Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Community and Family Health

Major Professor

Ellen Daley, Ph.D.

Co-Major Professor

Eric Buhi, Ph.D.

Committee Member

Julie Baldwin, Ph.D.

Committee Member

Anna Giuliano, Ph.D.

Committee Member

Alan Nyitray, Ph.D.


Male Sexual Minority, HPV Prevention, Mixed Methods, Integrative Model


Men who have sex with men (MSM) are at increased risk of anal cancer as a result of anal HPV infection. Routine HPV vaccination is recommended for all MSM up through age 26; however, vaccine uptake among this population is low. The Integrative Model of Behavioral Prediction (IM) was used to identify, describe, and explain psychosocial factors related to HPV vaccine decision-making for young MSM. A sequential mixed-methods approach consisting of semi-structured interviews, a quantitative survey, and a qualitative open-ended survey was used to address the following aims: (1) Determine salient outcome, normative, efficacy, and control beliefs related to HPV-vaccination among young MSM; (2) Identify information needs and trusted sources of information regarding HPV vaccination among young MSM; and (3) Develop and test a structural equation model guided by the Integrated Model of Behavioral Prediction. The purpose and objectives of this research address priorities outlined in the Institute of Medicine's report on health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations. Results highlight the lack of information and knowledge regarding HPV prevention in this population. The majority of respondents had heard of the HPV vaccine but generally perceived it as a women's health issue. Attitudes toward vaccination were generally positive, as was behavioral intention to get vaccinated within the next 12 moths. Salient behavioral beliefs described physical benefits such as lowering risk and promoting overall health. Psychological benefits were described as protecting sex partners and providing peace of mind. There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and potential side effects. Normative influences on decision-making were minimal. Availability, cost, and convenience were among the most salient external control factors. Issues surrounding disclosure of sexual minority status influenced control factors including self-efficacy. Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination. Empirical findings support the proposed behavioral model of vaccine decision-making.