HPV VACCINE COVERAGE IN APPALACHIAN VS. NON- APPALACHIAN OHIO

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1 HPV VACCINE COVERAGE IN APPALACHIAN VS. NON- APPALACHIAN OHIO NEWSPAPERS JANICE RAUP-KRIEGER, PHD The Ohio State University

2 Newspapers as a Source of Health Information in Appalachia Media as a source of health information Underserved populations Importance of newspapers in Appalachia The knowledge gap hypothesis Lack of media coverage of health disparities (Amzel & Ghosh, 2007)

3 Cervical Cancer in Appalachia Ohio Appalachia region considered medically underserved. Elevated cervical cancer rates (The Ohio Cancer Incidence Surveillance System, 2007). Incidence rates 24.4% greater. Mortality rates 41.7% greater.

4 HPV Vaccine HPV is the leading cause of cervical cancer (Munoz & Bosch, 1996). In 2006, the FDA approved the first vaccine that prevents the strains of HPV that cause cervical cancer.

5 Newspaper Coverage of the HPV Vaccine Pre-approval Articles did not link HPV to cervical cancer (Anhang, et al., 2004) Lack information about the role of the vaccine in preventing cervical cancer (Calloway et al., 2006) Post-approval Online articles mention link between HPV & cervical cancer, and over half provide information on dosing and efficacy. Information not included: vaccine does not protect against all types of HPV, side effects, and financial assistance for un- or under-insured.

6 What should newspaper articles include? Intentions and behaviors are often determined by feelings of threat and efficacy (Witte, 1992) Threat Incidence and mortality related to cervical cancer Behavioral risk factors for cervical cancer Efficacy Response efficacy (e.g., can prevent cervical cancer) Self-efficacy (e.g., coverage for underinsured)

7 Extended Parallel Process Model Danger Control Process Message Components Self-efficacy Response-efficacy Susceptibility Severity Perceived Efficacy Perceived Threat FEAR Protection Motivation Defense Motivation Adaptive Changes Maladaptive Changes No threat perceived No response Fear Control Process From Witte (1992).

8 RQ: What types of threat and efficacy information did Ohio newspapers provide about the HPV vaccine?

9 Cultural Considerations HPV is a sexually transmitted disease Core role of faith, religion, and morality in Appalachian culture (Simpson & King, 1999) RQ: Did coverage of the HPV vaccine differ in Appalachia Ohio newspapers and non-appalachia Ohio newspapers?

10 Method 121 articles published in Ohio newspapers between January 1, 2006 to December 31, Cervical cancer, cervical cancer vaccine, HPV, HPV vaccine Coding conducted by members of research team Intercoder agreement ranged from.70 to 1.00

11 Severity 31% included mortality rates More common in non-appalachian articles (47% vs. 2%) Focused on global and U.S. rates (no Ohio or Appalachia data) 48% mention that HPV is an STI. More common in non-appalachian articles (65% vs. 17%) 56% mention that HPV causes cervical cancer More common in non-appalachian articles (75% vs. 21%)

12 Susceptibility 16% included incidence rates More common in non-appalachian articles (23% vs. 2%) Focused on global and U.S. rates (no Ohio or Appalachia data) 21% mentioned risk factors for cervical cancer More common in non-appalachian articles (25% vs. 12%, p=.06) Failure to be screened within guidelines (12%), early sexual activity (5%), and smoking (3%)

13 Response Efficacy 51% mention the vaccine is intended for girls. More common in non-appalachian articles (70% vs. 17%) 45 % mention the approved age for vaccination More common in non-appalachian articles (61% vs. 14%) 33% mention vaccine should be administered prior to initiation of sexual activity More common in non-appalachian articles (46% vs. 10%)

14 Response efficacy 36% mention the vaccine can prevent genital warts. More common in non-appalachian articles (48% vs. 12%) 58% mention vaccine can prevent cervical cancer. More common in non-appalachian articles (80% vs. 17%)

15 Self-efficacy 26% mention cost of the vaccine. More common in non-appalachian articles (39% vs. 2%) 15% mention coverage for the un- or under-insured. More common in non-appalachian articles (22% vs. 2%) 7% mention where to obtain the shot locally. 12% mention where to obtain additional information.

16 Concerns about the HPV Vaccine Concerns mentioned in 33% of the articles: Mentioned only in non-appalachian articles (54% vs. 0%) Key concerns included: Promoting promiscuity (21%) Increased sexual activity prior to marriage (7%) Mandatory vaccination (17%) Parental rights (15%) Cost (13%)

17 What did we learn? Newspaper articles lacking information on threat and efficacy The importance of addressing socio-cultural concerns in health behavior change The role of gate keepers Differences in newspaper coverage may serve to reinforce cervical cancer disparities The need to document potential sources of knowledge gaps The need for intervention

18 Acknowledgements Mira Katz, Dana Eisenberg, Sarah Stargel, Parul Jain, Melanie Sarge, Angela Dossett, Jennifer Moreland National Cancer Institute Grants: P50CA and K07CA (M. Katz)

19 Thank you!