UC Irvine

Background: The Human Papillomavirus (HPV) can cause different types of cancer including cervical cancer. Disaggregate data show that cervical cancer among Vietnamese American (VA) women remains high (9.5 per 100,000) relative to other Asian American subgroups. While the HPV vaccine is widely available, uptake rates vary by both gender and ethnicity. Research suggests that sexual health conversations with parents during adolescence can influence decisions like vaccination in adulthood, however, sexual conversations are taboo in many Asian families. Consequently, young adults may turn to peers for support. Purpose: We sought to better understand how culture and gender may influence peer communication about the HPV vaccine, and in turn HPV vaccination uptake. Methods: We collected online surveys and interviews from Vietnamese Americans who received the HPV vaccination as an adult between the age of 18-26, or were currently unvaccinated. We used a) confirmatory factor analysis to validate a scale of received peer supportive communication (RSC-HPV) and perceived supportive communication about HPV vaccination (PSC-HPV), b) path analysis to assess whether sexual communication frequency and supportive communication explain gender differences in vaccination status, and c) qualitative interviews to better understand culture-centric sexual health and HPV vaccine communication narratives. Results: In study 1, a 3-factor measurement model (informational, emotional, and instrumental) was identified. Only perceived instrumental support in the PSC-HPV scale was significantly associated with HPV vaccination. In study 2, men and women had similar rates of vaccination; thus, peer communication did not explain gender differences in vaccination status. Among those who had discussed the HPV vaccine with their peers, informational SC and a higher communication frequency of “pleasure” topics were associated with vaccination status. Among those who had not discussed HPV vaccination, women more frequently discussed topics related to “sensitive” and “values.” Perceived instrumental SC and less discussion of “risk” topics were also related to vaccination. In study 3, culture-centric sexual health communication narratives included silence and shame, maturity, and peer comfort. HPV vaccine decision narratives comprised of protection narratives among the vaccinated and network influences among the unvaccinated. Peer communication about the HPV vaccine emerged after vaccinating, receiving an HPV diagnosis, discussing it with doctors, and partners. Non-discussion narratives occurred due to a lack of knowledge, cultural stigma, and lack of confidence in bringing up conversations. Discussion: Findings suggest that peers do communicate with each other about sexual health and HPV vaccination, but there are structural, cultural, and interpersonal factors that can also contribute to vaccine uptake. In practice, we recommend a multilevel approach utilizing network influences and culture-centric messages to increase HPV vaccine uptake among Vietnamese American young adults.