HPV Vaccination Among Young Adult Gay and Bisexual Men
HPV Vaccination Among Young Adult Gay and Bisexual Men
We surveyed individuals through the Harris Interactive LGBT Panel who were aged 18 to 26 years, lived in the United States, and self-identified as lesbian, gay, bisexual, or transgender (LGBT). This panel is a subset of the multimillion-member Harris Poll Online Panel, a voluntary research panel constructed using online and offline recruitment strategies. The Harris Poll Online Panel includes panel members throughout the entire United States and is similar to the US population on several demographic characteristics. Panel members complete multiple online surveys each month in exchange for points that can later be exchanged for rewards.
Of 2014 panel members who were confirmed eligible for the study, 1005 (50%) provided consent and completed our cross-sectional online survey in October and November 2013. We have included data on 428 young adult men who self-identified as gay or bisexual. These participants were from 47 states and the District of Columbia. We have not included data on lesbian and bisexual women (n = 543) or transgender individuals (n = 34) because it is likely that HPV vaccination and factors related to vaccination differ greatly between these groups.
We developed survey items on the basis of our previous HPV vaccine survey research. Because knowledge about HPV and the HPV vaccine is modest among gay and bisexual men, we provided participants with informative statements about these topics throughout the survey. Statements described what HPV is and the diseases it can cause, what the HPV vaccine is and who it is available for, the number of doses in the vaccine series, and the potential health benefits of the vaccine.
HPV Vaccination. HPV vaccine initiation (i.e., receipt of at least 1 dose of the 3-dose series) was the primary outcome for this study. We believe initiation was an appropriate outcome to examine because HPV vaccination for males is still a relatively new health behavior. A single survey item asked participants if they had received any doses of the HPV vaccine. For participants who indicated vaccine initiation, subsequent items assessed how many HPV vaccine doses they had received and the main reason they were vaccinated (participants could indicate only 1 reason from a list of potential reasons).
For participants who had initiated the vaccine series but not yet received all 3 doses, a survey question asked if they intended to get their remaining doses (yes, no, or don't know). If participants indicated that they did not intend or did not know if they would receive their remaining doses, an item assessed the main reason they might not receive these doses (participants could indicate only 1 reason from a list of potential reasons).
Among unvaccinated participants (i.e., those who had not yet received any doses), we assessed willingness to get the HPV vaccine under 2 conditions: (1) if it were free, and (2) if it cost $400 out of pocket. At the time of the survey, the HPV vaccine cost about $130 per dose (or about $400 for the 3-dose series) for those without health insurance that covered the vaccine. We used a 5-point scale for both willingness items, with responses of "definitely not willing," "probably not willing," "not sure," "probably willing," and "definitely willing" (possible range = 1–5). We also asked unvaccinated participants the main reason they had not yet received the HPV vaccine (participants could indicate only 1 reason from a list of potential reasons).
Correlates. We collected information on various demographic and health-related characteristics (Table 1 and Table 2). We focused primarily on constructs associated with HPV vaccination or vaccine acceptability in our past work. To obtain data regarding sexual identity and determine study eligibility, we asked potential participants, "Of the following, which do you consider yourself to be?" Response options included "heterosexual (straight)," "lesbian," "gay," "bisexual," "transgender," "other," "not sure," and "decline to answer." We classified participants as having no health insurance, having their own insurance (e.g., through work or school), or having insurance through their parents (which we believe is an important distinction to make for this age group).
We asked participants if they had disclosed their sexual orientation to their health care provider and if they thought they had ever been discriminated against by a health care provider because of their sexual orientation. We also asked participants if they had ever received a health care provider recommendation to get the HPV vaccine.
We assessed participants' knowledge about HPV with 6 items and classified them as having either high knowledge (answered 4 or more knowledge items correctly) or low knowledge (answered 3 or fewer knowledge items correctly). Examples of the knowledge items included "Do you think you can get HPV from having sex?" and "Do you think HPV can cause anal cancer?" All informative statements about HPV and the HPV vaccine we have described were provided after the knowledge items.
We examined participants' worry about getting HPV-related disease (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot"), perceived likelihood of getting HPV-related disease (3 items; α = 0.89; possible range = 1–4; response scale ranged from "no chance" to "high chance"), and perceived severity of HPV-related disease (1 item; possible range = 1–4; response scale ranged from "not at all" to "very"). The perceived severity item asked participants how serious they thought it would be if they got a disease caused by HPV.
Using items on the basis of the Carolina HPV Immunization Attitudes and Beliefs Scale, we assessed participants' perceived effectiveness of the HPV vaccine (3 items; α = 0.89, possible range = 1–4; response scale ranged from "not at all" to "a lot"), perceived potential harms of the HPV vaccine (4 items; α = 0.69; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree"), and perceived barriers (i.e., vaccine availability and affordability) to getting the HPV vaccine (2 items; α = 0.76; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree").
We examined perceived positive social norms by asking participants if they thought other people in the LGBT community are getting the HPV vaccine (1 item; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree"). We assessed participants' anticipated regret if they received the HPV vaccine and fainted (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot") and if they did not get vaccinated and later developed an HPV infection that could lead to health problems (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot"). We coded all continuous variables so that higher values indicated greater levels of that construct.
We used logistic regression models to first identify bivariate correlates of HPV vaccine initiation. We entered variables with P < .1 in bivariate analyses into a multivariate logistic regression model.
We constructed 2 multivariate models: (1) 1 that included whether participants had ever received a health care provider recommendation to get the HPV vaccine, and (2) 1 that excluded provider recommendation. We constructed the latter model because HPV vaccination without a provider recommendation is uncommon among males, and provider recommendation might depend on health care access and use. This approach is consistent with previous HPV vaccination analyses.
Among unvaccinated participants, we used paired t tests to compare willingness to get the HPV vaccine if the vaccine were free and if it cost $400 out of pocket. We analyzed data using SPSS version 19.0 (IBM Corp, Armonk, NY), and all statistical tests were 2-tailed with a critical α of 0.05.
Methods
We surveyed individuals through the Harris Interactive LGBT Panel who were aged 18 to 26 years, lived in the United States, and self-identified as lesbian, gay, bisexual, or transgender (LGBT). This panel is a subset of the multimillion-member Harris Poll Online Panel, a voluntary research panel constructed using online and offline recruitment strategies. The Harris Poll Online Panel includes panel members throughout the entire United States and is similar to the US population on several demographic characteristics. Panel members complete multiple online surveys each month in exchange for points that can later be exchanged for rewards.
Of 2014 panel members who were confirmed eligible for the study, 1005 (50%) provided consent and completed our cross-sectional online survey in October and November 2013. We have included data on 428 young adult men who self-identified as gay or bisexual. These participants were from 47 states and the District of Columbia. We have not included data on lesbian and bisexual women (n = 543) or transgender individuals (n = 34) because it is likely that HPV vaccination and factors related to vaccination differ greatly between these groups.
Measures
We developed survey items on the basis of our previous HPV vaccine survey research. Because knowledge about HPV and the HPV vaccine is modest among gay and bisexual men, we provided participants with informative statements about these topics throughout the survey. Statements described what HPV is and the diseases it can cause, what the HPV vaccine is and who it is available for, the number of doses in the vaccine series, and the potential health benefits of the vaccine.
HPV Vaccination. HPV vaccine initiation (i.e., receipt of at least 1 dose of the 3-dose series) was the primary outcome for this study. We believe initiation was an appropriate outcome to examine because HPV vaccination for males is still a relatively new health behavior. A single survey item asked participants if they had received any doses of the HPV vaccine. For participants who indicated vaccine initiation, subsequent items assessed how many HPV vaccine doses they had received and the main reason they were vaccinated (participants could indicate only 1 reason from a list of potential reasons).
For participants who had initiated the vaccine series but not yet received all 3 doses, a survey question asked if they intended to get their remaining doses (yes, no, or don't know). If participants indicated that they did not intend or did not know if they would receive their remaining doses, an item assessed the main reason they might not receive these doses (participants could indicate only 1 reason from a list of potential reasons).
Among unvaccinated participants (i.e., those who had not yet received any doses), we assessed willingness to get the HPV vaccine under 2 conditions: (1) if it were free, and (2) if it cost $400 out of pocket. At the time of the survey, the HPV vaccine cost about $130 per dose (or about $400 for the 3-dose series) for those without health insurance that covered the vaccine. We used a 5-point scale for both willingness items, with responses of "definitely not willing," "probably not willing," "not sure," "probably willing," and "definitely willing" (possible range = 1–5). We also asked unvaccinated participants the main reason they had not yet received the HPV vaccine (participants could indicate only 1 reason from a list of potential reasons).
Correlates. We collected information on various demographic and health-related characteristics (Table 1 and Table 2). We focused primarily on constructs associated with HPV vaccination or vaccine acceptability in our past work. To obtain data regarding sexual identity and determine study eligibility, we asked potential participants, "Of the following, which do you consider yourself to be?" Response options included "heterosexual (straight)," "lesbian," "gay," "bisexual," "transgender," "other," "not sure," and "decline to answer." We classified participants as having no health insurance, having their own insurance (e.g., through work or school), or having insurance through their parents (which we believe is an important distinction to make for this age group).
We asked participants if they had disclosed their sexual orientation to their health care provider and if they thought they had ever been discriminated against by a health care provider because of their sexual orientation. We also asked participants if they had ever received a health care provider recommendation to get the HPV vaccine.
We assessed participants' knowledge about HPV with 6 items and classified them as having either high knowledge (answered 4 or more knowledge items correctly) or low knowledge (answered 3 or fewer knowledge items correctly). Examples of the knowledge items included "Do you think you can get HPV from having sex?" and "Do you think HPV can cause anal cancer?" All informative statements about HPV and the HPV vaccine we have described were provided after the knowledge items.
We examined participants' worry about getting HPV-related disease (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot"), perceived likelihood of getting HPV-related disease (3 items; α = 0.89; possible range = 1–4; response scale ranged from "no chance" to "high chance"), and perceived severity of HPV-related disease (1 item; possible range = 1–4; response scale ranged from "not at all" to "very"). The perceived severity item asked participants how serious they thought it would be if they got a disease caused by HPV.
Using items on the basis of the Carolina HPV Immunization Attitudes and Beliefs Scale, we assessed participants' perceived effectiveness of the HPV vaccine (3 items; α = 0.89, possible range = 1–4; response scale ranged from "not at all" to "a lot"), perceived potential harms of the HPV vaccine (4 items; α = 0.69; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree"), and perceived barriers (i.e., vaccine availability and affordability) to getting the HPV vaccine (2 items; α = 0.76; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree").
We examined perceived positive social norms by asking participants if they thought other people in the LGBT community are getting the HPV vaccine (1 item; possible range = 1–5; response scale ranged from "strongly disagree" to "strongly agree"). We assessed participants' anticipated regret if they received the HPV vaccine and fainted (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot") and if they did not get vaccinated and later developed an HPV infection that could lead to health problems (1 item; possible range = 1–4; response scale ranged from "not at all" to "a lot"). We coded all continuous variables so that higher values indicated greater levels of that construct.
Data Analysis
We used logistic regression models to first identify bivariate correlates of HPV vaccine initiation. We entered variables with P < .1 in bivariate analyses into a multivariate logistic regression model.
We constructed 2 multivariate models: (1) 1 that included whether participants had ever received a health care provider recommendation to get the HPV vaccine, and (2) 1 that excluded provider recommendation. We constructed the latter model because HPV vaccination without a provider recommendation is uncommon among males, and provider recommendation might depend on health care access and use. This approach is consistent with previous HPV vaccination analyses.
Among unvaccinated participants, we used paired t tests to compare willingness to get the HPV vaccine if the vaccine were free and if it cost $400 out of pocket. We analyzed data using SPSS version 19.0 (IBM Corp, Armonk, NY), and all statistical tests were 2-tailed with a critical α of 0.05.
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