Low Human Papillomavirus Literacy Among Asian-American Women in California: an Analysis of the California Health Interview Survey



Asian-Americans are one of the fastest growing minority groups in the USA, and the literature notes high rates of human papillomavirus (HPV). In this study, we aimed to address whether key social determinants of health, especially health literacy, in combination with English language proficiency, and immigration status, were key factors in HPV knowledge and awareness among Asian-Americans.


The data was collected from the California Health Interview Survey (CHIS). The study population consisted of Asian adult females from 18 to 65 years of age, with a sample size of 2050 representing a population of 1,552,710. Survey-weighted descriptive, bivariate, and multivariable Poisson regression were conducted with alpha less than .05 to denote significance.


Nearly 45% of the population reported that they never heard of HPV, while 14% reported thinking HPV can cause AIDS, and 13% reported that HPV can go away on its own. HPV knowledge, however, was varied by Asian-American ethnicity as well as being foreign-born. Survey-weighted multivariable robust Poisson regression results show that, when compared with Japanese subgroup, Chinese, South Asians, and Koreans were less likely to have heard of HPV. Having heard of HPV was 31% lower among Asian-Americans who were foreign-born, as compared with those who were US-born. Foreign-born Asian-Americans were 196% more likely to think HPV causes AIDS. Ever having heard of HPV was also associated with low English language proficiency (70% lower), low health literacy (45% lower), and a combination of both (55%). While, those with low English language proficiency understood HPV is a sexually transmitted infection, a substantially high number associated it with AIDS.


Interventions towards increasing health literacy among Asian Americans are imperative in order increase HPV vaccination rates to reduce cervical cancer rates/deaths.

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  1. 1.

    Aragones A, Genoff M, Gonzalez C, Shuk E, Gany F. HPV vaccine and Latino immigrant parents: if they offer it, we will get it. Journal of Immigrant and Minority Health / Center for Minority Public Health. 2016;18(5):1060–5.

  2. 2.

    Becerra BJ, Arias D, Becerra MB. Low health literacy among immigrant Hispanics. J Racial Ethn Health Disparities. 2016;4:480–3.

  3. 3.

    Becerra MB, Becerra BJ, Daus GP, Martin LR. Determinants of low health literacy among Asian-American and Pacific Islanders in California. J Racial Ethn Health Disparities. 2015;2(2):267–73.

  4. 4.

    Bond SM, Cartmell KB, Lopez CM, Ford ME, Brandt HM, Gore EI, et al. Racial and ethnic group knowledge, perceptions and behaviors about human papillomavirus, human papillomavirus vaccination, and cervical cancer among adolescent females. J Pediatr Adolesc Gynecol. 2016;29(5):429–35.

  5. 5.

    Carteret M, Ed M. Cultural values of Asian patients and families | Dimensions of culture. n.d..Retrieved June 28, 2019, from

  6. 6.

    CDC. HPV vaccine prevents HPV and cancers that it causes. 2019a. Retrieved June 28, 2019, from Centers for Disease Control and Prevention website:

  7. 7.

    CDC. Other sexually transmitted diseases—2018 sexually transmitted diseases surveillance. 2019b. Retrieved December 18, 2019, from

  8. 8.

    Centers for Disease Control and Prevention. HPV | assessing rates through AFIX visits. 2016. Retrieved July 2, 2019, from

  9. 9.

    Drewry J, Garcés-Palacio IC, Scarinci I. Awareness and knowledge about human papillomavirus among Latina immigrants. Ethnicity & Disease. 2010;20(4):327–33.

  10. 10.

    Forster AS, McBride KA, Davies C, Stoney T, Marshall H, McGeechan K, et al. Development and validation of measures to evaluate adolescents’ knowledge about human papillomavirus (HPV), involvement in HPV vaccine decision-making, self-efficacy to receive the vaccine and fear and anxiety. Public Health. 2017;147:77–83.

  11. 11.

    Hepburn M. Health literacy, conceptual analysis for disease prevention. International Journal of Collaborative Research on Internal Medicine & Public Health. 2012;4(3) Retrieved from

  12. 12.

    Kandula NR, Wen M, Jacobs EA, Lauderdale DS. Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: cultural influences or access to care? Cancer. 2006;107(1):184–92.

  13. 13.

    Kim K, Kim B, Choi E, Song Y, Han H-R. Knowledge, perceptions, and decision making about human papillomavirus vaccination among Korean American women: a focus group study. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health. 2015;25(2):112–9.

  14. 14.

    Kimbrough J. Health literacy as a contributor to immigrant health disparities. Journal of Health Disparities Research and Practice. 2012;1(2) Retrieved from

  15. 15.

    Lai D, Bodson J, Davis FA, Lee D, Tavake-Pasi F, Napia E, et al. Diverse families’ experiences with HPV vaccine information sources: a community-based participatory approach. J Community Health. 2017;42(2):400–12.

  16. 16.

    Lee HY, Kwon M, Vang S, DeWolfe J, Kim NK, Lee DK, et al. Disparities in human papillomavirus vaccine literacy and vaccine completion among Asian American Pacific Islander undergraduates: implications for cancer health equity. J Am Coll Heal. 2015a;63(5):316–23.

  17. 17.

    Lee HY, Kwon M, Vang S, DeWolfe J, Kim NK, Lee DK, et al. Disparities in human papillomavirus vaccine literacy and vaccine completion among Asian American Pacific Islander undergraduates: implications for cancer health equity. Journal of American College Health: J of ACH. 2015b;63(5):316–23.

  18. 18.

    Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. J Gen Intern Med. 2015;30(8):1118–24.

  19. 19.

    Mayo Clinic. Cervical cancer—symptoms and causes. 2017; Retrieved June 28, 2019, from Mayo Clinic website:

  20. 20.

    Mayo Clinic. HPV infection—symptoms and causes. 2019; Retrieved June 28, 2019, from Mayo Clinic website:

  21. 21.

    Napolitano F, Gualdieri L, Santagati G, Angelillo IF. Knowledge and attitudes toward HPV infection and vaccination among immigrants and refugees in Italy. Vaccine. 2018;36(49):7536–41.

  22. 22.

    National Cancer Institute. Human Papillomavirus (HPV) Vaccines [CgvFactSheet]. 2018; Retrieved June 28, 2019, from National Cancer Institute website:

  23. 23.

    Nguyen GT, Leader AE, Hung WL. Awareness of anticancer vaccines among Asian American women with limited english proficiency: an opportunity for improved public health communication. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education. 2009;24(4):280–3.

  24. 24.

    Oh KM, Kreps GL, Jun J, Chong E, Ramsey L. Examining the health information–seeking behaviors of Korean Americans. J Health Commun. 2012;17(7):779–801.

  25. 25.

    Perez AD, Hirschman C. The changing racial and ethnic composition of the US population: emerging American identities. Popul Dev Rev. 2009;35(1):1–51.

  26. 26.

    Scarinci IC, Garcés-Palacio IC, Partridge EE. An examination of acceptability of HPV vaccination among African American women and Latina immigrants. J Women's Health. 2007;16(8):1224–33.

  27. 27.

    Sentell T, Braun KL. Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication. 2012;17(sup3):82–99.

  28. 28.

    Thompson ML, Myers JE, Kriebel D. Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? Occup Environ Med. 1998;55(4):272–7.

  29. 29.

    UCLA Center for Health Policy Research. CHIS methodology documentation. 2012; Retrieved from

  30. 30.

    U.S. Census Bureau. QuickFacts: California; United States. 2018; Retrieved July 2, 2019, from,US/INC110217.

  31. 31.

    U.S. Department of Health and Human Services-Office of Disease Prevention and Health Promotion. America’s health literacy: why we need accessible health information. n.d.; Retrieved from

  32. 32.

    U.S. Department of Health and Human Services-Office of Minority Health. Immunizations and Asians and Pacific Islanders. 2018; Retrieved from

  33. 33.

    Zhou M, Gatewood JV. Contemporary Asian America: a multidisciplinary reader. New York: NYU Press; 2000.

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Correspondence to Monideepa B. Becerra.

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The study was approved by Institutional Review Board as exempt as there are no human subject participants in secondary analysis.

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Nearly half of Asian-Americans never heard of HPV, with 14% thinking that HPV can cause AIDS. Around 13% also thought HPV goes away by itself. HPV knowledge was even lower among Asian-Americans who were not born in the USA or had low English language proficiency. These differences in HPV health literacy should be considered when working with the Asian-American population.

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Becerra, M.B., Avina, R.M., Mshigeni, S. et al. Low Human Papillomavirus Literacy Among Asian-American Women in California: an Analysis of the California Health Interview Survey. J. Racial and Ethnic Health Disparities (2020).

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  • HPV
  • Asian Americans
  • Immigrants
  • Social determinants
  • Health literacy