Rural women, particularly those residing in Appalachia, have some of the nation’s highest cervical cancer mortality rates. With support from federal and private grants, the University of Kentucky Center for Excellence in Rural Health-Hazard is attempting to address this issue. Eastern Kentucky-based researchers are surveying 18- to 26-year-old female community health center patients and college students about their risk factors for the disease, and then offering them free Gardasil, a vaccine against the virus that causes most cervical cancer cases

Bates, Wallace

Casey, Baretta R.

Crosby, Richard A.

Dignan, Mark B.

Godsey, Tonya D.

English

University of Kentucky

University of KentuckyUKnowledgeCenter for Excellence in Rural Health Presentations Rural Health5-2009Addressing Cervical Cancer in Central AppalachiaBaretta R. CaseyUniversity of Kentucky, bcase2@uky.eduRichard A. CrosbyUniversity of Kentucky, richard.crosby@uky.eduWallace BatesUniversity of Kentucky, wallace.bates@uky.eduTonya D. GodseyUniversity of Kentucky, tonya.godsey@uky.eduMark B. DignanUniversity of Kentucky, mbdign2@uky.eduRight click to open a feedback form in a new tab to let us know how this document benefits you.Follow this and additional works at: https://uknowledge.uky.edu/ruralhealth_presentPart of the Obstetrics and Gynecology Commons, and the Oncology CommonsThis Presentation is brought to you for free and open access by the Rural Health at UKnowledge. It has been accepted for inclusion in Center forExcellence in Rural Health Presentations by an authorized administrator of UKnowledge. For more information, please contactUKnowledge@lsv.uky.edu.Repository CitationCasey, Baretta R.; Crosby, Richard A.; Bates, Wallace; Godsey, Tonya D.; and Dignan, Mark B., "Addressing Cervical Cancer in CentralAppalachia" (2009). Center for Excellence in Rural Health Presentations. 5.https://uknowledge.uky.edu/ruralhealth_present/5Addressing Cervical Cancer in Central AppalachiaBaretta R. Casey, MD, MPH1; Richard A. Crosby, PhD2;Wallace Bates1; Tonya D. Godsey1; and Mark B. Dignan, PhD, MPH3Center for Excellence in Rural Health-Hazard1, College of Public Health2, and Department of Internal Medicine3, University of KentuckyMETHODSProcedures: Gardasil was provided at no cost. To avoid self- selection bias in the sample, the project was called the Women’s Health Study and reference to free Gardasil was avoided entirely.Compensation: After providing consent, women completed a self- administered questionnaire that assessed numerous psychosocial factors potentially related to Gardasil acceptance. Subsequently, women were compensated with $25 for their time.Measures: Three items were assessed using “ever” as the recall period: ever having an abnormal Pap test result, an STD, or having a friend/family diagnosed with cervical cancer.  One item asked, “How often do you worry that you might have HPV?” Response options were provided on a 4-point scale ranging from “never” to “frequently.” Three items assessed normative influences. The first asked, “Do you think your friends would want you to be vaccinated against HPV?” Two subsequent items replaced the word “friends” with “mother” and then with “father.” A series of statements were provided to women, with each statement reflecting a factor potentially associated with vaccine acceptance. Response options were provided on a 5-point scale ranging from (1) “strongly agree” to (5) “strongly disagree.”Analysis: Because the study is on-going, many women receiving dose 1 have not yet been due for dose 2 or dose 3. Thus, this preliminary analysis only compared women receiving dose 1 to those declining dose 1. Associations between continuous correlates and HPV vaccine acceptance were assessed by independent group t-tests. Associations between dichotomous correlates and HPV vaccine acceptance were assessed by the use of contingency table analyses to calculate prevalence ratios, their 95% confidence intervals, and their respective p values. Correlates achieving significance were entered into a multiple logistic regression model using forward stepwise entry. Multivariate significance was defined by an alpha level of .05 or less.ABSTRACTRural women, particularly those residing in central Appalachia, have some of the nation’s highest cervical cancer mortality rates. With support from a federal (U.S. Centers for Disease Control and Prevention) and private (Merck) grant, the University of Kentucky Center for Excellence in Rural Health-Hazard is attempting to address this issue. Two Eastern Kentucky-based researchers have surveyed 350 18- to 26-year-old female community health center patients and college students about their risk factors for the disease. The young women are then offered free Gardasil, a vaccine against the virus that causes most cervical cancer cases. The purpose of this project is to determine the prevalence of Quadrivalent Human Papillomavirus Recombinant Vaccine acceptance among traditional university-age women and to identify non-cost, psychosocial factors associated with acceptance. CONCLUSIONS1. Even when we offered Gardasil for free the uptake was poor. Social marketing programs are needed to promote increased uptake among young rural women (and someday soon, young rural men).2. Findings also suggest that daughters’ perceptions of their fathers’ endorsement of HPV vaccination may be critical to acceptance – more so than mother’s or friends’ endorsement.3. The experience of having an abnormal Pap test result may be a “window of opportunity” for providers to offer Gardasil.4. Vaccine safety and ease of return for boosters are critical perceptions – each can potentially be altered by social marketing programs.FINDINGS Average age of the sample was 21.3 years (standard deviation = 2.5 years). The vast majority (98.6 percent) self-identified as “Caucasian/white,” with the remainder identifying as members of other racial/ethnic backgrounds. Most (83.7 percent) reported having penile-vaginal sex in the past 12 months. One hundred and two women received their first dose of Gardasil, leaving 248 (70.9 percent) who had not accepted the offer of free vaccination. The mean age of women receiving the vaccine (21.5 years) was not significantly different than the mean age of those not accepting the vaccine (21.3 years) (t = .88; df = 348; p = .38).Among participants who answered “yes” to having had an abnormal pap smear, 40.7 percent received dose 1 of Gardasil. For participants who answered “no,” only 25.1 percent accepted the free vaccine. (p = .005)Figure 1 relates participants’ responses about whether friends or family members would “definitely want me to be vaccinated” to their subsequent decision about whether to accept a free dose of Gardasil. For instance, among participants answering “yes” with regard to their father, 38.7 percent received dose 1 of Gardasil; among those answering “no,” only 20.4 percent accepted the vaccine.Table 1 presents statistically significant (p < .05) attitudinal differences between study participants who accepted dose 1 and those who did not. Answers to health belief questions were on a 5-point scale ranging from (1) “strongly agree” to (5) “strongly disagree.”Table 2 shows factors that might have made a practical difference in participants’ decision about whether to accept the vaccine. However, none of these predictors were impactful to a statistically significant degree (p < .05).Table 3 shows the results of a multivariate analysis. Only four predictor variables retained significance.Figure 1Table 2Table 1Statistically insignificant predictorsof HPV vaccine acceptanceAfraid of needles p = .75May cause side  effectsp = .63I avoid medical  carep = .07Wouldn’t want  sexual history  takenp = .16Wouldn’t get 3  dosesp = .51Had sex in the past  12 monthsp = .61Ever had an STD p = .72Friend or family  had cervical cancerp = .62Never worry about  HPVp = .07Statistically significant differences between those whoaccepted the HPV vaccine and those who did notVariableMean for  those getting  dose #1Mean for those not getting  dose #1ProbabilityHPV is serious enough to justify  getting the vaccine1.63 1.90 p = .002I am not sure the vaccine is safe 3.47 2.96 p = .0001In general, vaccines are a good thing 1.69 1.91 p = .015I would not take the time to return  to the clinic for booster doses 4.21 3.89 p = .001I would not get booster doses if  excessive waiting room time was  involved3.74 3.38 p = .002 Note: Results are based on participant responses on a 5‐point scale ranging from (1)  “strongly agree” to (5) “strongly disagree.” For all results, a lower mean score  corresponds with greater participant agreement.Source: University of Kentucky “Predictors of HPV Vaccine Acceptance Among Young  Rural Women” study data, 2009Source: University of Kentucky “Predictors of HPV Vaccine  Acceptance Among Young Rural Women” study data, 2009Project service areaTable 3Multivariate AnalysisAdjusted OddsRatioConfidenceIntervalSignificance RemarksNever had an  abnormal Pap 1.98 95% CI = 1.15 – 3.38 p = .013About twice as likely  to decline if they  never had an  abnormal PapDid not indicate  that “Father” would definitely  want me to be  vaccinated1.76 95% CI  = 1.05 – 2.92 p = .03About 1.8 times more  likely to decline free  GardasilI could not easily  return to the  clinic for  boosters1.66 95% CI = 1.12 – 2.44 p = .0112% greater odds of  decline for each unit  of more agreement  with this statementLess agreement  with the  statement that  the vaccine is  not safe.65 95% CI = .59 ‐ .85 p = .002This is a protective  effect meaning that  for each unit of “less  agreement” on the 5‐ point scale young  women were 35% less  likely to decline the  free offer of GardasilSource: University of Kentucky “Predictors of HPV Vaccine Acceptance Among Young  Rural Women” study data, 2009

Addressing Cervical Cancer in Central Appalachia

https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1002&amp;context=ruralhealth_present

Addressing Cervical Cancer in Central Appalachia

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