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Book Knowledge and Beliefs Regarding HPV and Cervical Cancer Among Lakota Women Living on the Pine Ridge Reservation and Cultural Practices Most Predictive of Cervical Cancer Preventive Measures

Download or read book Knowledge and Beliefs Regarding HPV and Cervical Cancer Among Lakota Women Living on the Pine Ridge Reservation and Cultural Practices Most Predictive of Cervical Cancer Preventive Measures written by Dawn M. Bowker and published by . This book was released on 2017 with total page 268 pages. Available in PDF, EPUB and Kindle. Book excerpt: Human Papilloma Virus (HPV) is the most common sexually transmitted infection and is responsible for more than 90% of cervical cancers. Lakota women in the Northern Plains have a higher incidence of HPV infection not preventable by the HPV vaccine demonstrating the need for continued preventive measures including Pap smear screening and condom use. The purpose of this quantitative, cross-sectional, descriptive, correlational study was to examine the relationships between (a) what Lakota women know and believe about HPV and cervical cancer, (b) Lakota cultural practices, and (c) cervical cancer preventive measures. The HPV and cervical cancer knowledge and beliefs and cultural practices most predictive preventive measures were assessed using the Lakota women and cervical cancer instrument (Bowker, 2017). The instrument was developed, in part, with the assistance of Lakota tribal members reviewed the instrument for cultural validity. Reliability and internal consistency of the instrument met the criteria with Cronbach's alpha (>.70). The Lakota Women and Cervical Cancer instrument had an overall reliability of .743. The combined cultural practice questions (n=11) had a reliability with Cronbach's alpha of .832; the ceremony questions (n=5) had a reliability of .719 and reliability of the language questions (n=4) was .846. Participants include 89 Lakota women age 18 to 25 years who live on the Pine Ridge Reservation. Univariate, bivariate, and multivariate analysis were used to examine what Lakota women know and understand to be true about HPV and cervical cancer and their participation in Lakota practices, namely language and ceremony. The study revealed inaccuracies with the Lakota women's knowledge and beliefs related to HPV and cervical cancer and preventive measures and that cervical cancer knowledge and beliefs (p=.001) was a stronger predictor of preventive measures than HPV knowledge and beliefs (p=.125). In regards to traditional Lakota ceremony, the research identified three significant findings, the Hunkapi and HPV vaccine receipt (p=.03), participation in the Isnati and condom use (p=.01), and Lakota language spoken in home and getting recommended Pap smears (p=.00).

Book Human Papillomavirus and Cervical Cancer

Download or read book Human Papillomavirus and Cervical Cancer written by Andrea Jimmerson and published by . This book was released on 2018 with total page 190 pages. Available in PDF, EPUB and Kindle. Book excerpt: The human papillomavirus and cervical cancer are significant health issues for the women on Pine Ridge Reservation in South Dakota. The mortality rate of Lakota women dying from cervical cancer is significantly greater than the rest of the United States, with strands of the human papillomavirus only identified on Pine Ridge. One reason for this significant difference is the decreased participation in Lakota ceremonies, which hold deep meaning and moral teachings but were illegal for decades, causing a loss in protective cultural measures. Several studies completed on Pine Ridge specific to the human papillomavirus and cervical cancer found adolescents, parents, and health care providers desire an education program addressing human papillomavirus and cervical cancer specific to the Lakota’s cultural needs. This project created a program outline based on Pender’s Health Promotion Model, which focuses on health promoting behaviors from both the Western medical perspective and Lakota beliefs. With the project’s completion, the number of women on Pine Ridge with HPV could decrease significantly, and the relationships built among participants, cultural experts, the program developer, and the community, could create an impact beyond the content of the program.

Book Models  Measurement  and Metrology Extending the SI

Download or read book Models Measurement and Metrology Extending the SI written by William P. Fisher Jr., Leslie Pendrill and published by Walter de Gruyter GmbH & Co KG. This book was released on 2024-05-07 with total page 389 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Assessing Knowledge  Attitudes and Beliefs about Cervical Cancer  Human Papillomavirus and HPV Vaccine Among Shipibo Konibo Women of Peru

Download or read book Assessing Knowledge Attitudes and Beliefs about Cervical Cancer Human Papillomavirus and HPV Vaccine Among Shipibo Konibo Women of Peru written by Elizabeth Clark and published by . This book was released on 2014 with total page 31 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Shipibo-Konibo ethnic group is one of the largest indigenous populations in the Peruvian Amazon. Due to economic, cultural, and geographical barriers, Shipibo-Konibo women are less likely to access cervical cancer screening and therefore are at higher risk for cervical cancer mortality. To learn how cervical cancer is understood from the perspective of Shipibo-Konibo women and to see what factors influence a woman's decision to vaccinate or not vaccinate her daughter. Thirty in-depth, semi-structured interviews were conducted with Shipibo-Konibo women from a variety of different perspectives: urban, rural, with daughters who had and had not received the vaccine. Interviews were transcribed, coded and analyzed for themes. Without exception, all women in the study perceived cervical cancer as a dangerous disease and were in favor of their daughter receiving a vaccine that could protect them from cervical cancer. The main difference was: in the rural community, women had more medically accurate beliefs about the etiology of cervical cancer. In both communities, shame and poverty were identified as barriers to seeking preventive care and treatment for cervical cancer. These results are both encouraging, as the universal acceptability and perceived need of the HPV vaccine is high, and helpful in identifying areas of growth for future health education programs, especially surrounding risk factors for cervical cancer.

Book Cultural Beliefs Influencing Cervical Cancer Screening Behaviors Among Asian Indians in the U S

Download or read book Cultural Beliefs Influencing Cervical Cancer Screening Behaviors Among Asian Indians in the U S written by Regina Jillapalli and published by . This book was released on 2019 with total page 380 pages. Available in PDF, EPUB and Kindle. Book excerpt: While Asian Indians (AIs) are among the top three fastest-growing Asian minority populations in the United States, they fall short of the Healthy People 2020 cervical cancer screening target goals, with rates averaging approximately 70% compared to 83% among non-Hispanic Whites (American Cancer Society, 2016). Also, most cervical cancers can be prevented by the HPV vaccine. Therefore, purpose of the study was to explore the influence of cultural beliefs on cervical cancer screening (known colloquially as a pap smear) behaviors and HPV vaccinations among AIs. A qualitative descriptive ethnographic design was used to explore the cultural impact on cervical cancer screening behaviors among Asian Indian women (AIW). A purposive sample of 15 AIW aged 21 to 49 were interviewed. Data analysis revealed five themes that influenced cervical cancer screenings (pap smears) among these women, namely locus of control, concept of health, "no sex before marriage," awareness, and body image. A strong internal locus of control, a sense of being healthy, awareness (i.e., knowledge about cervical cancer and its prevention), and a positive body image facilitated cervical cancer screening behaviors. An external locus of control, belief that health is not a priority, "no sex before marriage," and a low body image became barriers to cervical cancer screening behavior. Despite AIWs' cultural beliefs, being employed, having health insurance, and receiving recommendations from their providers each had a positive influence on cervical cancer screening. Infections from the human papilloma virus (HPV) is a major cause of cervical cancers. Awareness about human papillomavirus (HPV) and recommendation from providers increased the likelihood of receiving and/or giving permission for their children, both boys and girls, to get the HPV vaccine. Lack of or limited knowledge about HPV and the concept of "no sex before marriage" were barriers to receiving and/or giving permission for their children to receive HPV vaccinations. This study's findings revealed current issues with cancer prevention educational programs. The findings also inform future research regarding the development of culturally-sensitive educational interventions to address cervical cancer screening behaviors among AIW

Book HPV Knowledge and Cervical Cancer Prevention in Women

Download or read book HPV Knowledge and Cervical Cancer Prevention in Women written by Kymberlee A. Montgomery and published by . This book was released on 2009 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Women s Knowledge of HPV and Their Perceptions of Physician Educational Efforts Regarding HPV and Cervical Cancer

Download or read book Women s Knowledge of HPV and Their Perceptions of Physician Educational Efforts Regarding HPV and Cervical Cancer written by Megan A. Cermak and published by . This book was released on 2009 with total page 98 pages. Available in PDF, EPUB and Kindle. Book excerpt: Human papillomavirus (HPV) was one of the most common sexually transmitted infections (STIs) in women of child-bearing age in the U.S. It was estimated that nearly three out of every four Americans between the ages of 15 and 49 would be infected with genital HPV over the course of their lifetime. Human papillomavirus was present in almost 100% of cervical cancers. Despite this growing epidemic, there was little knowledge and awareness of HPV among the general public. HPV was most often detected in abnormal Pap test results. However women undergoing Pap tests lacked basic knowledge about testing, abnormal results, and follow-up procedures. The purpose of this study was to determine women's knowledge of HPV and their perceptions of the education they received from their physician regarding the purpose of a Pap test, explanation of Pap test results, and how effectively the physician explained associations between HPV and cell abnormalities, cervical cancer, risk factors, and preventive measures. This study was needed due to the increased number of Human Papillomavirus infections and the lack of knowledge regarding testing, treatment, risk factors, and preventive measures. This study focused on the educational efforts of physicians and the knowledge levels of patients. This study was different from other studies in that it scored physicians' education efforts as perceived by their patients and measured patients' understanding of such efforts. This study was designed to identify and fill a possible void in the literature regarding HPV and physician education efforts. The results of this study benefited health education professionals and health care professionals by targeting potential gaps in education for future health promotion efforts. Information from this study could be used to help increase and promote dialogue between physicians and their patients. A survey containing 33 questions was completed by 109 women at a social service agency in the summer of 2008. Based on the data collected in this study it seems that physicians were not routinely providing information about HPV to their female patients. Women reported their physicians were not educating them on testing for HPV and cervical cancer, risk factors associated with contracting HPV, and preventive measures associated with HPV. Women who had younger physicians were more likely to have a physician who discussed these topics with them than women who had older physicians. Single women also reported more discussion with their physician on these topics than married women. Such findings should be shared with physicians, all sexually active women, and used by health educators to develop more effective interventions aimed at HPV prevention.

Book The Social Context of Cervical Cancer Knowledge and Prevention Among Haitian Immigrant Women

Download or read book The Social Context of Cervical Cancer Knowledge and Prevention Among Haitian Immigrant Women written by Janelle Marie Menard and published by . This book was released on 2008 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book The Association Between Biculturalism  Knowledge of Cervical Cancer Screening  Religiosity  and Perceived Barriers to Cervical Cancer Screening Among Churchgoing Hispanic Women

Download or read book The Association Between Biculturalism Knowledge of Cervical Cancer Screening Religiosity and Perceived Barriers to Cervical Cancer Screening Among Churchgoing Hispanic Women written by and published by . This book was released on 2014 with total page 35 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, racial/ethnic disparities in cervical cancer preventive practices exist. Hispanics in the U.S. are the largest and most rapidly growing demographic group, with a population increase four times higher than the general population. Cervical cancer screening rates among the Hispanic women population remain low. Lack of access to the Papanicolaou test (Pap smear test) and follow-up treatment are key factors that help explain the high rates of cervical cancer among Hispanic women compared to those of other races or ethnicities. Current research shows that cervical cancer screening practices are influenced by multiple factors such as cultural beliefs, religiosity, and perceived barriers to cervical cancer screening. The purpose of this cross-sectional study is to examine the association between biculturalism, knowledge of cervical cancer screening, religiosity (perceived religiosity to health outcomes and church cohesion) and perceived barriers to cervical cancer screening among churchgoing Hispanic women who are participants in the Fe en Acción /Faith in Action study in San Diego, CA (n=312). The Health Belief Model was used as the theoretical framework to identify modifying factors that influence cervical cancer screening practices. Surveys were administered and information was gathered about their Hispanic women's biculturalism, knowledge about cervical cancer prevention and religiosity (perceived religious influence on health outcomes and church cohesion) and perceived barriers to cervical cancer screening. Linear regression models were used to determine whether there were significant differences among variables. Results from the linear regressions indicated a significant association between knowledge of cervical cancer prevention and the number of perceived barriers to cervical cancer screening. Additionally, one dimension of religiosity "illness as punishment for sin" was significantly associated with the number of perceived barriers to cervical cancer screening.

Book Assessment of College Women s Knowledge  Perceptions and Preventive Behaviors Regarding Human Papillomavirus and Cervical Cancer

Download or read book Assessment of College Women s Knowledge Perceptions and Preventive Behaviors Regarding Human Papillomavirus and Cervical Cancer written by Kimberly Ingledue and published by . This book was released on 2000 with total page 142 pages. Available in PDF, EPUB and Kindle. Book excerpt: Due to an increase in Human Papillomavirus (HPV) and cervical cancer, health educators were challenged with the task of increasing knowledge, perceived threat and preventive behaviors among college women. It had been implied that cervical cancer was causally related to infection with HPV. During the 1990's HPV infection had become an epidemic due in part to an increase in the number of sexual partners and a decrease in age at initiation of sexual activity. This trend indicated a rising wave of cancer of the cervix, and hence the critical importance of mass cancer screening. Misconceptions about susceptibility, severity and a lack of knowledge increased risk of cervical cancer. The purpose of this study was to assess the relationship among college women's knowledge, perceptions and behaviors regarding human papillomavirus (HPV) and cervical cancer. This study surveyed 430 college women ages 18 through 30 from the University of Cincinnati. Significant findings were determined from this study. The first was that as knowledge increased, perceived severity decreased. This indicated that women who were more informed about cervical cancer believed that cervical cancer was easily cured if found in the early stages. The second was that as the number of sexual partners increased, perceived susceptibility increased; therefore, engaging in risky behavior made women believe they were more susceptible to HPV/cervical cancer. Another significant finding was that as knowledge, perceived susceptibility and perceived severity increased, the percentage of women obtaining a yearly Pap test increased. The results of this study contributed to greater awareness and prevention of HPV /cervical cancer, and established targeted areas for future health promotion and education efforts. Health education professionals have the opportunity to impact HPV/cervical cancer rates by increasing the amount and quality of education and by continuing to participate in research on this important issue.

Book Saving Lives

    Book Details:
  • Author : Salome Kidele Kapella
  • Publisher :
  • Release : 2006
  • ISBN :
  • Pages : 144 pages

Download or read book Saving Lives written by Salome Kidele Kapella and published by . This book was released on 2006 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book EHEALTH LITERACY  MEDICAL MISTRUST AND CERVICAL CANCER PREVENTION KNOWLEDGE  BELIEFS AND BEHAVIORS AMONG AFRICAN AMERICAN WOMEN

Download or read book EHEALTH LITERACY MEDICAL MISTRUST AND CERVICAL CANCER PREVENTION KNOWLEDGE BELIEFS AND BEHAVIORS AMONG AFRICAN AMERICAN WOMEN written by Angela Jamila Johnson and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cervical cancer (CC) is a major global public health problem and is the third most common cancer among women worldwide. In the United States, African Americans have the second highest incidence rates of CC, due to having the highest rates of Human papillomavirus (HPV) acquisition, lower likelihood of engaging in routine pap smears, and persistently low vaccine uptake. Prevention and early intervention through HPV vaccination and pap smears, respectively, are of paramount importance to reduce racial cancer disparities. Due to cultural mistrust of the health care system, many African Americans resort to non-traditional forms of health information. Considering the combined contributions of medical mistrust, increased reliance on electronic-based health information and the disproportionate burden of HPV susceptibility among young-adult African American women, this population warrants further attention in research informed by culturally relevant frameworks. The Health Literacy Skills Framework (HLSF) considers external factors (i.e., culture, media, and family) that impact the synthesis of health information. Black Feminist Thought scholarship complements the HLSF by providing a frame through which to examine how Black women's oppressive intersecting identities (i.e., race, gender, and class) shaped their perspectives about women's health and added needed context for assessing Black women's health literacy. This thesis sought to examine the relationship between eHealth literacy, medical mistrust, and CC preventive behaviors among African American college women. More specifically, this study explored relationships between the CC preventive behavior among African American college women and the following potential contributors to this behavior: 1) perceived eHealth literacy 2) CC knowledge/beliefs and 3) the Black female collective unique health experience related to provider recommendations regarding CC prevention, medical mistrust, and gendered-racial microaggressions. A total of 146 African American women completed an online survey that assessed for self-perceived eHealth literacy, medical mistrust, gendered-racial microaggressions, and CC-related prevention behaviors, knowledge, and beliefs. Most participants had received at least one-dose of the HPV vaccine and all age-eligible participants had received a pap-smear once in their lifetime. A vast majority of participants considered themselves to have high eHealth literacy but did not demonstrate adequate CC knowledge. Additionally perceived eHealth literacy did predict CC knowledge and CC prevention related beliefs. Specifically, participants who were confident in their ability to understand online health information were more likely to have greater CC knowledge and more positive beliefs toward the HPV vaccine and pap-smears. A qualitative analysis of CC prevention behaviors among study participants yielded six overarching themes including: 1) Strong Black Woman, 2) Oppression, 3) Medical Mistreatment/Mistrust, 4) Health Literacy, 5) Medical Autonomy, and 6) Cultural Health Factors. Clinical implications of these findings and relevance to future research are discussed.

Book HPV and Cervical Cancer Knowledge  Belief Systems  and Screening Practices of Undergraduate Women at the University of Texas at El Paso

Download or read book HPV and Cervical Cancer Knowledge Belief Systems and Screening Practices of Undergraduate Women at the University of Texas at El Paso written by Kylene Kilgore and published by . This book was released on 2004 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Book Factors Associated with Acceptance of Human Papillomavirus Vaccine  a Study of Spanish Information Seekers

Download or read book Factors Associated with Acceptance of Human Papillomavirus Vaccine a Study of Spanish Information Seekers written by Julie Kornfeld and published by . This book was released on 2009 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Cervical cancer is the second most common malignancy worldwide. Infection with HPV is a necessary cause of cervical. Hispanic women in the U.S. experience significantly higher rates of invasive disease than non-Hispanic Whites. In this population, HPV vaccines hold significant potential to eliminate further disparities in cervical cancer morbidity and mortality. The purpose of this study was to examine factors associated with Human Papillomavirus (HPV) vaccine acceptability among a national sample of Spanish speaking callers to the National Cancer Institute2s (NCI) Cancer Information Service (CIS). Specifically this research aimed to identify the sociodemographic, sociocultural and attitudinal determinants of HPV vaccine acceptability. This research involved a cross-sectional study with phone-based interviews conducted in Spanish (n = 836). All female Spanish callers to the CIS were asked to respond to a three-part questionnaire that included items relating to ethnic identity and acculturation, knowledge of cervical cancer and related risk factors, and HPV vaccine acceptability. Descriptive, univariate and multivariate logistic regression were used to characterize the study population and to determine the effect of each of the demographic/sociocultural variables on vaccine acceptance. Independent predictors of HPV vaccine acceptability were determined using multivariate linear regression models. Results showed that HPV vaccine acceptance was high among this group of Hispanic women (78%) and that attitudes about vaccines in general and the HPV vaccine specifically were positive. Factors associated with vaccine acceptance included physician recommendation, awareness and accurate knowledge about HPV, and speaking only or mostly Spanish. Other important predictors included influence of peers, positive attitudes about vaccines in general, higher education and being a mother of a female adolescent. The primary reason cited by those who did not favor vaccination was concern over vaccine safety. This research was the first study looking at vaccine acceptability in a large, national sample of Hispanic women. HPV vaccination can lead to important public health benefits for Hispanic women. Targeted educational interventions must take into account the important sociocultural and attitudinal influences on the decision to vaccinate, such as those identified in the present study. Future educational efforts must involve the physician and take into the account the cultural context of attitudes and beliefs regarding vaccine safety and disease susceptibility. Further studies elucidating the interplay between culture specific beliefs and practices regarding vaccination and the decision to participate in HPV vaccination are needed.

Book College Women s Attitudes  Behaviors  and Beliefs Regarding the HPV Vaccine

Download or read book College Women s Attitudes Behaviors and Beliefs Regarding the HPV Vaccine written by Rosemary M. Caron and published by . This book was released on 2008 with total page 25 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Cervical cancer is primarily caused by the human papillomavirus (HPV) and is the second most common cause of cancer-related mortality among women. Purpose: College women may be at risk for contracting HPV based on their sexual behavior. An exploratory analysis was conducted, following the release of the HPV vaccine, Gardasil[R], to (1) determine awareness of HPV and Gardasil[R], (2) assess attitudes, behaviors, and beliefs about the HPV vaccine, and (3) identify information sources that college women are accessing. Methods: A cross-sectional study of college women (n=293) enrolled in a Northeastern university voluntarily completed a self-administered questionnaire regarding knowledge, attitudes, behaviors, and beliefs about HPV and the HPV vaccine. Statistical analyses include descriptive statistics, Pearson's correlations, and paired sample t-tests. Results: Sexually active respondents would recommend the HPV vaccine to others and disagree that HPV vaccination would encourage risky sexual behavior. Yet, "need more information" is the predominant reason respondents would not get the HPV vaccine if it were offered for free. Discussion: Correlations are identified on how self-reported knowledge influenced attitudes, behaviors, and beliefs regarding the HPV vaccine. Translation to Health Education Practice: These findings should assist health educators in developing integrated public health education efforts for HPV vaccination that are targeted towards this at-risk population. (Contains 2 tables and 1 note.).

Book A Preliminary Study of Mothers  Social Support  Spirituality  Knowledge  and Acceptability of the HPV Vaccine for Daughters

Download or read book A Preliminary Study of Mothers Social Support Spirituality Knowledge and Acceptability of the HPV Vaccine for Daughters written by Kimberly L. J. Price and published by . This book was released on 2013 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Human Papillomavirus (HPV) vaccine has the potential to significantly reduce the disease burden of cervical cancer, which disproportionately affects vulnerable and underserved populations. Although social support and spirituality have been examined with how cancer patients cope with disease, little is known about how they influence preventive behaviors, such as HPV vaccine acceptability. The purpose of this study was to fill gaps in the research about the relationships between social support, spirituality (both behaviors and beliefs), and cervical cancer prevention through HPV vaccine acceptability. Based on a review of the literature and theoretical models (Health Belief Model and Theory of Reasoned Action), a three-page, 64-item survey instrument was developed to measure a mother's spiritual and social connections, and how they relate to her knowledge, attitudes, behaviors/experiences, and behavioral intentions toward the HPV vaccine for her daughter. Mothers with 9 to 18 year old daughters were recruited from the Greater Cincinnati area at community health clinics and neighborhood events. One hundred six women completed the written survey and responses were analyzed. Overall, the mothers who participated in this study were knowledgeable regarding HPV and the HPV vaccine, had favorable attitudes toward the HPV vaccine and vaccines in general and were inclined to talk with daughters about the HPV vaccine. Most aspects of spirituality and social support were not found to be associated with mothers' knowledge, attitudes, and behaviors/behavioral intentions, however, results in this preliminary study showed that mothers with stronger spiritual beliefs were more likely to have talked to their daughters about the HPV vaccine. Results in this study also showed that mothers with more knowledge of HPV and the HPV vaccine had more favorable attitudes toward the HPV vaccine. Mothers with more knowledge of HPV had a greater intention to talk to daughter about the HPV vaccine and to have daughter vaccinated, and mothers with more knowledge about the HPV vaccine were more likely to have already talked to their daughters about the HPV vaccine, had a greater intention to talk to daughter about the vaccine, and had a greater intention to have daughter vaccinated. Mothers had greater intentions to talk to daughters about the HPV vaccine if they had a more favorable attitude toward the HPV vaccine, and mothers with lower annual household incomes showed a more favorable attitude toward the HPV vaccine, specifically in agreeing that the HPV vaccine should be a routine childhood immunization. Race, age of daughter, and doctor's recommendation were also associated with mothers' behaviors or behavioral intentions. The findings in this preliminary study supported the concept of the knowledge-attitudes-behavior continuum, and indicated that further study on the impact of spiritual beliefs (apart from practices/religiosity), social support networks' and physicians' influence, and race/ethnicity on HPV vaccine acceptability is warranted. Understanding the variables that may influence HPV vaccine acceptability is crucial to eliminating health disparities in women's reproductive health.