Sexually Transmitted Diseases

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Psychosocial Predictors of Hepatitis B Vaccination Among Young African-American Gay Men in the Deep South

RHODES, SCOTT D. PhD, MPH*; DICLEMENTE, RALPH J. PhD†‡§

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Abstract

Background: Despite recommendations for vaccination against hepatitis B virus (HBV) of men who have sex with men (MSM), most remain unvaccinated.

Goal: The goal of this study was to identify attitudes and beliefs associated with vaccination against HBV among black MSM.

Study Design: The Birmingham Vaccine Acceptance Questionnaire was used to collect data from gay bar patrons.

Results: Of the 143 participants, nearly 42% reported at least one dose of HBV vaccine. In multivariable analysis, characteristics associated with vaccination were a decreased perception of barriers to HBV vaccination (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.22–0.61;P = 0.001); increased perceived medical severity (OR, 5.34; 95% CI, 2.38–11.96;P = 0.001) and personal severity (OR, 2.22; 95% CI, 1.38–3.56;P = 0.006) of HBV infection; and increased perceived general medical self-efficacy (OR, 9.22; 95% CI, 3.52–24.11;P = 0.0001) and personal self-efficacy (OR, 2.3; 95% CI, 1.14–4.63;P = 0.008) to complete the three-dose series.

Conclusions: Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing perceived severity of HBV infection and self-efficacy to complete the vaccine series.

HEPATITIS B VIRUS (HBV) INFECTION continues to be one of the most frequently reported preventable diseases in the United States, despite the licensure of a vaccine in 1982. 1 In the United States, an estimated 240,000 new infections occur annually, 1 and currently an estimated 1.25 million individuals in this country are chronically infected with HBV. 2–5 Sequelae resulting from chronic HBV infection include cirrhosis of the liver and hepatocellular carcinoma, and an estimated 6,000 deaths occur annually from these complications. 6–9

Because HBV can be transmitted through sexual activity, 10 the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Gay and Lesbian Medical Association recommend vaccination against HBV for all men who have sex with men (MSM), 1,11 a group for whom HBV has been identified as one of the most important sexually transmitted diseases (STDs). 1,12–15 However, available national epidemiologic data and results of community-based HBV vaccination programs indicate that the majority of MSM are not vaccinated. 13,15,16

Estimates of the prevalence of previous HBV infection in this population range from 5% to 81%; prevalence of hepatitis B surface antigen (HBsAg) varies from 1% to 11%. 17,18 Self-reported vaccination rates among sexually active MSM are low, ranging from 11% to 48%. 12,15,18–23

Recent studies examining HBV infection by race indicate a substantially higher incidence of new HBV infections as well as a higher level of HBV prevalence among blacks. 2,5,24 Despite the low rates of vaccination among MSM and the increased incidence and prevalence among blacks, little is known about HBV vaccination acceptance that could help guide tailored intervention efforts 12,16,18,21–23,25,26. Although the association of race with disease most likely is a proxy for some other characteristic, 27,28 understanding vaccination behavior among subgroups is essential to ensure that appropriately tailored, effective intervention strategies are designed and implemented.

In this study, we sought to explore the psychosocial variables that may affect HBV vaccination acceptance among a conventional outreach sample of black MSM. Findings from this study may inform intervention efforts to increase vaccination rates among black MSM, a subsample of MSM that is particularly neglected in the HBV vaccination behavioral literature. 29 Findings from this study also may inform future interventions designed to enhance vaccination within this population as vaccines against HIV and hepatitis C become available.

Constructs from two of the most widely used behavior change theories 30 were integrated to identify theory-based correlates of HBV vaccination among a convenience sample of MSM. The theories used in this study of HBV vaccination included the health belief model (HBM) 30–34 and the social cognitive theory. 35–37 These theories have been used successfully to explain factors that contribute to health behavior and the mechanisms by which these factors operate. 30

Among adult and adolescent MSM, the HBM has been used to understand sexual risk behavior, 38–41 HIV testing, 42,43 HIV treatment initiation, 44 and risk-reduction intervention participation and completion. 45 When applied to HBV vaccination, the HBM postulates that in order for individuals to participate in a health behavior, they must believe that (1) they are personally susceptible to HBV infection (perceived susceptibility); (2) contracting HBV would have a negative impact on their lives (perceived severity); (3) getting vaccinated against HBV would be beneficial (perceived benefits); and (4) getting vaccinated is not discouraged by insurmountable barriers (perceived barriers).

Perceived self-efficacy is a central concept within the social cognitive theory and is considered to be its most important construct. 35,37 Perceived self-efficacy is defined as the conviction that one can successfully execute the behavior required to produce the desired outcome in various situations. 35–37 Among MSM, perceived self-efficacy has been used to understand HIV sexual risk reduction behavior. 38,41,46–48 When applied to HBV vaccination, self-efficacy is the confidence that an individual perceives himself or herself to have to complete the three-dose vaccination series despite various perceived barriers and limitations.

To the best of our knowledge, this is the first published study to investigate theory-based attitudes and beliefs about HBV vaccination among black MSM, a group at increased risk of exposure to HBV.

© Copyright 2003 American Sexually Transmitted Diseases Association

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