used separate multivariable logistic regression models to assess associations between parents’ mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. Results: A substantial minority of parents reported a history of vaccine refusal (15%) or delay (27%). Vaccination confidence was negatively associated with refusal of any vaccine (odds ratio [OR] = 0.58, 95% confidence interval [CI], 0.54–0.63) as well as refusal of MMR, varicella, and flu vaccines specifically. Negative associations between vaccination confidence and measures of vaccine delay were more moderate, including delay of any vaccine (OR = 0.81, 95% CI, 0.76–0.86). Vaccination confidence was positively associated with having received vaccines, including MMR (OR = 1.53, 95% CI, 1.40–1.68), varicella (OR = 1.54, 95% CI, 1.42–1.66), and flu vaccines (OR = 1.32, 95% CI, 1.23–1.42). Conclusions: Vaccination confidence was consistently associated with early childhood vaccination behavior across multiple vaccine types. Our findings support expanding the application of the Vaccination Confidence Scale to measure vaccination beliefs among parents of young children. [ABSTRACT FROM AUTHOR]

Objective. To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia. Methods. We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants' percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening. Results. On average, screening data were obtained on 564 intervention and 559 comparison participants per year. There was no difference in the Wave 4 CRC screening rates of intervention and comparison counties (35.2% versus 31.4%). Multivariate analyses found that high perceived risk of CRC, willingness to have a CRC test if recommended by a doctor, doctor recommendation of a CRC screening test, and patient-physician communication about changes in bowel habits, family history of CRC, and eating fruits and vegetables were significant (p < 0.05) predictors of being within CRC screening guidelines. Conclusions. The intervention was not effective in increasing CRC rates among Ohio Appalachian adults. Future research should determine how media and clinic-based interventions can be modified to improve CRC screening rates among this underserved population. [ABSTRACT FROM AUTHOR]

Purpose: Mother-daughter communication about sex is associated with healthier behavior during adolescence. We sought to characterize mothers' communication with their daughters about human papillomavirus (HPV) vaccine and the potential for these discussions to provide an opportunity for talking about sexual health.Methods: During December 2009, we conducted an online survey with a nationally representative sample of US mothers of girls aged 11 to 14 years (n = 900; response rate = 66%). We used 3 complimentary approaches to assess HPV vaccine as an opportunity for mother-daughter communication about sex. Estimates are weighted.Results: Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have also talked with their daughters about sex (92% vs. 74%, OR = 3.25, CI = 1.57-6.68, P < 0.05), in multivariate analyses. Among mothers who talked about sex when they talked about HPV vaccine, many felt that HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%).Conclusions: HPV vaccine discussions provide a cue to mother-daughter communication about sex that is as important as some more widely recognized cues. Discussions about HPV vaccine are an acceptable opportunity for mothers to talk with their daughters at an age when communication about sex is most influential. It may be possible for parents to capitalize on HPV vaccine discussions already happening in many families to promote sexual health. [ABSTRACT FROM AUTHOR]