A number of international studies have focused on knowledge and attitudes related to HPV and the HPV vaccine. However, a majority of these studies have been conducted in Europe, Asia, and Africa [17
], with little work done in Latin America [11
] and no studies conducted in the Caribbean. This study is the first to report on overall HPV and HPV vaccine knowledge and perception in a sample of Black volunteers containing a large number of subjects from the US and Caribbean, and we have compared our findings by geographic residence. Our previous study showed a lack of knowledge among people of African descent in the US, which remained consistent with our current findings and other published literature [24
]. However, the present study indicates that overall knowledge was significantly lower in Bahamian participants when compared to American Blacks, even after adjusting for possible confounders.
More than half of participants from each location were aware that a vaccine for HPV is available; however Bahamian participants were less aware of this. Studies that focused on populations of African descent, outside of the US, report a similar lack of knowledge in regard to vaccine availability [21
], and educational attainment has been shown to be associated with familiarity of HPV and its vaccine [23
]. In our study population, US participants had higher levels of education compared to Bahamian participants, which could explain the lesser familiarity with HPV and its vaccine in the Bahamas compared to the US. For persons who were aware of the HPV vaccine, there were slight differences between the US and Bahamas in the type of resource from which they received this information. While advertisements were the major resource for obtaining information about HPV vaccines for both the US and Bahamian populations, health professionals were also an important resource for the US population but not as much for the Bahamas. Further investigations that help clarify the reasons why health professionals are not currently important resources for educating the Bahamian population about HPV vaccines are warranted and might help provide insight for improving HPV vaccine awareness in this geographic region.
Published literature suggests that in most cases, after parents were well informed about the risks and benefits of the vaccine, they were willing to vaccinate their children [11
], and we have noted that in our study the majority of parents were willing to vaccinate their daughters. For the US, parents who were unwilling to vaccinate their daughters identified their reasons as safety concerns. However, in this study we were not able to compare the reasons for unwillingness of parents to vaccinate their children between the two countries, because of low response rates to those questions for the Bahamian parents. It was not clear why the response rate for this question was low; however, it is possible that the participants may not have been comfortable with disclosing their reasons.
In general, attitudes related to HPV vaccination were similar between the US and BHM but differed when the two populations were asked if a well-informed child should be able to request vaccination at sexual health clinics without parental consent. US participants were more likely to agree with this statement (P
< 0.001). This difference may suggest that Americans have a higher self-worth in regard to their health, which is not the case when it comes to children. Hughes reports that children considered themselves to be passive participants when determining their course of medical care [29
]. In our study population, the majority of parents from BHM were married in contrast to the parents from the US. In the West Indies, the importance of family has been distinguished and deemed quite atypical to that of the western world. Although speculative, the rationale behind the majority of Bahamian respondents disagreeing with children being able to receive the vaccine without parental consent might be explained by differences in overall family structure and child rearing practices, which have been shown to differ when compared to the US [30
]. Still, with the spread of American culture globally, family values have begun to change within the Caribbean [30
], which would explain why younger respondents from BHM tended to agree with the statement.
Respondents who agreed with the statement about children being able to decide about their own vaccination tended to be younger people (<35 years), regardless of geographic location (P < 0.001).