ABSTRACT
BACKGROUND: Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean nonpatient population in Jamaica, Grenada, and Trinidad and Tobago. METHODS: A cross-sectional study involving 1209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and human papillomavirus (HPV) and HPV vaccine knowledge and beliefs. Descriptive analyses and χ2 tests were conducted. RESULTS: The χ2 tests showed age is statistically significantly related to participants' response to stigma items such as "community members believe cervical cancer is viewed as shameful" (P = .0001); "women with cervical cancer are treated with less respect than usual by others" (P < .0001); "women with cervical cancer are rejected by family members" (P = .0007); "women with cervical cancer are rejected by intimate partners" (P < .0001); and "intimate partners blame women for having cervical cancer" (P = .0032). Additionally, age has statistically significant associations with endorsements of negative views of cervical cancer from the community (P < .0001) and family (P < .0001) as key barriers to cervical cancer care (item: "discourage women from seeking and obtaining screening and treatment"). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma. CONCLUSIONS: Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities.
Subject(s)
Health Knowledge, Attitudes, Practice , Papillomavirus Infections , Social Stigma , Uterine Cervical Neoplasms , Humans , Female , Uterine Cervical Neoplasms/psychology , Uterine Cervical Neoplasms/ethnology , Uterine Cervical Neoplasms/prevention & control , Cross-Sectional Studies , Adult , Middle Aged , Health Knowledge, Attitudes, Practice/ethnology , Age Factors , Young Adult , Papillomavirus Infections/ethnology , Papillomavirus Infections/psychology , Jamaica/ethnology , Trinidad and Tobago , Grenada/ethnology , Papillomavirus Vaccines/administration & dosage , Adolescent , Aged , Caribbean Region/ethnology , Sexual Partners/psychology , Shame , Family/psychology , Early Detection of Cancer/psychologyABSTRACT
Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.
Subject(s)
Mexican Americans , Papillomavirus Infections , Papillomavirus Vaccines , Vaccination Hesitancy , Vaccination , Adolescent , Adult , Female , Humans , Young Adult , Health Knowledge, Attitudes, Practice , Papillomavirus Infections/ethnology , Papillomavirus Infections/prevention & control , Papillomavirus Infections/psychology , Papillomavirus Vaccines/therapeutic use , Patient Acceptance of Health Care/ethnology , Patient Acceptance of Health Care/psychology , Vaccination/psychology , Vaccination Hesitancy/ethnology , Vaccination Hesitancy/psychology , Cultural CompetencyABSTRACT
OBJECTIVES: High-risk human papillomavirus (HR-HPV) is an important risk factor for esophageal cancer. Macrophages constitute a crucial immune medium for regulating HPV-related tumors; however, the specific regulatory mechanisms remain unknown. Therefore, the purpose of our current study was to investigate the mechanism by which HPV16E6 regulates macrophages to promote the invasion and metastasis of esophageal cancer. METHODS: HPV16E6 infection was detected by polymerase chain reaction. Immunohistochemistry was used to verify the distribution of tumor-associated macrophages (TAMs) and MMP-9 expression in esophageal squamous cell carcinoma tissues (ESCCs), and cancer adjacent normal tissues (CANs) from Kazakh patients. ESCC cells were transfected with a plasmid over-expressing HPV16E6 and non-contact cocultured with macrophages. RESULTS: The infection rate of HPV16E6 in Kazakh ESCCs was clearly higher than that in CANs (P < 0.05). The density of CD163-positive TAMs was significantly positively correlated with HPV16E6 infection in ESCCs (P < 0.05). After coculturing macrophages and EC9706 cells transfected with the HPV16E6 plasmid, the phenotype of macrophages transformed into M2 macrophages. The migration and invasion ability of ESCC cells were higher in the HPV16E6-transfected and coculture group than in the HPV16E6 empty vector-transfected and non-cocultured HPV16E6-transfected groups (all P < 0.05). The density of M2-like TAMs in ESCCs was positively correlated with the level of MMP-9 expression. MMP-9 expression in the HPV16E6-ESCC coculture macrophages group was substantially higher than that in controls (all P < 0.05). CONCLUSIONS: HPV16 infection mediates tumor-associated macrophages to promote ESCC invasion and migration.
Subject(s)
Esophageal Neoplasms/pathology , Esophageal Squamous Cell Carcinoma/pathology , Human papillomavirus 16 , Oncogene Proteins, Viral/metabolism , Papillomavirus Infections/complications , Repressor Proteins/metabolism , Tumor-Associated Macrophages/pathology , Antigens, CD/metabolism , Antigens, Differentiation, Myelomonocytic/metabolism , Cell Differentiation , China/ethnology , Coculture Techniques , Esophageal Neoplasms/ethnology , Esophageal Neoplasms/virology , Esophageal Squamous Cell Carcinoma/ethnology , Esophageal Squamous Cell Carcinoma/virology , Humans , Matrix Metalloproteinase 9/metabolism , Neoplasm Invasiveness , Oncogene Proteins, Viral/genetics , Papillomavirus Infections/ethnology , Phenotype , Receptors, Cell Surface/metabolism , Repressor Proteins/genetics , Tumor Microenvironment , Tumor-Associated Macrophages/metabolism , Tumor-Associated Macrophages/virologyABSTRACT
BACKGROUND: The high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV). Geographical, socioeconomic and ethnic barriers in developing countries challenge primary and secondary prevention measures of cervical cancer. We aimed to determine the prevalence of HPV infection and the viral load of HR-HPV 9vHPV-related types black women resident in rural semi-isolated communities. METHODS: A descriptive study was conducted with 273 cervical samples of women from rural communities of Southeastern Brazil. Viral DNA was amplified by PCR, the genotype was identified by Reverse Line Blot (RLB) and Restriction Fragment Length Polymorphism (RFLP), and real-time PCR was applied to determine the viral load. RESULTS: HPV frequency was 11.4% (31/273), associated with the presence of cytological abnormalities (32.3%; p < 0.001). Thirty-one distinct genotypes were detected; HR-HPV occurred in 64.5% (20/31) of the samples and the most prevalent type were HPV52 > 58, 59. Multiple infections occurred with up to nine different genotypes. The viral load of HR-HPV 9vHPV-related types was higher in lesions than in normal cytology cases (p = 0.04); "high" and "very high" viral load occurred in HSIL and LSIL, respectively (p = 0.04). CONCLUSIONS: We highlight that despite the low HPV frequency in the black rural women population, the frequency of HR-HPV was high, particularly by the HR-HPV52 and 58 types. Moreover, the HR-HPV viral load increased according to the progression from normal to lesion, being a potential biomarker to identify those women at higher risk of developing cervical lesions in this population.
Subject(s)
Black People/statistics & numerical data , Papillomaviridae/isolation & purification , Papillomavirus Infections/epidemiology , Uterine Cervical Neoplasms/virology , Viral Load , Adolescent , Adult , Aged , Brazil/epidemiology , DNA, Viral/analysis , Female , Genotype , Humans , Middle Aged , Papillomaviridae/classification , Papillomaviridae/genetics , Papillomavirus Infections/ethnology , Papillomavirus Infections/virology , Polymorphism, Restriction Fragment Length , Prevalence , Real-Time Polymerase Chain Reaction , Risk Factors , Rural Population/statistics & numerical data , Viral Load/genetics , Young AdultABSTRACT
OBJECTIVE: To assess human papillomavirus (HPV) vaccination coverage among adolescents by provider recommendation status. STUDY DESIGN: The 2011-2016 National Immunization Survey-Teen data were used to assess HPV vaccination coverage among male adolescents by provider recommendation status. Multivariable logistic analyses were conducted to evaluate associations between HPV vaccination and provider recommendation status. RESULTS: HPV vaccination coverage among male adolescents increased from 8.3% in 2011 to 57.3% in 2016. Likewise, the prevalence of provider recommendation increased from 14.2% in 2011 to 65.5% in 2016. In 2016, HPV coverage was higher in male adolescents with a provider recommendation than in those without a provider recommendation (68.8% vs 35.4%). In multivariable logistic regression, characteristics independently associated with a higher likelihood of HPV vaccination included receipt of a provider recommendation, age 16-17 years, black or Hispanic race/ethnicity, any Medicaid insurance, ≥2 physician contacts in the previous 12 months, and urban or suburban residence. Participants with a mother with some college or a college degree, those with a mother aged 35-44 years, and those who did not have a well-child visit at age 11-12 years had a lower likelihood of HPV vaccination. CONCLUSIONS: Receiving a provider recommendation for vaccination was significantly associated with receipt of HPV vaccine among male adolescents, indicating that a provider recommendation for vaccination is an important approach to increase vaccination coverage. Evidence-based strategies, such as standing orders and provider reminders, alone or in combination with health system interventions, are useful for increasing provider recommendations and HPV vaccination coverage among male adolescents.
Subject(s)
Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/therapeutic use , Vaccination/statistics & numerical data , Adolescent , Black or African American , Evidence-Based Medicine , Female , Health Services Accessibility , Healthcare Disparities , Hispanic or Latino , Humans , Male , Mothers , Multivariate Analysis , Papillomavirus Infections/ethnology , Surveys and Questionnaires , United StatesABSTRACT
BACKGROUND & OBJECTIVES: Human papillomavirus (HPV) infections play a crucial role in the aetiology of cervical cancer (CC), and HPV16 is the primary viral genotype associated with CC. A number of variants of the HPV16 E6 gene are involved in the progression of CC, differing in their prevalence and biological and biochemical properties. This study was designed to determine the frequency of HPV types 16/18 and to identify the presence of HPV16 E6-variants in asymptomatic Mexican women. METHODS: A total of 189 cervical Pap smears were collected from women attending public health services in three different cities in Sinaloa, Mexico. Viral DNA was identified by amplification of E6 viral gene fragments using polymerase chain reaction (PCR). Identification of variants was done by sequencing a DNA fragment (321bp) of the HPV16 E6 gene. RESULTS: More than half of the women tested were HPV-positive (52.38%), with HPV16 being the most frequent genotype (21.16%), followed by HPV18 (8.99%). Sequence analysis of the E6-HPV16 PCR products showed that in all cases, the viruses corresponded to European variants. It was further observed that the E350G intra-variant was the most common (>76%). INTERPRETATION & CONCLUSIONS: This study showed a predominance of European lineage variants of HPV16 among asymptomatic women from Sinaloa, Mexico, predominantly with of the E350G variant. This variant has been shown to be associated with an increased risk of early development of CC. The use of molecular identification of carcinogenic HPV and Pap test screening may be a good strategy for monitoring women to prevent CC.
Subject(s)
Oncogene Proteins, Viral/genetics , Papillomaviridae , Papillomavirus Infections , Repressor Proteins/genetics , Uterine Cervical Neoplasms , Adult , Disease Progression , Female , Genetic Variation , Humans , Mexico/epidemiology , Papillomaviridae/classification , Papillomaviridae/genetics , Papillomaviridae/pathogenicity , Papillomavirus Infections/diagnosis , Papillomavirus Infections/ethnology , Papillomavirus Infections/virology , Sequence Analysis, DNA/methods , Uterine Cervical Neoplasms/ethnology , Uterine Cervical Neoplasms/virologyABSTRACT
INTRODUCTION: Research on the association between periodontitis and oral human papilloma virus (HPV) infection is inconsistent. The cross-sectional association of severe periodontitis with oral HPV infection was investigated in a sample of Hispanic adults. METHODS: Data from the 2014-2016 San Juan Overweight Adults Longitudinal Study (nâ¯=â¯740) was analyzed. Periodontitis assessment and self-collection of oral HPV samples followed the National Health and Nutrition Examination Survey methodology. Periodontitis was defined using the Centers of Disease Control and Prevention/American Academy of Periodontology definition. HPV typing was performed using polymerase chain reaction. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: 5.7% of participants had oral HPV infection and 20.3% had severe periodontitis. Adults with severe periodontitis had higher odds of oral HPV infection than those with none/mild disease (OR=2.9, 95% CI: 1.0-8.4, pâ¯<â¯0.05) in multivariable analysis. Adults with clinical attachment loss≥â¯7â¯mm and pocket depth PD≥â¯6â¯mm had 2- to 3-fold higher odds of HPV infection. CONCLUSIONS: Severe periodontitis was positively associated to oral HPV infection. Longitudinal evaluation of periodontal inflammation's role in acquisition and persistence of oral HPV infection is needed, as periodontitis screening could identify individuals at increased risk of HPV-related oral malignancies.
Subject(s)
Papillomavirus Infections/ethnology , Papillomavirus Infections/epidemiology , Periodontitis/ethnology , Periodontitis/virology , Adult , Age Factors , Aged , Cross-Sectional Studies , Female , Hispanic or Latino , Humans , Logistic Models , Longitudinal Studies , Male , Middle Aged , Odds Ratio , Periodontitis/epidemiology , Puerto Rico/epidemiology , Risk Factors , Sex FactorsABSTRACT
OBJECTIVES: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. METHODS: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. RESULTS: Mean age of participants was 40.3 years (± 10.3SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having ≥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02-4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93-6.62), active genital warts (aPOR = 3.45, 95% CI:1.60-7.42), and CD4 counts ≤ 200 (aPOR = 4.24, 95% CI: 1.67-10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. CONCLUSIONS: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population.
Subject(s)
Cervix Uteri/virology , Coinfection/epidemiology , HIV Infections/epidemiology , Hispanic or Latino , Papillomavirus Infections/ethnology , Papillomavirus Infections/epidemiology , Adult , Coinfection/virology , Condylomata Acuminata/epidemiology , Condylomata Acuminata/etiology , Condylomata Acuminata/virology , Cost of Illness , Cross-Sectional Studies , DNA, Viral , Female , HIV Infections/complications , HIV Infections/virology , Humans , Logistic Models , Odds Ratio , Papillomaviridae/genetics , Papillomavirus Infections/complications , Papillomavirus Infections/virology , Prevalence , Puerto Rico/epidemiology , Risk Factors , Sexual Partners , Surveys and Questionnaires , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/virologyABSTRACT
BACKGROUND: Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. AIM: To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. METHODS: A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. RESULTS: Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. LIMITATIONS: Human papillomavirus typing was not done owing to a lack of facilities. CONCLUSIONS: There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.
Subject(s)
Focal Epithelial Hyperplasia/diagnosis , Focal Epithelial Hyperplasia/ethnology , Indians, Central American/ethnology , Population Surveillance , Adolescent , Child , Child, Preschool , Female , Humans , Incidence , Male , Mexico/ethnology , Mouth Mucosa/pathology , Papillomaviridae/isolation & purification , Papillomavirus Infections/diagnosis , Papillomavirus Infections/ethnologyABSTRACT
BACKGROUND: Underserved ethnic minority women experience significant disparities in cervical cancer incidence and mortality, mainly due to lack of cervical cancer screening. Barriers to Pap smear screening include lack of knowledge, lack of health insurance and access, and cultural beliefs regarding disease prevention. In our previous SUCCESS trial, we demonstrated that HPV self-sampling delivered by a community health worker (CHW) is efficacious in circumventing these barriers. This approach increased screening uptake relative to navigation to Pap smear screening. SUCCESS trial participants, as well as our community partners, provided feedback that women may prefer the HPV self-sampler to be delivered through the mail, such that they would not need to schedule an appointment with the CHW. Thus, our current trial aims to elucidate the efficacy of the HPV self-sampling method when delivered via mail. DESIGN: We are conducting a randomized controlled trial among 600 Haitian, Hispanic, and African-American women from the South Florida communities of Little Haiti, Hialeah, and South Dade. Women between the ages of 30 and 65 years who have not had a Pap smear within the past 3 years are eligible for the study. Women are recruited by CHWs and complete a structured interview to assess multilevel determinants of cervical cancer risk. Women are then randomized to receive HPV self-sampling delivered by either the CHW (group 1) or via mail (group 2). The primary outcome is completion of HPV self-sampling within 6 months post enrollment. DISCUSSION: Our trial is among the first to examine the efficacy of the mailed HPV self-sampling approach. If found to be efficacious, this approach may represent a cost-effective strategy for cervical cancer screening within underserved and underscreened minority groups. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02202109 . Registered on 9 July 2014.
Subject(s)
Black or African American , Early Detection of Cancer/methods , Hispanic or Latino , Minority Groups , Papillomaviridae/isolation & purification , Papillomavirus Infections/virology , Postal Service , Specimen Handling , Uterine Cervical Neoplasms/virology , Vulnerable Populations , Adult , Aged , Clinical Protocols , Female , Florida/epidemiology , Haiti/ethnology , Health Status Disparities , Healthcare Disparities/ethnology , Humans , Middle Aged , Minority Health , Papillomavirus Infections/diagnosis , Papillomavirus Infections/ethnology , Patient Acceptance of Health Care/ethnology , Predictive Value of Tests , Research Design , Time Factors , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/ethnology , Women's HealthABSTRACT
OBJECTIVE: Haitian women have the highest incidence of cervical cancer within the Western hemisphere. Intravaginal hygiene practices have been linked with human papilloma virus (HPV) infection and cervical dysplasia. These practices, known as 'twalet deba' in Haitian Creole, are common among Haitian women and are performed with various natural and synthetic agents. As part of a community-based participatory research initiative aimed at reducing cervical cancer disparities in rural Haiti, we explored the use of intravaginal agents and their associations with high-risk HPV infection. DESIGN: Community Health Workers recruited 416 women for cervical self-sampling from two neighborhoods within Thomonde, Haiti. Participants were interviewed regarding intravaginal hygiene practices and completed a cervical self-sampling procedure. Cervical samples were analyzed for the presence of high-risk HPV infection. Associations between each intravaginal agent and high-risk HPV infection were examined via univariate logistic regression analyses, as well as via multivariate analyses controlling for sociodemographic factors and concurrent agent use. RESULTS: Nearly all women (97.1%) performed twalet deba, using a variety of herbal and commercially produced intravaginal agents. Approximately 11% of the participants tested positive for high-risk HPV. Pigeon pea and lime juice were the only agents found to be associated with high-risk HPV in the univariate analyses, with women who used these agents being approximately twice as likely to have high-risk HPV as those who did not. Only pigeon pea remained significantly associated with high-risk HPV after controlling for sociodemographic factors and concurrent agent use. CONCLUSION: Two agents, pigeon pea and lime juice, may contribute to risk for HPV infection in this population. Results suggest that in addition to cervical cancer screening interventions, future preventive initiatives should focus on minimizing risk by advocating for the use of less-toxic twalet deba alternatives.
Subject(s)
Health Knowledge, Attitudes, Practice/ethnology , Hygiene , Papillomavirus Infections/ethnology , Vaginal Douching/adverse effects , Administration, Intravaginal , Adult , Alum Compounds/administration & dosage , Cajanus , Citrus aurantiifolia , Community-Based Participatory Research , Female , Fruit and Vegetable Juices , Haiti/epidemiology , Humans , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Plant Preparations/administration & dosage , Potassium Permanganate/administration & dosage , Risk Factors , Soaps/administration & dosage , Vaginal Douching/methods , Women's Health/ethnologyABSTRACT
While medical research ethics guidelines frame participants as individual and autonomous, anthropologists emphasize the relational nature of health research participation. I analyze interviews with Mexican male HPV study participants and their wives to examine how research participants themselves focus on relationships when imagining research-related benefits. I argue that couples incorporated the local trope of the Mexican citizenry as a biologically homogeneous national body, which individual members help or harm through their gendered health behavior to understand these benefits. I use the concept of "ethical intercorporeality" to discuss spouses' understandings of themselves as parts of bio-social wholes-the couple, family, and society-that they believed men's research participation could aid both physically and socially. This finding extends the insight that focusing on relationships rather than individuals is necessary for understanding the consequences of medical research by showing how participants themselves might apply this perspective in context-specific ways.
Subject(s)
Biomedical Research/ethics , Health Behavior/ethnology , Papillomavirus Infections/ethnology , Research Subjects/psychology , Anthropology, Medical , Female , Humans , Male , Mexico/ethnology , PapillomaviridaeABSTRACT
OBJECTIVE: The purpose of this study was to understand through a quantitative assessment, the views of HPV and HPV vaccination among parents of sons from a FQHC in PR. METHODS: A self-administered questionnaire was given to a convenience sample of 200 parents of sons 9-17 years old. RESULTS: Nearly 30% of the parents reported that their sons had initiated the HPV vaccine regimen. Health care provider recommendation was significantly associated with vaccine initiation. Among parents of unvaccinated sons, the main reason for not getting the HPV vaccine was they did not know that boys were allowed to get the vaccine. CONCLUSIONS: Future efforts should focus on multilevel interventions aimed to increase knowledge as well as other modified behavioral determinants in parents of young males about HPV and the vaccine. Capacity building efforts should be targeted also to increase health providers' education and communication skills to promote HPV vaccination effectively.
Subject(s)
Health Knowledge, Attitudes, Practice , Papillomavirus Infections/psychology , Papillomavirus Vaccines/administration & dosage , Parents/psychology , Patient Acceptance of Health Care/psychology , Adolescent , Adult , Child , Cross-Sectional Studies , Female , Humans , Male , Papillomavirus Infections/ethnology , Patient Acceptance of Health Care/ethnology , Puerto Rico , Safety-net Providers , Socioeconomic FactorsABSTRACT
Women with inflammatory bowel disease (IBD) may be at increased risk of human papilloma virus (HPV) infection and HPV-related malignancies, as many are immunocompromised secondary to the use of immunosuppressant agents. Several studies have addressed the knowledge about cervical cancer risk factors in different populations, particularly HPV infection and its association with cervical malignancies; most of these studies show poor patient knowledge. The purpose of this study is to describe the knowledge of females with IBD about HPV infection and the HPV vaccine. We performed a cross-sectional study in 147 consecutive patients attending the clinics of the University of Puerto Rico Center for IBD from 2009 to 2010. An interviewer-administered questionnaire was used to collect information on demographics, lifestyles, and HPV-related knowledge of participants. Bivariate analysis using the chi-square statistics and Fisher's exact test was used to examine factors associated with HPV awareness. The mean age of participants was 36.6 years (SD = 13.91 years). Three fourth (77 %) of women had awareness of the existence of HPV, and 58 % did know about the existence of HPV vaccines. Among those who had heard about HPV, 79.6 % knew that HPV can cause cervical cancer, and 57.5 % knew that the virus is sexually transmitted. Among those who knew of the vaccine, 75.3 % learned about its existence through the media, while only 15.3 %, through their health-care provider. Only three women within recommended ages (2 %) had been vaccinated against HPV, although 50 % of participants indicated that they would definitely/probably vaccinate against HPV in the future. A significant trend was observed, where more educated women were more likely to have heard of HPV (p for trend = 0.0017). Women who were high school graduates/some college (OR = 6.63, 95 % CI = 1.71-25.66) and those with at least an associate degree (OR = 11.69, 95 % CI = 3.05-45.89) were more likely to be aware of the HPV vaccine than women without a high school degree. Our study documents poor knowledge of HPV and HPV vaccine in this population of IBD patients in Puerto Rico. Although vaccination coverage is low in this population, women are receptive to the possibility of vaccination in the future. Given that this population may be at an increased risk of HPV infection and related morbidities, education and vaccination programs should be promoted among them.
Subject(s)
Health Knowledge, Attitudes, Practice/ethnology , Hispanic or Latino/psychology , Inflammatory Bowel Diseases/ethnology , Papillomavirus Infections/ethnology , Papillomavirus Vaccines , Adult , Cross-Sectional Studies , Female , Hispanic or Latino/statistics & numerical data , Humans , Papillomavirus Infections/prevention & control , Puerto Rico , Risk Factors , Uterine Cervical Neoplasms/ethnology , Uterine Cervical Neoplasms/virologyABSTRACT
A clinic-based intervention study was conducted among high-risk human papillomavirus (HPV)-infected Latinas aged 18-64 years between April 2006 and May 2008 on the Texas-Mexico border. Women were randomly assigned to receive a printed material intervention (n=186) or usual care (n=187) and were followed at three months, six months, and 12 months through telephone surveys and review of medical records. The HPV knowledge of nearly all women had increased greatly, but only two-thirds of women reported they had received follow-up care within one year of diagnosis regardless of additional health education messaging. Our findings suggest that, regardless of type of health education messaging, Latinas living on the Texas-Mexico border are aware that follow-up care is recommended, but they may not receive this care. Individual, familial and medical care barriers to receipt of follow-up care may partially account for the higher rates of cervical cancer mortality in this region.
Subject(s)
Aftercare/statistics & numerical data , Health Knowledge, Attitudes, Practice/ethnology , Hispanic or Latino/education , Hispanic or Latino/psychology , Papillomavirus Infections/ethnology , Papillomavirus Infections/therapy , Patient Education as Topic , Adolescent , Adult , Female , Follow-Up Studies , Hispanic or Latino/statistics & numerical data , Humans , Mexico , Middle Aged , Risk Assessment , Texas , Young AdultABSTRACT
BACKGROUND: Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS: This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS: One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION: Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.
Subject(s)
Kidney Transplantation , Neoplasms/ethnology , Postoperative Complications/ethnology , Skin Neoplasms/ethnology , Adult , Africa/ethnology , Caribbean Region/ethnology , Female , Guadeloupe/epidemiology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Incidence , Male , Middle Aged , Neoplasms/etiology , Neoplasms, Radiation-Induced/ethnology , Neoplastic Syndromes, Hereditary/ethnology , Papillomavirus Infections/ethnology , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Skin Neoplasms/etiology , Sunlight/adverse effects , Tumor Virus Infections/ethnologyABSTRACT
OBJECTIVE: Indigenous women from the Amazon regions have some of the highest rates of cervical cancer in the world. This study evaluated cervical cytology and human papillomavirus (HPV) in native women that differ by lifestyle and interaction with western society. Yanomami women are isolated deep in the Amazon with a hunter/gatherer lifestyle. Macuxi and Wapishana women live in proximity to western society. METHODS: To select a representative group of women from each district, random cluster sampling was used, considering each registered village as a cluster. Cervical samples were collected for cytology and HPV detection and typing by PCR amplification and next generation sequencing. The study was approved by the National IRB and by tribal leaders. RESULTS: 664 native women were enrolled from 13 indigenous villages (76% participation rate). Yanomami women had higher rates of abnormal cytology (5.1% vs. 1.8%, p = 0.04) and prevalent HR-HPV (34.1% vs. 19.2%, p<0.001). Yanomami women >35 y of age were significantly more likely to have HR-HPV, whereas women ≤ 35 y did not significantly differ between groups. Prevalence of HPV was significantly different amongst geographically clustered Yanomami women (p<0.004). The most prevalent HPV types in the entire group were HPV31 (8.7%), HPV16 (5.9%) and HPV18 (4.4%). CONCLUSION: Isolated endogenous Yanomami women were more likely to be HPV+ and rates increased with age. Study of HPV in isolated hunter-gather peoples suggests that long-term persistence is a characteristic of prehistoric humans and patterns reflecting decreased prevalence with age in western society represents recent change. These studies have implications for cervical cancer prevention and viral-host relationships.
Subject(s)
Early Detection of Cancer , Indians, South American/statistics & numerical data , Papillomaviridae/isolation & purification , Papillomavirus Infections/ethnology , Social Isolation , Uterine Cervical Neoplasms/prevention & control , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Cluster Analysis , Cross-Sectional Studies , Culture , DNA, Viral/analysis , Female , Humans , Middle Aged , Papillomaviridae/classification , Papillomaviridae/genetics , Population Groups/statistics & numerical data , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Prevalence , Rainforest , Uterine Cervical Neoplasms/ethnology , Uterine Cervical Neoplasms/virology , Vaginal Smears , Young AdultABSTRACT
Cervical cancer remains a leading cause of mortality in developing countries regardless of biomedical advances in prevention modalities. Specifically, Panama experiences one of the highest rates of cervical cancer worldwide. The objective of this study was to explore knowledge, behavioral, and sociocultural factors related to cervical cancer prevention among Panamanian women. A theory-guided, population-based quantitative survey following participatory processes was administered to a randomized sample of females (18-44 years) residing in a high-risk Panamanian community. Participants (n = 324) reported low knowledge regarding HPV, cervical cancer, and the purpose of the Pap test. Furthermore, low perceived susceptibility, high-risk sexual behaviors (e.g., low contraception and condom use) and adverse attitudes toward the Pap test (e.g., shame, fear) were identified. Television, newspapers/magazines, and relatives/friends/neighbors were common sources to receive health information. Significant gaps in knowledge and behavioral factors were identified, which may interfere with cervical cancer prevention efforts. Future strategies should reflect the sociocultural context, such as interpersonal relations, when developing and implementing cervical cancer programs, with the ultimate goal of decreasing the persistent burden among Latin American women.
Subject(s)
Health Knowledge, Attitudes, Practice , Papillomavirus Infections/ethnology , Urban Population , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/ethnology , Adolescent , Adult , Culture , Early Detection of Cancer/statistics & numerical data , Female , Humans , Panama , Papanicolaou Test , Patient Acceptance of Health Care/ethnology , Sexual Behavior , Socioeconomic Factors , Young AdultABSTRACT
OBJECTIVE: to analyze the quality of life (QoL) of men with AIDS from the perspective of the model of social determinants of health (MSDH). METHOD: cross-sectional study conducted in an outpatient infectious diseases clinic from a Brazilian university hospital over the course of one year with a sample of 138 patients. A form based on the MSDH was used to collect sociodemographic data addressing individual, proximal, intermediate determinants and the influence of social networks together with an instrument used to assess the QoL of people with HIV/AIDS. The project was approved by the Institutional Review Board (Protocol No. 040.06.12). RESULTS: according to MSDH, most men with AIDS were between 30 and 49 years old (68.1%), mixed race (59.4%), heterosexual (46.4%), single (64.5%), Catholic (68.8%), had a bachelor's degree (39.2%), had no children (61.6%), and had a formal job (71.0%). The perception of QoL in the physical, level of independence, environment, and spirituality domains was intermediate, while QoL was perceived to be superior in the domains of psychological and social relationship. A perception of lower QoL was presented by homosexual (p=0.037) and married men (p=0.077), and those with income below one times the minimum wage (p=0.042). A perception of greater QoL was presented by those without a religion (p=0.005), living with a partner (p=0.049), and those who had a formal job (p=0.045). CONCLUSION: social determinants influence the QoL of men with AIDS. .
OBJETIVO: analisar a qualidade de vida (QV) de homens com AIDS, na perspectiva do modelo da determinação social da saúde (MDSS). MÉTODO: Estudo transversal, realizado em ambulatório de infectologia de um hospital universitário no Brasil durante um ano, com amostra de 138 pacientes. Para coleta de dados, utilizaram-se o formulário de caracterização sociodemográfica baseado no MDSS, envolvendo os determinantes individuais, proximais, intermediários e influência das redes sociais, além do instrumento de avaliação da QV de pessoas com HIV/AIDS. Projeto aprovado pelo comitê de ética sob protocolo no 040.06.12. RESULTADOS: segundo o MDSS, a maioria dos homens com AIDS possuíam faixa etária de 30-49 anos (68,1%), cor parda (59,4%), heterossexuais (46,4%), solteiros (64,5%), católicos (68,8%), nível superior (39,2%), sem filhos (61,6%) e com vínculo empregatício (71,0%). A percepção da QV foi intermediária nos domínios físico, nível de independência, meio ambiente e espiritualidade, e para domínios psicológico e relações sociais, foi superior. Houve menor percepção da QV para homossexuais (p=0,037), casados (p=0,077) e com renda menor que um salário mínimo (p=0,042). Houve maior percepção da QV para pessoas sem religião (p=0,005), que moravam com parceiro (p=0,049) e com vínculo empregatício (p=0,045). CONCLUSÃO: os determinantes sociais influenciam na QV de homens com AIDS. .
OBJETIVO: analizar la calidad de vida (CV) de hombres con Sida bajo la perspectiva del modelo de la determinación social de la salud (MDSS). MÉTODO: estudio transversal, realizado en ambulatorio de enfermedades infecciosas de un hospital universitario en Brasil, durante un año, con una muestra de 138 pacientes. Para recolección de datos se utilizaron el formulario de caracterización sociodemográfica basado en el MDSS, conteniendo los determinantes individuales, proximales, intermediarios y la influencia de las redes sociales, además del instrumento de evaluación de la CV de personas con HIV/Sida. Proyecto aprobado por el comité de ética con el protocolo n° 040.06.12. RESULTADOS: según el MDSS, la mayoría de los hombres con Sida se encontraba en el intervalo etario de 30 a 49 años (68,1%), color parda (59,4%), heterosexuales (46,4%), solteros (64,5%), católicos (68,8%), nivel superior (39,2%), sin hijos (61,6%) y con vínculo de empleo (71,0%). La percepción de la CV fue intermedia en los dominios: físico, nivel de independencia, medio ambiente y espiritualidad, y para los dominios psicológicos y relaciones sociales, fue superior. Hubo menor percepción de la CV para homosexuales (p=0,037), casados (p=0,077) y con renta menor que un salario mínimo (p=0,042). Hubo mayor percepción de la CV para personas sin religión (p=0,005), que vivían con compañero (p=0,049) y con vínculo de empleo (p=0,045). CONCLUSIÓN: los determinantes sociales influencian la CV de hombres con Sida. .
Subject(s)
Humans , Female , Adolescent , Immunization Programs/statistics & numerical data , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Residence Characteristics , Catchment Area, Health , Data Collection , Health Knowledge, Attitudes, Practice , Healthcare Disparities , Insurance Coverage , Mothers , Papillomavirus Infections/ethnology , United States , Uterine Cervical Neoplasms/prevention & controlABSTRACT
Despite the existence of guidelines recommending vaccination against the human papillomavirus (HPV) and widespread availability of the vaccine through the Vaccines for Children program, HPV vaccination rates among island Puerto Ricans are suboptimal. Advertising plays a central role in promoting HPV vaccination by increasing awareness of and knowledge about the vaccine; however, little is known about the influence of cultural factors on the impact of HPV messages delivered through the media. The aim of this qualitative study was to explore the role of ethnic identity on the attitudes towards HPV vaccine advertising among island Puerto Ricans. Five focus groups (n = 23) were conducted with parents and non-vaccinated females. Our analysis found several themes that may influence attitudes towards HPV vaccine advertising among this population: physical ethnic similarity, relevance of information, and sociocultural congruence. Findings may assist in developing culturally appropriate health promotion programs and media to promote HPV vaccination among Puerto Ricans.