Sherman Bendu M, Islam Jessica Y, Gartner Danielle R
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
Center for Immunization and Infection Research in Cancer, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Cancer Epidemiol Biomarkers Prev. 2023 Nov 1;32(11):1625-1634. doi: 10.1158/1055-9965.EPI-23-0547.
American Indian and Alaskan Native (AIAN) people experience a disproportionately high incidence of human papillomavirus (HPV)-related cancers and mortality, and these rates vary across geographic regions. To address the unexplained regional differences among AIAN people, we describe regional variations and sociodemographic correlates of HPV-related knowledge and HPV vaccination awareness indicators.
A cross-sectional study was implemented with data for 866 AIAN respondents pooled from eight cycles of the Health Information National Trends Survey. We used χ2 tests to determine whether there were regional differences in the indicators and then used multivariable, modified Poisson regression to explore associations between sociodemographic characteristics and HPV-related knowledge and vaccination awareness measures.
Of the 13 indicators, just one demonstrated regional variation. However, we observed a high level of uncertainty regarding HPV and HPV vaccine-related knowledge and experience. We also observed that women were more likely than men to have heard of HPV [adjusted prevalence ratio (aPR), 1.29; 95% confidence interval (CI):1.03-1.63], the HPV vaccine (aPR, 1.59; 95% CI: 1.15-2.22), and to have discussed it with their providers (aPR, 3.69; 95% CI: 1.47-9.28). There were also differences by age, education, and insurance status.
High levels of uncertainty and lack of regional variation in indicators suggest that there may be missed opportunities across Indian Country for engagement between health care providers and AIAN in HPV-related conversations.
Efforts toward improving HPV knowledge and vaccination should target all at-risk sexes (and genders), age groups, and education levels. Moreover, AIAN-serving health care providers should be empowered with sufficient understanding, so they are prepared for discussions with at-risk patients.
美国印第安人和阿拉斯加原住民（AIAN）人群中，人乳头瘤病毒（HPV）相关癌症的发病率和死亡率异常高，且这些比率在不同地理区域有所不同。为了解决AIAN人群中无法解释的区域差异问题，我们描述了HPV相关知识和HPV疫苗接种意识指标的区域差异及社会人口学相关性。
开展了一项横断面研究，数据来自健康信息国家趋势调查八个周期汇总的866名AIAN受访者。我们使用卡方检验来确定指标是否存在区域差异，然后使用多变量修正泊松回归来探索社会人口学特征与HPV相关知识及疫苗接种意识指标之间的关联。
在13项指标中，只有一项显示出区域差异。然而，我们观察到关于HPV及HPV疫苗相关知识和经验存在高度不确定性。我们还观察到，女性比男性更有可能听说过HPV[调整患病率比（aPR），1.29；95%置信区间（CI）：1.03 - 1.63]、HPV疫苗（aPR，1.59；95%CI：1.15 - 2.22），并与医疗服务提供者讨论过（aPR，3.69；95%CI：1.47 - 9.28）。在年龄、教育程度和保险状况方面也存在差异。
指标的高度不确定性和缺乏区域差异表明，在印第安地区，医疗服务提供者与AIAN人群进行HPV相关对话可能存在错失机会的情况。
提高HPV知识和疫苗接种的努力应针对所有高危性别、年龄组和教育水平。此外，为AIAN人群提供服务的医疗服务提供者应具备充分的了解，以便为与高危患者的讨论做好准备。
