Latinos are the ethnic group most likely to develop cancers linked to the human papillomavirus and also among the least likely to be immunized against the infection.

Hopes are high that a new five-year study led by researchers at the Fielding School of Public Health and Jonsson Comprehensive Cancer Center at UCLA will identify the best methods for increasing the rate of vaccination against the human papillomavirus (HPV) among Latino teen boys and girls. The study is funded by a $6.6 million award from the Patient-Centered Outcomes Research Institute.

HPV is a sexually transmitted disease that has been linked to several forms of cancer including most cervical cancers, cancers of the vagina, anus, penis and rectum and cancers at the back of the throat.

While vaccines to prevent many strains of HPV were introduced in the U.S. more than ten years ago, vaccination rates among U.S. teens, especially low-income and minority groups, remain low, said Roshan Bastani, the study’s lead researcher and a professor at the UCLA Fielding School of Public Health.

Cervical cancer was diagnosed in about ten in 100,000 Latinas compared with about eight in 100,000 women of all races in 2014, according to the most recent data on the disease from the U.S. Centers for Disease Control and Prevention. Latino men have a rate of cancer of the penis that is 1.3 per 100,000 men, compared to 0.7 per 100,000 men of all races.

The UCLA researchers are testing methods of increasing rates of HPV vaccination at a network of health clinics in the Los Angeles area, Northeast Valley Health Corporation, serving a largely Latino population.

At the clinics, located in the San Fernando and Santa Clarita valleys, ninety percent of children age three have received all their childhood vaccines, but only about 35 percent of teens have received the full course of the HPV vaccine. The vaccination is administered in two or three doses (depending on a patient’s age), each delivered six months apart.

Rates of HPV vaccination at the clinics —particularly the subsequent doses needed to complete the HPV vaccine series – are low among teens for a number of reasons, including reluctance among some providers to discuss sexual health with patients and their parents and the fact that it is an adolescent vaccine.

“Parents are often less informed about the need for adolescent vaccines than childhood ones, and unlike most childhood vaccines, it’s not required for school attendance,” said Bastani.

“Initiation rates are reasonably good among our population,” said Debra Rosen, Director of Quality and Health Education at the Northeast Valley Health Corporation, “but the subsequent doses are needed to complete the series and…parents aren’t always aware how important this is.”

In addition to the disparities in rates of cancer, women of color including Latinas are also more likely to have more severe cases and higher death rates from the cancer, Bastani said.

Recent state data also shows that cervical cancer rates are substantially higher among Latinos compared to non-Latino whites in Los Angeles.

Researchers will compare two strategies (and a combination of both) for improving HPV vaccine rates:

• Parent reminders: text messages or mailed letters sent to parents of adolescent clinic patients due for a dose of the HPV vaccine.
• Clinic-based strategies including educating clinic providers and staff about the importance of HPV vaccination and tactics for discussing and recommending the vaccine to parents. The clinics will also establish new policies and procedure to highlight the HPV vaccine and make sure it is offered to all eligible patients even if a clinic visit is for a different medical issue.

The study team estimates that about 17,000 teens will be seen for medical care at the clinics participating in the study over the next five years. The researchers will analyze the clinic’s electronic medical records to see if the interventions made a difference in increasing HPV vaccination rates among those patients.

Increasing the rates of HPV vaccination will decrease, but not eliminate, cancers linked to HPV. The vaccine protects against many, but not all, HPV strains. Even women fully vaccinated with the HPV vaccine must be screened for cervical cancer, according to the American Cancer Society.