EFFECTS OF FEMININITY IDEOLOGIES AND SEXUAL SELF-CONCEPT ON HPV VACCINATION INTENTIONS: AN EXPLORATORY EXTENSION OF EXISTING HEALTH BEHAVIOR CHANGE MODELS
Human Papillomaviruses (HPVs) are a group of over 100 different types of related viruses currently infecting 79 million Americans, making it the most pervasive sexually transmitted infection in the United States (American Cancer Society [ACS], 2013; Centers for Disease Control [CDCa], 2013). Persistent exposure to high-risk HPV types (e.g.,Types 16 and 18) due to unprotected sex remains the single-most important risk factor for developing serious pre-cancerous and cancerous lesions of the reproductive and genital regions (CDC, 2007). Although incidence and mortality rates associated with cervical cancer continue to decrease every year since 1955, largely due to the availability of Pap tests and other screening programs, invasive cervical cancer still remains a serious national health issue with 12,360 new cases and 4,020 projected deaths for 2014 alone (ACS, 2014). Sexually active young adults have the highest rates of infection, with one study citing a 44.8% prevalence of HPVs in a sample of females between the ages of 20 and 24 years (Weller & Stanberry, 2007). Despite widespread access to vaccination programs, only 33.4% of female adolescents have received all three doses of either vaccination (CDC, 2013b). Among college populations, rates of vaccination are estimated to be a mere 12.7% (Laz, Rahman, & Berenson). Examining antecedents of sexual risk behavior may better capture the nuances of social realities impacting HPV-related protective health intentions and behaviors and thus lend explanatory power to traditional models of health behavior change. Missing from discourses of sexual risk behavior is a thorough appreciation of how women feel and experience their sexuality and to what extent these lived experiences influence decisions concerning their health, including preventive HPV-related sexual health practices (e.g., Savin-Williams & Diamond, 2004).This project explored how factors reflecting differential systems of power, privilege, and gendered sexual scripts complement existing constructs of health behavior theory (i.e., Health Belief Model [HBM; Rosenstock, 1966], Theory of Planned Behavior and Reasoned Action [TPB; Ajzen, 1985; 1991; Fishbein & Ajzen, 1975]), to influence both sexual risk behaviors and HPV vaccination intentions of 261 sexually active college women (age 18-26). Specific aims were: to examine the contribution of constructs related to femininity ideology (body objectification and inauthenticity in relationships) (Tolman & Porche, 2000) and sexual self-schema (Johnson Vickerburg & Deaux, 2005; Snell, 1995) to vaccination intentions via their impact on sexual risk behaviors. Using structural equation modeling, full support was found for a model of sexual risk behavior that included femininity ideology and both positive and negative sexual self-schemas. The final model of HPV vaccination intention provided partial support for constructs associated with health behavior theory (vulnerability, safety/effectiveness, subjective norms). Additionally, the hypothesized relationships between sexual risk behavior with perceived vulnerability and physician communication with vaccine intention were also supported. The indirect effects of femininity ideology on both sexual risk behavior and vaccination intentions operated chiefly through negative sexual self-schema. Other findings included inadequate personal protection, insufficient preventative gynecological care, dearth of HPV-related health knowledge, and lack of vaccine intentionality among participants. Appreciating the broader sociocultural antecedents of HPV vaccination decision-making may generate novel opportunities for individual-level interventions and vaccination campaign efforts.