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Kohler RE, Wagner RB, Vega J, Rivera YM, Kantor L, Greene K. HPV Vaccination Information Access, Needs, and Preferences Among Black and Hispanic Mothers. JOURNAL OF HEALTH COMMUNICATION 2024:1-14. [PMID: 39129253 DOI: 10.1080/10810730.2024.2386594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
HPV-associated cancer disparities disproportionately affect Black/African American and Hispanic individuals in the U.S. HPV vaccination, which can prevent many HPV-associated cancers, should be clearly recommended by pediatricians to parents of adolescents aged 9-12, yet uptake and completion remain lower than other adolescent vaccinations. We used the Structural Influence Model of Health Communication to explore communication inequalities from interviews with 19 Black and Hispanic mothers of adolescents. We identified HPV vaccination information seeking behaviors, media use, and preferred channels to address information needs. This study provides insights into how mothers' nativity and ethno-racial identity influenced how they accessed and processed information from various sources. Preferences for digital and community-based strategies to address information gaps and hesitancy concerns are also presented. Findings suggest future prevention strategies must increase access to accurate information that resonates with NH-Black and Hispanic communities' needs and is disseminated via preferred communication channels to maximize the effects of multi-level interventions promoting HPV vaccination among communities experiencing disparities.
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Affiliation(s)
- Racquel E Kohler
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Rachel B Wagner
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Jacqueline Vega
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Yonaira M Rivera
- School of Communication & Information, Rutgers University, New Brunswick, New Jersey, USA
| | - Leslie Kantor
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Kathryn Greene
- School of Communication & Information, Rutgers University, New Brunswick, New Jersey, USA
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Johnston C, Scheele S, Bachmann L, Boily MC, Chaiyakunapruk N, Deal C, Delany-Moretlwe S, Lee S, Looker K, Marshall C, Mello MB, Ndowa F, Gottlieb S. Vaccine value profile for herpes simplex virus. Vaccine 2024; 42:S82-S100. [PMID: 39003018 DOI: 10.1016/j.vaccine.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 01/15/2024] [Indexed: 07/15/2024]
Abstract
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are chronic, highly prevalent viral infections that cause significant morbidity around the world. HSV-2 is sexually transmitted and is the leading cause of genital ulcer disease (GUD). It also increases the risk of HIV acquisition, fueling the HIV epidemic. HSV-1 is typically acquired in childhood through nonsexual contact and contributes to oral and ocular disease, but it can also be sexually transmitted to cause GUD. Both HSV-1 and HSV-2 cause neonatal herpes and neurologic disease. Given the ubiquitous nature of HSV-1 and HSV-2 infections and the limited existing prevention and control measures, vaccination would be the most efficient strategy to reduce the global burden of morbidity related to HSV infection. Vaccine strategies include prophylactic vaccination, which would prevent infection among susceptible persons and would likely be given to adolescents, and therapeutic vaccinations, which would be given to people with symptomatic genital HSV-2 infection. This document discusses the vaccine value profile of both types of vaccines. This 'Vaccine Value Profile' (VVP) for HSV is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by subject matter experts from academia, non-profit organizations, government agencies and multi-lateral organizations. All contributors have extensive expertise on various elements of the HSV VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Christine Johnston
- Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA.
| | - Suzanne Scheele
- Center for Vaccine Introduction and Access, PATH, Washington, DC, USA
| | - Laura Bachmann
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Carolyn Deal
- Enteric and Sexually Transmitted Diseases Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Shaun Lee
- Monash University Malaysia, Subang, Malaysia
| | - Katharine Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Caroline Marshall
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kim SK, Kornides M, Chittams J, Waas R, Duncan R, Teitelman AM. Pilot Randomized Controlled Trial of an Intervention to Promote HPV Uptake Among Young Women Who Attend Subsidized Clinics. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00229-6. [PMID: 39030937 DOI: 10.1016/j.jogn.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE To evaluate the preliminary efficacy, acceptability, and feasibility of Step Up to Prevention, a technology-enhanced intervention to promote human papillomavirus (HPV) vaccination uptake among young minority and low-income women. DESIGN A pilot randomized controlled trial. SETTING Two federally supported outpatient clinics in a large city in the northeastern United States. PARTICIPANTS Women who were 18 to 26 years of age (N = 60). METHODS We randomized participants into four groups: computer information, in-person tailored, combined, and usual care. We administered computer-assisted self-interview surveys before the intervention (baseline), immediately after the intervention (postintervention), and after their clinic visit (post-clinic visit). We conducted a descriptive analysis of participant characteristics. For preliminary efficacy, we used logistic regression-assessed HPV vaccine initiation uptake rates, and we used descriptive statistics to compare theoretical mediators. We used conventional content analysis to assess participant feedback about intervention acceptability. We assessed feasibility through recruitment and retention rates and our ability to deliver the intervention. RESULTS We observed significant differences in initial HPV vaccine uptake between the intervention groups and the usual care group. Participant feedback indicated that the intervention was acceptable, empowering, and informative. We met our recruitment target, maintained a high retention rate (98%), and delivered the complete intervention to all participants. CONCLUSION We report the preliminary efficacy, acceptability, and feasibility of this intervention to promote HPV vaccine initiation among young women in federally subsided health care settings by advancing favorable views and improving knowledge about HPV vaccination.
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Spencer JC, Spees LP, Biddell CB, Odebunmi OO, Ilyasova AA, Yanguela J, Lich KH, Mills SD, Higgins CR, Ozawa S, Wheeler SB. Inclusion of marginalized populations in HPV vaccine modeling: A systematic review. Prev Med 2024; 182:107941. [PMID: 38522627 PMCID: PMC11194695 DOI: 10.1016/j.ypmed.2024.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Models simulating the potential impacts of Human Papillomavirus (HPV) vaccine have been used globally to guide vaccination policies and programs. We sought to understand how and why marginalized populations have been incorporated into HPV vaccine simulation models. METHODS We conducted a systematic search of PubMed, CINAHL, Scopus, and Embase to identify studies using simulation models of HPV vaccination incorporating one or more marginalized population through stratification or subgroup analysis. We extracted data on study characteristics and described these overall and by included marginalized groups. RESULTS We identified 36 studies that met inclusion criteria, which modeled vaccination in 21 countries. Models included men who have sex with men (MSM; k = 16), stratification by HIV status (k = 9), race/ethnicity (k = 6), poverty (k = 5), rurality (k = 4), and female sex workers (k = 1). When evaluating for a marginalized group (k = 10), HPV vaccination was generally found to be cost-effective, including for MSM, individuals living with HIV, and rural populations. In studies evaluating equity in cancer prevention (k = 9), HPV vaccination generally advanced equity, but this was sensitive to differences in HPV vaccine uptake and use of absolute or relative measures of inequities. Only one study assessed the impact of an intervention promoting HPV vaccine uptake. DISCUSSION Incorporating marginalized populations into decision models can provide valuable insights to guide decision making and improve equity in cancer prevention. More research is needed to understand the equity impact of HPV vaccination on cancer outcomes among marginalized groups. Research should emphasize implementation - including identifying and evaluating specific interventions to increase HPV vaccine uptake.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America.
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Olufeyisayo O Odebunmi
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Anna A Ilyasova
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Juan Yanguela
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Colleen R Higgins
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sachiko Ozawa
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Hagens A, Sloof AC, Janghorban R. Using a Dynamic Model to Estimate the Cost-Effectiveness of HPV Vaccination in Iran. Vaccines (Basel) 2024; 12:438. [PMID: 38675821 PMCID: PMC11054652 DOI: 10.3390/vaccines12040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to determine the cost-effectiveness of vaccination against HPV. An age-sex structured dynamic disease transmission model was created to estimate the spread of HPV and the HPV-related incidence of cervical cancer (CC) in Iran. Sixteen age groups of men and women were incorporated to reflect the differences in sexual preferences, vaccination uptake, and disease-related outcomes. Three scenarios were evaluated by using an Incremental Cost-Effectiveness Ratio (ICER) with gained quality-adjusted life years (QALYs). ICER values below one gross domestic product (GDP) per capita are evaluated as highly cost-effective. Vaccination reduces the number of infections and CC-related mortality. Over time, the vaccinated group ages and older age groups experience protection. An initial investment is required and savings in treatment spending reduce the impact over time. Vaccinating girls only was found to be cost-effective, with an ICER close to once the GDP per capita. Vaccinating both sexes was shown to be less cost-effective compared to girls only, and vaccinating boys only was not found to be cost-effective, with an ICER between once and three times, and greater than three times the GDP per capita, respectively. The estimates are conservative since societal cost-saving and the impact of other HPV-related illnesses were not considered and would likely reduce the ICERs.
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Affiliation(s)
- Arnold Hagens
- Department of Health Sciences, University Medical Center Groningen, University of Groningen (RUG), 9713 AV Groningen, The Netherlands
- Triangulate Health Ltd., Doncaster DN11 9QU, UK
| | | | - Roksana Janghorban
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz 71936-13119, Iran;
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Spencer JC, Burger EA, Campos NG, Regan MC, Sy S, Kim JJ. Adapting a model of cervical carcinogenesis to self-identified Black women to evaluate racial disparities in the United States. J Natl Cancer Inst Monogr 2023; 2023:188-195. [PMID: 37947333 PMCID: PMC10637021 DOI: 10.1093/jncimonographs/lgad015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Self-identified Black women in the United States have higher cervical cancer incidence and mortality than the general population, but these differences have not been clearly attributed across described cancer care inequities. METHODS A previously established microsimulation model of cervical cancer was adapted to reflect demographic, screening, and survival data for Black US women and compared with a model reflecting data for all US women. Each model input with stratified data (all-cause mortality, hysterectomy rates, screening frequency, screening modality, follow-up, and cancer survival) was sequentially replaced with Black-race specific data to arrive at a fully specified model reflecting Black women. At each step, we estimated the relative contribution of inputs to observed disparities. RESULTS Estimated (hysterectomy-adjusted) cervical cancer incidence was 8.6 per 100 000 in the all-race model vs 10.8 per 100 000 in the Black-race model (relative risk [RR] = 1.24, range = 1.23-1.27). Estimated all-race cervical cancer mortality was 2.9 per 100 000 vs 5.5 per 100 000 in the Black-race model (RR = 1.92, range = 1.85-2.00). We found the largest contributors of incidence disparities were follow-up from positive screening results (47.3% of the total disparity) and screening frequency (32.7%). For mortality disparities, the largest contributor was cancer survival differences (70.1%) followed by screening follow-up (12.7%). CONCLUSION To reduce disparities in cervical cancer incidence and mortality, it is important to understand and address differences in care access and quality across the continuum of care. Focusing on the practices and policies that drive differences in treatment and follow-up from cervical abnormalities may have the highest impact.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Caroline Regan
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Le D, Kim HJ, Wen KY, Juon HS. Disparities in awareness of the HPV vaccine and HPV-associated cancers among racial/ethnic minority populations: 2018 HINTS. ETHNICITY & HEALTH 2023; 28:586-600. [PMID: 36045478 PMCID: PMC10512437 DOI: 10.1080/13557858.2022.2116630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/18/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults. DESIGN Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January-May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis. RESULTS About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07-0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35-0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36-0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18-45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine. CONCLUSION Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers.
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Affiliation(s)
- Daisy Le
- School of Nursing, The George Washington University, 1919 Pennsylvania Avenue, NW, Suite 500, Washington, DC 20006, USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, 3rd Floor, Washington, DC 20052, USA
| | - Hee Jun Kim
- Research Institute of Nursing Science, College of Nursing, Ajou University, 206 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Kuang-Yi Wen
- Department of Medical Oncology, Thomas Jefferson University
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University
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Perkins R, Mitchell E. Cervical cancer disparities. J Natl Med Assoc 2023; 115:S19-S25. [PMID: 37202000 DOI: 10.1016/j.jnma.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Rebecca Perkins
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Edith Mitchell
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, United States.
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Dang JHT, McClure S, Gori ACT, Martens T, Mojadedi A, Smith U, Austin CJ, Chen MS. Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents. J Rural Health 2023; 39:136-141. [PMID: 35798683 PMCID: PMC9771865 DOI: 10.1111/jrh.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic. METHODS This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up. FINDINGS The proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. CONCLUSIONS The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.
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Affiliation(s)
- Julie H. T. Dang
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, California, USA
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | - Alexandra C. T. Gori
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | | | - Ulissa Smith
- Neighborhood Wellness Foundation, Sacramento, California, USA
| | | | - Moon S. Chen
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California, USA
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Suk R, Liao K, Bauer CX, Basil C, Li M. Human Papillomavirus Vaccine Administration Trends Among Commercially Insured US Adults Aged 27-45 Years Before and After Advisory Committee on Immunization Practices Recommendation Change, 2007-2020. JAMA HEALTH FORUM 2022; 3:e224716. [PMID: 36525257 PMCID: PMC9856534 DOI: 10.1001/jamahealthforum.2022.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Importance In 2019, the Advisory Committee on Immunization Practices (ACIP) recommended patient-clinician shared decision-making for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years. Less is known about the HPV vaccine administration trends in this age group before and after this recommendation update. Objective To examine the association between the ACIP recommendation update and the HPV vaccine administration among US adults aged 27 to 45 years. Design, Setting, and Participants This large commercial claim-based retrospective cohort study used the Optum Clinformatics database for validated claims from January 1, 2007, through December 31, 2020. A total of 22 600 520 US adults aged 27 to 45 years without previous HPV vaccination claims during the study and enrollment period were included. Main Outcomes and Measures The first-appearing HPV vaccination claim per individual was defined as a new HPV vaccine administration. Interrupted time-series analyses were conducted to assess the association between the ACIP update and the quarterly vaccine administration rate change. The annual rate trends across race and ethnicity groups and the proportions of vaccination cases by sub-age groups and valent types were also estimated. Vaccine administration trends were assessed by race and ethnicity in this age group because HPV vaccination trends were found to differ by race and ethnicity in the initially eligible population. Results Among 22 600 520 final study participants, the majority were men (50.9%) and non-Hispanic White (53.4%), and the mean (SD) age when first observed was 34.6 (5.8) years. In women, the ACIP update was associated with an immediate increase in vaccine administration rate (coefficient β2, 40.18 per 100 000 persons; P = .01) and an increased slope (coefficient β3, 9.62 per 100 000 persons per quarter; P = .03) over time postupdate. The ACIP update was only associated with an immediate increase in vaccine administration in men (coefficient β2, 27.54; P < .001). The annual rate trends were similar across race and ethnicity groups. Age at vaccine administration shifted over time (eg, women aged 40-45 years comprised only 4.9% of vaccinations in 2017, then 19.0% in 2019, and 22.7% in 2020). The most administered HPV vaccines in 2020 were 9 valent (women, 97.0%; men, 97.7%). Conclusions and Relevance In this population-based cohort study, there were statistically significant increases in HPV vaccine administration in adults aged 27 to 45 years after the ACIP recommendation update. Patient-clinician shared decision-making may have been the main associated factor for this increase. Further research is warranted to explore the decision-making process in receiving HPV vaccination and to develop effective decision aids to maximize the cancer prevention benefit in this age group.
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Affiliation(s)
- Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Kaiping Liao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Cici X. Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Catherine Basil
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio
| | - Meng Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
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11
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Cox JE, Bogart LM, Elliott MN, Starmer AJ, Meleedy-Rey P, Goggin K, Banerjee T, Samuels RC, Hahn PD, Epee-Bounya A, Allende-Richter S, Fu CM, Schuster MA. Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population. Pediatrics 2022; 150:189547. [PMID: 36127315 DOI: 10.1542/peds.2021-054186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nationally, 54.2% of youth are fully vaccinated for human papilloma virus (HPV) with persistent gender and racial/ethnic disparities. We used a quality improvement approach to improve completion of the HPV vaccine series by age 13 years. As a secondary aim, we examined racial/ethnic and gender differences in vaccine uptake. METHODS The study setting included 2 pediatric, academic, primary care practices in Massachusetts. We designed a multilevel patient-, provider-, and systems-level intervention addressing parental hesitancy, provider communication, and clinical operations. Rates of HPV series completion by age 13 were monitored using a control p chart. Bivariate and multivariate analyses evaluated vaccine completion differences on the basis of clinic size, gender, and race/ethnicity. RESULTS Between July 1, 2014, and September 30, 2021, control p charts showed special cause variation with HPV vaccine initiation by age 9 years, increasing from 1% to 52%, and vaccine completion by 13 years, increasing from 37% to 77%. Compared with White and Black children, Hispanic children were more likely to initiate the HPV vaccine at age 9 (adjusted odds ratio [95% confidence interval] = (1.4-2.6)] and complete the series by age 13 (adjusted odds ratio [95% confidence interval] = 2.3 (1.7-3.0). CONCLUSIONS A multilevel intervention was associated with sustained HPV vaccine series completion by age 13 years. Hispanic children were more likely to be vaccinated. Qualitative family input was critical to intervention design. Provider communication training addressed vaccine hesitancy. Initiation of the vaccine at age 9 and clinicwide vaccine protocols were key to sustaining improvements.
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Affiliation(s)
- Joanne E Cox
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura M Bogart
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,RAND Corporation, Santa Monica, California
| | | | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Kathy Goggin
- Schools of Medicine and Pharmacy, Health Services and Outcome Research, Children's Mercy Hospital and University of Missouri, Kansas City, Missouri
| | - Taruna Banerjee
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Organizational Quality and Patient Safety, Cambridge Health Alliance, Cambridge Massachusetts
| | - Ronald C Samuels
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of General Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Phillip D Hahn
- Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra Epee-Bounya
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophie Allende-Richter
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chong-Min Fu
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,RAND Corporation, Santa Monica, California
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12
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Reno JE, Dempsey AF. Promoting HPV vaccination among Latinx: an application of the extended parallel processing model. J Behav Med 2022; 46:324-334. [PMID: 35178652 DOI: 10.1007/s10865-022-00293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Vaccine hesitancy is a substantial barrier to increasing HPV vaccination rates among Latinx in the US who experience disproportional rates of HPV-related cancers. The current research tests the effectiveness of culturally-targeted, fear-appeal messages designed using the Extended Parallel Processing Model (EPPM). We compared differences among Latinx young adults and parents of adolescents of the effectiveness of messages that highlight HPV-related cancers, genital warts, or a control condition to promote online information seeking about the HPV vaccine-a known precursor to vaccination intention. Results found messages containing EPPM messaging elements produced significantly higher self-reported intention to seek information about HPV vaccines in comparison to a control message group. However, participants who received control messages had the highest percentage of hyperlink clicks to more information about HPV (a novel measure of information seeking). Findings suggest that fear appeals may be effective for promoting information seeking about HPV vaccination, which in turn could increase vaccine utilization, among Latinx participants. Clinical trial registration number (NCT05206669) retrospectively registered January 25, 2022.
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Affiliation(s)
- Jenna E Reno
- University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 210-16, Aurora, CO, 80045, USA.
| | - Amanda F Dempsey
- University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 210-16, Aurora, CO, 80045, USA
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13
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Risley C, Stewart MW, Geisinger KR, Hiser LM, Morgan JC, Owens KJ, Ayyalasomayajula K, Rives RM, Jannela A, Grunes DE, Zhang L, Schiffman M, Wentzensen N, Clarke MA. STRIDES - STudying Risk to Improve DisparitiES in Cervical Cancer in Mississippi - Design and baseline results of a Statewide Cohort Study. Prev Med 2021; 153:106740. [PMID: 34293382 PMCID: PMC8595817 DOI: 10.1016/j.ypmed.2021.106740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 07/17/2021] [Indexed: 12/13/2022]
Abstract
Cervical cancer rates in Mississippi are disproportionately high, particularly among Black individuals; yet, research in this population is lacking. We designed a statewide, racially diverse cohort of individuals undergoing cervical screening in Mississippi. Here, we report the baseline findings from this study. We included individuals aged 21 years and older undergoing cervical screening with cytology or cytology-human papillomavirus (HPV) co-testing at the Mississippi State Health Department (MSDH) and the University of Mississippi Medical Center (UMMC) (December 2017-May 2020). We collected discarded cytology specimens for future biomarker testing. Demographics and clinical results were abstracted from electronic medical records and evaluated using descriptive statistics and chi-square tests. A total of 24,796 individuals were included, with a median age of 34.8 years. The distribution of race in our cohort was 60.2% Black, 26.4% White, 7.5% other, and 5.9% missing. Approximately 15% had abnormal cytology and, among those who underwent co-testing at MSDH (n = 6,377), HPV positivity was 17.4% and did not vary significantly by race. Among HPV positives, Black individuals were significantly less likely to be HPV16/18 positive and more likely to be positive for other high-risk 12 HPV types compared to White individuals (20.5% vs. 27.9%, and 79.5% and 72.1%, respectively, p = 0.011). Our statewide cohort represents one of the largest racially diverse studies of cervical screening in the U.S. We show a high burden of abnormal cytology and HPV positivity, with significant racial differences in HPV genotype prevalence. Future studies will evaluate cervical precancer risk, HPV genotyping, and novel biomarkers in this population.
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Affiliation(s)
- Carolann Risley
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, Rockville, MD, United States of America; University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America; University of Mississippi Medical Center, Department of Cell and Molecular Biology, Jackson, MS, United States of America.
| | - Mary W Stewart
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America.
| | - Kim R Geisinger
- Joint Pathology Center, Walter Reed National Military Medical Center, Silver Spring, MD, United States of America; East Carolina University, Department of Pathology, Greenville, NC, United States of America.
| | - Laree M Hiser
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America.
| | - Jody C Morgan
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America.
| | - Kenyata J Owens
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America; University of Mississippi Medical Center, Center for Informatics & Analytics, Jackson, MS, United States of America.
| | - Krishna Ayyalasomayajula
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America; University of Mississippi Medical Center, Center for Informatics & Analytics, Jackson, MS, United States of America.
| | - Rhonda M Rives
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America; University of Mississippi Medical Center, Department of Pathology, Jackson, MS, United States of America..
| | - Ashish Jannela
- University of Mississippi Medical Center, Center for Informatics & Analytics, Jackson, MS, United States of America.
| | - Dianne E Grunes
- University of Mississippi Medical Center, Department of Pathology, Jackson, MS, United States of America..
| | - Lei Zhang
- University of Mississippi Medical Center, School of Nursing, Jackson, MS, United States of America; Mississippi State Department of Health, Research & Statistics, Jackson, MS, United States of America.
| | - Mark Schiffman
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, Rockville, MD, United States of America.
| | - Nicolas Wentzensen
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, Rockville, MD, United States of America.
| | - Megan A Clarke
- National Cancer Institute, Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, Rockville, MD, United States of America.
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14
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Spencer JC, Brewer NT, Coyne-Beasley T, Trogdon JG, Weinberger M, Wheeler SB. Reducing Poverty-Related Disparities in Cervical Cancer: The Role of HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2021; 30:1895-1903. [PMID: 34503948 PMCID: PMC8492489 DOI: 10.1158/1055-9965.epi-21-0307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/21/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. METHODS We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). RESULTS We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. CONCLUSIONS High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. IMPACT Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.
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Affiliation(s)
- Jennifer C Spencer
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tamera Coyne-Beasley
- Departments of Pediatrics and Internal Medicine, Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Tsui J, Vincent A, Anuforo B, Btoush R, Crabtree BF. Understanding primary care physician perspectives on recommending HPV vaccination and addressing vaccine hesitancy. Hum Vaccin Immunother 2021; 17:1961-1967. [PMID: 33439768 PMCID: PMC8189098 DOI: 10.1080/21645515.2020.1854603] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
HPV vaccination rates have improved in recent years, but remain suboptimal in the United States. Physician recommendation is associated with increased uptake; however, specific strategies used by physicians to recommend the vaccine and address hesitancy are underexplored. We iteratively conducted qualitative in-depth interviews with family medicine and pediatrics/adolescent medicine physicians recruited from four primary care settings (federally qualified health centers and hospital-affiliated practices) within a large academic-hospital system in New Jersey. Interviews aimed to understand factors influencing physician recommendations. Transcripts were analyzed iteratively using a team-based, thematic content analysis approach. All physicians reported strong support for HPV vaccination, intention to recommend for target age groups, and providing factsheets to parents. Many physicians used electronic medical records and/or the state immunization registry for monitoring vaccinations, but few were able to report their own clinic-level rates. The majority said they needed to overcome both hesitancy for at least 10-30% of parents and misinformation from the internet. Most cited having their own children vaccinated for HPV as a first-line strategy for addressing parental hesitancy. Other strategies included using data or professional authority to address safety concerns, linking HPV to cervical cancer, highlighting only needing two doses if vaccinated younger, and normalizing the vaccine. While our findings indicate physicians are knowledgeable about HPV vaccination and recommend it to parents, strategies to overcome parental hesitancy varied. Physician, clinic, and health-system-based strategies need to be adopted to overcome parental hesitancy for HPV vaccination.
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Affiliation(s)
- Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashley Vincent
- Medical Student, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Bianca Anuforo
- Division of Nursing Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rula Btoush
- Division of Nursing Science, Rutgers School of Nursing, Newark, NJ, USA
| | - Benjamin F Crabtree
- Division of Nursing Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson, Medical School, New Brunswick, NJ, USA
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16
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The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. J Low Genit Tract Dis 2021; 25:187-191. [PMID: 34138787 DOI: 10.1097/lgt.0000000000000614] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The American Cancer Society (ACS) released updated cervical cancer screening guidelines in 2020 that endorse a shift in practice to primary human papillomavirus (HPV) screening in people with a cervix, beginning at ages of 25-65 years. When access to US Food and Drug Administration-approved primary HPV testing is not available, the ACS offers cotesting or cytology as acceptable alternative strategies but suggests that these testing modalities may be excluded from future iterations of the guidelines. The ASCCP recognizes the benefits and risks of primary HPV cervical cancer screening while acknowledging the barriers to widespread adoption, including implementation issues, the impact of limited HPV vaccination in the United States, and inclusion of populations who may not be well represented on primary HPV screening trials, such as underrepresented minorities. The ASCCP endorses the 2018 US Preventive Services Task Force Recommendation Statement and supports the ACS cervical cancer screening guidelines. Most importantly, the ASCCP endorses any cervical cancer screening for secondary prevention of cervical cancer and recommends interventions that improve screening for those who are underscreened or unscreened.
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17
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Emerson A, Allison M, Saldana L, Kelly PJ, Ramaswamy M. Collaborating to offer HPV vaccinations in jails: results from a pre-implementation study in four states. BMC Health Serv Res 2021; 21:309. [PMID: 33827560 PMCID: PMC8028758 DOI: 10.1186/s12913-021-06315-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Correctional facilities are an underutilized venue for reaching young adults who have not vaccinated for human papillomavirus (HPV). The objective of this study was to identify factors that are associated with jail and local health department (LHD) interest in partnering to offer HPV vaccinations to young adults in jail. METHODS Consolidated framework for implementation research (CFIR)-guided surveys were conducted with jail administrators in Iowa, Kansas, Missouri, and Nebraska, September 2017-October 2018. Jail survey data were analyzed using chi square distribution and relative risk regression. Using data from sister surveys conducted with LHD administrators in the same counties (results previously reported), we identified characteristics of counties in which both the jail and LHD indicated interest in collaborating to offer HPV vaccinations in the jail. RESULTS Jail survey response was 192/347 (55.3%). Surveys with LHDs yielded 237/344 (68.9%) responses. Eleven communities were identified where both the jail and LHD expressed interest. Only "any vaccines provided in jail" predicted shared interest (RR: 5.36; CI: 2.52-11.40; p < .01). For jail administrators, offering other vaccines was 3 times (CI:1.49-6.01; p < .01) and employing a nurse 1.65 times more likely (CI: 1.20-2.28; p < .01) to predict interest in collaborating to offer HPV vaccination. Open-ended responses indicated that managing linkages and stakeholder investment were areas of emphasis where collaborations to provide vaccinations in the jails had been previously implemented. CONCLUSIONS Interest in jail-LHD partnerships to provide HPV vaccinations in jails exists in the Midwest but will require building-out existing programs and linkages and identifying and strengthening shared values, goals, and benefits at all levels.
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Affiliation(s)
- Amanda Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
| | - Molly Allison
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
| | - Lisa Saldana
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, Oregon, 97401, USA
| | - Patricia J Kelly
- Jefferson School of Nursing, Thomas Jefferson University, Center City Campus, 901 Walnut Street, 8th Floor, Philadelphia, PA, 19107, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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18
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Tabler J, Mykyta L, Schmitz RM, Kamimura A, Martinez DA, Martinez RD, Flores P, Gonzalez K, Marquez A, Marroquin G, Torres A. Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.-Mexico Border. J Community Health 2020; 44:127-136. [PMID: 30094723 DOI: 10.1007/s10900-018-0562-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
U.S.-Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43-3.68), PR 1.88 (1.04-3.41), respectively] and sexual partners met online [PR 3.73 (1.00-14.06), PR 19.98 (5.70-70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60-3.87), AOR 1.52 (1.11-2.07), AOR 1.97 (1.20-3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.
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Affiliation(s)
- Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E. University Ave., Laramie, WY, 82071, USA.
| | - Laryssa Mykyta
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA.,Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Rachel M Schmitz
- Department of Sociology, Oklahoma State University, Stillwater, OK, USA
| | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Paloma Flores
- Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Karina Gonzalez
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Alvaro Marquez
- Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Gladys Marroquin
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Andy Torres
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
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19
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Emerson A, Allison M, Kelly PJ, Ramaswamy M. Barriers and facilitators of implementing a collaborative HPV vaccine program in an incarcerated population: A case study. Vaccine 2020; 38:2566-2571. [PMID: 32046888 DOI: 10.1016/j.vaccine.2020.01.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Men and women in county jails make up a population that is difficult to reach with traditional preventive health interventions. Collaborations between local health departments and county jails represent an opportunity to enhance public health by reaching a vulnerable population with services like vaccinations. The objective of this study was to coordinate planning and implementation of a collaborative program between a local health department (HD) and a county jail to offer human papillomavirus (HPV) vaccinations to adolescents (ages 10-17) and young adults (ages 18-26) in the jail and to identify facilitators and barriers to inform future program development. METHODS A county-municipal jail and a local HD in Kansas participated. A case study method was employed based on data collected from a focus group, telephone interviews, and site observations, September 2016 to December 2017. Data were coded using codes roughly drawn from the consolidated framework for implementation research (CFIR). Codes were then consolidated into themes related to barriers and facilitators. RESULTS No adults were vaccinated; two juveniles were vaccinated. Barriers to a collaborative program to offer HPV vaccine to young adults arose in two areas: constrained resources and divergent organizational cultures and priorities. Barriers to offering HPV vaccinations to juveniles in the jail included parental consent and the unpredictable, often brief duration of juvenile detentions. A shared commitment to offering HPV vaccination services by leaders and staff in the two agencies was a key facilitator. CONCLUSION Finding ways to leverage leadership and staff buy-in and address specific barriers of constrained resources and divergent culture and priorities merits close attention, since partnerships between jails and local HD have potential to increase HPV vaccination rates in an overlooked population and advance public health.
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Affiliation(s)
- Amanda Emerson
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St, Kansas City, MO 64108, USA.
| | - Molly Allison
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Patricia J Kelly
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St, Kansas City, MO 64108, USA.
| | - Megha Ramaswamy
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
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20
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Fu LY, Zimet GD, Latkin CA, Joseph JG. Social Networks for Human Papillomavirus Vaccine Advice Among African American Parents. J Adolesc Health 2019; 65:124-129. [PMID: 30956139 PMCID: PMC6589357 DOI: 10.1016/j.jadohealth.2019.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/16/2019] [Accepted: 01/30/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Despite that human papillomavirus (HPV) vaccination could prevent ∼90% of HPV-associated cancers, only 65.5% of American adolescents initiate vaccination. African Americans have the highest prevalence of morbidity and mortality from HPV-associated cancers. Mounting evidence suggests that advice from social contacts is associated with vaccine acceptance. The present study examines the associations of social processes with HPV vaccine refusal among African American parents. METHODS A cross-sectional survey was conducted among African American parents of children aged 10-12 years before a health-care visit at which HPV vaccine was offered by the health-care provider. Data from the 353 parents who named at least one social contact who advised them about vaccines were included in these analyses. RESULTS Only 54.4% of the participants consented to HPV vaccination for their children. On average, parents had 2 to 3 social contacts who provided vaccine advice. Vaccine advice networks were generally dense, family-centric, and homophilous. Slightly over 80% of all parents trusted family members and friends for vaccine advice "some" or "a lot." Controlling for sociodemographic characteristics and reason for the health-care visit, perceived high exposure to anti-HPV vaccine viewpoints and low exposure to pro-HPV vaccine viewpoints were both associated with HPV vaccine refusal (adjusted odds ratio = 1.5, 95% confidence interval = 1.01, 2.3, and adjusted odds ratio = 1.7, 95% confidence interval = 1.2, 2.6, respectively). CONCLUSIONS Social processes may be associated with HPV vaccine refusal among African American parents. Interventions designed to educate African American parents about HPV vaccine to increase uptake should consider leveraging vaccine advice networks for greater impact.
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Affiliation(s)
- Linda Y Fu
- General and Community Pediatrics, Children's National Health System, Washington, DC.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California
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21
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Spencer JC, Calo WA, Brewer NT. Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis. Prev Med 2019; 123:197-203. [PMID: 30930259 PMCID: PMC6724708 DOI: 10.1016/j.ypmed.2019.03.037] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 01/20/2023]
Abstract
Studies disagree about whether racial and ethnic groups have lower or higher human papillomavirus (HPV) vaccination uptake, an important issue given large disparities in some HPV cancers. We sought to characterize and explain racial and ethnic differences in HPV vaccination. We systematically searched PubMed, CINAHL, Embase, and Web of Science to identify US studies through mid-2017 reporting associations of race and ethnicity with HPV vaccination. We identified 118 studies (n = 3,095,486) published in English that reported HPV vaccine initiation or follow-through in the US from which we could calculate effect sizes. We used random effects meta-analysis to synthesize effect sizes for comparisons of Whites or non-Hispanics to Blacks, Hispanics, Asians, or all minority groups combined. Studies showed no racial or ethnic differences in HPV vaccine initiation overall. However, when restricting to studies using provider-verified vaccination data, minorities were 6.1% [3.3%-8.8%] more likely than Whites to initiate HPV vaccination. Advantages were larger for Hispanics, males, and younger samples (age < 18). In contrast, minorities were 8.6% [5.6%, 11.7%], less likely than Whites to follow-through with the full HPV vaccine series, a disparity present across all participant and study characteristics. More recent studies found larger advantages for racial and ethnic minorities in HPV vaccine initiation and smaller disparities in follow-through. In summary, high-quality studies found racial and ethnic minorities are more likely to initiate but less likely to follow-through with HPV vaccination, a clear finding that self-report studies obscure. Higher HPV vaccine initiation among minorities suggests potential reductions in HPV cancer disparities.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
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22
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Lee J, Carvallo M, Lee E, Chung J, Shin C. Affective and Cognitive Attitudes on Cervical Health Behaviors Among Asian American Women. FAMILY & COMMUNITY HEALTH 2019; 42:123-132. [PMID: 30768477 DOI: 10.1097/fch.0000000000000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cervical cancer is a major cause of death for Vietnamese and Korean American women, yet their screening rates remain low. This study explored factors influencing cervical health behaviors of these populations, using a 2-dimensional model (ie, affect and cognition) of attitude structure approach. Semistructured interviews were conducted with 33 participants. A semantic content analysis was used to identify major codes and themes across the transcripts. Multiple aspects of both negative and positive affect and cognition, which led to 3 different cervical health behaviors (avoidance, ambivalence, and acceptance), emerged from the interviews. The clinical implications of these findings are discussed.
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Affiliation(s)
- Jongwon Lee
- College of Nursing, The University of New Mexico, Albuquerque (Dr J. Lee); Department of Psychology, University of Oklahoma, Norman (Dr Carvallo); UCLA School of Nursing (Dr E. Lee); Virginia Commonwealth University School of Nursing, Richmond (Dr Chung); and Arizona State University College of Nursing and Health Innovation, Phoenix (Dr Shin)
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Cooper DL, Zellner-Lawrence T, Mubasher M, Banerjee A, Hernandez ND. Examining HPV Awareness, Sexual Behavior, and Intent to Receive the HPV Vaccine Among Racial/Ethnic Male College Students 18-27 years. Am J Mens Health 2018; 12:1966-1975. [PMID: 30334489 PMCID: PMC6199446 DOI: 10.1177/1557988318803163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/16/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
Human papillomavirus (HPV) awareness and vaccination among males in the general population is low. Men in general, but particularly racial/ethnic men, are disproportionately affected by HPV. The purpose of this article is to examine college males' (a) HPV awareness, (b) sexual behaviors, and (c) intention to receive the HPV vaccination. A non-probability sample of all students who self-reported their race/ethnicity and were attending a university in Southeastern United States were contacted by the university registrar's office and recruited to participate in the 15-minute survey. Males, ages 18-27 years ( N = 190), were identified for this study. χ2, t-tests, and binomial logistic regression analyses assessed the relationship between knowing about HPV and HPV vaccine and the intent to receive the HPV vaccination. Findings indicated that 67.4% of the sample identified as Hispanic or Black. Among all men, 73.2% reported previous sexual experience and 49.5% were currently sexually active. There were 79.5% who had previous knowledge about HPV and 55.8% had knowledge about the HPV vaccine; 71.1% of the sample did not intend to receive the vaccine. Hispanic and Black men were less likely to identify as virgins, more likely to be sexually active, and more likely to have sexual experiences at an earlier age compared to White, Asian, and other men. Men with previous HPV vaccine knowledge (28.4%) were more likely to intend to receive the vaccine compared to men who did not have previous knowledge about the vaccine (14.9%). Providing males with information about HPV, its transmission, and possible HPV-related outcomes may increase HPV vaccine uptake.
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Affiliation(s)
- Dexter L. Cooper
- Morehouse School of Medicine, Cancer Health Equity Institute, Atlanta, GA, USA
| | | | - Mohamed Mubasher
- Morehouse School of Medicine, Clinical Research Center, Atlanta, GA, USA
| | - Ananya Banerjee
- Morehouse School of Medicine, Prevention Research Center, Atlanta, GA, USA
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Smith MA, Hall M, Lew JB, Canfell K. Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand. Vaccine 2018; 36:6314-6324. [DOI: 10.1016/j.vaccine.2018.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022]
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Lama Y, Chen T, Dredze M, Jamison A, Quinn SC, Broniatowski DA. Discordance Between Human Papillomavirus Twitter Images and Disparities in Human Papillomavirus Risk and Disease in the United States: Mixed-Methods Analysis. J Med Internet Res 2018; 20:e10244. [PMID: 30217792 PMCID: PMC6231890 DOI: 10.2196/10244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Racial and ethnic minorities are disproportionately affected by human papillomavirus (HPV)-related cancer, many of which could have been prevented with vaccination. Yet, the initiation and completion rates of HPV vaccination remain low among these populations. Given the importance of social media platforms for health communication, we examined US-based HPV images on Twitter. We explored inconsistencies between the demographics represented in HPV images and the populations that experience the greatest burden of HPV-related disease. OBJECTIVE The objective of our study was to observe whether HPV images on Twitter reflect the actual burden of disease by select demographics and determine to what extent Twitter accounts utilized images that reflect the burden of disease in their health communication messages. METHODS We identified 456 image tweets about HPV that contained faces posted by US users between November 11, 2014 and August 8, 2016. We identified images containing at least one human face and utilized Face++ software to automatically extract the gender, age, and race of each face. We manually annotated the source accounts of these tweets into 3 types as follows: government (38/298, 12.8%), organizations (161/298, 54.0%), and individual (99/298, 33.2%) and topics (news, health, and other) to examine how images varied by message source. RESULTS Findings reflected the racial demographics of the US population but not the disease burden (795/1219, 65.22% white faces; 140/1219, 11.48% black faces; 71/1219, 5.82% Asian faces; and 213/1219, 17.47% racially ambiguous faces). Gender disparities were evident in the image faces; 71.70% (874/1219) represented female faces, whereas only 27.89% (340/1219) represented male faces. Among the 11-26 years age group recommended to receive HPV vaccine, HPV images contained more female-only faces (214/616, 34.3%) than males (37/616, 6.0%); the remainder of images included both male and female faces (365/616, 59.3%). Gender and racial disparities were present across different image sources. Faces from government sources were more likely to depict females (n=44) compared with males (n=16). Of male faces, 80% (12/15) of youth and 100% (1/1) of adults were white. News organization sources depicted high proportions of white faces (28/38, 97% of female youth and 12/12, 100% of adult males). Face++ identified fewer faces compared with manual annotation because of limitations with detecting multiple, small, or blurry faces. Nonetheless, Face++ achieved a high degree of accuracy with respect to gender, race, and age compared with manual annotation. CONCLUSIONS This study reveals critical differences between the demographics reflected in HPV images and the actual burden of disease. Racial minorities are less likely to appear in HPV images despite higher rates of HPV incidence. Health communication efforts need to represent populations at risk better if we seek to reduce disparities in HPV infection.
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Affiliation(s)
- Yuki Lama
- Department of Family Science, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Tao Chen
- Center for Language and Speech Processing, Johns Hopkins University, Baltimore, MD, United States
| | - Mark Dredze
- Center for Language and Speech Processing, Johns Hopkins University, Baltimore, MD, United States
| | - Amelia Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington DC, DC, United States
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Disparities in Human Papillomavirus Vaccine Completion Rates Among Females in an Integrated Health Care System. Obstet Gynecol 2018; 132:717-723. [DOI: 10.1097/aog.0000000000002802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Temkin SM, Rimel BJ, Bruegl AS, Gunderson CC, Beavis AL, Doll KM. A contemporary framework of health equity applied to gynecologic cancer care: A Society of Gynecologic Oncology evidenced-based review. Gynecol Oncol 2018; 149:70-77. [PMID: 29605053 DOI: 10.1016/j.ygyno.2017.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/19/2017] [Accepted: 11/07/2017] [Indexed: 01/21/2023]
Abstract
Health disparities are defined as the preventable difference in the burden of disease, injury, and violence, or opportunity to achieve optimal health that socially disadvantaged populations experience compared to the population as a whole. Disparities in incidence and cancer outcomes for women with gynecologic malignancies have been well described particularly for American women of Black race. The etiology of these disparities has been tied to socio-economics, cultural, educational and genetic factors. While access to high quality treatment has been primarily linked to survival from cervical and ovarian cancer, innate biologic distinctions have been principally cited as reasons for differences in incidence and mortality in cancers of the uterine corpus. This article will update the framework of disparities to incorporate a broader understanding of the social determinants of health and how they affect health equity by addressing the root causes of disparities within the health care system. Special populations are identified who are at risk for health inequities which include but are not limited to Black race, underserved racial and ethnic minorities (e.g. indigenous peoples, low English fluency), trans/gender nonconforming people and rural populations. Each of these populations at risk have unique structural barriers within the healthcare system impacting gynecologic cancer outcomes. The authors provide practical recommendations for practitioners aimed at eliminating cancer related outcome disparities.
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Affiliation(s)
- Sarah M Temkin
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | - B J Rimel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Camille C Gunderson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma city, OK, USA
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Jamieson L, Garvey G, Hedges J, Mitchell A, Dunbar T, Leane C, Hill I, Warren K, Brown A, Ju X, Roder D, Logan R, Johnson N, Smith M, Antonsson A, Canfell K. Human Papillomavirus and Oropharyngeal Cancer Among Indigenous Australians: Protocol for a Prevalence Study of Oral-Related Human Papillomavirus and Cost-Effectiveness of Prevention. JMIR Res Protoc 2018; 7:e10503. [PMID: 29884604 PMCID: PMC6015268 DOI: 10.2196/10503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Oropharyngeal cancer is an important, understudied cancer affecting Aboriginal and Torres Strait Islander Australians. The human papillomavirus (HPV) is a significant risk factor for oropharyngeal cancer. Current generation HPV vaccines are effective against the 2 most common types of high-risk HPVs in cancer (hrHPVs 16/18). Objectives This study aims (1) to yield population estimates of oncogenic genotypes of HPV in the mouth and oropharynx of defined Aboriginal and Torres Strait Islander populations; (2) to estimate the proportion of oropharyngeal cancer attributable to HPV among these Australian citizens; (3) to estimate the impact of HPV vaccination as currently implemented on rates of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians; and (4) taking into account impact on oropharyngeal as well as cervical cancer, to evaluate efficacy and cost-effectiveness of targeted extended HPV vaccination to older ages, among our study population. Methods Our study design and operation is straightforward, with minimal impost on participants. It involves testing for carriage of hrHPV in the mouth and oropharynx among 1000 Aboriginal South Australians by simple saliva collection and with follow-up at 12 and 24 months, collection of sexual history at baseline, collection of information for estimating health state (quality-of-life) utilities at baseline, genotyping of viruses, predictive outcome and cost-effectiveness modeling, data interpretation and development of vaccination, and follow-up management strategies driven by the Aboriginal community. Results Participant recruitment for this study commenced in February 2018 and enrollment is ongoing. The first results are expected to be submitted for publication in 2019. Conclusions The project will have a number of important outcomes. Synthesis of evidence will enable generation of estimates of the burden of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and indicate the likely effectiveness and cost-effectiveness of prevention. This will be important for health services planning, and for Aboriginal health worker and patient education. The results will also point to important areas where research efforts should be focused to improve outcomes in Aboriginal and Torres Strait Islander Australians with oropharyngeal cancer. There will be a strong focus on community engagement and accounting for the preferences of individuals and the community in control of HPV-related cancers. The project has international relevance in that it will be the first to systematically evaluate prevention of both cervical and oropharyngeal cancer in a high-risk Indigenous population taking into account all population, testing, and surveillance options. Registered Report Identifier RR1-10.2196/10503
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Amanda Mitchell
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Terry Dunbar
- Yaitya Purruna Indigenous Health Unit, University of Adelaide, Adelaide, Australia
| | - Cathy Leane
- Aboriginal Health Division Women's and Children's Health Network, Adelaide, Australia
| | - Isaac Hill
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Kate Warren
- Pika Wiya Health Service Inc, Port Augusta, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - David Roder
- School of Health Sciences, Univesity of South Australia, Adelaide, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Newell Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, Australia
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29
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Choi N, Curtis CR, Loharikar A, Fricchione M, Jones E, Balzer E, Liu Y, Levin M, Chavez-Torres M, Morita J, Caskey R. Successful Use of Interventions in Combination to Improve Human Papillomavirus Vaccination Coverage Rates Among Adolescents-Chicago, 2013 to 2015. Acad Pediatr 2018; 18:S93-S100. [PMID: 29502644 DOI: 10.1016/j.acap.2017.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
Abstract
In 2013, National Immunization Survey-Teen data indicated that >40% of female adolescents had not initiated the human papillomavirus (HPV) vaccine series and >60% had not completed the series, documenting vaccination rates much lower than those for other vaccines recommended for adolescents. The Chicago Department of Public Health (CDPH) was 1 of 22 jurisdictions nationwide to receive a Prevention and Public Health Fund award through the Centers for Disease Control and Prevention to improve HPV vaccination rates among adolescents. The CDPH implemented 5 interventions targeting the public, clinicians and their staff, and diverse immunization and cancer prevention stakeholders. Compared with 2013 jurisdiction-specific HPV vaccination rates among all adolescents, Chicago's HPV vaccination rates were increased significantly in 2014 and 2015. This article details the methods and results of Chicago's successful interventions, the particular strengths as well as barriers encountered, and future steps necessary for sustaining improvement.
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Affiliation(s)
- Nancy Choi
- Departments of Medicine and Pediatrics, University of Illinois at Chicago, Chicago, Ill.
| | - C Robinette Curtis
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Anagha Loharikar
- Chicago Department of Public Health, Chicago, Ill; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Ga
| | | | - Elissa Jones
- Chicago Department of Public Health, Chicago, Ill
| | - Elise Balzer
- Immunization Services Division, Centers for Disease Control and Prevention assigned to Chicago, Department of Public Health, Chicago, Ill; EverThrive Illinois, Chicago, Ill
| | - Yang Liu
- Chicago Department of Public Health, Chicago, Ill
| | - Marcia Levin
- Chicago Department of Public Health, Chicago, Ill
| | | | - Julie Morita
- Chicago Department of Public Health, Chicago, Ill
| | - Rachel Caskey
- Departments of Medicine and Pediatrics, University of Illinois at Chicago, Chicago, Ill
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Lai D, Bodson J, Davis FA, Lee D, Tavake-Pasi F, Napia E, Villalta J, Mukundente V, Mooney R, Coulter H, Stark LA, Sanchez-Birkhead AC, Kepka D. Diverse Families' Experiences with HPV Vaccine Information Sources: A Community-Based Participatory Approach. J Community Health 2018; 42:400-412. [PMID: 27734247 DOI: 10.1007/s10900-016-0269-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N = 228). Ninenty-three of these participants also participated in ten focus groups conducted in three languages. Descriptive statistics and Fishers' Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born = 50 % vs US-born = 30 %, p < 0.05; medium acculturation = 60 % vs high acculturation = 26 %, p = 0.01), while greater proportions of US-born participants reported media sources (49 % vs foreign-born = 29 %, p < 0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p < 0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.
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Affiliation(s)
- Djin Lai
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA. .,College of Nursing, University of Utah, Salt Lake City, UT, USA.
| | - Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA
| | - France A Davis
- Community Faces of Utah, Salt Lake City, UT, USA.,Calvary Baptist Church, Salt Lake City, UT, USA
| | - Doriena Lee
- Community Faces of Utah, Salt Lake City, UT, USA.,Calvary Baptist Church, Salt Lake City, UT, USA
| | - Fahina Tavake-Pasi
- Community Faces of Utah, Salt Lake City, UT, USA.,National Tongan American Society, Salt Lake City, UT, USA
| | - Edwin Napia
- Community Faces of Utah, Salt Lake City, UT, USA.,Urban Indian Center, Salt Lake City, UT, USA
| | - Jeannette Villalta
- Community Faces of Utah, Salt Lake City, UT, USA.,Hispanic Healthcare Task Force, Salt Lake City, UT, USA
| | - Valentine Mukundente
- Community Faces of Utah, Salt Lake City, UT, USA.,Best of Africa, West Valley, UT, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA
| | - Heather Coulter
- Community Outreach and Collaboration Core, Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Louisa A Stark
- Community Outreach and Collaboration Core, Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Department of Human Genetics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ana C Sanchez-Birkhead
- College of Nursing, University of Utah, Salt Lake City, UT, USA.,Community Faces of Utah, Salt Lake City, UT, USA.,Hispanic Healthcare Task Force, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, Salt Lake City, UT, USA
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Johnson HC, Lafferty EI, Eggo RM, Louie K, Soldan K, Waller J, Edmunds WJ. Effect of HPV vaccination and cervical cancer screening in England by ethnicity: a modelling study. Lancet Public Health 2018; 3:e44-e51. [PMID: 29307388 PMCID: PMC5765530 DOI: 10.1016/s2468-2667(17)30238-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/25/2017] [Accepted: 10/23/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Health equality is increasingly being considered alongside overall health gain when assessing public health interventions. However, the trade-off between the direct effects of vaccination and herd immunity could lead to unintuitive consequences for the distribution of disease burden within a population. We used a transmission dynamic model of human papillomavirus (HPV) to investigate the effect of ethnic disparities in vaccine and cervical screening uptake on inequality in disease incidence in England. METHODS We developed an individual-based model of HPV transmission and disease, parameterising it with the latest data for sexual behaviour (from National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) and vaccine and screening uptake by ethnicity (from Public Health England [PHE]) and fitting it to data for HPV prevalence (from ARTISTIC, PHE, Natsal-3) and HPV-related disease incidence (from National Cancer Registry [ONS]). The outcome of interest was the age-adjusted incidence of HPV-related cancer (both cervical and non-cervical) in all women in England in view of differences and changes in vaccination and screening uptake by ethnicity in England, over time. We also studied three potential public health interventions aimed at reducing inequality in HPV-related disease incidence: increasing uptake in black and Asian females to match that in whites for vaccination; cervical screening in women who turn 25 in 2018 or later; and cervical screening in all ages. FINDINGS In the pre-vaccination era, before 2008, women from ethnic minorities in England reported a disproportionate share of cervical disease. Our model suggests that Asian women were 1·7 times (95% credibility interval [CI] 1·1-2·7) more likely to be diagnosed with cervical cancer than white women (22·8 vs 13·4 cases per 100 000 women). Because HPV vaccination uptake is lower in ethnic minorities, we predict an initial widening of this gap, with cervical cancer incidence in Asian women up to 2·5 times higher (95% CI 1·3-4·8) than in white women 20 years after vaccine introduction (corresponding to an additional 10·8 [95% CI 10·1-11·5] cases every year). In time, we predict that herd immunity benefits will diffuse from the larger white sub-population and the disparity will narrow. Increased cervical screening uptake in vaccinated women from ethnic minorities would lead to rapid improvement in equality with parity in incidence after 20 years of HPV vaccination. INTERPRETATION Our study suggests that the introduction of HPV vaccination in England will initially widen a pre-existing disparity in the incidence of HPV-related cancer by ethnicity, partly due to herd immunity disproportionately benefiting subgroups with high vaccination rates. Although in time this induced disparity will narrow, increasing cervical screening uptake in girls from ethnic minorities should be encouraged to eliminate the inequality in cervical cancer incidence in the medium term. We recommend that dynamic effects should be considered when estimating the effect of public health programmes on equality. FUNDING Cancer Research UK.
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Affiliation(s)
- Helen C Johnson
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Erin I Lafferty
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosalind M Eggo
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Karly Louie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate Soldan
- National Centre for Infectious Disease Surveillance and Control (CIDSC), London, UK
| | - Jo Waller
- Health Behaviour Research Centre, London, UK
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Benard VB, Watson M, Saraiya M, Harewood R, Townsend JS, Stroup AM, Weir HK, Allemani C. Cervical cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5119-5137. [PMID: 29205300 DOI: 10.1002/cncr.30906] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Overall, cervical cancer survival in the United States has been reported to be among the highest in the world, despite slight decreases over the last decade. Objective of the current study was to describe cervical cancer survival trends among US women and examine differences by race and stage. METHODS This study used data from the CONCORD-2 study to compare survival among women (aged 15-99 years) diagnosed in 37 states covering 80% of the US population. Survival was adjusted for background mortality (net survival) with state- and race-specific life tables and was age-standardized with the International Cancer Survival Standard weights. Five-year survival was compared by race (all races, blacks, and whites). Two time periods, 2001-2003 and 2004-2009, were considered because of changes in how the staging variable was collected. RESULTS From 2001 to 2009, 90,620 women were diagnosed with invasive cervical cancer. The proportion of cancers diagnosed at a regional or distant stage increased over time in most states. Overall, the 5-year survival was 63.5% in 2001-2003 and 62.8% in 2004-2009. The survival was lower for black women versus white women in both calendar periods and in most states; black women had a higher proportion of distant-stage cancers. CONCLUSIONS The stability of the overall survival over time and the persistent differences in survival between white and black women in all US states suggest that there is a need for targeted interventions and improved access to screening, timely treatment, and follow-up care, especially among black women. Cancer 2017;123:5119-37. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Vicki B Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rhea Harewood
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julie S Townsend
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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HPV Vaccination: Are We Meeting Our Targets in Cervical Cancer Prevention? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0216-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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34
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Cooper DL, Hernandez ND, Rollins L, Akintobi TH, McAllister C. HPV vaccine awareness and the association of trust in cancer information from physicians among males. Vaccine 2017; 35:2661-2667. [PMID: 28396210 DOI: 10.1016/j.vaccine.2017.03.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Black and Hispanic men are diagnosed with more HPV-related cancers and at later stages compared to other racial/ethnic groups. Physician communication with men about HPV vaccination may be beneficial to increasing HPV vaccinations and decreasing HPV transmission. The purpose of this study was to examine HPV and HPV vaccine awareness among men by race, and the association between trust in cancer information from physicians and ever hearing about HPV and the HPV vaccine. METHODS U.S. adult males (age 18+) were identified from the 2014 Health Information National Trends Survey (HINTS) (n=1203). Binomial logistic regression models assessed the influences of race/ethnicity and trust of cancer information from physicians on men having heard of HPV and the HPV vaccination. RESULTS Approximately 50% of the sample had never heard of HPV and 53% had never heard of the vaccine. Black men were less likely to know that HPV is sexually transmitted compared to White and Hispanic men (p<0.001). Hispanic and Black men were less likely to have heard about the HPV vaccine when compared to White men (p<0.001). Additionally, Hispanic men were less likely to trust a doctor about cancer information compared to White and Black men (p<0.001). CONCLUSION Findings highlight the lack of awareness about HPV among men. Furthermore, statistically significant racial/ethnic differences were found in HPV vaccine knowledge and trust in receiving cancer information from physicians. Future interventions should include community-based approaches and improved physicians' HPV-related communication to increase knowledge and uptake of the HPV vaccine.
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Affiliation(s)
- Dexter L Cooper
- Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, United States.
| | - Natalie D Hernandez
- Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, United States
| | - Latrice Rollins
- Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, United States
| | - Tabia Henry Akintobi
- Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, United States
| | - Calvin McAllister
- Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, United States
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Abstract
OBJECTIVES To review current evidence about cancer screening challenges that lead to cancer health disparities in minority populations. DATA SOURCES Research reports, published journal articles, web sites, and clinical practice observations. CONCLUSION There are significant disparities that exist in cancer screening practices among racial and ethnic minority and underrepresented populations, resulting in disproportionately higher cancer mortality rates in these populations. IMPLICATIONS FOR NURSING PRACTICE Nurses are positioned to lead in educating, promoting, and bringing awareness to cancer screening recommendationsand current cancer prevention guidelines for at-risk individuals, and help them to implement these guidelines to reduce incidence and mortality.
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Townsend JS, Steele CB, Hayes N, Bhatt A, Moore AR. Human Papillomavirus Vaccine as an Anticancer Vaccine: Collaborative Efforts to Promote Human Papillomavirus Vaccine in the National Comprehensive Cancer Control Program. J Womens Health (Larchmt) 2017; 26:200-206. [PMID: 28263672 DOI: 10.1089/jwh.2017.6351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Widespread use of the human papillomavirus (HPV) vaccine has the potential to reduce incidence from HPV-associated cancers. However, vaccine uptake among adolescents remains well below the Healthy People 2020 targets. The Centers for Disease Control and Prevention (CDC) National Comprehensive Cancer Control Program (NCCCP) awardees are well positioned to work with immunization programs to increase vaccine uptake. The CDC chronic disease management information system was queried for objectives and activities associated with HPV vaccine that were reported by NCCCP awardees from 2013 to 2016 as part of program reporting requirements. A content analysis was conducted on the query results to categorize interventions according to strategies outlined in The Guide to Community Preventive Services and the 2014 President's Cancer Panel report. Sixty-two percent of NCCCP awardees had planned or implemented at least one activity since 2013 to address low HPV vaccination coverage in their jurisdictions. Most NCCCP awardees (86%) reported community education activities, while 65% reported activities associated with provider education. Systems-based strategies such as client reminders or provider assessment and feedback were each reported by less than 25% of NCCCP awardees. Many NCCCP awardees report planning or implementing activities to address low HPV vaccination coverage, often in conjunction with state immunization programs. NCCCP awardees can play a role in increasing HPV vaccination coverage through their cancer prevention and control expertise and access to partners in the healthcare community.
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Affiliation(s)
- Julie S Townsend
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - C Brooke Steele
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Nikki Hayes
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Achal Bhatt
- 2 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Angela R Moore
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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Jedy-Agba EE, Dareng EO, Adebamowo SN, Odutola M, Oga EA, Igbinoba F, Otu T, Ezeome E, Bray F, Hassan R, Adebamowo CA. The burden of HPV associated cancers in two regions in Nigeria 2012-2014. Cancer Epidemiol 2016; 45:91-97. [PMID: 27780076 PMCID: PMC5124511 DOI: 10.1016/j.canep.2016.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/09/2016] [Accepted: 10/16/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION HPV attributable cancers are the second most common infection-related cancers worldwide, with much higher burden in less developed regions. There are currently no country-specific estimates of the burden of these cancers in Nigeria just like many other low and middle income countries. METHODS In this study, we quantified the proportion of the cancer burden in Nigeria that is attributable to HPV infection from 2012 to 2014 using HPV prevalence estimated from previous studies and data from two population based cancer registries (PBCR) in Nigeria. We considered cancer sites for which there is strong evidence of an association with HPV infection based on the International Agency for Research on Cancer (IARC) classification. We obtained age and sex-specific estimates of incident cancers and using the World Standard Population, we derived age standardized incidence (ASR) rates for each cancer type by categories of sex, and estimated the population attributable fractions (PAF). RESULTS The two PBCR reported 4336 new cancer cases from 2012 to 2014. Of these, 1627 (37.5%) were in males and 2709 (62.5%) in females. Some 11% (488/4336) of these cancers were HPV associated; 2% (38/1627) in men and 17% (450/2709) in women. Of the HPV associated cancers, 7.8% occurred in men and 92.2% in women. The ASRs for HPV associated cancers was 33.5 per 100,000; 2.3 and 31.2 per 100,000 in men and women respectively. The proportion of all cancers attributable to HPV infection ranged from 10.2 to 10.4% (442-453 of 4336) while the proportion of HPV associated cancers attributable to HPV infection ranged from 90.6% to 92.8% (442-453 of the 488 cases). In men, 55.3% to 68.4% of HPV associated cancers were attributable to HPV infection compared to 93.6% to 94.8% in women. The combined ASR for HPV attributable cancers ranged from 31.0 to 31.7 per 100,000. This was 1.4 to 1.7 per 100,000 in men and 29.6 to 30.0 per 100,000 in women. In women, cervical cancer (n=392, ASR 28.3 per 100,000) was the commonest HPV attributable cancer, while anal cancer (n=21, ASR 1.2 per 100,000) was the commonest in men. CONCLUSIONS HPV attributable cancers constitute a substantial cancer burden in Nigerian women, much less so in men. A significant proportion of cancers in Nigerian women would be prevented if strategies such as HPV DNA based screening and HPV vaccination are implemented.
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Affiliation(s)
- E E Jedy-Agba
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - E O Dareng
- Center for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - S N Adebamowo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA
| | - M Odutola
- Institute of Human Virology, Abuja, Nigeria
| | - E A Oga
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA
| | | | - T Otu
- University of Abuja Teaching Hospital Gwagwalada, Nigeria
| | - E Ezeome
- University of Nigeria Teaching Hospital Enugu, Nigeria
| | - F Bray
- International Agency for Research on Cancer, Lyon, France
| | - R Hassan
- Federal Ministry of Health, Abuja, Nigeria
| | - C A Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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