Effects of Socioeconomic Status and Health Care Access on Low Levels of Human Papillomavirus Vaccination Among Spanish-Speaking Hispanics in California

Shingisai Chando and T. Robert Harris are with The University of Texas School of Public Health, Dallas Regional Campus. Jasmin A. Tiro is with the Department of Clinical Sciences, University of Texas Southwestern Medical Center and the Harold C. Simmons Cancer Center, Dallas. Sarah Kobrin and Nancy Breen are with the Division Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.
American Journal of Public Health (Impact Factor: 4.55). 12/2012; 103(2). DOI: 10.2105/AJPH.2012.300920
Source: PubMed


Little is known about the effect of language preference, socioeconomic status, and health care access on human papillomavirus (HPV) vaccination. We examined these factors in Hispanic parents of daughters aged 11 to 17 years in California (n = 1090). Spanish-speaking parents were less likely to have their daughters vaccinated than were English speakers (odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.31, 0.98). Adding income and access to multivariate analyses made language nonsignificant (OR = 0.68; 95% CI = 0.35, 1.29). This confirms that health care use is associated with language via income and access. Low-income Hispanics, who lack access, need information about free HPV vaccination programs.(Am J Public Health. Published online ahead of print December 13, 2012: e1-e3. doi:10.2105/AJPH.2012.300920).

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    • "Spanish girls do not have an easier access to vaccines, as vaccines are given for free to all subjects living in Spain, therefore the explanation that immigrant population know less about the disease is not due to a lack of contact with the health system or lower education, as we passed the questionnaires in schools. There are descriptions in the USA of Latin American girls being less vaccinated, and it is possibly due to cultural or traditional barriers rather than having less facilities [32]. "
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    ABSTRACT: Background HPV vaccine coverage is far from ideal in Valencia, Spain, and this could be partially related to the low knowledge about the disease and the vaccine, therefore we assessed these, as well as the attitude towards vaccination in adolescent girls, and tried to identify independently associated factors that could potentially be modified by an intervention in order to increase vaccine coverage. Methods A cross sectional study was conducted in a random selection of schools of the Spanish region of Valencia. We asked mothers of 1278 girls, who should have been vaccinated in the 2011 campaign, for informed consent. Those that accepted their daughters’ participation, a questionnaire regarding the Knowledge of HPV infection and vaccine was passed to the girls in the school. Results 833 mothers (65.1%) accepted participation. All their daughters’ responded the questionnaire. Of those, 89.9% had heard about HPV and they associated it to cervical cancer. Only 14% related it to other problems like genital warts. The knowledge score of the girls who had heard about HPV was 6.1/10. Knowledge was unrelated to the number of contacts with the health system (Pediatrician or nurse), and positively correlated with the discussions with classmates about the vaccine. Adolescents Spanish in origin or with an older sister vaccinated, had higher punctuation. 67% of the girls thought that the vaccine prevented cancer, and 22.6% felt that although prevented cancer the vaccine had important safety problems. 6.4% of the girls rejected the vaccine for safety problems or for not considering themselves at risk of infection. 71.5% of the girls had received at least one vaccine dose. Vaccinated girls scored higher knowledge (p = 0.05). Conclusion Knowledge about HPV infection and vaccine was fair in adolescents of Valencia, and is independent to the number of contacts with the health system, it is however correlated to the conversations about the vaccine with their peers and the vaccination status. An action to improve HPV knowledge through health providers might increase vaccine coverage in the adolescents.
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    ABSTRACT: Introduction: Hispanic workers in the United States comprise a considerable portion of the workforce, especially in the construction industry — one of the most dangerous industries in the nation. Despite a decline during the recent economic downturn, Hispanic workers still accounted for about one quarter of the construction workforce in 2010. Given the hazards construction workers face, access to healthcare is essential. Yet many Hispanic construction workers are much less likely to use healthcare services than their white, non-Hispanic counterparts. Although healthcare disparities among Hispanics are well-documented, Hispanics are a heterogeneous population, and single-item measures may be inadequate to explain determinants of healthcare utilization. This study targets Hispanic construction workers with limited English proficiency (LEP) and examines whether language is an additional barrier to healthcare utilization when other barriers are present (e.g., uninsurance, poverty). Method: A large nationally representative dataset, the 2008 Survey of Income and Program Participation (SIPP) was used for this study. Two waves of the SIPP data were combined for analysis and healthcare utilization was measured by aspects such as medical provider visits and use of prescription medications. Differences in the receipt of health services by level of English proficiency were tested with chi-square tests, ANOVA, and multiple regression analyses. Potential confounders for healthcare utilization, including age, health status, health insurance coverage, education, family income, and employment status were controlled for in the regression models and 95% confidence intervals were computed. SAS’s SURVEY procedures and SAS-callable SUDAAN were employed to account for the complex survey design of the SIPP. Results: More than 80% of Hispanic construction workers did not speak English at home; furthermore, 37% of Hispanic construction workers did not speak English very well or did not speak English at all. In general, Hispanic workers were significantly less likely to have health insurance coverage (p < 0.001) than white, non-Hispanic workers. Among those with LEP, nearly 90% were uninsured. Hispanic workers lagged far behind their white, non-Hispanic counterparts in healthcare utilization. This disparity increased among LEP Hispanic workers. Only 24% of LEP Hispanics contacted a physician in the past 12 months compared to 39% of Hispanics with English proficiency and 64% of white, non-Hispanics. Multivariate models showed that the association between English proficiency and healthcare utilization was statistically significant after controlling for confounders such as insurance coverage, health status, age, and income (p < 0.001). Conclusion: Language barriers increased healthcare disparities among Hispanic construction workers. To improve healthcare among those with LEP, decision makers should target ways to diminish or mitigate language barriers to healthcare utilization.
    Health Disparities: Epidemiology, Racial/Ethnic and Socioeconomic Risk Factors and Strategies for Elimination. edited by Owen T. Jackson and Kathleen A. Evans, 01/2013; Nova Science Publishers, Inc.., ISBN: 978-1-62618-571-5
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    ABSTRACT: Abstract PURPOSE OF REVIEW: Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation. RECENT FINDINGS: New evidence suggests that disparities are more pronounced in access to living vs. deceased donors. National allocation policies have mitigated racial differences in pediatric deceased donor kidney transplant (DDKT) access after waitlisting. However, disparities in access to DDKT are stark for minority emerging adults, who lose pediatric priority allocation. Although absence of health insurance poses an important barrier to transplant, even after adjustment for insurance status and neighborhood poverty, disparities persist. Differential access to care and unjust social structures are posited as important modifiable barriers to achieving equity in pediatric transplant access. SUMMARY: Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential. PMID: 23508056
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