title: Communication about sex and HPV among Puerto Rican mothers and daughters.
abstract: Although opportunities to vaccinate against human papillomavirus (HPV) are available, vaccination rates in Puerto Rico remain low. Communication between parents and adolescents about sexual topics may influence decisions about HPV vaccination uptake, particularly among young women; yet, few studies have addressed this issue. This qualitative study explored Puerto Rican mothers' and daughters' communication on sex-related topics, and HPV, including the HPV vaccine.
  
  
  
  Thirty participants, including 9 mothers and 21 daughters, participated in seven focus groups. Participants were divided into groups of mothers and daughters, and further stratified by vaccination status. Transcripts were analyzed using a modified grounded theory approach to identify emergent themes.
  
  
  
  Focus group data revealed four main themes: (1) limited parent-daughter communication about sex-related topics; (2) daughters' discomfort discussing sex-related topics with their parents; (3) parental focus on abstinence; and, (4) limited parent-daughter communication about HPV and the HPV vaccine.
  
  
  
  Although daughters in this study struggled with feelings of embarrassment, invasion of privacy, encouragement of abstinence, and the fear of parents' reaction to them being sexually active prior to marriage, they also recognized the need to increase the parent-daughter communication about sex-related topics including HPV and the HPV vaccine. Educational efforts should target both daughters and parents to increase communication skills and self-efficacy and to enable them to discuss sexual health in open and nonjudgmental conversations.
authors.affiliation: a Division of Population Health Sciences, PR Comprehensive Cancer Center , University of Puerto Rico , San Juan , Puerto Rico.|b Health Services Administration, Evaluation Program , Graduate School of Public Health, University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Vivian
authors.initials: V
authors.lastname: Colón-López
authors.affiliation: c Center for Health Promotion and Prevention Research, The University of Texas School of Public Health , Houston , TX , USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Fernández-Espada
authors.affiliation: d UPR-MDACC Partnership for Excellence in Cancer Research Program , University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Camille
authors.initials: C
authors.lastname: Vélez
authors.affiliation: e School of Nursing, University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Velda J
authors.initials: VJ
authors.lastname: Gonzalez
authors.affiliation: a Division of Population Health Sciences, PR Comprehensive Cancer Center , University of Puerto Rico , San Juan , Puerto Rico.|f Department of Restorative Sciences , School of Dental Medicine, University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Elba C
authors.initials: EC
authors.lastname: Diaz-Toro
authors.affiliation: g Gillings School of Global Public Health, Department of Health Policy and Management , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.affiliation: c Center for Health Promotion and Prevention Research, The University of Texas School of Public Health , Houston , TX , USA.
authors.forename: Lara S
authors.initials: LS
authors.lastname: Savas
authors.affiliation: b Health Services Administration, Evaluation Program , Graduate School of Public Health, University of Puerto Rico , San Juan , Puerto Rico.|d UPR-MDACC Partnership for Excellence in Cancer Research Program , University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Angela
authors.initials: A
authors.lastname: Pattatucci
authors.affiliation: c Center for Health Promotion and Prevention Research, The University of Texas School of Public Health , Houston , TX , USA.
authors.forename: María E
authors.initials: ME
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D003142:Communication; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008875:Middle Aged; D009034:Mother-Child Relations / Q000523:psychology; D030361:Papillomavirus Infections / Q000517:prevention & control / Q000523:psychology*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D011647:Puerto Rico; D012723:Sex; D012736:Sex Education; D012746:Sexual Abstinence / Q000208:ethnology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV vaccine; Human papilloma virus; Puerto Rico; Virus del papiloma humano; adolescentes; adolescents; communication; comunicación; investigación cualitativa; qualitative research; sexual topics; temas sexuales; vacuna contra el VPH