Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States

IntroductionCompared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population.MethodsBlack mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother’s HPV Perceptions, Mother’s Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale (“I will definitely not have my daughter get the vaccine” to “I will definitely have my daughter get the vaccine”) which was dichotomously recoded for binomial logistic regressions.ResultsHalf of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother’s HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers’ intentions to vaccinate their daughters against HPV when controlling for all other factors.DiscussionIn addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination

Understanding the relationship between sexual identity, life satisfaction, psychological well-being, and online community use

Identity-based frameworks allow for a diverse look at sexuality because they consider non-binary groups that are typically excluded. This study sought to address gaps in LGBQ research by utilizing a diverse sample of sexual identities. It was hypothesized that asexual, demisexual, polysexual, and pansexual individuals would report lower levels of life satisfaction and psychological well-being, more frequent support-seeking internet use, and lower sense of community compared to gay, lesbian, and bisexual individuals. A total of 284 individuals completed an online survey. Results suggest that experiences of life satisfaction, well-being, and sense of community are more nuanced than considered in past research. Further research is needed to create more inclusive means of intervention for LGBQ individuals

Predictors of Sexual Health in Black Lesbian and Bisexual Women Who Have Sex with Men

Black lesbian and bisexual women (BLGB) who have sex with men bear a disproportionate burden of risk for HIV/STIs, and pregnancy compared to LGB women of other races. This study explored associations among LGB identity, social and systemic factors, and sexual risk among BLGB. BLGB women who reported sexual experiences with male partners (N = 320) completed an anonymous online survey including demographics, sexual history, LGB identity, perceived support from family and LGB community, and experience and trust in healthcare providers. LGB identity was positively related to family (r = .26, p \u3c .001) and community support (r = .26, p \u3c .001). Although stronger identity was related to more positive experiences with patient-provider communication regarding LGB sexual health issues (r = -.11, p \u3c .05), it was also associated with believing health care providers discriminate against LGB (r = -.33, p \u3c .001) and Black women (r = -.34, p \u3c .001). Stronger identity was also related to greater contraceptive self-efficacy with males (r = .32, p \u3c .001) despite an association with higher levels of sexual health risk (r = .17, p \u3c .01). Family, community, and individual health care providers can play a positive role in LGB identity, and in turn, lead to greater contraceptive self-efficacy among BLGB having sex with men. However, LGB identity may not play a protective role against sexual risk and may increase anticipated sexual and racial stigma within healthcare settings. Ultimately, more research that approaches sexual health from an intersectional perspective is needed to fully understand these nuanced relationships

Social Determinants of HPV Vaccination Intentions Among Black Mothers with Young Daughters

High-risk HPV infections are responsible for a large percentage of cancers and related mortality among women. Compared to other-race counterparts, Black women experience greater risk of persistent high-risk infection, and consequently, greater risk of HPV-related outcomes including genital warts and the highest incidence rate of vaginal cancer and mortality rate of cervical cancer. Vaccination uptake among Black adolescent girls between 9 to 17 years old remains suboptimal, however. Hesitancy to accept the HPV vaccine among Black parents magnifies HPV disparities facing Black girls throughout their development. Guided by the health belief model and the theory of planned behavior, the current study investigated Black mothers’ intentions to vaccinate their daughter against HPV, integrating across these two frameworks to identify key psychological and social determinants of HPV vaccine intentions. A total of 402 Black mothers of young daughters ages 9 to 15 completed an online survey which assessed HPV beliefs and attitudes across four domains: Mother’s HPV Perceptions (knowledge, susceptibility, severity), Mother’s Vaccine Attitudes (general vaccine attitudes, perceived HPV vaccine benefits, safety concerns, and mother’s self-efficacy to request the vaccine), Cues to Action (community norms, peer norms, and doctor recommendation), and Barriers to HPV Vaccination (inaccessibility, cultural medical mistrust, and sexual risk and stigma). This study explored (1) the extent to which these determinants were associated with HPV vaccine intentions among Black mothers, and (2) the extent to which these four domains overall and uniquely explained variance in HPV vaccine intentions among Black mothers. Approximately half of participants intended to vaccinate their daughter. All determinants except HPV knowledge were each significantly associated with HPV vaccine intentions in bivariate analyses. The four domains of determinants contributed 40% of the total 62% of variance in HPV vaccine intentions explained by the multivariate model. Factors of mother’s vaccine attitudes and cues to action emerged as central determinants of HPV vaccine intentions among this population. These findings suggest that public health campaigns which simply provide information or knowledge about HPV infection and vaccination are insufficient. Population-tailored public health messaging aimed at increasing HPV vaccine acceptance among Black mothers must consider their unique concerns and needs

COVID-19 Pediatric Vaccine Hesitancy among Racially Diverse Parents in the United States

On 29 October 2021, the U.S. FDA authorized the Pfizer-BioNTech COVID-19 (SARS-CoV-2) vaccine for emergency use in children ages 5–11 years. Racial/ethnic minorities have born the greatest burden of pediatric COVID-19 infection and hospitalization. Research indicates high prevalence of parental vaccine hesitancy among the general population, underscoring the urgency of understanding how race/ethnicity may influence parents’ decision to vaccinate their children. Two weeks prior to FDA approval, 400 Hispanic and non-Hispanic Asian, Black, and White parents of children 5–10 years participated in an online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Compared to 31% Black, 45% Hispanic, and 25% White parents, 62% of Asian parents planned to vaccinate their child. Bivariate and multivariate ordinal logistic regression demonstrated race/ethnicity, parental vaccine status, education, financial security, perceived childhood COVID-19 susceptibility and severity, vaccine safety and efficacy concerns, community support, and FDA and physician recommendations accounted for 70.3% of variance for vaccine hesitancy. Findings underscore the importance of multipronged population targeted approaches to increase pediatric COVID-19 vaccine uptake including integrating health science literacy with safety and efficacy messaging, communication efforts tailored to parents who express unwillingness to vaccinate, and interventions developed in partnership with and delivered through existing trusted community coalitions

COVID-19 Vaccine Hesitancy among Parents of Children under Five Years in the United States

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use (EUA) in children ages 6 months–4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years, and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine-preventable diseases. Research following the October 2021 EUA for vaccines for children 5–11 indicates a high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1–4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe that children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID-19 vaccine uptake for young children

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Importance Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. Objective To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. Design, Setting, and Participants This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Exposures Lensectomy with primary IOL implantation. Main Outcome and Measures Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. Results The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. Conclusions and Relevance In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring