Rana Sanjana K, Perkins Rebecca B, Carr Devan, Feldman Sarah, Welch Kelly, Duffey-Lind Eileen, Villa Alessandro
Team Maureen, North Falmouth, MA, USA.
Department of Obstetrics and Gynecology, Boston University Chobanian and Avdesian School of Medicine and Boston Medical Center Cancer Center, Boston, MA, USA.
J Community Health. 2025 Feb;50(1):98-110. doi: 10.1007/s10900-024-01401-1. Epub 2024 Sep 5.
Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.
在美国，人乳头瘤病毒（HPV）疫苗接种率和宫颈癌筛查率并不理想，在女同性恋、男同性恋、双性恋、跨性别、酷儿和双性人（LGBTQI+）身份认同的女性以及跨性别男性等历史上服务不足的群体中尤其如此。因此，我们的横断面研究评估了LGBTQI+身份认同的女性和跨性别男性中与这些比率相关的因素。通过HER移动应用程序的成员在2022年3月至5月期间可获得的在线调查，评估了1983名LGBTQI+身份认同的女性和跨性别男性的HPV相关癌症知识、HPV疫苗接种和宫颈癌筛查状况，以及自我采集用于筛查的可接受性。使用2022年11月至2023年12月的多变量逻辑回归评估社会人口统计学因素、疫苗接种和筛查之间的关联。大多数18 - 26岁的参与者（77.0%）和≥46岁参与者的6.3%（P < 0.001）至少接种了一剂HPV疫苗。宫颈癌筛查率与年龄呈正相关：21 - 26岁人群中70.5%，≥46岁人群中96.1%（P < 0.001）。筛查与男性性别认同呈负相关（比值比，0.13；95%置信区间，0.04 - 0.42；P < 0.001），与未参保呈负相关（比值比，0.40；95%置信区间，0.24 - 0.67；P < 0.001），与未接种HPV疫苗呈负相关（比值比，0.28；95%置信区间，0.18 - 0.43；P < 0.001）。29.6%未接受筛查的人认为不需要筛查，22.1%的人对盆腔检查感到不适。40.4%的所有参与者更倾向于自我采集用于筛查。我们的研究结果表明有提高筛查和疫苗接种的机会。在筛查不足的个体中，缺乏对筛查必要性的了解以及对盆腔检查的不适是重要障碍。有必要针对患者知识、从业者沟通以及探索自我筛查策略进行有针对性的干预。
