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BACKGROUND: Racial/ethnic minorities in the USA exhibit reduced health literacy (HL) proficiency, leading to increased health disparities. It is unclear how the effect of birth status (immigrant/US-born) affects HL proficiency among racial/ethnic minorities. OBJECTIVE: To identify the direct, indirect, and total effects of birth status on HL proficiency among a nationally representative population of racial/ethnic minority adults in the USA. DESIGN: A cross-sectional study of 2019 data from the Medial Expenditure Panel Survey. PARTICIPANTS: Participants aged 18 or older reporting as racial/ethnic minorities (Black, Asian, or Hispanic) with non-missing data. MAIN MEASURES: We predicted HL proficiency for each participant using a previously published model. Path analysis was used to estimate the direct, indirect, and total effects of birth status on HL proficiency, accounting for several other covariates. Prevalence ratios were estimated using adjusted Poisson regression to evaluate differences in the Below Basic HL category. KEY RESULTS: An estimated weighted 81,092,505 participants were included (57.5% US-born, 42.5% immigrant). More racial/ethnic minority immigrant participants fell into the lowest category of HL proficiency, Below Basic (14.3% vs 5.5%, p

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

The coronavirus pandemic has escalated rates of anxiety in the general U.S. population. Understanding how factors associated with coronavirus anxiety at the start of the pandemic differed among populations hardest impacted by coronavirus anxiety is key to effectively remediating negatively associated health outcomes and to better understand how to address concerns of the public at the start of a global pandemic. This study was a secondary analysis of data from a cross-sectional online survey of 1165 Prolific users between 13 and 15 March 2020. Data were collected from a stratified sample of U.S. adults aged 20 or older and currently living in the United States. The sample was stratified for age, gender, and race. Coronavirus anxiety was assessed as the dependent variable, alongside three independent variables: coronavirus crisis perception, perceived economic risk of coronavirus, and general self-efficacy. Multiple linear regression assessed the associations between the independent variables and coronavirus anxiety. Interactions between independent variables and two sociodemographic variables (i.e., gender, race) were also explored. The models were adjusted for age, gender, race, education, employment, and income. The average age of participants was 45.6 ± 15.7. The majority (76%) identified as White, approximately half identified as female and reported obtaining a bachelor's degree or higher. Coronavirus crisis perception and perceived economic risk of coronavirus were positively associated with coronavirus anxiety (β = 0.46, 95% CI = 0.41, 1.00; β = 0.14, 95% CI = 0.09, 1.00, respectively). General self-efficacy was negatively associated with coronavirus anxiety (β = -0.15, 95% CI = -1.00, -0.11). Gender and race both moderated the association between coronavirus crisis perception and anxiety. Race moderated the association between perceived economic risk and coronavirus crisis perception. These results provide a foundation to further explore cognitive factors in subgroups disproportionately affected by anxiety during the pandemic.

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute's evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women's interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women's online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

Family communication surrounding HPV vaccination can support or hinder HPV cancer prevention strategies. We used narrative communication theory to elicit HPV vaccine decision narratives in the context of family communication from a purposive sample of 29 parents of adolescents. Parent narratives indicated that family negotiations occur throughout the decision-making process, topic avoidance was common among parents of unvaccinated and undervaccinated children, parents had concerns that vaccination is a sign of approving sexual permissiveness, and family communication was often prompted by encounters in the exam room. Understanding complex family dynamics in the context of vaccination decision-making, the role of family communication (or lack thereof) in decisions, and effective negotiation and communication strategies can inform messaging tactics aimed at addressing disagreements in families and indicate how vaccinating may align rather than conflict with family values. [ABSTRACT FROM AUTHOR]

Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina ( n = 24) and Vietnamese ( n = 24) women, and PPOSBC staff ( n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men's HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother-daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.

Abstract: Prevention of cervical cancer is of utmost importance to women's health given that it accounts for the second most common cancer death among women worldwide with an estimated 19,000 HPV related cancer cases in women annually in the U.S., 12,200 newly diagnosed cervical cancer cases, and 4,290 deaths. HPV associated cervical cancer disparities remain with highest incidence of cervical cancer among U.S. Latina, African American, and Vietnamese young adults coupled with lowest screening rates. HPV is a necessary contributor to cervical cancer as well as anogenital, penile, and orophayngeal cancers. The point prevalence among U.S. women aged 14-59 is 45% among young adult women particularly minority women. The purpose of this study was to adapt an HPV vaccine intervention, originally designed for college women, to the community setting. Three pilot studies are in the process (Vietnamese and Latina women are being interviewed summer 2016 in Orange County, CA and will be reported on at conference) or completed (Muslim African American women were interviewed in Philadelphia, PA, summer 2015) – at Planned Parenthood. All interviews focus on two aspects of adapting the HPV vaccine intervention: eliciting vaccine decision narratives and collecting preferences on communication channels to effectively reach young adult women. In a collaboration between Planned Parenthood of Orange County (PPOC), UCI, and CSUF, a pilot study (N=50; 25 Vietnamese and 25 Latina women aged 18-26) will be implemented during the summer of 2016. We report at this time, on an ongoing collaboration with Planned Parenthood of Philadelphia with the aim of developing a culturally targeted intervention for African American young adult women (including Muslim African American). A Narrative Engagement Framework (NAF) guided interviews eliciting vaccine decision narratives. Semi-structured interviews (N=26 young adult women) elicited HPV vaccine decision narratives and asked about communication channel preferences for receiving vaccine reminder messages. Interviews were conducted over a month between June 18-July 16 2015. Purposive sampling was used to interview a majority vaccinated (N=15) and minority unvaccinated (N=9) to uncover barriers as well interview two PP staff to gain a clinic staff perspective on prevalence of HPV and vaccination. Women were spontaneously recruited from the waiting room and received $20 cash card as compensation for their time (a 30 minute interview). A grounded theory, inductive approach was used to analyze data for vaccination decision themes, motivation for vaccinating, and/or critical sources or events that led to vaccinating. Three independent coders read and re-read data for emerging decision stories and channel preferences. Memo writing occurred during and within days of the interviews. A majority of women (92%) were sexually active with few using condoms (67% did not use). Results on decision stories revealed several key themes: Stories of staying healthy (I really care about my health), keeping female reproductive parts healthy (so that you can have children), stories of experiencing an abnormal Pap smear, stories of family or co-workers getting cancer and HPV, getting the word out about vaccination (stories of “unawareness”), Planned Parenthood providers not bringing up vaccinating for HPV among young adults, HPV as an invisible disease that can damage your insides, the need to talk with your male friends and with your doctor to raise awareness, and stories about protecting yourself from cancer. Emergent themes on communication channels and health kiosk use included: How time is spent in the waiting room, familiarity with food but not health kiosks, the importance of having health kiosks be interactive and engaging, unfamiliarity with QR codes, and willingness to receive health messages via texting. An interactive, engaging health kiosk with four decision story one-minute videos is in development. The intervention was adapted on several dimensions: visual adaptation (some actresses in videos wear hijab/veil); stylistic language adaptation; using a Philadelphia accent; content adaptation: Linking vaccine messages with health child bearing messages. Interviews with PP staff revealed the lack of policy and financial incentives for PP clinics to offer HPV vaccination. Themes and challenges from Philadelphia pilot work inform the OC pilot study. Policy implications of this research include exploring the role for expansion of the Family PACT to cover HPV vaccination at Planned Parenthood clinics in OC that serve as the number one provider of women's health and serve communities of lower socioeconomic status. Citation Format: Suellen Hopfer, Samantha Garcia, Huong Duong. Culturally Grounded HPV Vaccine Decision Narratives and Communication Channel Preferences among African-American, Vietnamese, and Latina Young Adult Women attending Planned Parenthood Clinics. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A26.