Sociodemographic predictors of perceived weight discrimination.

BACKGROUND: Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS: A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS: At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS: Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Experiences of discrimination and snacking behavior in Black and Latinx children.

Little is known about how discrimination contributes to health behaviors in childhood. We examined the association between children's exposure to discrimination and their snacking behavior in a sample of youth of color (N = 164, Mage = 11.5 years, 49% female, 60% Black, 40% Hispanic/Latinx). We also explored whether children's body mass index (BMI) or sleepiness moderated the association between discrimination and calorie consumption. The significant link between discrimination and calorie consumption was moderated by children's BMI, such that discrimination was associated with calorie consumption for children with BMI percentiles above 79%. Children's sleepiness did not serve as an additional moderator. Efforts to promote health should consider children's broader socio-contextual experiences, including discrimination, as factors that may shape eating patterns.

Factors associated with HPV-associated sexual risk behaviors among sexually active college students.

High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors-number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural-urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases.

Perceived Weight Discrimination and General Coping Strategies.

BACKGROUND: Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health. METHOD: Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health. RESULTS: Perceived weight discrimination was associated with greater use of disengaged coping strategies (ß = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (ß = - .11, p < .01) and support (ß = - .09, p < .01) coping strategies, which did not consistently mediate the association with health. CONCLUSION: Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.

Weight Discrimination and Health Risk Behavior in Racial, Ethnic, and Sexual Minority Adults.

BACKGROUND: People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway. PURPOSE: We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation. METHODS: Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status). RESULTS: Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. CONCLUSIONS: Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

People with high body weight remain one of the most stigmatized groups in the USA and face significant discrimination due to their weight. Experiencing weight discrimination is associated with poor health, yet little is known about the underlying pathways that explain this association and even less is known about those pathways in socially marginalized groups. We investigated unhealthy behavior as a possible a pathway by assessing associations between weight discrimination and several health risk behaviors and identifying whether those associations vary by gender, race, ethnicity, or sexual orientation. A diverse sample of 2,632 U.S. adults completed an online survey. Previous experience with weight discrimination was found to be associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and poor sleep. The association between weight discrimination and binge eating, alcohol use, and physical activity was stronger in men than in women, yet exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. Weight discrimination was associated with engagement in unhealthy behaviors and associations were largely similar across participants from diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

The role of childhood unpredictability in adult health.

This research differentiated childhood unpredictability (i.e., perceptions of uncertainty or instability due to turbulent environmental changes) from other related constructs to identify its role in adult health. Study 1 (N = 441) showed that, beyond other childhood adversity variables (poverty and adverse childhood experiences or ACEs) and demographic characteristics, perceptions of unpredictability were associated with greater functional disability and worse health-related quality of life (assessed via the CDC's HRQOL Healthy Days measure and the RAND SF-36). Study 2 (N = 564) replicated those findings in a more racially diverse sample and showed that associations with childhood unpredictability held while also controlling for the Big 5 personality traits. Findings suggest that effects of unpredictability were especially pronounced among Hispanic (in Study 1), and Black/African American and low-income participants (in Study 2). Experiencing childhood environments that are perceived to be uncertain, unstable, or uncontrollable may put children on a path toward poor health outcomes in adulthood. Findings advance theories of child adversity and health and identify childhood unpredictability as a potentially valuable target for intervention.

Rural-Urban Disparities in HPV Vaccination Coverage Among Adolescents in the Central Part of the State of Illinois, USA.

Human Papillomavirus (HPV) is associated with six cancers and widespread immunization with HPV vaccine could reduce the number of these cancers. Although HPV vaccination rates are available for the state of Illinois and the city of Chicago, data are limited for specific areas. We assessed rates of HPV vaccine initiation and completion among adolescents in central Illinois and identified factors associated with initiation and completion. This was a retrospective study of adolescents (aged 11-17) who receive care at the Southern Illinois University Medicine Department of Pediatrics. The outcome variables were HPV vaccination initiation (receipt of ≥ 1 dose) and completion (receipt of ≥ 2 or 3 doses, depending on age of initiation). Multivariable logistic regressions were used to identify factors associated with HPV vaccine uptake. A total of 9,351 adolescents were included in the study. Overall, HPV vaccine initiation was 46.2% and completion was 24.7%. In adjusted analyses, adolescents residing in rural areas were 38% and 24% less likely to initiate (aOR = 0.62; 95 CI: 0.54-0.72) and complete (aOR = 0.76; 95 CI: 0.65-0.88) the HPV vaccine compared with those residing in urban areas. Similarly, adolescents were less likely to initiate and complete the HPV vaccine if they were not update to date on the hepatitis A, meningococcal, or Tdap vaccinations. HPV vaccination rates in central Illinois were low, and far below the national average and the Illinois state average. Future directions should include interventions to increase HPV vaccine uptake, particularly in rural areas.

College Students' Awareness of the Link Between Human Papillomavirus (HPV) and HPV-Associated Cancers.

We describe the level of awareness of the link between HPV and HPV-associated cancers and identify demographic and lifestyle factors associated with awareness. This was a cross-sectional study of college students (n = 862) at a public Midwestern university conducted between February and May 2021. The outcomes were student's awareness-accessed by asking students if they knew whether HPV was causally link with anal, cervical, vaginal, oropharyngeal, vulvar, and penile cancers. Logistic regression models estimated the association between sociodemographic and sexual behavior and awareness of the link between HPV and HPV-associated cancers. Approximately 70% were aware that HPV causes cervical, 53% were aware HPV causes vaginal, 40% were aware HPV causes vulvar cancers, 39% were aware HPV causes oropharyngeal, 38% were aware HPV causes penile, and 34% were aware HPV causes anal cancers. In multivariable analyses, men were less likely to be aware that HPV causes vaginal (aOR = 0.42, 95% CI 0.30-0.59) or vulvar cancers (aOR = 0.54, 95% CI 0.38-0.77) compared to women. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV causes anal (aOR = 1.98, 95% CI 1.17-3.34), penile (aOR = 1.82, 95% CI 1.11-2.97), vaginal (aOR = 1.81, 95% CI 1.14-2.88), or vulvar (aOR = 2.05, 95% CI 1.24-3.40) cancers. Awareness of the link between HPV and HPV-associated cancers was low, except cervical. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake.

Characteristics Associated with Low-Value Cancer Screening Among Office-Based Physician Visits by Older Adults in the USA.

BACKGROUND: After a certain age, cancer screening may expose older adults to unnecessary harms with limited benefits and represent inefficient use of health care resources. OBJECTIVE: To estimate the frequency of cervical, breast, and colorectal cancer screening among adults older than US Preventive Services Task Force (USPSTF) age thresholds at which screening is no longer considered routine and to identify physician and patient factors associated with low-value cancer screening. DESIGN: Observational study using pooled cross-sectional data (2011-2016) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. PARTICIPANTS: Analyses for cervical and breast cancer screening were limited to visits by women over age 65 (N=37,818) and ages 75 and over (N=19,451), respectively. Analyses for colorectal cancer screening were limited to visits by patients over age 75 (N=31,543). MAIN MEASURES: Cancer screening procedures were coded as low value using USPSTF age thresholds. KEY RESULTS: Between 2011 and 2016, an estimated 509, 507, and 273 thousand potentially low-value Pap smears, mammograms, and colonoscopies/sigmoidoscopies, respectively, were ordered annually. Low-valuecervical cancer screening was less likely to occur for visits with older (vs. younger) patients. Compared to visits by non-HispanicWhite women, low-valuecervical and breast cancer screening was less likely to occur for visits by women whose race/ethnicitywas something other than non-HispanicWhite, non-HispanicBlack, or Hispanic. Obstetrician/gynecologistswere more likely to order low-valuePap smears and mammograms compared to family/generalpractice physicians. CONCLUSIONS: Thousands of cervical, breast, and colorectal cancer screenings at ages beyond routine guideline thresholds occur each year in the USA. Further research is needed to understand whether this pattern represents clinical inertia and resistance to de-adoption of previous screening practices, or whether physicians and/or patients perceive a higher value in these tests than that endorsed by experts writing evidence-based guidelines.

Clinicians' perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study.

BACKGROUND: Women with behavioral health (BH) conditions (e.g., mental illness and substance abuse) receive fewer cervical cancer (CC) screenings, are diagnosed at more advanced cancer stages, and are less likely to receive specialized treatments. The aim of this study was to identify barriers that healthcare providers face in providing CC screening to women with BH conditions. METHODS: Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups in North Florida with 26 primary care and BH clinicians and staff to examine perceived barriers to CC screening among their patients with BH conditions to guide the future development of a tailored cervical cancer screening and follow-up intervention. Thematic analysis was used to analyze verbatim transcripts from audiotaped focus groups. RESULTS: Three main themes of barriers emerged from the data: 1) BH conditions related barriers included a history of trauma, stigma and discrimination, and uncontrolled comorbid conditions, 2) System level barriers related to lack of integration between BH and primary care, and 3) Similar barriers to the general population including lack of health insurance, insufficient processes to send out reminders, and challenges with communicating with patients. CONCLUSIONS: Tailored CC screening interventions that address the unique needs of women with BH conditions are needed. Strategies that address improving trust between patients and healthcare providers, identifying avenues to improve receipt of screening during time-limited clinical visits, connecting BH and primary care providers, and addressing the social determinants of health have potential to improve CC screening rates for women with BH conditions.

Evaluation of a Text Messaging-Based Human Papillomavirus Vaccination Intervention for Young Sexual Minority Men: Results from a Pilot Randomized Controlled Trial.

BACKGROUND: Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and HPV-related anal cancer. Although a safe and effective vaccine is available to prevent HPV infection, HPV vaccine uptake among young MSM remains low. PURPOSE: This pilot randomized controlled trial tested the acceptability, feasibility, and preliminary efficacy of a text messaging-based HPV vaccination intervention for young sexual minority men. METHODS: In 2018, unvaccinated sexual minority men aged 18-25 years were recruited from Chicago to participate in a 9 month sexual health program called txt2protect. Participants (N = 150) were randomized to the intervention or control condition. Intervention condition messages focused primarily on HPV vaccination, with only a brief mention of other sexual health practices (e.g., condom use and HIV testing), while control condition messages focused on a variety of sexual health practices with only a brief mention of HPV vaccination. Participants received daily text messages for the first 3 weeks and monthly text messages for the remaining ~8 months of the trial. Participants completed surveys at baseline and 3 week and 9 month follow-ups. RESULTS: Participants reported high satisfaction with the intervention. Although trial retention was high (with over 88% completing the 9 month survey), the study fell short of meeting its recruitment goal. HPV vaccine series initiation was significantly higher among intervention participants (19.4%) compared to control participants (6.6%), odds ratio = 3.43, 95% confidence interval: 1.17, 10.08. CONCLUSIONS: Findings suggest that txt2protect is an acceptable and potentially promising intervention for increasing HPV vaccine initiation among young sexual minority men. CLINICAL TRIAL REGISTRATION: NCT02994108.

The Underuse of STI Prevention Counseling in Primary Care.

Although sexually transmitted infection (STI) rates are increasing in the United States, prevention efforts remain limited. This study examined how often STI prevention counseling is given during primary care office visits using nationally representative data. Sexually transmitted infection prevention counseling occurred in 0.6% of visits and differences by patient race and physician specialty were observed.

Personality traits and preventive cancer screenings in the Health Retirement Study.

The Five-Factor model of personality has been associated with a wide range of health behaviors and health outcomes. However, few studies have examined whether personality traits are related to cancer screening in older adults. The present study investigated the cross-sectional associations between personality traits and the probability of obtaining a recent preventive screening for breast, cervical, prostate, and colorectal cancer. Participants from the Health and Retirement Study (N = 14,394, Mage = 68.14 years, range = 50-102 years, 58.6% female) completed a personality inventory and reported on cancer screenings in the 2010-2012 assessment. Logistic regression models were used to analyze the data, including age, race, ethnicity, gender, education, income, and wealth as covariates. Higher conscientiousness was associated with a higher likelihood of obtaining breast, cervical, and prostate screening. Higher extraversion was related to higher odds of breast, cervical, and colorectal screening. Higher neuroticism was linked to higher odds of colorectal screening, and conscientiousness moderated the link between neuroticism and cervical screening. These associations were significant in models that accounted for demographic and socioeconomic factors. The effect sizes were in the range of a 10-20% higher likelihood of cancer screening for 1 SD difference in personality. The present findings suggest that conscientiousness and extraversion were related to preventive cancer screenings, whereas neuroticism, openness and agreeableness were largely unrelated to the likelihood of such screenings. If these results are further replicated, health policy makers may consider personality traits when planning and implementing screening recommendations to improve preventive medicine.

Understanding women's hesitancy to undergo less frequent cervical cancer screening.

Inappropriate cervical cancer screening (e.g., screening too often) can result in unnecessary medical procedures, treatment, and psychological distress. To balance the benefits and harms, cervical cancer screening guidelines were recently modified in favor of less frequent screening (i.e., every 3 to 5 years). This study investigated women's acceptance of less frequent cervical cancer screening and their primary concerns about extending the screening interval beyond one year. A national sample of 376 U.S. women ages 21-65 completed an online survey in 2014. Predictors of willingness to get a Pap test every 3 to 5 years were identified using logistic regression. We also examined perceived consequences of less frequent screening. Over two thirds were willing to undergo less frequent screening if it was recommended by their healthcare provider. Nevertheless, nearly 20% expressed discomfort with less frequent screening and 45% were either in opposition or unsure whether they would be comfortable replacing Pap testing with primary HPV testing. Women whose most recent Pap test was (vs. was not) within the past year and women who ever (vs. never) had an abnormal Pap test were less willing to extend the screening interval. Additionally, women who typically saw an obstetrician/gynecologist or nurse practitioner for their Pap test (vs. a family physician) were less accepting of the guidelines. Hesitancy about the longer screening interval appears to stem from concern about developing cancer between screenings. Findings contribute to the growing body of research on cancer overscreening and may inform interventions for improving adherence to cancer screening guidelines.

Predictors of provider recommendation for HPV vaccine among young adult men and women: findings from a cross-sectional survey.

BACKGROUND: Although physician recommendation is one of the strongest predictors of human papillomavirus (HPV) vaccination, it is unclear for whom physicians are recommending the vaccine. To help guide intervention efforts, this study investigated predictors of participant-reported physician recommendation for HPV vaccine among young adults in the USA. METHODS: Women and men (N=223) aged 18-26 years were recruited online through Craigslist, a popular classified advertisements website. Ads were posted in the 25 largest US cities from September 2013 to March 2014. Participants completed a survey that assessed demographic and sociopolitical characteristics, sexual history, HPV vaccination history, and whether they had ever received a recommendation for HPV vaccine from a physician or healthcare provider. RESULTS: Fifty-three per cent reported receiving a recommendation for HPV vaccine and 45% had received ≥1 dose of HPV vaccine. Participants who received a recommendation were over 35 times more likely to receive ≥1 dose of HPV vaccine relative to participants without a recommendation. Bivariable and multivariable correlates of provider recommendation were identified. Results from the multivariable model indicated that younger (aged 18-21 years), female, White participants with health insurance (ie, employer-sponsored or some other type such as military-sponsored) were more likely to report receiving a recommendation for HPV vaccine. CONCLUSIONS: Results suggest that physician recommendation practices for HPV vaccination vary by characteristics of the patient. Findings underscore the key role of the healthcare provider in promoting HPV vaccination and have important implications for future HPV vaccine interventions with young adults.

Predictors of Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men.

BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted infection that causes anal, penile, and oropharyngeal cancers in men. Men who have sex with men (MSM) are at particularly high risk for HPV infection and HPV-related disease. Human papillomavirus vaccination is currently recommended for all MSM in the United States through age 26 years, yet little is known about HPV vaccine uptake in this population. The purpose of this study was to identify predictors of HPV vaccine uptake and barriers and facilitators to HPV vaccination that may be unique to young MSM. METHODS: Men aged 18 to 26 years (n = 336) were recruited via advertisements placed on a geospatial smartphone dating application designed for MSM. Participants completed an online survey. Correlates of vaccine uptake and provider recommendation for HPV vaccine were identified using logistic regression. RESULTS: In total, 21% of participants had received at least 1 dose of HPV vaccine. Provider recommendation was the strongest predictor of uptake such that MSM with a recommendation were more than 40 times more likely to have been vaccinated. Additional predictors of uptake included age and HPV vaccine attitudes. Predictors of provider recommendation included sexual identity, race/ethnicity, condomless anal sex, and HIV status. Psychosocial correlates and barriers and facilitators to HPV vaccination among unvaccinated men were also identified. CONCLUSIONS: Findings highlight potential disparities in HPV vaccine uptake, as well as disparities in provider recommendation practices for HPV vaccination. Future interventions should aim to clarify misconceptions, modify psychosocial beliefs, and address barriers and facilitators to HPV vaccine uptake specific to young MSM.

When Different Message Frames Motivate Different Routes to the Same Health Outcome.

BACKGROUND: Message framing is an effective strategy for promoting health behavior. PURPOSE: We examined the relative effectiveness of framed messages that simultaneously promoted two different health behaviors-eating a calcium-rich diet and taking calcium supplements-for preventing osteoporosis. Because those behaviors are associated with different perceptions of risk, we predicted that gain- and loss-framed messages would have opposite effects. METHODS: In two experiments, participants (N1 = 69; N2 = 219) were randomly assigned to a gain- or loss-framed message presenting two osteoporosis prevention behaviors. RESULTS: A gain-framed advantage was observed for dietary calcium consumption, but the opposite-a loss-framed advantage-was observed for use of calcium supplements. Message frame interacted with baseline calcium consumption behavior for some outcomes. CONCLUSIONS: Both gain- and loss-framed messages increased osteoporosis prevention behavior, but their relative effectiveness depended on the type of behavior. Framed messages can have opposite effects on different behaviors used to achieve a common health goal.

The role of trust, vaccine information exposure, and Health Belief Model variables in COVID-19 vaccination intentions: Evidence from an HBCU sample.

African Americans have been disproportionately affected by COVID-19 and COVID-19 vaccines were initially met with hesitancy from the African American community. This study identified predictors of COVID-19 vaccination intentions among students attending a Historically Black College and University (HBCU) when COVID-19 vaccines first became available. Unvaccinated students (N = 224) completed a survey. Path analysis modeled relationships among exogenous variables (trust, exposure to pro- and anti-vaccine information), proposed mediators (Health Belief Model variables), and COVID-19 vaccination intentions. Students reported low trust in government officials, medical professionals, and the vaccine development process. Direct predictors of vaccination intentions included trust, perceived benefits, and perceived barriers. Students with lower trust reported lower benefits, increased concerns about side effects, and were more likely to view COVID-19 vaccination as low priority, and these factors in turn predicted intentions. Findings highlight the urgent need for theory-driven, culturally sensitive, age-relevant messaging to reduce vaccine hesitancy among Black young adults.

Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment.

BACKGROUND: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents' vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. OBJECTIVE: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app's usability. METHODS: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. RESULTS: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child's vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents' children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). CONCLUSIONS: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient.

Increasing human papillomavirus vaccine acceptability by tailoring messages to young adult women's perceived barriers.

BACKGROUND: Human papillomavirus (HPV) vaccination is a safe and effective primary prevention strategy for cervical cancer. Despite the need for effective HPV vaccination interventions, relatively few have been tested. Moreover, existing interventions have tended to use a one-size-fits-all educational approach. We investigated whether tailoring intervention materials to young adult women's perceived barriers to HPV vaccination-a known psychosocial predictor of vaccine uptake-would increase women's intentions to receive the HPV vaccine. METHODS: Young adult women (N = 94; aged 18-26 years) who had not been vaccinated against HPV were randomly assigned to read either a nontailored message about HPV vaccination or a message that was individually tailored to participants' perceived barriers to HPV vaccine uptake (e.g., safety concerns, cost, and not sexually active). Participants' intentions to receive the HPV vaccine in the next year were assessed before and after delivery of the intervention and served as the primary outcome variable. RESULTS: The most commonly selected barrier and primary reason for not getting vaccinated was concern about vaccine adverse effects (endorsed by 55%). Knowledge about HPV vaccination increased after exposure to the intervention but did not differ by experimental condition. Although HPV vaccination intentions increased from pretest to posttest in both conditions, participants in the tailored condition reported greater increases in intentions than did participants in the nontailored condition (F1,90 = 4.02, P = 0.048, partial η = 0.043). CONCLUSIONS: Findings suggest that tailoring intervention materials to women's individual barriers is a potentially promising strategy for increasing HPV vaccination among young adult women.