Regional variation in HPV Knowledge and Awareness among American Indians and Alaska Natives: an analysis of the Health Information National Trends Survey, 2011-2020.

Abstract

American Indian and Alaskan Native (AIAN) people experience a disproportionately high incidence of HPV-related cancers and mortality, and these rates vary across geographic regions. To address the unexplained regional differences among AIAN people, we describe regional variations and socio-demographic correlates of HPV-related knowledge and HPV vaccination awareness indicators. A cross-sectional study was implemented with data for 866 AIAN respondents pooled from eight cycles of the Health Information National Trends Survey (HINTS). We used chi-square tests to determine if there were regional differences in the indicators and then used multivariable, modified Poisson regression to explore associations between socio-demographic characteristics and HPV-related knowledge and vaccination awareness measures. Of the 13 indicators, just one demonstrated regional variation. However, we observed a high level of uncertainty regarding HPV and HPV-vaccine-related knowledge and experience. We also observed that women were more likely than men to have heard of HPV (aPR 1.29, 95%CI:1.03-1.63), the HPV vaccine (aPR 1.59, 95%CI: 1.15-2.22), and to have discussed it with their providers (aPR 3.69, 95%CI: 1.47-9.28). There were also differences by age, education, and insurance status. High levels of uncertainty and lack of regional variation in indicators suggest that there may be missed opportunities across Indian Country for engagement between healthcare providers and AIAN in HPV-related conversations. Efforts towards improving HPV knowledge and vaccination should target all at-risk sexes (and genders), age groups, and education levels. Moreover, AIAN-serving healthcare providers should be empowered with sufficient understanding, so they are prepared for discussions with at-risk patients.