









































Human Papillomavirus Vaccination 
Among Low-Income,

Underserved Youth in the Greater 
Washington, D.C., and

Hackensack, NJ Metropolitan 
Areas

Madelyn McLaughlin, Joan Riley, Chiranjeey Dash, Lucile 
Adams-Campbell, Kenneth Tercyak

Volume Three
Edition One
Fall 2022

 
GEORGETOWN SCIENTIFIC
RESEARCH JOURNAL

18



Georgetown Scientific Research Journal 

Human Papillomavirus Vaccination Among Low-Income, 
Underserved Youth in the Greater Washington, D.C., and 
Hackensack, NJ Metropolitan Areas 

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1 Department of Human Science, Georgetown University, Washington, D.C. 
2 Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer 
Center, Washington, D.C. 
3 Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, 
D.C.
E-mail: mm4486@georgetown.edu
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Human Papillomavirus (HPV) is the most common sexually transmitted infection. In 2018, 43 million 
cases of HPV were recorded in the United States, mostly afflicting young adults in their late teens and 
early twenties. Gardasil-9, the HPV vaccine currently distributed in the U.S., protects against nine HPV 
types that cause genital warts and cancers, such as cervical, penile, and oropharyngeal cancer. There is an 
urgent need for widespread pre-exposure vaccination against HPV among adolescents to prevent the 
spread of the disease and the future development of associated cancers. This study aims to identify barriers- 
including lack of knowledge or access, relationship with a provider, and sociocultural factors- to HPV 
vaccination, to understand the complex motivations behind HPV vaccination and hesitancy to improve 
vaccine uptake and the health of the community. By identifying these interpersonal and systemic barriers, 
we can begin to understand what contributes to the lower vaccination rates in low-income, medically 
underserved communities and what is needed to address them. Data for this analysis was drawn from a 
quantitative survey and qualitative narratives compiled from key informant interviews (KIIs). Data 
suggested that receipt of a provider recommendation is associated with vaccine uptake, and greater 
knowledge of HPV is significantly associated with vaccination. The KIIs revealed that COVID-19 
strengthened existing beliefs about vaccination generally, indicating that individuals prone to vaccine 
hesitancy grew more hesitant while proponents of vaccination pre-pandemic became more supportive after 
COVID-19. In conclusion, data suggested that increasing the frequency of provider recommendations for 
HPV vaccination and awareness of HPV would positively impact uptake and result in higher vaccination 
rates nationwide. Further studies are needed to assess the impact of additional factors, such as medical 
mistrust, vaccine hesitancy, and stress stemming from COVID-19 on HPV vaccination. 

Keywords: human papillomavirus, vaccine, hesitancy, barrier 

11.. IInnttrroodduuccttiioonn

Pre-exposure vaccination is one of the most
effective interventions for preventing the 

transmission of disease, particularly for Human 
Papillomavirus (HPV).1 Providing vaccines as 

1919



Georgetown Scientific Research Journal 

 

1. Introduction

Pre-exposure vaccination is one of the 

most effective interventions for preventing 

the transmission of disease, particularly for 

Human Papillomavirus (HPV).1 Providing 

vaccines as primary prevention is crucial for 

maintaining and protecting public health. 

HPV is the most common sexually 

transmitted infection and 70% of cervical 

cancers are caused by HPV types 16 and 18, 

both of which are protected against by 

Gardasil-9, the HPV vaccine currently 

distributed in the US. 1,2,3,4 Globally, vaccines 

have reduced the burden of vaccine-

preventable diseases such as polio and 

smallpox, and with widespread coverage, this 

could be possible for HPV as well.2,3 

Since its initial Food and Drug 

Administration (FDA) approval for females in 

2006 and males in 2009, the HPV vaccine has 

been surrounded by misinformation and 

controversy. Many misconceptions persist 

about the purpose of the HPV vaccine for 

males. Some believe that HPV and cervical 

cancer are synonymous, leading them to 

falsely believe that HPV is solely a women's 

health issue.5 Physicians are also less likely to 

recommend the HPV vaccine to males, which 

could be attributed to the 3-year delay in FDA 

approval for males and the resulting 

misconception that it is not necessary for 

males.6 Additionally, there are fears about 

safety and efficacy as well as concerns that it 

would promote premature sexual activity in 

pre-teens who receive the vaccine.7,8 There is 

consistent evidence that the relative novelty 

of and misinformation regarding the vaccine 

contribute to increased vaccine refusal by 

parents, which leads us to hypothesize that 

these two factors are associated with lower 

vaccination rates.7,8,9 Vaccine refusal refers to a 

parent’s decision to not vaccinate their child, 

while vaccination rate refers to the proportion 

of children who have received the vaccine and 

can be measured by analyzing the number of 

eligible children who have and have not been 

vaccinated in a given population. The lack of 

widespread and comprehensive HPV vaccine 

mandates has also contributed to the reduced 

uptake of the HPV vaccine. Only three states 

and Washington, D.C. require the HPV 

vaccine. Some of those mandates were 

implemented as recently as 2021, so they have 

not yet been able to have a significant impact 

on vaccination rates.10 Such myths and 

missteps with the HPV vaccine rollout have 

contributed to the slow and reluctant 

acceptance of the vaccine in the U.S. 

Low vaccination rates can also be 

attributed to socioeconomic barriers such as 

access to a provider recommendation, one of 

the most significant indicators of whether a 

child will be vaccinated.11 For uninsured 

families that do not regularly see a provider 

or families that have been mistreated by the 

medical system, a provider recommendation 

is challenging to obtain or holds little value. 

Parents who do not regularly interact with 

healthcare environments due to proximity to 

the nearest provider or insurance status might 

be unaware of HPV, the vaccine, and how to 

access information. This lack of awareness 

and access would inhibit vaccine acceptance 

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Georgetown Scientific Research Journal 

 

and receipt. Financial barriers, such as 

concerns about the cost to vaccinate their 

child with or without insurance or being 

unable to afford traveling and taking time off 

of work to take their child to a doctor’s office 

may also significantly impact vaccination 

rates. Asking parents about their experiences 

with these barriers or what they know and 

think about the vaccine can help determine 

where gaps in access and knowledge exist 

and attempt to fill them. Our target 

populations come from low-income, 

underserved communities. Being uninsured, 

undocumented, concerned about cost, or 

hesitant to trust healthcare professionals are 

important factors parents grapple with when 

deciding whether to have their children 

vaccinated against HPV. By conducting the 

surveys and key informant interviews, we can 

determine which factors weigh most heavily 

on parents’ minds and work to mitigate those 

barriers to increase HPV vaccination rates in 

target communities. 

Healthy People 2030, a U.S. Department of 

Health and Human Services initiative, set a 

goal of having 80% of adolescents up-to-date 

on their HPV vaccination, which has not been 

reached in any of the states included in the 

study.12 According to 2019 data, the most 

recently published data for the catchment 

areas, only 75.5% of males and females in 

Washington, D.C, 68.9% in Maryland, and 

51.4% in New Jersey were up-to-date on their 

HPV vaccinations, demonstrating that many 

regions, and all of those included in this 

study, are falling short of vaccination goals.13 

A November 2021 study found that the 

Cervarix HPV vaccination reduced cervical 

cancer incidence rates by 87% when 

comparing girls who received the vaccine at 

ages 12 or 13 to those who did not receive it.2 

These findings quantify the effectiveness of 

the vaccine in preventing HPV and the impact 

that reducing HPV infection rates has on 

cervical cancer rates. This underscores the 

importance of understanding the complex 

motivations behind HPV vaccination to better 

target interventions that can improve vaccine 

uptake and ensure lasting community health. 

This study seeks to characterize 

individual, familial, and systemic barriers to 

HPV vaccination among low-income, 

underserved children 10-17 years of age in the 

greater Washington, D.C. and Hackensack, NJ 

metropolitan areas to better understand the 

factors that influence a parent or guardian’s 

decision to vaccinate a child against HPV or 

not. We hypothesized that barriers such as 

inadequate knowledge (defined as limited or 

incorrect knowledge of HPV and the HPV 

vaccine), financial hardship, lack of access, 

medical mistrust, and greater stress due to 

COVID-19, would be associated with low 

vaccine uptake in this sample.  

2. Methods 

2.1 Design 

This IRB-approved study was conducted 

from May 2021 to January 2022. A mixed 

methods approach, consisting of a 

quantitative survey and qualitative Key 

Informant Interviews (KII) conducted with 

parents of children 10-17 years of age in the 

catchment area, was used to assess the 

barriers to accessing and receiving the HPV 

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Georgetown Scientific Research Journal 

 

vaccine. Data was collected via an online 

survey through the Lombardi 

Comprehensive Cancer Center’s Cancer 

Prevention and Control Program at 

Georgetown University. Participants 

completed a 46-item survey administered 

online through the REDCap platform. The 

survey was adapted from existing measures 

such as the Hopkins Medical Mistrust Index, 

Vaccine Hesitancy Scale, and the SARS-CoV-

2-related worry (CoV-Wo) scale and included 

the HPV Vaccine Knowledge & Beliefs scale 

and items assessing awareness and 

intent.8,14,15,16 Summary scores were calculated 

for each measure with higher scores 

indicating greater knowledge, mistrust, 

hesitancy, and COVID-19 stress.  

2.2 Participants 

Parents of children 10-17 years of age 

living in the catchment area (Washington, 

D.C., Prince George’s and St. Mary’s Counties 

in Maryland, and Bergen, Hudson, and 

Passaic Counties in New Jersey) were eligible 

to participate. Using Facebook’s advertising 

platform, parents were targeted by selecting 

an audience with interests such as parenting 

and family and narrowing to users 25-55 

years of age living in the catchment area. 

Between May and September 2021, across 

Facebook and Instagram platforms, the 

advertisements reached over 57,000 

individuals from the high-risk target 

populations. The survey was also advertised 

on flyers in community settings, such as 

primary care offices, starting in July 2021. A 

total of 29 participants completed the survey 

and 3 elected to participate in an optional 

follow-up key informant interview. The key 

informant interviews (KII) were conducted 

between November 2021 and January 2022 

and lasted approximately 20 minutes. 

2.3 Instruments 

Demographic data collected included 

race/ethnicity, education, and income (Table 

A1). Awareness of the HPV vaccine (whether 

the participant had ever heard of it or not) and 

the HPV vaccination status of the respondent 

were also recorded. Family Composition was 

determined by asking participants how many 

10-17-year-old children are in the household 

as well as the age, gender, ethnicity, and race 

of each child. Participants were asked to 

complete the remainder of the survey with 

one child in mind. For participants with two 

or more children 10-17 years of age, one child 

was randomly selected to be considered for 

the survey. Child HPV Experience/Intentions 

was determined by asking whether the child 

had received any doses of the HPV vaccine 

and if so, how many. If the child had not 

received any doses, they were asked to 

specify the main reason behind the child’s 

vaccination status. Intent to vaccinate and 

physician recommendation were also 

assessed. Additional data was obtained using 

the following instruments (Table A2). 

The 8-item HPV Vaccine Knowledge & 

Beliefs scale was adapted from the Group-

Based Medical Mistrust Scale and was used to 

determine what participants know or believe 

to be true about the HPV vaccine and if 

greater HPV knowledge was correlated with 

vaccination.14 

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The 7-item Hopkins Medical Mistrust 

Index measures the level of medical mistrust 

to determine the extent to which mistrust of 

healthcare providers, organizations, and 

health systems may have contributed to HPV 

vaccine hesitancy.17  

The 9-item Vaccine Hesitancy Scale 

measures a person’s level of vaccine 

hesitancy.16 It was used to examine how 

hesitancy regarding childhood vaccines, in 

general, may have impacted a parents’ 

decision to vaccinate against HPV.  

The 6-item SARS-CoV-2- related worry 

(CoV-Wo) Scale measures how stressed a 

person is regarding COVID-19 and related 

issues such as financial strain or health 

concerns.18 This scale was used to determine if 

there was a correlation between increased 

“worry” about COVID-19 and HPV 

vaccination. 

The Key Informant Interviews (KII) were 

conducted via Zoom and lasted 

approximately 20 minutes. They were 

recorded and transcribed for data analysis. 

Participants were asked 12 questions about 

their knowledge of and opinions regarding 

HPV and the HPV vaccine to assess beliefs, 

experience, barriers to access, and hesitancy. 

To prevent implicit biases from influencing 

the KIIs, the interview was conducted 

without video, and the questions were 

purposefully framed to avoid stigmatizing 

language. 

2.4 Data Analysis 

Statistical analyses were prepared in 

Microsoft Excel and were conducted using an 

online statistical calculator.19 Descriptive 

statistics were used to compare vaccinated 

and unvaccinated groups. One-tailed 

student’s t-tests were used to compare the 

means of each of the four dependent variables 

between the parents of vaccinated and 

unvaccinated children (Table A3). 

3. Results 

In this sample, 29 parents of 43 children 

completed the survey. 20 out of 29 (69.0%) 

parents reported vaccinating their children 

against HPV, seven (24.14%) reported not 

vaccinating their children against HPV, and 

two (6.90%) were unsure of their child’s 

vaccination status. There were 29 vaccinated 

children, 12 unvaccinated children, and 2 

children with unknown vaccination status 

recorded. None of the seven parents who did 

not vaccinate their children against HPV 

reported receiving a physician 

recommendation.  

Parents in this sample with greater HPV 

knowledge were more likely to have their 

children receive the vaccine (Table A3, p = 

0.0044). Lesser vaccine hesitancy was shown 

to have a marginally significant association 

with vaccination (Table A3, p = 0.094). Among 

other barriers to vaccination that were 

assessed in this sample, no significant 

findings emerged. 

All three KII participants attributed their 

decision to vaccinate to a provider 

recommendation. They were also all generally 

proponents of vaccination and expressed that 

COVID-19 has strengthened their existing 

beliefs in vaccines. They all reported that 

wanting to protect their child from potentially 

contracting HPV or developing associated 

cancers was their primary motivation for 

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Georgetown Scientific Research Journal 

 

choosing to vaccinate their child against HPV. 

All three KII participants reported employing 

a cost-benefit analysis of vaccination, 

ultimately deciding that the protection 

conferred by the HPV vaccine outweighed 

any possible side effects.  

4. Discussion 

Our results show a relationship between 

knowledge and awareness of both HPV and 

the HPV vaccine, vaccine hesitancy, provider 

recommendation, and HPV vaccination 

status, findings that are consistent with prior 

literature. Parents with greater knowledge 

and awareness and lesser vaccine hesitancy 

who receive a provider recommendation are 

more likely to vaccinate their children. This 

emphasizes the importance of increasing 

public knowledge of HPV as well as 

encouraging provider recommendations, 

particularly for medically underserved 

populations such as this sample. 

There is consistent evidence in the 

literature that provider recommendation is a 

significant predictor of vaccination, which is 

supported by sentiments expressed by all KII 

participants and the finding that none of the 

parents who chose not to vaccinate their 

children against HPV reported receiving a 

provider recommendation.11 In line with 

hypotheses and literature, this suggests that 

receipt of a recommendation from a trusted 

provider is a crucial predictor of vaccination 

and emphasizes how impactful a provider 

recommendation can be for a parent deciding 

whether to vaccinate their child against HPV. 

Providers can contribute to raising awareness 

and knowledge of the HPV vaccine, and a 

trusted recommendation can be the 

determining factor for vaccine uptake. This 

underscores the need for providers to make 

HPV vaccine recommendations a priority to 

improve the health and well-being of their 

communities. 

Limited knowledge of HPV and the HPV 

vaccine is shown to be a significant barrier in 

this sample, consistent with hypotheses and 

existing literature. This finding suggests that 

there is a need for increased awareness and 

education so that parents are not only aware 

of HPV, but also understand the importance 

of vaccination to prevent infection and the 

development of associated cancers. 

Correcting widespread misinformation by 

providing credible data and facts about HPV 

and the vaccine could have a significant, 

positive impact on vaccination rates. For 

populations who do not have a primary care 

provider or accessible, accurate health 

information, limited knowledge hinders 

widespread vaccination. 

Results also indicate that lesser vaccine 

hesitancy is marginally associated with 

vaccination in this sample. Hesitancy was 

expected to be a key barrier to HPV 

vaccination because of the many myths and 

fears that have persisted since the initial 

vaccine rollout in 2006. There was fear about 

the vaccine’s safety and efficacy and hesitancy 

stemming from fear of encouraging 

premature sexual activity, and many of the 

reasons for hesitancy remain significant 

factors in parents’ decisions to vaccinate their 

children today. These findings emphasize the 

overlap between knowledge and hesitancy 

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Georgetown Scientific Research Journal 

 

and suggest that, with improved knowledge 

of HPV and the HPV vaccine, hesitancy could 

decrease, and vaccine uptake could increase. 

Knowledge and hesitancy are closely related, 

and addressing both barriers is necessary to 

increase vaccination rates in medically 

underserved communities.  

It was expected that lesser medical 

mistrust would be associated with 

vaccination, but no significant findings 

emerged. Mistrust and hesitancy often go 

hand-in-hand, particularly amongst low-

income, medically underserved communities, 

so further research is needed to fully elucidate 

the relationship between medical mistrust 

and HPV vaccine hesitancy among vulnerable 

populations.15,20 

4.1 Limitations 

The small sample size (n=29) was a 

limitation of this study, with a greater 

proportion of participants having vaccinated 

their children. This could have influenced 

findings by excluding the proportion of more 

at-risk, medically underrepresented parents 

and children who are less likely to vaccinate. 

Similarly, all three KIIs were conducted with 

parents who vaccinated their children against 

HPV, also omitting the unvaccinated 

population that we aimed to target. While all 

three KIIs were conducted with parents who 

vaccinated their children, understanding the 

factors that lead parents to vaccinate their 

children highlights gaps for parents who 

choose not to vaccinate and suggests where 

interventions should be focused. Since the 

relationship with a provider was revealed to 

be so important, interventions should focus 

on providers as facilitators of HPV vaccine 

information and recommendation. 

5. Conclusions 

The intersections of awareness, 

knowledge, hesitancy, and trust in providers 

are emphasized by these findings as all these 

barriers are shown to influence HPV 

vaccination among the sample. Not only does 

this data contribute to a better understanding 

of the barriers and motivations for HPV 

vaccination among low-income, underserved 

parents, but it also indicates what 

interventions would be most effective for 

increasing HPV vaccination rates in these 

communities. The small sample size is a 

limitation. However, there is value in the 

consistent nature of the KIIs and all findings 

being consistent with previous literature. 

Despite this limitation, these findings have 

contributed to a better understanding of 

factors that influence parents’ decision to 

vaccinate their children against HPV and the 

gaps that exist which prevent parents from 

choosing to do so. Consequently, the findings 

provide information that can be used to 

address barriers and improve HPV 

vaccination rates in medically underserved 

communities. In the future, studies should 

aim to obtain a greater sampling from these 

communities to capture the diversity of 

experiences, opinions, and beliefs parents 

have regarding HPV and the HPV vaccine for 

their children. This study contributes to an 

expanding line of research to better 

understand barriers and facilitators of HPV 

vaccination in children from vulnerable 

communities. 

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Georgetown Scientific Research Journal 

 

Acknowledgments 

The author would like to acknowledge the 

Georgetown University Lombardi 

Comprehensive Cancer Center’s Cancer 

Prevention and Control Program for their 

support as well as the community members 

who participated in this study. This research 

was supported by the Dr. Scholl Foundation. 

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Appendix 

Table A1. Characteristics of HPV Survey Respondents (n=43). Demographic data are presented 
as a percentage (%) of the total and as the number (n) of participants who responded to each category. 
 
Demographics         n  % 

 
Race/Ethnicity (n=43) 

 American Indian/Alaskan Native      n=4 9.30% 
 Asian          n=1 2.33% 

Black or African American       n=10 23.26% 

Native Hawaiian or Other Pacific Islander     n=0 0.0% 
White          n=14 32.56% 

Other          n=4 9.30% 

Hispanic/Latinx        n=10 23.26% 
 

Education (n=30) 

 Less than high school        n=1 3.33% 
High school/GED        n=10  33.33% 

Two year degree/some college       n=7 23.33% 

Bachelor’s degree        n=3 10.0% 
Professional degree        n=9 30.0% 

 
Annual Household Income (n=30) 

Less than $30,000        n=10 33.33% 

$30,000 to $59,000        n=5 16.67% 
$60,000 to $99,000        n=6 20.0% 

$100,000 or more        n=9 30.0% 

 
Child gender (n=43) 

 Female          n=22 51.16% 

Male          n=21 48.84% 
 

Child vaccinated (n=43) 

 Yes          n=29 67.44% 
 No         n=12 27.91% 

 Unsure          n=2 6.90% 

 
Number of children/respondent (n=29) 

 One child         n=17 58.62% 
 Two children         n=10 34.48% 

 Three children         n=2 6.90% 

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Table A2. Survey Instruments. Items included in the survey from the HPV Vaccine Knowledge & 
Beliefs Scale, Hopkins Medical Mistrust Index, Vaccine Hesitancy Scale, and SARS-CoV-2- related worry 
(CoV-Wo) Scale. 
 

Survey Measure Items 

HPV Vaccine Knowledge & Beliefs Scale 1. “The HPV vaccine can prevent certain types of genital warts.” 
2. “Men can get HPV.” 
3. “The HPV vaccine can protect against certain types of cervical 

cancer.” 
4. “The HPV vaccine is available for males and females between 9 and 

26 years old.” 
5. “You can’t get the HPV vaccine if you had HPV.” 
6. “The HPV vaccine does not protect against every type of HPV.” 
7. “The HPV vaccine protects against anal cancer.” 
8. “The HPV vaccine will cure cervical cancer.”  

Hopkins Medical Mistrust Index 1. “You’d better be cautious when dealing with health organizations.” 
2. “Patients have sometimes been deceived or misled by health care 

organizations.” 
3. “When health care organizations make mistakes they usually cover it 

up.” 
4. “Health care organizations are more concerned about making money 

than taking care of people.” 
5. “Health care organizations don’t always keep your information 

totally private.” 
6. “Sometimes I wonder if health care organizations really know what 

they are doing.” 
7. “Mistakes are common in health care organizations.” 

Vaccine Hesitancy Scale 1. “Childhood vaccines are important for my child’s health.” 
2. “Childhood vaccines are effective.” 
3. “Having my child vaccinated is important for the health of others in 

my community.” 
4. “All childhood vaccines offered by the government program in my 

community are beneficial.” 
5. “New vaccines carry more risks than older vaccines.” 
6. “The information I received about vaccines from the vaccine program 

is reliable and trustworthy.” 
7. “Getting vaccines is a good way to protect my child/children from 

diseases.” 
8. “Generally I do what my doctor or health care provider recommends 

about vaccines for my child/children.” 
9. “I am concerned about serious adverse effects of vaccines.” 

SARS-CoV-2- related worry (CoV-Wo) Scale 1. “I am worried about getting the coronavirus.” 
2. “I am worried about my family/friends getting the coronavirus.” 
3. “I am very worried about giving someone else the coronavirus.” 
4. “I am worried about money because of the coronavirus.” 
5. “I am worried about having enough food because of the 

coronavirus.” 
6. “I am worried about medical bills if I get sick because of the 

coronavirus.” 

29



Georgetown Scientific Research Journal 

 

Table A3. Associations between Barriers to Vaccination and Vaccination Status (n=27). 
Correlational data was calculated between HPV knowledge, medical mistrust, vaccine 

hesitancy, COVID stress, and vaccination status using an online statistical calculator. Higher 

scores indicate greater knowledge, mistrust, hesitancy, and COVID stress. 

* Correlation is significant (p< 0.05) 

 

Measure Mean SD T-value P-value 

HPV Knowledge (n=27) 5.04 2.24 2.84 0.0044* 

Vaccinated (n=21) 5.62 1.75   

Unvaccinated (n=6) 3.00 2.76   

Medical Mistrust (n=25) 17.92 5.36 0.72 0.24 

Vaccinated (n=20) 18.35 4.97   

Unvaccinated (n=5) 16.40 7.06   

Vaccine Hesitancy (n=25) 17.72 4.65 -1.36 0.094 

Vaccinated (n=20) 17.10 4.62   

Unvaccinated (n=5) 20.20 4.32   

COVID stress (n=25) 19.76 6.65 -0.31 0.38 

Vaccinated (n=20) 19.55 7.08   

Unvaccinated (N=5) 20.60 5.18   

 

 
 

30




	Table of Contents
	Letter From the Editors
	Trends in Pro-Gun Control Tweets Surrounding a Mass ShootingEvent Suggest Time-Dependent Changes in Public Response
	Human Papillomavirus Vaccination Among Low-Income,Underserved Youth in the Greater Washington, D.C., andHackensack, NJ Metropolitan Areas
	Best Practices for Health Literacy Education for EnglishLanguage Learners
	About the Authors
	Acknowledgments
	GSRJ Volume 3 Edition 1 back.pdf
	Table of Contents
	Letter From the Editors
	Trends in Pro-Gun Control Tweets Surrounding a Mass ShootingEvent Suggest Time-Dependent Changes in Public Response
	Human Papillomavirus Vaccination Among Low-Income,Underserved Youth in the Greater Washington, D.C., andHackensack, NJ Metropolitan Areas
	Best Practices for Health Literacy Education for EnglishLanguage Learners
	About the Authors
	Acknowledgments




