Coralia Vázquez-Otero

Trends and predictors of HPV vaccination among U.S. College women and men.

BACKGROUND HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females. METHODS The National College Health Assessment-II (Fall 2009-2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015. RESULTS Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18-21 vs. 22-26years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only. CONCLUSIONS These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.

Dispelling the myth: Exploring associations between the HPV vaccine and inconsistent condom use among college students.

Human papillomavirus (HPV) vaccination is safe and effective in preventing anogenital cancers and warts. However, myths have surrounded the HPV vaccine since its approval, including the possibility that HPV vaccinated young people are more likely to engage in risky sexual behaviors. The purpose of this study was to assess the association between HPV vaccination and engaging in inconsistent condom use in a sample of U.S. college students. A secondary data analysis of the National College Health Assessment-II (Fall 2013) was conducted in 2015. Risky sexual activity was operationalized as inconsistent condom use for oral, vaginal or anal sexual activity. Logistic regression models were stratified by sexual activity and gender, and controlled for socio-demographics and history of STIs. Inconsistent condom use was reported among females for vaginal (47%), oral (94%), and anal sex (75%); while males reported levels of inconsistency for vaginal (38%), oral (94%), and anal sex (58%). Sixty-nine percent of females reported receiving the HPV vaccine compared to 43% of males. Among females, there was no significant association between HPV vaccination and inconsistent condom use in any of the sexual activities. Among males, there was no significant association between HPV vaccination and inconsistent condom use in oral or vaginal sex. HPV-vaccinated males were less likely to report inconsistent condom use during anal sexual activity. This study contributes to the increasing evidence that HPV vaccination is not associated with risky sexual behavior. Dispelling this myth is important to facilitate uptake and completion of the HPV vaccine in the U.S.

The Intersection of Gender Identity and Violence: Victimization Experienced by Transgender College Students

College students disproportionately experience victimization, stalking, and relationship violence when compared with other groups. Few studies explore victimization by the gender identity of college students, including those who identify as transgender. The purpose of this study is to explore the rates of violence experienced by transgender students compared with male and female college students. This study utilized the National College Health Assessment–II (NCHA-II) and included data from students (n = 82,538) across fall 2011, 2012, and 2013. Bivariate statistics and binary logistic regression were conducted to test the relationships between gender identity and victimization. Transgender students (n = 204) were compared with male (n = 27,322) and female (n = 55,012) students. After adjusting for individual factors, transgender students had higher odds of experiencing all nine types of violence when compared with males and higher odds of experiencing eight types of violence than females. Transgender students experienced the highest odds in crimes involving sexual victimization, including attempted sexual penetration (adjusted odds ratio [aOR]: 9.49, 95% confidence interval [CI] = [6.17, 14.59], d = 1.00), sexual penetration without consent (aOR: 9.06, 95% CI = [5.64, 14.53], d = 0.94), and being in a sexually abusive relationship (aOR: 6.48, 95% CI = [4.01, 10.49], d = 0.48), than did male students. Findings reveal increased odds of victimization among transgender students when compared with male and female students. Results demonstrate the need for more comprehensive violence prevention efforts in college settings.

Understanding the supportive care needs of Hispanic men cancer survivors

ABSTRACT Objective. To date, there is a paucity of research and information on Hispanic men cancer survivors (HMCS), who comprise part of the largest and fastest growing racial/ethnic minority group in the country. The purpose of this paper is to provide a deeper understanding of the supportive care needs of HMCS. Design. Three focus groups with a community sample of HMCS (n = 18) and interviews with providers (n = 5) were conducted to explore the supportive care needs of Hispanic men who had been diagnosed with cancer within the last five years. The data were analyzed using applied thematic analysis techniques. Results. Findings from focus groups and interviews are presented concurrently. The overarching themes that emerged were the need for: culturally sensitive cancer care and better communication with providers; cancer treatment-related information and comprehensive survivorship care; support and to connect with other cancer survivors and the need to negotiate changing gender role expectations and still provide for their family. Conclusion. Study findings contribute to the literature by presenting the supportive care needs of HMCS and illustrate the need for continued research to address disparities in access to cancer information and in the provision of culturally sensitive care. We provide recommendations and suggestions to address the supportive care needs of HMCS.

Acceptability of a Virtual Patient Educator for Hispanic Women.

There are few Spanish language interactive, technology-driven health education programs. Objectives of this feasibility study were to (a) learn more about computer and technology usage among Hispanic women living in a rural community and (b) evaluate acceptability of the concept of using an embodied conversational agent (ECA) computer application among this population. A survey about computer usage history and interest in computers was administered to a convenience sample of 26 women. A sample video prototype of a hospital discharge ECA was administered followed by questions to gauge opinion about the ECA. Data indicate women exhibited both a high level of computer experience and enthusiasm for the ECA. Feedback from community is essential to ensure equity in state of the art dissemination of health information.

Sexually Transmitted Infection Prevention With Long-Acting Reversible Contraception: Factors Associated With Dual Use

Background Long-acting reversible contraception (LARC) is extremely effective in preventing pregnancy; however, it does not provide sexually transmitted infection (STI) prevention. Therefore, dual use is recommended for the prevention of STIs, in addition to pregnancy, by using LARC methods with condoms. This study assessed factors associated with LARC only use and dual-LARC and condom use among college women. Methods The National College Health Assessment-II Fall 2012 to 2013 was used for this analysis. The analytic sample was restricted to women who used a LARC method (ie, intrauterine device or implant) (N = 1658). The main outcome was dual method use, LARC and condom, at last sex. An adjusted logistic regression model assessed sociodemographic factors (age, relationship, race), health care utilization (routine gynecological examination), and sexual behavior (number of partners) as factors associated with dual condom-LARC use at the last time of vaginal-sex. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated. Results Among women reporting LARC use, 24% used a condom. Dual users were less likely to have only 1 sexual partner (adjusted PR [aPR], 0.66; 95% CI, 0.54–0.81) and be in a relationship. Dual users were more likely than LARC-only users to be Hispanic (aPR, 1.34; 95% CI, 1.01–1.78), black (aPR, 1.40; 95% CI, 1.07–1.83), and biracial/multiracial (aPR, 1.38; 95% CI, 1.10–1.73). Conclusions These findings illustrate differences between dual-condom LARC and LARC-only college users. It is likely that relationship status and number of partners influences perceived risk for STIs and decision making for dual use among this population.

Rethinking Preconception Care: A Critical, Women’s Health Perspective

Objectives Preconception care aims to provide care to reproductive aged individuals in order to improve pregnancy and birth outcomes. Given that preconception care is a public health priority, it is important to evaluate the evolution of this health paradigm and the promotion of preconception messages that are obtained by the public. We identified online preconception health messages, which were critically assessed through a women’s health perspective. Methods We searched for “preconception care” on three major search engines. Websites were included if they were U.S.-based, provided content in English, and mentioned preconception care. Blogs and journal articles were excluded. The final sample included 52 websites. Using a content analysis approach, we assessed the presence of gender bias and identified other emergent themes. Results The majority of websites focused on preconception care for women only (67%). The recommendations centered on: (1) health behaviors for women (e.g., folic acid, drinking, smoking); (2) visiting healthcare providers; and (3) evaluating medical risks. Moreover, most content implied that women desired, or should desire, pregnancy. Overall, the messages used biomedical language and rarely mentioned other important health topics, such as social support and violence. Conclusions The primary messages presented on preconception care websites emphasized biomedical aspects of women’s health. The current context of preconception care medicalizes this pre-pregnancy period by defining it as a biomedical condition requiring lifestyle changes and interventions. Additionally, the biases presented in these messages assumed women want and are capable of pregnancies and excluded an integral factor for heteronormative reproduction—men.

Cultural adaptation of a supportive care needs measure for Hispanic men cancer survivors

ABSTRACT Objective. Research with ethnic minority populations requires instrumentation that is cultural and linguistically relevant. The aim of this study was to translate and culturally adapt the Cancer Survivor Unmet Needs measure into Spanish. Methods. We describe the iterative, community-engaged consensus-building approaches used to adapt the instrument for Hispanic male cancer survivors. We used an exploratory sequential mixed method study design. Methods included translation and back-translation, focus groups with cancer survivors (n = 18) and providers (n = 5), use of cognitive interview techniques to evaluate the comprehension and acceptability of the adapted instrument with survivors (n = 12), ongoing input from the projects community advisory board, and preliminary psychometric analysis (n = 84). Results. The process emphasized conceptual, content, semantic, and technical equivalence. Combining qualitative and quantitative approaches offered a rigorous, systematic, and contextual approach to translation alone and supports the cultural adaptation of this measure in a purposeful and relevant manner. Conclusion. Our findings highlight the importance of going beyond translation when adapting measures for cross-cultural populations and illustrate the importance of taking culture, literacy, and language into consideration.

Abnormal pap tests among women living in a Hispanic migrant farmworker community: A narrative of health literacy.

This study explored narrative responses following abnormal Pap tests among Hispanic migrant farmworkers (N = 18; ages 22–50 years) via in-depth interviews in Florida. Qualitative analyses utilized health literacy domains (obtain/process/understand/communicate) as a conceptual framework. Participants described how they (1) obtained information about getting a Pap test, (2) processed positive and negative reactions following results, (3) understood results and recommended health-promoting behaviors, and (4) communicated and received social support. Women had disparate reactions and understanding following an abnormal Pap result. Health literacy was a meaningful conceptual framework to understand assets and gaps among women receiving an abnormal Pap test result. Future interventions should incorporate health literacy domains and facilitate patient–provider communications and social support to assist women in decision-making and health-promoting behaviors, ultimately decreasing cancer disparities.

College institutional characteristics and the use of barrier methods among undergraduate students

Abstract Sexually transmitted infections (STIs) may be prevented through the use of barrier methods, but rates of use among US college students are low. Previous research focuses on individual-level factors influencing barrier method use, but few studies consider community-level influences. This study examined consistency of barrier use by college institutional characteristics including region, enrolment, control (public or private), locale, type, or religious-affiliation. Data from the Autumn 2013 US National College Health Assessment-II (n = 13,400; 57 colleges) were analysed. Prevalence ratios were calculated for consistent barrier method use during vaginal, oral and anal sex. Consistent barrier use during vaginal sex was associated with enrolment at a college in the Northeast, compared to the West (aPR: 1.16 [95%CI 1.01–1.29], p = 0.04), and enrolment at larger institutions compared to smaller colleges. Attending a private college or university was associated with more consistent barrier method use during vaginal sex and anal sex compared to those attending a public college or university. Findings demonstrate differences in barrier method use by institutional-level factors, and future research should consider the role of the college community. US college-based health promotion should include barrier method interventions at multiple levels if STIs are to be reduced.