The Influence of Medical Providers on HPV Vaccination among Children of Mexican Mothers: A Comparison between Mexico and the Midwest Region of the United States

"Participants in both countries chose health care professional recommendations as one of the most important factors in their decision to vaccinate their children."

This paper describes a two-site parallel study conducted in Xalapa, Veracruz, Mexico and Omaha, Nebraska, United States (US) to examine knowledge and beliefs about the human papillomavirus (HPV) vaccine and the potential reasons for differences in HPV vaccination uptake rates. The intention was to generate new insights that may lead to interventions to improve vaccination rates in the US and Mexico.

The researchers explain that, among cervical cancer patients in the US, a disproportionate number are Hispanics/Latinos. Also, about a third of patients diagnosed with cervical cancer annually in Mexico die of the disease. Vaccines are available to protect against HPV, which can cause cervical cancer (among other cancers). When compared to non-Hispanic White adolescents (49.2%), first-dose rates and completion rates for the vaccine continue to be below the rates of the other recommended vaccines and below the Healthy People 2020 vaccination goal of 80%. In contrast, Mexico's population has consistently had a higher vaccine initiation and completion rate than the US and even higher than the Healthy People 2020 set goal. Previous studies have documented low levels of awareness and knowledge about HPV, the vaccine, and HPV's role in the etiology of cervical cancer among Hispanics/Latinos living in the US. Studies in Mexico have found that some of the indicators for not vaccinating children against HPV were not knowing about the vaccine and not knowing about sexually transmitted infections (STIs).

This cross-sectional study was conducted among a total of 200 mothers (100 in each sister city) between May and July of 2017 to assess how knowledge about HPV and the HPV vaccine plays a role in a mother's decision to vaccinate her child. Selected findings:

• Mothers living in Mexico showed better knowledge about HPV and HPV vaccine (77.8%) than participants living in the U.S. (48%) p < .0001.
• Most of the women surveyed in Mexico (99%) and the US (94%) believe that vaccines are beneficial.
• Mothers living in Mexico were more likely to respond that HPV vaccines are beneficial, safe, and appropriate for preteens between 9 and 12 years old than mothers living in the US (84% and 41% respectively).
• Logistic regression revealed that receiving information about the HPV vaccine from medical providers was a significant predictor of mothers' willingness to vaccinate their children.

Given that mothers in Mexico were more likely to consider the vaccine as only appropriate for girls, the researchers suggest that it is necessary to use a gender-neutral approach when developing prevention programmes in Mexico - and, by extension, to tailor communications appropriately.

In light of knowledge deficits, especially when comparing the US and Mexican study participants, one suggestion would be to include more health-based education delivered in a culturally and linguistically appropriate manner to parents of Hispanic/Latino origin.

In conclusion, because healthcare professional recommendations were found to play a significant role in mothers' decision about HPV vaccination in both study cites, it is "critical to foster physician-patient communication to take action in combating HPV and utilizing HPV vaccines".