gloria manuel, marlene marquez, and jennifer nguyen university of colorado denver fall 2013

Barriers and Intervention Methods for Preventing Human

Papillomavirus in the Latino Hispanic Community

Gloria Manuel, Marlene Marquez, and Jennifer NguyenUniversity of Colorado Denver

Fall 2013

HPV is the most common and most costly sexually transmitted disease worldwide

Nearly all cervical cancers are caused by the Human papillomavirus (HPV) strains 16 & 18◦ About12,000 cervical cancer cases per

year◦ About 4,000 cervical cancer deaths per

year

Approximately 42.5% of U.S. women are infected with HPV at some point in their lives

HPV and Cervical Cancer

(National Cancer Institute, SEER Data, 2013)

(American Cancer Society, 2012)

Incidence and Mortality Rates1999-2007

HPV-Related Cancers in Women

(JNCI, 2012 )

Annual Report to the Nation on the Status of Cancer, 1975-2009.

HPV Vaccine Recommendations:◦ Gardasil and Cervarix◦ Females ages 11-26: 11-17 and 18-26 years old◦ Males ages 11-21◦ 3 doses over 6 months

Reducing Behavioral Risks◦ Regular use of condoms◦ Limiting the number of partners

Cervical Cancer Prevention

(ACS, 2012)

HPV Testing Recommendations◦ Age 30 or older ◦ Abnormal Pap smears

Cervical Cancer Screening Recommendations◦ Beginning at age 21◦ Ages 21 to 29 - Pap test every 3 years◦ Ages 30 to 65 - Pap test and HPV test every 5

years; OR a Pap test alone every 3 years.

Cervical Cancer Early Detection

(ACS, 2012; CDC, 2013)

HPV infection Diet Smoking Poverty Oral Contraceptives Family History

Cervical Cancer Risk Factors

(ACS, 2012)

Healthy People 2020’s objective for cervical cancer is to reduce the mortality rate by 10%

Objective for Cervical Cancer

Baseline: 2.4 uterine cervix cancer deaths per 100,000 females occurred in 2007 (age adjusted to the year 200 standard population

Target: 2.2 deaths per 100,000 females

Target-Setting Method: 10 percent improvement

Cost and Access to Care Cultural Beliefs/Language Lack of Knowledge/Literacy

Misconceptions Psychological Factors Patient/Parents Factors/

Acceptance

Factors Affecting Cervical Cancer Prevention and

Treatment

Parental consent/acceptance Barriers for parents Physicians/pediatricians beliefs and

attitudes

Parent & Health Care Provider Factors in Acceptance of Vaccine

Addressing cost issue Education Engaging health care workers Culturally-tailored interventions Engage friends and family Empowering Latinas

Interventions to Reduce Health Disparity

Discuss cost issue with patients Financial assistance (e.g., cover cost, co-

pays) Work with the Vaccines for Children program

Addressing Cost

Culturally tailored educational materials to increase HPV and vaccines knowledge◦ Use different methods to educate

Radionovelas Pamphlets in Spanish Magazines/Newspapers in Spanish Focus groups – both adolescents and parents

Provide pediatricians with resources and trainings on how to approach parents

Increasing Knowledge

Engaging health care workers◦ Using Promotoras

Culturally tailored interventions◦ Address barriers to community (i.e. transportation

problems), use community-based methods, include schools, churches, etc.

Culturally-Tailored Interventions

Engaging friends and family◦ Educating parents, peers, siblings◦ Having informative sessions for parents-only

Empowering women to advocate for themselves and their children

Increase Social Network

HPV in boys and men Life of HPV vaccine Continue building

culturally-tailored research and interventions for Latinas

Future Directions

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