HPV vaccination among African-American adolescent girls in 4 U.S. cities: Prevalence, correlates, and psychosocial barriers

The HPV vaccine offers hope that the incidence of cervical cancer can be dramatically reduced worldwide. In the U.S., cervical cancer has become primarily a disease of low-income minority women. To improve understanding about vaccination barriers, we investigated (a) HPV vaccination prevalence and (b) the association between HPV vaccine acceptability (intentions and uptake) and demographic, health behavior, and psychosocial variables. African-American girls enrolled in a four-city HIV prevention trial (N = 915; M age = 15) completed computer-assisted interviews that assessed HPV vaccination intent and uptake, HPV knowledge, physician trust, STD history, sexual behavior, and exposure to Gardasil ads. Approximately two-thirds (65%) had heard of Gardasil and 26% reported having received the vaccine. Vaccination rates were higher in two northern cities relative to two southern cities (35% vs. 19%). In multivariate logistic regression analyses, greater HPV knowledge (p < .001), lifetime history of anal sex (p < .005), higher grade level (p < .05), and being from a northern city (p < .001) were significant correlates of past vaccination. For individuals who had not been vaccinated, greater physician trust (p < .001), HPV knowledge (p < .01), and older age (p < .05) were related to vaccination intent in a multivariate regression model. Findings show the importance of regional differences in vaccine uptake and suggest that lack of HPV knowledge and distrust in providers may serve as vaccination barriers. Research should clarify regional differences in vaccine uptake and test innovative approaches to enhance trust and vaccine acceptance among African-American teens.