A theory-based approach to assessing predictors of HPV vaccine acceptance among a sample of African-American women in the South

Background: Cervical cancer, which is caused by Human Papillomavirus (HPV), has a 60% higher incidence among African-American women than white women in the US. Prior research has documented associations between Health Belief Model (HBM) constructs and HPV vaccine acceptance within adolescent females and parents. Research has also assessed the impact mental health has on health promoting behaviors. Currently, no research has evaluated the mediating pathway that subjective mental health status has on the health promoting behavior of HPV vaccinations. Objective: The present study assesses how subjective mental health status mediates HBM constructs in predicting HPV vaccine acceptance. Methods: Prospective survey of a sample of African-American women recruited from the waiting room of three clinics. Women completed computer assisted questionnaires. A multivariate logistic regression was performed to determine the relationship between HBM constructs and HPV vaccine acceptance and whether subjective mental health status was a mediator. Results: One hundred African-American women (age 18-45) were enrolled. The majority of participants (73%) were willing to accept an HPV vaccine. Multivariate logistic regression analyses indicated that, compared to the “no perceived susceptibility” group, “high perceived susceptibility” was associated with an increase in the odds of HPV vaccine acceptance (OR=3.88, 95% CI=1.21-12.39, p<.05). No significant associations were identified for “low perceived susceptibility.” Subjective mental health status was identified as a partial mediator. Conclusions: These findings offer insight to inform future public health efforts intended to increase HPV vaccine acceptance. Mental health interventions may affect HPV vaccine acceptance and decrease cervical cancer disparities among African-American women.