br Human papillomavirus HPV and cervical
2.3. Human papillomavirus (HPV) and cervical cancer
In the United States, women of color are more likely to develop cervical cancer and to be diagnosed with a later stage disease compared with white women (Banister et al., 2013). In South Carolina, new cer-vical cancer diagnoses between 1996 and 2013 were about 40% higher among African-American women (11.8 cases per 100,000) compared to white women (8.4 cases per 100,000) (SCDHEC, 2016). Moreover, the cervical cancer Vorinostat (SAHA, MK0683) from 1996 to 2014 was more than two times higher among African-American women (5.1 deaths per 100,000) compared to white women (2.2 deaths per 100,000) (SCDHEC, 2016). These disparities may be exacerbated in rural areas where lower SEP creates barriers to HPV vaccination uptake and cervical cancer screening (Keating et al., 2008). Marginalized populations, including women of color, uninsured and underinsured individuals, and im-migrants face increased risks for HPV infection and HPV-related cancers compared to their white counterparts (De and Budhwani, 2017; Burdette et al., 2017; Banister et al., 2013; Bond et al., 2016).
A growing literature has investigated racial and ethnic disparities in HPV vaccination and cervical cancer screening among African-American and Hispanic populations (e.g., Bellinger et al., 2015; Bellinger et al., 2015; Luque et al., 2012; Maness et al., 2016). Through an intersectional approach, Agenor et al. (2014) found that sex of sexual partners, race/ethnicity and other socioeconomic factors im-pacted cervical cancer screening disparities. Studies show that race/ ethnicity, culture, and geography intersect with health care access, age, and SEP to determine HPV vaccination uptake and cervical cancer screening behaviors (Bellinger et al., 2013, 2015). Scholars argue in favor of a new culture-centered approach to studying and addressing health disparities that incorporates various components of social in-equality (Bellinger et al., 2013; Galbraith et al., 2016). A culture-cen-tered theoretical approach interrogates the dominant communicative processes that marginalize subaltern communities based on race/eth-nicity, SEP, and gender (Dutta, 2015b). In this framework, culture is defined as the local context where the experiences and meanings of health and illness are negotiated and co-constructed based on shared practices, values, and norms (Dutta, 2014, 2015a).
Galbraith et al. (2016) suggested that in order to develop eﬀective interventions, future research should incorporate culture-centered theories, such as the reproductive justice framework, to move beyond health behavior change theories focused on attitudes and awareness. For example, in one integrative review of factors associated with HPV vaccine acceptability among African-American and Hispanics in the U.S., there were parental concerns that HPV vaccination could lead to adolescent sexual activity combined with an attitude of low perceived risk of HPV infection among their daughters (Galbraith et al., 2016). A focus group study in Colorado reported that Hispanic parents with Social Science & Medicine 232 (2019) 289–297
daughters who had not initiated the HPV vaccine believed that HPV vaccination might encourage premarital sex, which was considered sinful because of Christian religious beliefs. However, the study also noted that lack of eﬀective communication from health care providers to Hispanic parents about the need to complete the 3-dose series and education about the vaccine was a barrier to both completion and in-itiation (Albright et al., 2017). In another study with Mexican im-migrant women in Georgia using cultural consensus analysis, percep-tions of risk related to sexual behaviors and HPV as causative factors for cervical cancer were ranked higher than genetic or behavioral factors (Luque et al., 2015). Health communication and social marketing campaigns that incorporate the voices of the target audience throughout development and implementation of health education on HPV and cervical cancer provide increased acceptability and uptake of health behaviors (Cates and Coyne-Beasley, 2015; Dempsey and Zimet, 2015).