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Davis KR, Norman SL, Olson BG, Demirel S, Taha AA. A Clinical Educational Intervention to Increase HPV Vaccination Rates Among Pediatric Patients Through Enhanced Recommendations. J Pediatr Health Care 2022; 36:589-597. [PMID: 35933285 DOI: 10.1016/j.pedhc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) causes largely preventable cancers by completing a vaccination series. However, pediatric HPV vaccination rates remain low. Current evidence indicates that integrating five factors creates a high-quality recommendation associated with higher HPV vaccination rates. This quality improvement project aimed to evaluate the impact of an educational intervention to improve the quality of providers' recommendations and subsequent vaccination rates. METHOD Using the Squire 2.0 Guidelines, clinical staff were observed during well-child visits (aged 11-12 years) before and after the intervention across three Plan-Do-Study-Act cycles. RESULTS Thirty-nine encounters with mostly (n = 31; 80%) families of color. The quality of vaccine recommendations was improved after the intervention; however, vaccination rates did not increase for the 39 patients. Providers' delivery approach (presumptive vs. conversational) did increase vaccination rates. DISCUSSION Providers' delivery style appears to be important when making HPV vaccine recommendations.
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Affiliation(s)
- Kelley R Davis
- Kelley R. Davis, Instructor, Department of Pediatrics, Pediatric Nurse Practitioner Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR
| | - Sharon L Norman
- Sharon L. Norman, Assistant Professor, School of Nursing, Oregon Health & Science University, and Pediatric Clinical Nurse Specialist, Randall Children's Pediatric Care, Legacy Health, Portland, OR
| | - Bradley G Olson
- Bradley G. Olson, Medical Director, Randall Children's Pediatric Care, Legacy Health, Portland, OR
| | - Shaban Demirel
- Shaban Demirel, Interim Vice President Research Administration, Legacy Research Institute, Legacy Health, Portland, OR
| | - Asma A Taha
- Asma A. Taha, Professor, School of Nursing, Oregon Health & Science University, Portland, OR.
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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3
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Mansfield LN, Vance A, Nikpour JA, Gonzalez-Guarda RM. A systematic review of human papillomavirus vaccination among US adolescents. Res Nurs Health 2021; 44:473-489. [PMID: 33860541 DOI: 10.1002/nur.22135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/07/2022]
Abstract
The human papillomavirus (HPV) causes many anogenital and oral cancers affecting young adults in the United States. Vaccination during adolescence can prevent HPV-associated cancers, but vaccine uptake among adolescents is low and influenced by factors serving as barriers and facilitators to HPV vaccination. In this systematic review, we synthesized research using the socioecological framework model to examine individual-level, relationship-level, community-level, and societal-level factors that influence HPV vaccine initiation and completion among US adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the methodology for this review. An electronic search was conducted in January 2020 using PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest Central, Scopus, and American Psychological Association PsycInfo databases. The Joanna Briggs Institute tools were used to assess the quality for the 57 studies included in this review. The most consistent influences of HPV vaccination included age at vaccination, awareness, and knowledge about HPV vaccination, socioeconomic status, insurance status, race/ethnicity, and preventative care behaviors at the individual level. Provider recommendation, familial/peer support of vaccination, and parental health behaviors were influences at the relationship level. Although fewer findings elucidated community-level and societal-level influences, high-poverty areas, high-risk communities with large proportions of racial/ethnic minority groups, healthcare facilities servicing children, and combined health policies appear to serve as facilitators of HPV initiation and completion. Findings from this review can inform culturally relevant and age-specific interventions and multi-level policies aiming to improve HPV vaccination coverage in the United States.
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Affiliation(s)
- Lisa N Mansfield
- School of Nursing, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine and Health Services Research, National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Ashlee Vance
- Institute for Healthcare Policy and Innovation, National Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
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Jafari SDG, Appel SJ, Shorter DG. Risk Reduction Interventions for Human Papillomavirus in Rural Maryland. J Dr Nurs Pract 2020; 13:134-141. [PMID: 32817502 DOI: 10.1891/jdnp-d-19-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is largely vaccine preventable. The Healthy People 2020 target goal for vaccine administration is 80%. Current United States (U. S.) rates are far lower primarily because of vaccine hesitancy and lack of provider recommendation. OBJECTIVE Implement a risk reduction initiative to increase HPV vaccine rates in females aged 12-26 in five rural counties in Maryland. METHODS A convenience sample from a rural community screened an HPV documentary movie, Questionnaire responses pre- and postscreening were surveyed for impact on vaccine readiness. Postscreening focus group comments were analyzed for common themes. Females aged 12-26 from a University Medical Group Women's Health Center located in rural Maryland were targeted. Chart review of immunization records 90 days pre- and postprovider vaccine recommendation demonstrated impact. RESULTS Public awareness events have the potential to impact HPV vaccine hesitancy, but this research did not achieve statistical significance. Direct provider to patient recommendations resulted in a 15% increase in HPV immunizations. CONCLUSIONS Education of vaccine-eligible individuals should be undertaken. IMPLICATIONS FOR NURSING Providers who recommend administration of the vaccine significantly increase immunization rates.
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Varman M, Sharlin C, Fernandez C, Vasudevan J, Wichman C. Human Papilloma Virus Vaccination Among Adolescents in a Community Clinic Before and After Intervention. J Community Health 2019; 43:455-458. [PMID: 29368102 DOI: 10.1007/s10900-018-0467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human Papilloma Virus (HPV) is the most common sexually transmitted disease with over 14 million infections in 2008. Certain HPV types have been identified in up to 70% of cases of cervical and anal cancers. Despite being safe and effective, HPV vaccination rates remain low. Vaccination and demographic data was collected pre-and post-intervention. Among 13 thru 17-year-old cohort females were significantly more likely to be fully vaccinated. Assessment also found that patients insured by Medicaid were significantly more likely to be fully vaccinated than patients insured privately. Post-intervention vaccination rate is similar to baseline rates. There was non-significant improvement in HPV vaccination coverage after intervention. Male and privately insured patients of Creighton's Pediatric Clinic have lower HPV vaccination coverage than their counterparts. More direct efforts are needed in vaccination process and policy in the clinic to improve immunization against HPV among children and adolescents.
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Affiliation(s)
- M Varman
- Creighton University School of Medicine, Omaha, NE, USA. .,Department of Pediatrics, Creighton University, Omaha, NE, USA.
| | - C Sharlin
- Creighton University School of Medicine, Omaha, NE, USA
| | - C Fernandez
- Creighton University School of Medicine, Omaha, NE, USA.,Department of Pediatrics, Creighton University, Omaha, NE, USA
| | - J Vasudevan
- Creighton University School of Medicine, Omaha, NE, USA.,Department of Pediatrics, Creighton University, Omaha, NE, USA
| | - C Wichman
- Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
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da Silva LEL, de Oliveira MLC, Galato D. [Human papillomavirus vaccine receptivity: a systematic reviewReceptividad con respecto a la vacuna contra el virus del papiloma humano: revisión sistemática]. Rev Panam Salud Publica 2019; 43:e22. [PMID: 31093246 PMCID: PMC6459371 DOI: 10.26633/rpsp.2019.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022] Open
Abstract
Objetivo. Caracterizar a receptividade à vacina contra o papilomavírus humano (HPV) e descrever as barreiras e os facilitadores dessa receptividade. Métodos. Trata-se de uma revisão sistemática conforme o protocolo PRISMA 2015. Os repositórios MEDLINE e Web of Science foram consultados utilizando combinações dos termos papillomavirus, vaccine, adherence e acceptance para identificar artigos publicados de 2006 a 2017. Foram incluídos artigos originais em qualquer idioma e excluídos artigos duplicados. Foram analisadas identificação do artigo, tipificação metodológica e caracterização da amostra. A receptividade foi caracterizada em termos de aceitação e adesão. Resultados. Foram identificados 212 artigos, sendo 10 selecionados para análise. A maioria dos estudos evidenciou receptividade favorável, porém heterogênea, havendo maior aceitação do que adesão, principalmente por adolescentes do sexo feminino. Foram identificados 11 facilitadores e nove barreiras à receptividade, com destaque para conhecimento relativo ao tema e padrão de comportamento individual frente ao problema. Observou-se a inexistência de um método padronizado que avalie a temática e a imprecisão dos conceitos associados a aceitação e adesão. Diante disso, o estudo propôs conceitos de aceitação (intenção voluntária de receber uma vacina ou concordar que a mesma representa uma boa estratégia preventiva) e adesão (ato de iniciar a vacinação e completar o esquema). Conclusões. Novos estudos são necessários para aprofundar a análise dos preditores da receptividade. Sugere-se a construção de um instrumento baseado na percepção do público alvo e em conceitos precisos de aceitação e adesão, que possibilite melhor compreensão do fenômeno e estimule a adesão e o alcance de coberturas vacinais adequadas.
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Affiliation(s)
- Lídia Ester Lopes da Silva
- Programa de Pós-Graduação em Ciências e Tecnologia da Saúde (PPGCTS) PPGCTS Faculdade de Ceilândia (FCE) Universidade de Brasília (UnB) BrasíliaDF Brasil Universidade de Brasília (UnB), Faculdade de Ceilândia (FCE), Programa de Pós-Graduação em Ciências e Tecnologia da Saúde (PPGCTS), Brasília (DF), Brasil
| | - Maria Liz Cunha de Oliveira
- Programa de Mestrado Profissional em Ciências da Saúde Programa de Mestrado Profissional em Ciências da Saúde Escola Superior de Ciências da Saúde (ESCS) BrasíliaDF Brasil Escola Superior de Ciências da Saúde (ESCS), Programa de Mestrado Profissional em Ciências da Saúde, Brasília (DF), Brasil
| | - Dayani Galato
- Programa de Pós-Graduação em Ciências e Tecnologia da Saúde (PPGCTS) PPGCTS Faculdade de Ceilândia (FCE) Universidade de Brasília (UnB) BrasíliaDF Brasil Universidade de Brasília (UnB), Faculdade de Ceilândia (FCE), Programa de Pós-Graduação em Ciências e Tecnologia da Saúde (PPGCTS), Brasília (DF), Brasil
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Abstract
PROBLEM It has been reported that some adolescents and young women who started taking human papillomavirus (HPV) vaccination are not completing all three doses. The aim of this study was to systematically review intervention studies on HPV vaccination completion. ELIGIBILITY CRITERIA Intervention studies with a comparison group that assessed HPV vaccination completion rate as the primary outcome variable in adolescents and adults younger than 26years of age, and published in English from 2006 to 2016, were eligible for review. SAMPLE Five studies from a literature search of CINAHL, EMBASE, PsycARTICLES, PubMed, SCOPUS, and Web of Science databases were included in this review. RESULTS The overall quality of the reviewed studies was moderate, and the studies have mainly been conducted in a high-income country. Intervention strategies were DVD-based education on HPV and reminders that were delivered via either electronic or non-electronic methods. Some studies used fixed type of electronic reminders. Others chose preference-based electronic reminders, allowing participants to select one or two delivery options from e-mail, text message, automated telephone message, or Facebook message. Non-electronic reminders were letters sent by standard mail. CONCLUSIONS The rates of HPV vaccination completeness increased with the interventions. However, the completeness rate of HPV vaccination remained unsatisfactory and lower than its initiation rate. IMPLICATIONS Educational and reminder interventions for HPV vaccination could contribute to HPV vaccination completion. However, this review highlights the need for more high-quality studies to identify the best way to promote vaccination completion.
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Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
| | | | - Ye Dong Son
- Department of Nursing, Woosuk University, Wanju-gun, Jeollabuk-do, South Korea
| | - Sun-Mi Chae
- College of Nursing, Seoul National University, Seoul, South Korea.
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Mullins TLK, Rosenthal SL, Zimet GD, Ding L, Morrow C, Huang B, Kahn JA. Human Papillomavirus Vaccine-Related Risk Perceptions Do Not Predict Sexual Initiation Among Young Women Over 30 Months Following Vaccination. J Adolesc Health 2018; 62:164-169. [PMID: 29198772 PMCID: PMC5803391 DOI: 10.1016/j.jadohealth.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE We examined longitudinally the relationship between human papillomavirus (HPV) vaccine-related risk perceptions and initiation of sexual activity among adolescent women over 30 months after HPV vaccination. METHODS Participants included 91 sexually inexperienced women aged 13-21 years receiving the HPV vaccine who completed at least three of five study visits. At every visit, participants completed surveys assessing HPV vaccine-related risk perceptions (perceived risk of sexually transmitted infections [STIs] other than HPV, perceived need for safer sexual behaviors), and sexual initiation. Outcomes were sexual initiation and age of sexual initiation. Associations between risk perceptions and outcomes were examined using ordered logistic regression models for sexual initiation and interval censored survival analyses for age of sexual initiation. RESULTS Mean age at baseline was 14.9 years (standard deviation [SD] 1.4). Most participants perceived themselves to be at risk of STIs other than HPV (mean scale score = 4.0/10; SD 2.1) and perceived a need for safer sexual behaviors (mean scale score = 1.5/10; SD 1.5). By 30 months, 65 participants (78%) initiated sex. Perceived risk of STIs and perceived need for safer sexual behaviors were not associated with sexual initiation or age of sexual initiation. Older age at baseline was associated with sooner sexual initiation (p = .02) and older age at sexual initiation (p < .001). Results of ordered logistic regression and survival analyses were unchanged when controlling for baseline age. CONCLUSIONS HPV vaccine-related risk perceptions were not associated with sexual initiation or age of sexual initiation, providing further support that HPV vaccine-related risk perceptions are unlikely to lead to riskier sexual behaviors.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
| | - Susan L. Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University and New York Presbyterian Morgan Stanley Children’s Hospital, 622 West 168 Street, PH17th floor, room 102a, New York, NY 10032, USA
| | - Gregory D. Zimet
- Division of Adolescent Medicine, Indiana University, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Charlene Morrow
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
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