








































www.companyofscientists.com/index.php/chd  e1  Cancer Health Disparities 

RESEARCH 

HPV Vaccination Strategies in Immigrant 

Dense Communities 
Kimlin Ashinga, Mayra Serranoa, Marisela Garciaa, Katty Nerioa, Alejandro Fernandeza, Margaret Martinezb , 

Rita Singhalc, Andrette Ward b, Aneesah Robinsonb , Karen Tinsley b, Camille Ragind Marcella Nunez-Smithe, 

Rebecca Perkinsf, Gerard Antoineg 

a. Center of Community Alliance for Research and Education, Department of Population  Sciences,

City of Hope National Medical Center, Duarte, CA, United States.
b. ChapCare, 455 W. Montana Street, Pasadena, CA 91103, United States
c. Los Angeles County Department of Public Health,  Office of Women’s Health, 3400 Aerojet

Avenue, Third Floor, El Monte, CA 91731
d. Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111-2497
e. Yale School of Medicine,  P.OBox 208088, IE-61 SHM, New Haven, CT 06520-8088
f. Boston University School of Medicine, 72 East Concord St. Boston, MA 02118

g. Caribbean Medical Providers Practicing Abroad, Kailua, Hawaii, 96734

*Corresponding author: Kimlin Ashing, email: kashing@coh.org

ABSTRACT 
We aimed to identify practices and barriers affecting HPV vaccination (HPVV) within immigrant dense 

communities. Interviews were conducted with multisectoral stakeholders including safety-net clinic 

personnel, parents, and members of the HPVV community advisory council. The results underscored 

poignant issues relevant to immigrant communities at local and national levels: 1) Immigrant inclusive, 

public health and health system interventions to increase awareness of health facilities safe zone for 

immigrant children tied to HPVV campaigns. 2) Clear and strong provider HPVV recommendation 

approaches that are culturally and linguistically responsive. 3) Provider must be aware of his/her own 

biases and attend to the cultural beliefs and practices of parents for a more genuine and effective 

facilitation of vaccination. Providers, in particular, emphasized examining the provider cultural 

continuance relevant to HPVV clinical encounter and provider-patient relationship, as well as ongoing 

provider education and communication for increased HPVV among immigrant providers. At the 

national and local levels, we must ensure health facility safe-zone for immigrant children to obtain 

low/no cost healthcare including HPVV to attain the Healthy People 2020 goals of 85% HPVV. 

KEYWORDS: adolescent HPV vaccination, immigrant health, HPV-related cancer prevention 

Citation: Ashing K et al (2019) HPV Vaccination Strategies in Immigrant Dense Communities. Cancer 

Health Disparities. 4: e1-8. doi:10.9777/chd.2019.1013



 
 
 
 
 

 

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INTRODUCTION 

Oncogenic Human Papillomavirus (HPV) is 

responsible for several cancers including cancers of 

the genitalia and oral cavity. Every year 

approximately 27,000 individuals are affected by 

cancers caused by HPV(8). Low income, ethnic 

minority and immigrant communities suffer unequal 

burden and death due to HPV-related cancers 

(Aragones et al., 2013; Bruno et al., 2014; Kobetz et 

al., 2012). Today we have the HPV vaccine (HPVV) 

that is one of only two cancer prevention vaccines. 

Therefore, it is not surprising that increasing HPV 

vaccination (HPVV), among eligible population aged 

9-26 years, is singled out as “one of the most 

profound opportunities for cancer prevention” in the 

report “Accelerating HPV Vaccine Uptake: A Report 

to the President of the United States.”(2014) 

Improving HPVV rates among all youths is highly 

desirable. Unfortunately, uptake and coverage 

remain unacceptably low. Therefore, increasing 

HPVV in youths who are members of communities 

with elevated risk and burden of HPV infection, and 

HPV-related illnesses and cancers is especially critical 

and urgent.  (Aragones et al., 2013; Bruno et al., 2014; 

Jeudin et al., 2013; Joseph et al., 2014; Kobetz et al., 

2012).  

Immigrant HPV Vulnerability and Missed 

Opportunity for Cancer Prevention: Immigrant 

populations, in particular Latin American and 

Caribbean immigrants, have the highest HPV-related 

cancer burden and death in the U.S.(Jeudin et al., 

2013; Joseph et al., 2014). Among immigrant women, 

HPV-related cervical cancer incidence is 2 times, and 

mortality 3 times greater than the general U.S. 

population.  Further, the mortality rate for Whites at 

2.8 reflects  a 17% decline compared Black and 

Latina immigrants with  a mortality rate of 6.5 that is 

equivalent to a 22% increase (Kobetz et al., 2012; 

Senkomago et al., 2017; Villa, 2012). In general, 

mortality from cervical cancer is declining nationally 

(Smith et al., 2018) and even in the Caribbean 

(Cancer, 2012; Warner et al., 2018), but cervical 

cancer mortality shows increases for immigrant 

women (Schleicher, 2007; Seeff and McKenna, 2003). 

Immigrants’ HPV-related cancer burden is an 

unacceptable yet preventable U.S. health disparity. 

Immigrant communities must be targeted for HPV 

vaccination (HPVV) to prevent cancer and reduce 

mortality disparities. 

However, immigrant communities face unique 

healthcare barriers and challenges. Immigrants tend 

to concentrate in ethnic enclaves and immigrant 

dense neighborhoods with low provider HPVV 

recommendation and delivery (Aragones et al., 2013; 

Bruno et al., 2014). Additionally, immigrants while 

suffering disproportionate disease burden, have low 

HPVV acceptability, and uptake (Ashing et al., 2017; 

Blackman et al., 2013; Cofie et al., 2018; Goss et al., 

2013; Jemal et al., 2013; Joseph et al., 2014),  leaving 

immigrants at persistent, elevated risk for oncogenic 

HPV infections and HPV-related cancers.  

HPVV can prevent cervical, genital and oral cancers 

(Siegel et al., 2015). The U.S. advises HPVV 

improvement by changing clinic and provider 

practice (Senkomago et al., 2017) (Kessels et al., 2012; 

Krantz et al., 2018; Perkins et al., 2012). Providers who 

are predominant in HPV-vulnerable immigrant 

communities ought to be identified. Health 

organizations, and the fields of Public health and 

Behavioral Medicine acknowledges the importance 

of multisectoral engagement including 

patient/community involvement to inform both 

population as well as local community responsive 

healthcare structure and practice (Alcaraz et al., 2017; 

Martin et al., 2016). Immigrant community members 

and parents are valuable sources of data, yet they 



 
 
 
 
 

 

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are often not included in developing health care 

practice. This informative study aims to engage 

multisectoral stakeholders including clinic personnel, 

providers, public health professionals, advocates and 

parents to identify practices and barriers affecting 

HPVV within an immigrant dense community. 

APPROACH AND METHODS 

A discovery science informative research design was 

employed using qualitative methods. Therefore, we 

conducted informative, qualitative research 

employing a semi-structured interview.  This format 

allowed us to exam targeted domains with open 

discussions to capture the relevant narrative of the 

issue(s) of interest.(Jamshed, 2014)  Specifically for 

this study, in-depth interviews were conducted with 

diverse stakeholder participants. The City of Hope 

IRB was submitted and reviewed, and the study was 

approved as exempt status. 

Participants 

As community clinics provide much of the HPVV to 

adolescents in particular low-income and immigrant 

families; for example, over 55% of HPVV in LA 

County adolescents occur at community clinics (Los 

Angeles County Department of Public Health and 

Office of Health Assessment and Epidemiology, 

2011). Thus, clinic personnel were interviewed 

including administrators (e.g., 1 medical director and 

1 CEO), 5 providers (pediatricians (n=2), physician 

assistant, nurse, behavioral health specialist); support 

teams (e.g., scheduler, administrative analyst). 

Additionally, we interviewed14 persons representing 

regional HPVV Community Advisory Boards – public 

health professionals and community advocates 

within county and regional HPVV focused coalitions. 

These interviews were conducted via phone or face-

to-face in their offices by the lead author. 

 In addition, semi-structured interviews and open-

ended questions were conducted with 8 clinic 

parent/patients who were immigrants (5 vaccine 

initiators and 3 non-initiators).  Immigrant 

participants were identified via community 

organization partners. We had a high response rate 

of 80% as 8 of the 10 invited participated. Clinic 

participants were Latina (3 Mexicans; 3 Central 

Americans; and 2 Afro-Caribbeans, English language 

proficient). The Latinas were mostly Spanish 

language preferred; thus, there interviews were 

conducted in Spanish. The patient interviews were 

conducted by well-trained bilingual staff at 

community centers. All interviews lasted about 45 

minutes and copious notes were taken. The notes 

were then organized into a thematic matrix.  

RESULTS 

Clinic-Level 

The clinic-level formative interviews underscored 

community clinic administrative and provider buy-in 

as well as technological capacity to implement and 

evaluate multilevel HPVV improvements. Most 

community clinics, especially those designed as 

Federally Qualifies Health Centers (FQHC) under the 

Affordable Care Act, have in-place electronic medical 

records (EMR) systems in place that can be effectively 

utilized. Coordinated utilization of clinic’s EMR 

system for HPVV improvements was identified by the 

clinical administrators and providers. They 

highlighted that, EMR systems can be used to better 

track HPVV dosage and completion, identify patients 

who are HPVV naivee, and identity patients who are 

schedule for well visits and other adolescent vaccine 

– so that providers can be prompted, both via the 

EMR and on the schedule to recommend the HPVV. 

Clinic administrators and support staff endorsed 

addressing system-level factors such as improving 

clinic vaccination scheduling and diversity inclusive 



 
 
 
 
 

 

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visual and printed displays that is careful not to label 

or stigmatize any particular ethnic or immigrant 

group.  It was recommended that the clinic provide 

more flexible immunization and HPVV appointments, 

including vaccine only appointments; as well as 

displaying the benefits of all adolescent 

immunization. Further, these prominent visual and 

printed displays must be culturally and linguistically 

responsive.  

Community Advisory Board (CAB) 

The HPVV Community Advisory Board (CAB) 

formative interviews focused on healthcare system 

factors that emphasized the community clinic model 

of healthcare for the community, especially youth 

and children. The CAB emphasized that healthcare 

facilities must be safe zones for immigrant families 

and children. The CAB recommended creating a 

vaccine friendly clinic culture by: 1) displaying 

prominent, culturally and linguistically informed 

poster and printed resources highlighting the 

benefits of adolescent vaccine including HPV 

vaccine; 2) having vaccine only appointments and  

giving provider recommendation and reminders so 

that following the initial dose that subsequent 

vaccine completion appointments are made prior to 

patients leaving the clinic; and 3) attending to 

broader social determinants including community 

and neighborhood characteristics and 

socioeconomic status including education, age, 

gender, job status and immigrant experience.  

Additionally, the CAB highlighted parental constraints 

(including concerns about safety and cost, as well as 

time needed for the two or three HPVV within 6-

12months for HPVV completion –depending on age 

at initiation). The CAB also presented parental values 

that inhibit parents from vaccination due to country 

of origin cultural stigma associated with HPVV due to 

the HPV-infection link with sexually transmitted 

diseases (STD), sexual promiscuity that is particularly 

prominent among immigrant populations especially 

from the Latin American region(Joseph et al., 2014; 

Villa, 2012).  

Provider-level 

The formative narrative from the providers also 

revealed concerns about parents’ hesitance due to: 1) 

parental stigma associated with HPV as a STD and 

hence, the HPV vaccine is condoning early sexual 

initiation; 2) parental cultural gender attitude that 

influence practices allowing for positive increases in 

vaccination among boys but hesitance for 

vaccination among their girls. This is evident by data 

showing greater progress in male HPVV (Control 

and Prevention, 2013); 3) parental mistrust of the 

health system that may be especially present in a 

cross cultural provider-patient relationship. The 

providers also identified provider-driven factors that 

can improve HPVV; they advised their provider 

colleagues to de-emphasize provider fragility -- “do 

not take the vaccine rejection personally and 

permanently”.  

These providers emphasized provider responsibility 

such that each new visit is an opportunity to re-

introduce vaccination…“doctors are influential” and 

“persistence pays”. These providers acknowledged 

that providers ought to consider their/provider 

cultural issues… “as providers may themselves be 

immigrants with cultural beliefs and practices that 

may influence their [provider] HPVV 

recommendation and facilitation.  These providers 

believe that these HPVV focused trainings will 

enhance their patient education and communication 

during physical examination visit.  Together with 

using every visit as an opportunity to educate and 

vaccinate, this patient-centered, provider-directed 

approach for building trust and parental adherence 

were noted.   



 
 
 
 
 

 

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The three professional groups including clinic 

administrators, CAB and providers all agreed that 

there are social determinant factors that critically 

influence HPVV uptake among immigrants. These 

social determinants include immigration histories of 

both providers and patients e.g., country of origin. 

These stakeholders identified social status as another 

social determinant. The interviewees, affirmed that 

many recent immigrants in particular those who are 

lower income, educational attainment and job status 

experience both health care cost (i.e., HPVV cost) as 

well as health care access (e.g., HPVV initiation and 

completion) concerns. They also asserted that health 

care access is further hampered by a related social 

determinant– place and stability of residence. These 

interviewees identified that immigrants who are poor 

suffer housing instability. They contended that 

housing instability and insecurity exacerbate health 

care access challenges and make having a place to 

call ones medical home extremely difficult.  

Patient-Level 

Overall, immigrant parents advised that parents are 

not sufficiently aware of the HPVV and where to get 

the vaccine. Our immigrant parents voiced that they 

are, in general, very concerned about where to safely 

access healthcare (health facility safe-zone for 

healthcare delivery) and the cost of health care. Thus, 

the parents recommended: 1) ensure healthcare safe 

zone for all immigrant children; and 2) create 

welcoming health centers by prominent culturally 

and linguistically responsive displays e.g., pictures 

within the clinics. These parents also recommended 

posting clinic specific ads within local ethnic 

newspapers and on local advocacy organizations’ 

websites -- that reflect the immigrant communities. 

The parents advised that these ads should inform 

them where to get the vaccine, lists the benefits of 

the vaccine, and state that the vaccines are covered 

regardless of all youth regardless of immigration 

status.  Among the parents, they agreed that stigma 

is a consideration that may be a more serious 

concern especially among the elite classes of 

immigrants. Only two parents reported stigma as a 

primary barrier. All parents underscored the 

centrality of the provider role as they reported that 

most immigrants and immigrant communities are 

served by immigrant providers. Moreover, they 

acknowledged that in many immigrant communities 

medical providers are held in great esteem and 

prominence in their countries of origin(Esposito and 

Castaneda, 2017).  

However, provider-parent communication 

challenges were revealed. Immigrant parents had 

specific advice for providers regarding improving 

HPVV: 1) Give HPVV recommendation that is strong, 

matter-of-fact and states the greater protection 

benefit for younger girls and boys and that “ it 

[HPVV] is best medicine for 11-12 year olds”. In fact, 4 

of the 5 who vaccinated, revealed that they had 

some concerns i.e., safety-- but the provider 

recommendation prevailed; this was revealed and 

supported in the provider input. 2) Remove the 

words “new vaccine” from their recommendation (as 

commonly done by providers). These parents 

articulated that “new” means “innovation” to 

providers, but “new” means “experimental” within the 

community. Experimental for our parents connotes 

that they and their children are being used without 

full disclosure for medical experiments. They 

confirmed that the provider recommendation of the 

“new vaccine” feeds into parents’ safety and efficacy 

concerns. 3) Schedule subsequent vaccine dose 

appointments at the time of vaccine initiation so the 

parent has the appointments before leaving the 

clinic.  Parents preferred this pre-scheduling that 

served as an education about the vaccines as well as 

it give them sufficient time to plan for this brief 

medical visit. Saturday clinics were highly favored. 



 
 
 
 
 

 

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The parents also indicated that, personal time 

constraints and being able to vaccinate up to age 18 

may contribute to low vaccine uptake especially at 

the younger ages—parent believed that they can 

wait till the teen is older. 

DISCUSSION 

 Immigrant communities are at elevated risk for HPV-

related cancers. Hence, immigrant communities 

ought to be prioritized for HPVV improvements. Our 

results underscored poignant issues relevant to 

immigrant communities that may be relevant no only 

at our local level but at the national level as well. Our 

findings suggest that: 1) Immigrant inclusive, public 

health and health system interventions to increase 

awareness of health facilities safe zone for immigrant 

children tied to HPVV health literacy campaigns 

including where to obtain low/no cost HPVV are 

urgently needed. 2) Clear and strong provider HPVV 

recommendation approaches that are culturally and 

linguistically responsive. 3) Provider must be aware of 

his/her own biases and attend to the cultural beliefs 

and practices of parents for a more genuine and 

effective facilitation of vaccination. The parents and 

providers agreed on the centrality of the provider-

parent relationship and appropriate communication. 

The caring, trustworthy, persistent providers trump 

parental hesitation and results in acceptance and 

vaccination. 

The provider responsibility finding, suggests that 

providers’ cultural persistence and continuance -- 

that is the adherence to cultural beliefs and values, in 

particular beliefs and values about sexuality and 

gender roles -- may influence providers’ own HPVV 

acceptability and practice. Hence, these providers 

emphasized examining the provider cultural 

continuance relevant to HPVV clinical encounter and 

provider-patient relationship, as well as ongoing 

training to increase HPVV. 

Populations with particularly low HPVV rates and 

those with high HPV infection and HPV-related 

cancer burden must be prioritized for provider-

driven and parent focused vaccination improvement 

projects. This formative research underscored the 

importance of focusing on HPVV within immigrant 

dense communities. Our findings suggest that there 

are distinct facilitators and barriers to HPVV 

improvements among immigrant groups. This 

discovery science with key stakeholders also 

suggested that social determinants including 

immigration histories of providers and patients as 

well as social status -- type and place of residence, 

income, education and job status of patients -- 

influence immigrant providers’ clinical encounter and 

HPVV care delivery. 

This paper presents the voices of immigrant parents 

and broad based community advocates along with 

clinic administration and providers to inform clinic 

practice aimed at appropriate and sustainable HPVV 

improvement practices particularly targeting 

immigrant populations.  Therefore, systemic factors 

including assuring health facility safe zone for 

immigrant children ought to be considered in order 

to achieve the nations’ health agenda of protecting 

all our children against HPV-related cancers. Over all, 

responding to systemic, provider and parent issues 

are central to informing our efforts to improve the 

clinical encounter promoting HPVV among all 

populations -- especially among immigrant and HPV 

vulnerable communities towards attaining the 

Healthy People 2020 goal of 85% HPVV. 

 

 

 



 
 
 
 
 

 

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Acknowledgements 

The authors wish to thank the Los Angeles County 

HPV Vaccine Coalition and CHAPCare Community 

Health Clinics 

Conflict of interest 
The authors declare that they have no conflict of 

interest. 

Funding 

This research did not receive any specific grant from 

funding agencies in the public, commercial, or not-

for-profit sectors. 

Authors’ contributions 
Kimlin Ashing led the overall study and writing. 

Mayra Serrano, Marisela Garcia, Katty Nerio, 

Alejandro Fernandez contributed to the data 

collection and writing. Margaret Martinez , Rita 

Singhal, Andrette Ward, Aneesah Robinson, Karen 

Tinsley, Camille Ragin, Marcella Nunez-Smith, 

Rebecca Perkins, Gerard Antoine contributed to the 

conceptualization and writing 

REFERENCES 
Report: Accelerating HPV Vaccine Uptake – Urgency for 

Action to Prevent Cancer [U.S.] President’s Cancer Panel 

(PCP):  February 2014 

http://deainfo.nci.nih.gov/advisory/pcp/annualReports/H

PV/index.htm#sthash.LfsA4o48.dpbs 

Alcaraz, K.I., Sly, J., Ashing, K., Fleisher, L., Gil-Rivas, V., Ford, 

S., Jean, C.Y., Lu, Q., Meade, C.D., and Menon, U. (2017). 

The ConNECT Framework: a model for advancing 

behavioral medicine science and practice to foster health 

equity. Journal of behavioral medicine 40, 23-38. 

Aragones, A., Bruno, D., and Gany, F. (2013). Attitudes 

surrounding implementation of the HPV vaccine for 

males among primary care providers serving large 

minority populations. Journal of health care for the poor 

and underserved 24, 768. 

Ashing, K.T., Carrington, A., Ragin, C., and Roach, V. (2017). 

Examining HPV-and HPV vaccine-related cognitions and 

acceptability among US-born and immigrant hispanics 

and US-born and immigrant non-Hispanic Blacks: a 

preliminary catchment area study. Cancer Causes & 

Control 28, 1341-1347. 

Blackman, E., Thurman, N., Halliday, D., Butler, R., Francis, D., 

Joseph, M., Thompson, J., Akers, A., Andraos-Selim, C., 

and Bondzi, C. (2013). Multicenter study of human 

papillomavirus and the human papillomavirus vaccine: 

knowledge and attitudes among people of African 

descent. Infectious diseases in obstetrics and gynecology 

2013. 

Bruno, D.M., Wilson, T.E., Gany, F., and Aragones, A. (2014). 

Identifying human papillomavirus vaccination practices 

among primary care providers of minority, low-income 

and immigrant patient populations. Vaccine 32, 4149-

4154. 

Cancer, I.A.f.R.o. (2012). GLOBOCAN 2012: estimated cancer 

incidence, mortality and prevalence worldwide in 2012. 

Cofie, L.E., Hirth, J.M., Guo, F., Berenson, A.B., Markides, K., 

and Wong, R. (2018). HPV Vaccination Among Foreign-

Born Women: Examining the National Health Interview 

Survey 2013–2015. American journal of preventive 

medicine 54, 20-27. 

Control, C.f.D., and Prevention (2013). Human papillomavirus 

vaccination coverage among adolescent girls, 2007-2012, 

and postlicensure vaccine safety monitoring, 2006-2013-

United States. MMWR Morbidity and mortality weekly 

report 62, 591. 

Esposito, L., and Castaneda, R. (2017). How Foreign Health 

Providers Impact U.S. Health Care - Stemming the flow 

would affect the neediest areas most. 

Goss, P.E., Lee, B.L., Badovinac-Crnjevic, T., Strasser-Weippl, 

K., Chavarri-Guerra, Y., St Louis, J., Villarreal-Garza, C., 

Unger-Saldaña, K., Ferreyra, M., and Debiasi, M. (2013). 

Planning cancer control in Latin America and the 

Caribbean. The Lancet Oncology 14, 391-436. 

Jamshed, S. (2014). Qualitative research method-interviewing 

and observation. Journal of basic and clinical pharmacy 5, 

87-88. 

Jemal, A., Simard, E.P., Dorell, C., Noone, A.-M., Markowitz, 

L.E., Kohler, B., Eheman, C., Saraiya, M., Bandi, P., and 

Saslow, D. (2013). Annual report to the nation on the 

status of cancer, 1975–2009, featuring the burden and 

trends in human papillomavirus (HPV)–associated 

cancers and HPV vaccination coverage levels. JNCI: 

Journal of the National Cancer Institute 105, 175-201. 

Jeudin, P., Liveright, E., Del Carmen, M.G., and Perkins, R.B. 

(2013). Race, ethnicity and income as factors for HPV 

vaccine acceptance and use. Human vaccines & 

immunotherapeutics 9, 1413-1420. 

Joseph, N.P., Clark, J.A., Mercilus, G., Wilbur, M., Figaro, J., and 

Perkins, R. (2014). Racial and ethnic differences in HPV 

knowledge, attitudes, and vaccination rates among low-

income African-American, Haitian, Latina, and Caucasian 

young adult women. Journal of pediatric and adolescent 

gynecology 27, 83-92. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e8                                              Cancer Health Disparities 

RESEARCH 

Kessels, S.J., Marshall, H.S., Watson, M., Braunack-Mayer, A.J., 

Reuzel, R., and Tooher, R.L. (2012). Factors associated 

with HPV vaccine uptake in teenage girls: a systematic 

review. Vaccine 30, 3546-3556. 

Kobetz, E., Kish, J.K., Campos, N.G., Koru-Sengul, T., Bishop, I., 

Lipshultz, H., Barton, B., and Barbee, L. (2012). Burden of 

human papillomavirus among Haitian immigrants in 

Miami, Florida: Community-based participatory research 

in action. Journal of oncology 2012. 

Krantz, L., Ollberding, N.J., Beck, A.F., and Carol Burkhardt, M. 

(2018). Increasing HPV vaccination coverage through 

provider-based interventions. Clinical pediatrics 57, 319-

326. 

Los Angeles County Department of Public Health, and Office 

of Health Assessment and Epidemiology (2011). Los 

Angeles County Health Survey: HPV Vaccination (13-17 

year olds)  

Martin, D.N., Lam, T.K., Brignole, K., Ashing, K.T., Blot, W.J., 

Burhansstipanov, L., Chen, J.T., Dignan, M., Gomez, S.L., 

and Martinez, M.E. (2016). Recommendations for cancer 

epidemiologic research in understudied populations and 

implications for future needs (AACR). 

Perkins, R.B., Brogly, S.B., Adams, W.G., and Freund, K.M. 

(2012). Correlates of human papillomavirus vaccination 

rates in low-income, minority adolescents: a multicenter 

study. Journal of Women's Health 21, 813-820. 

Schleicher, E. (2007). Immigrant women and cervical cancer 

prevention in the United States. Baltimore: Women’s and 

Children’s Health Policy Center, Johns Hopkins 

Bloomberg School of Public Health. 

Seeff, L.C., and McKenna, M.T. (2003). Cervical cancer 

mortality among foreign-born women living in the 

United States, 1985 to 1996. Cancer Detection and 

Prevention 27, 203-208. 

Senkomago, V., Duran, D., Loharikar, A., Hyde, T.B., 

Markowitz, L.E., Unger, E.R., and Saraiya, M. (2017). CDC 

Activities for Improving Implementation of Human 

Papillomavirus Vaccination, Cervical Cancer Screening, 

and Surveillance Worldwide. Emerging infectious 

diseases 23, S101. 

Siegel, R.L., Miller, K.D., and Jemal, A. (2015). Cancer statistics, 

2015. CA: a cancer journal for clinicians 65, 5-29. 

Smith, R.A., Andrews, K.S., Brooks, D., Fedewa, S.A., 

Manassaram‐Baptiste, D., Saslow, D., Brawley, O.W., and 

Wender, R.C. (2018). Cancer screening in the United 

States, 2018: A review of current American Cancer Society 

guidelines and current issues in cancer screening. CA: A 

Cancer Journal for Clinicians 68, 297-316. 

Villa, L.L. (2012). Cervical cancer in Latin America and the 

Caribbean: the problem and the way to solutions. Cancer 

Epidemiology and Prevention Biomarkers 21, 1409-1413. 

Warner, W.A., Lee, T.Y., Badal, K., Williams, T.M., Bajracharya, 

S., Sundaram, V., Bascombe, N.A., Maharaj, R., Lamont-

Greene, M., and Roach, A. (2018). Cancer incidence and 

mortality rates and trends in Trinidad and Tobago. BMC 

cancer 18, 712. 

 

 

 

 

 

 

 

 

 


