(WITHDRAWN) The Role of English Proficiency in HPV and HPV Vaccine Awareness: A Cross-Sectional Study across Race/Ethnicity

Background and Purpose: Defined as a set of viruses transmitted through vaginal, anal, or oral sex, Human papillomavirus (HPV) is a leading cause in nearly 91% of cervical cancer and anal cancer, 63% of penile cancer, and 70% of oropharynx cancer The HPV vaccine is available to prevent infection and occurrence of HPV-related cancers. The present study aimed to examine levels of HPV and HPV vaccine awareness and the associated factors, particularly English proficiency, with the awareness levels across four race/ethnicity groups including Non-Hispanic White, Non-Hispanic African American, Hispanic, and Non-Hispanic Asian.

Methods: The cross-sectional data were merged by Cycle 1 and Cycle 2 of Health Information National Trends Survey 5 (HINTS5, Cycle 1, and Cycle 2, N = 5,868). Univariate analysis was used to examine descriptive information of sociodemographic characteristics (i.e., age, gender, race/ethnicity, marital status, educational attainment, and household income), health care resources (i.e., regular health care provider, frequency of visiting health care providers, and health insurance coverage), caregiver of children, number of children in the household, English proficiency, and self-reported health status. Bivariate analysis was applied to examine the correlation of each variable with HPV awareness and HPV vaccine awareness, with crosstab used for categorical variables and independent sample t-test used for the only continuous variable, age. Lastly, binary logistic regression analyses across race/ethnicity were conducted on all variables to predict HPV and HPV vaccine awareness across different race/ethnicity groups.

Results: Overall, most participants heard of HPV (62.2%) and HPV vaccine (61.3%). Compared to the HPV awareness level in Non-Hispanic White (66.0%), the HPV awareness in Non-Hispanic African American (59.2%), Hispanic (57.6%), and Non-Hispanic Asian (41.8%) were lower. Moreover, 68.0% of Non-Hispanic White heard of the HPV vaccine, while only 54.5% of Non-Hispanic African American, 51.1% of Hispanic and 42.5% of Non-Hispanic Asian heard of it. Regarding HPV awareness, regression analysis reported that most variables were significantly associated with HPV awareness or in at least one race/ethnicity group. English proficiency was found to be significant in Non-Hispanic White (OR=2.588, p<.001), Non-Hispanic African American (OR=5.155, p<.001), and Hispanic (OR=1.607, p<.05). With regard to HPV vaccine awareness, most variables were significantly related to HPV vaccine awareness in at least one race/ethnicity group despite having health insurance. Speaking English well was found to be significant in all race/ethnicity groups including Non-Hispanic White (OR=2.189, p<.001), Non-Hispanic African American (OR=2.405, p<.05), Hispanic (OR=2.075, p<.001), and Non-Hispanic Asian (OR=3.093, p<.01)

Conclusions and Implications: The results of this study suggest that the awareness levels of HPV and HPV vaccine are moderate, but lower for Non-Hispanic African American, Hispanic, and Non-Hispanic Asian. Awareness of HPV and HPV vaccine are highly associated with age, gender, education, household income, frequency of visiting health care providers, and English proficiency for all or most race/ethnicity groups. In order to improve awareness of HPV and HPV vaccine, the disparity across race/ethnicity and various predictors according to race/ethnicity may be considered.