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  • br Beth Sundstroma Ellie Smithb

    2019-11-12


    Beth Sundstroma,∗, Ellie Smithb, Cara Delayc, John S. Luqued, Caroline Davilae, Bailey Federa, Vincenza Paddocka, Jessie Poudriera, Jennifer Young Piercef, Heather M. Brandtg
    a Department of Communication, College of Charleston, Charleston, SC, USA
    b College of Public Health and Human Sciences, Oregon State University, USA
    c Department of History, College of Charleston, Charleston, SC, USA
    d Institute of Public Health, Florida A&M University, USA
    e Department of Public Health Sciences, Medical University of South Carolina, USA
    f Mitchell Cancer Institute, University of South Alabama, USA
    g Arnold School of Public Health, University of South Carolina, USA
    Keywords:
    United States
    HPV
    Cervical cancer
    Qualitative methodology
    Reproductive justice 
    Cervical cancer is a preventable disease. HPV infection has been linked to more than 90% of cervical cancers. A vaccine to prevent the acquisition of HPV has been available since 2006. The purpose of this study was to investigate women's perceptions of cervical cancer prevention, including HPV vaccination. A reproductive jus-tice framework guided data collection and analysis.
    In 2016, researchers conducted 70 in-depth, semi-structured qualitative interviews with women aged 19–78 years in South Carolina. A purposive sampling approach was employed to maximize requisite variety based on social, economic, and environmental axes of inequality. Participants self-identified as white (53%), African American (33%), and Hispanic (9%). Data analysis included an inductive constant comparative method to identify patterns and themes across the interviews. Misinformation about the prevalence and risk of HPV and cervical cancer led to “othering” of women with HPV-related diagnoses based on the flawed assumption of not being at risk.
    Participants described a lack of knowledge about the effectiveness and safety of the HPV vaccine. Social norms influenced participants' perceptions of HPV 9(S)-HODE and cervical cancer, including concerns about sexual activity and intergenerational communication. Participants’ social construction of identity, including race/ethnicity, socioeconomic position, ability, age, gender, sexual orientation, and immigration status, im-pacted their perceptions of cervical cancer screening and the HPV vaccine. In particular, participants believed that the HPV vaccine was “only for girls” and identified gender norms that limited uptake. Participants described barriers to accessing health care and cervical cancer screening, including cost, health insurance, and life changes (e.g., pregnancy, relocating). Many participants experienced an abnormal Papanicolaou test and described follow-up care, including biopsies and treatment for cervical dysplasia.
    Findings from this study offer insight into women's identity and perceptions of cervical cancer prevention. Results provide practical recommendations to increase women's agency in the development of successful public health interventions.
    1. Introduction
    The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States (CDC, 2017b; McQuillan et al., 2017; Satterwhite et al., 2008). According to the Centers for Disease Control and Prevention (CDC), HPV is ubiquitous and almost
    B. Sundstrom, et al.
    HPV infection has been linked to more than 90% of cervical cancers (CDC, 2017a). Each year, over 30,000 men and women are diagnosed with HPV-related cancers in the United States. Although cervical cancer is a relatively rare outcome, the numbers of pre-cancerous lesions are significant and lead to abnormal Papanicolaou (Pap) tests and anxiety, which remains a common experience for many women (Moyer, 2012). Each year, approximately 400,000 women present with abnormal Pap test results. A vaccine to prevent the acquisition of HPV has been available since 2006. The latest vaccine, HPV-9 prevents approximately 90% of HPV-related cancers (FDA, 2014). In 2016, the CDC and the Advisory Committee on Immunization Practices (ACIP) recommended that 11–12 year old boys and girls receive only two doses of the HPV-9 vaccine six months apart. Older adolescents ages 15–26 still need three doses of the HPV vaccine (CDC, 2016a). Since 2010, the Affordable Care Act (ACA) requires most private health insurance plans to cover all vaccines recommended by the ACIP without cost-sharing. The Vaccines for Children (VFC) program provides vaccines for children who are uninsured and Medicaid-eligible.