Human Papillomavirus Vaccine Knowledge and Attitudes, Preventative Health Behaviors, and Medical Mistrust Among a Racially and Ethnically Diverse Sample of College Women

J. Racial and Ethnic Health Disparities (2015) 2:77–85 DOI 10.1007/s40615-014-0050-2 Human Papillomavirus Vaccine Knowledge and Attitudes, Preventative Health Behaviors, and Medical Mistrust Among a Racially and Ethnically Diverse Sample of College Women Stephanie K. Kolar & Christopher Wheldon & Natalie D. Hernandez & Lauren Young & Nancy Romero-Daza & Ellen M. Daley Received: 7 April 2014 / Revised: 1 July 2014 / Accepted: 22 August 2014 / Published online: 11 September 2014 # W. Montague Cobb-NMA Health Institute 2014 Abstract Introduction Medical mistrust is associated with disparities in a variety of health outcomes. The human papillomavirus (HPV) vaccine has the potential to decrease disparities in cervical cancer by preventing infection with the virus that causes these malignancies. No study has examined associations between medical mistrust and preventative health behaviors including the HPV vaccine among young minority women. Methods Self-reported racial/ethnic minority students completed a web-based survey in fall of 2011. Wilcoxon and Kruskal-Wallis were used to test differences in medical mistrust scores by demographics and health behaviors. Results Medical mistrust varied significantly by race with Black women reporting the highest scores. Women with no regular health-care provider (HCP) or who had difficulty talking to their provider had higher mistrust. Higher medical mistrust was associated with a preference to receive HPV vaccine recommendation from a HCP of the same race or ethnicity among unvaccinated women. Black and Asian women who had not received the HPV vaccine had higher mistrust scores than vaccinated women. Perceived difficulty in talking to a HCP was associated with ever having a Pap smear. Discussion Awareness of medical mistrust and the influence on health behaviors may aid in increasing delivery of quality health services for racial and ethnic minority populations. Further research among different populations is needed to elucidate impacts of medical mistrust and provider communication on preventative health behaviors. Keywords HPV . STI . Medical mistrust . Preventative . Provider communication MSC codes 62P10 . 62P25 . 91C99 Electronic supplementary material The online version of this article (doi:10.1007/s40615-014-0050-2) contains supplementary material, which is available to authorized users. S. K. Kolar (*) Department of Psychology, College of Arts and Sciences, University of Miami, 1120 NW 14th Street, Room 1521, Miami, FL 33136, USA e-mail: N. D. Hernandez Satcher Health Leadership Institute, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA e-mail: C. Wheldon : E. M. Daley Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA L. Young STD Control Program, Arizona Department of Health Services, Phoenix, AZ, USA e-mail: C. Wheldon e-mail: E. M. Daley e-mail: N. Romero-Daza Department of Anthropology, University of South Florida, Tampa, FL, USA e-mail: 78 Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) and is associated with anogenital warts and cancers in men and women. Racial/ethnic minorities are disproportionately affected by HPV-related cancers. Black and Hispanic women have higher rates of HPV prevalence [1] and cervical cancer incidence and mortality compared to Whites [2]. Prevention of cervical cancer previously relied on screening with cytology, the Pap smear [3]. The quadrivalent HPV vaccine is approved for women and men aged 9 to 26 and protects against types 6 and 11 (associated with 90 % of genital warts) and types 16 and 18 (associated with 70 % of cervical cancers). The vaccine is approved to prevent cervical, vaginal, and vulvar cancers/precancerous lesions (in women), genital warts, and anal cancers/precancerous lesions (both sexes). The Centers for Disease Control and Prevention estimates that approximately 26,000 cancers attributable to HPV occur annually in men and women, including virtually all 11,500 cervical cancer cases [4]. HPV 16 is also the most common type found in other HPV-related cancers; thus, the current vaccine has the potential to prevent a substantial number of cancers and the nonavalent vaccine currently in development may prevent an additional 20 % of cervical cancer cases [5]. Recent national and regional data on HPV vaccine utilization among adolescents, the targeted age group for vaccination, have identified disparities in vaccine uptake [6–11]. Emerging data on young adult women, who have the highest rates of HPV infection and HPV-related diseases, show continued disparities in vaccine uptake among this group [11, 10, 12]. In the 2010 adult vaccination coverage report, Hispanics had lower HPV vaccination coverage (15.1 %) compared with non-Hispanic Whites (22.4 %) [13]. The HPV vaccine has the potential to decrease disparities in cervical dysplasia and cancer if available to adolescent and young adult lowincome and minority populations [14]. Medical mistrust is associated with disparities in cancer stage at diagnosis [15], breast cancer surgical and postsurgical adjuvant treatment and quality of life [16, 17], underutilization of health services [18], routine health examinations [19, 20], and cancer screening [21–23]. Studies of mistrust in HIV+ populations found associations between HIV conspiracy beliefs and antiretroviral treatment non-adherence [24] and less condom use [25] among Black men. Few studies have examined associations between medical mistrust with STI preventative behaviors, and studies of medical mistrust and cancer screening have been conducted among older populations [21–23]. No study has examined potential associations between medical mistrust and preventative health behaviors such as cervical cancer screening and HPV vaccination among young racial and ethnic minorities. To begin to address this gap, this analysis examined J. Racial and Ethnic Health Disparities (2015) 2:77–85 associations between medical mistrust and provider communication with preventative health behaviors among racial/ ethnic college students. We hypothesized that higher mistrust and greater difficulty talking to health-care providers (HCPs) would be associated with lack of preventative health behaviors in this population. Methods Participants Participants were recruited from a large, public university in the Southeastern USA. Self-reported racial and ethnic minority students were sent an email invitation from the university’s registrar’s office with a link asking them to participate in a 15min web-based survey. Survey items were adapted from previous research of psychosocial HPV studies among men and women [26–29] and were based on constructs from the Health Belief Model [30] and Social Cognitive Theory [31]. Items assessed a range of topics including sociodemographics, sexual behaviors, HPV knowledge and awareness, psych (...truncated)