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School-based HPV vaccination positively impacts parents' attitudes toward adolescent vaccination. Vaccine 2021; 39:4190-4198. [PMID: 34127299 DOI: 10.1016/j.vaccine.2021.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP). METHODS Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013-2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent's knowledge about HPV vaccination; and their adolescent's understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis. RESULTS Parents' of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents' responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents' knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males. CONCLUSIONS Parents' positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents' knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.
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The effectiveness of vaccination to prevent the papillomavirus infection: a systematic review and meta-analysis. Epidemiol Infect 2020; 147:e156. [PMID: 31063090 PMCID: PMC6518793 DOI: 10.1017/s0950268818003679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Our purpose was to determine the effectiveness and harms of vaccination in patients with any sexual history to prevent the prevalence of papillomavirus infection. A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. The risk of bias was evaluated with the Cochrane Collaboration's tool. Analysis of fixed effects was conducted. The primary outcome was the infection by any and each human papillomavirus (HPV) genotype, serious adverse effects and short-term adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were bivalent vaccine/tetravalent/nonavalent vs. placebo/no intervention/other vaccines. We included 29 studies described in 35 publications. Bivalent HPV vaccine offers protection against HPV16 (RD −0.05, 95% CI −0.098 to −0.0032), HPV18 (RD −0.03, 95% CI −0.062 to −0.0004) and HPV16/18 genotypes (RD of −0.1, 95% CI −0.16 to −0.04). On the other side, tetravalent HPV vaccine offered protection against HPV6 (RD of −0.0500, 95% CI −0.0963 to −0.0230), HPV11 (RD −0.0198, 95% CI −0.0310 to −0.0085). Also, against HPV16 (RD of −0.0608, 95% CI −0.1126 to −0.0091) and HPV18 (RD of −0.0200, 95% CI −0.0408 to −0.0123). There was a reduction in the prevalence of HPV16, 18 and 16/18 genotypes when applying the bivalent vaccine, with no increase in adverse effects. Regarding the tetravalent vaccine, we found a reduction in the prevalence of HPV6, 11, 16 and 18 genotypes, with no increase in adverse effects.
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Cordoba-Sanchez V, Tovar-Aguirre OL, Franco S, Arias Ortiz NE, Louie K, Sanchez GI, Garces-Palacio IC. Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents. Prev Med Rep 2019; 16:100977. [PMID: 31508297 PMCID: PMC6722392 DOI: 10.1016/j.pmedr.2019.100977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022] Open
Abstract
In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.
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Affiliation(s)
- Verónica Cordoba-Sanchez
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Olga Lucía Tovar-Aguirre
- Grupo GINEI, Programa de Bacteriología, Universidad Católica de Manizales UCM, Carrera 23 No. 60-63, Manizales, Colombia
| | - Sandra Franco
- Grupo Promoción de la salud y Prevención de la Enfermedad, Facultad de Ciencias para la Salud, Universidad de Caldas, Calle 65 No. 26-10, Manizales, Colombia
| | - Nelson Enrique Arias Ortiz
- Grupo Promoción de la salud y Prevención de la Enfermedad, Facultad de Ciencias para la Salud, Universidad de Caldas, Calle 65 No. 26-10, Manizales, Colombia
| | - Karly Louie
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London SE1 9RT, UK
| | - Gloria Ines Sanchez
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Isabel C Garces-Palacio
- Grupo de Epidemiologia, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
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Troha M, Šterbenc A, Mlaker M, Poljak M. Human papillomavirus (HPV) infection and vaccination: knowledge and attitudes among healthcare professionals and the general public in Slovenia. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Restivo V, Costantino C, Fazio TF, Casuccio N, D'Angelo C, Vitale F, Casuccio A. Factors Associated with HPV Vaccine Refusal among Young Adult Women after Ten Years of Vaccine Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040770. [PMID: 29673135 PMCID: PMC5923812 DOI: 10.3390/ijerph15040770] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/03/2018] [Accepted: 04/14/2018] [Indexed: 11/16/2022]
Abstract
In Italy, the Human Papillomavirus (HPV) vaccination was implemented for twelve years old girls in 2007, but its coverage was lower than the recommended level. Sicily is one of the Italian administrative regions with lower vaccination coverage, with a value of 59% for those born in 1996 increasing to 62% coverage for those born in 1999. The aim of the study was to investigate factors associated with the refusal of HPV vaccination among young adult women of Palermo, Italy. The study was approved by the Ethics Committee of the Policlinico “Paolo Giaccone” Hospital (Palermo 1) and the questionnaire was validated in a convenience sample representing 10% of the young women. A cross-sectional study was conducted through the administration of a telephone questionnaire, consisting of 23 items on HPV infection and vaccination knowledge based on the Health Belief Model framework. The eligible population were young women (18–21 years old) who had at least a vaccination among all included in the Sicilian vaccination schedule, without starting or completing HPV vaccination. Overall, 141 young women were enrolled (response rate 22%). Among them, 84.4% were unvaccinated and 15.6% had at least one dose of the HPV vaccine. In multivariate analysis, the factors associated with the refusal of the HPV vaccination were a bachelor’s as the education level (OR = 10.2, p = 0.041), lower participation at school seminar on HPV (OR = 0.2, p = 0.047) and lower perception of HPV vaccine benefits (OR = 0.4, p = 0.048). Public health educational program focusing and tailored on benefits perception of HPV vaccine and HPV disease severity, carried out at school or during medical visits, can be useful to improve HPV vaccination uptake.
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Affiliation(s)
- Vincenzo Restivo
- Department of Science for Health Promotion and Mother Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
| | - Claudio Costantino
- Department of Science for Health Promotion and Mother Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
| | - Tiziana Francesca Fazio
- Department of Science for Health Promotion and Mother Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
| | - Nicolò Casuccio
- Department of Medical Prevention, Local Health Unit of Palermo, Palermo 90141, Italy.
| | - Claudio D'Angelo
- Department of Medical Prevention, Local Health Unit of Palermo, Palermo 90141, Italy.
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127 Palermo, Italy.
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Ward JK, Crépin L, Bauquier C, Vergelys C, Bocquier A, Verger P, Peretti-Watel P. ‘I don’t know if I’m making the right decision’: French mothers and HPV vaccination in a context of controversy. HEALTH RISK & SOCIETY 2017. [DOI: 10.1080/13698575.2017.1299856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeremy K. Ward
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- LIED, Paris Diderot University, Paris, France
| | - Laure Crépin
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- Department of Social Sciences, Ecole Normale Supérieure de Cachan, Cachan, France
| | - Charlotte Bauquier
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- GRePS, Lumière Lyon 2 University, Lyon, France
| | - Chantal Vergelys
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
| | - Aurélie Bocquier
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
| | - Pierre Verger
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
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Lefevere E, Hens N, De Smet F, Beutels P. The impact of non-financial and financial encouragements on participation in non school-based human papillomavirus vaccination: a retrospective cohort study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:305-315. [PMID: 25773050 DOI: 10.1007/s10198-015-0680-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Adolescent vaccination coverage under a system of non school-based vaccination is likely to be suboptimal, but might be increased by targeted encouragement campaigns. We analysed the effect on human papillomavirus (HPV) vaccination initiation by girls aged 12-18 of two campaigns set up in Flanders (Belgium) in 2007 and 2009: a personal information campaign and a combined personal information and financial incentive campaign. METHODS We analysed (objective) data on HPV vaccination behaviour from the National Alliance of Christian Mutualities (NACM), Flanders' largest sickness fund. We used z-scores to compare the monthly proportion of girls initiating HPV vaccination over time between carefully selected intervention and control groups. Separate analyses were done for older and younger girls. Total sample sizes of the intervention (control) groups were 221 (243) for the personal information campaign and 629 (5,322) for the combined personal information and financial incentive campaign. RESULTS The personal information campaign significantly increased vaccination initiation, with older girls reacting faster. One year after the campaign the percentages of vaccination initiation for the oldest girls were 64.6 and 42.8 % in the intervention and control group, respectively (z = 3.35, p = 0.0008); for the youngest girls the percentages were 78.4 and 68.1 % (z = 1.71, p = 0.09). The combined personal information and financial incentive campaign increased vaccination initiation among certain age groups. One year after the campaign the difference in percentage points for HPV vaccination initiation between intervention and control groups varied between 18.5 % (z = 3.65, p = 0.0002) and 5.1 % (z = 1.12, p = 0.26). CONCLUSION Under a non school-based vaccination system, personal information and removing out-of-pocket costs had a significant positive effect on HPV vaccination initiation, although the effect substantially varied in magnitude. Overall, the obtained vaccination rates remained far below those realised under school-based HPV vaccination.
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Affiliation(s)
- Eva Lefevere
- Herman Deleeck Centre for Social Policy, University of Antwerp, St Jacobstraat 2, 2000, Antwerp, Belgium.
| | - Niel Hens
- Center for Statistics (CenStat), Hasselt University, Diepenbeek, Belgium
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - Frank De Smet
- National Alliance of Christian Mutualities (NACM), Brussels, Belgium
- Department of Public Health and Primary Care, Occupational, Environmental & Insurance Medicine, KU Leuven, Leuven, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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Collange F, Fressard L, Pulcini C, Sebbah R, Peretti-Watel P, Verger P. General practitioners' attitudes and behaviors toward HPV vaccination: A French national survey. Vaccine 2016; 34:762-8. [PMID: 26752063 DOI: 10.1016/j.vaccine.2015.12.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. METHODS Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. RESULTS Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03). CONCLUSION Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.
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Affiliation(s)
- Fanny Collange
- Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, 13005 Marseille, France; INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France
| | - Lisa Fressard
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Céline Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Lorraine University, Paris Descartes University, EA 4360 Apemac, 54505 Vandœuvre-lès-Nancy cedex, France
| | - Rémy Sebbah
- Regional Unions of Healthcare Professionals (Southeastern Region) - Self-employed Physicians (URPS-ML PACA), 13006 Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Pierre Verger
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France; INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 75014 Paris, France.
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Lee A, Wong MCS, Chan TT, Chan PKS. A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine. BMC Public Health 2015; 15:935. [PMID: 26392084 PMCID: PMC4578840 DOI: 10.1186/s12889-015-2269-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background A high coverage of human papillomavirus (HPV) vaccination is required to achieve a clinically significant reduction in disease burden. Countries implementing free-of-charge national vaccination program for adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary on-site school-based mass vaccination programs have demonstrated high coverage. Here, we tested whether this could be an option for countries without a government-supported vaccination program as in Hong Kong. Method A Home-School-Doctor model was evolved based on extensive literature review of various health promotion models together with studies on HPV vaccination among adolescent girls. The outcome measure was uptake of vaccination. Factors associated with the outcome were measured by validated surveys in which 4,631 students from 24 school territory wide participated. Chi-square test was used to analyze association between the categorical variables and the outcome. Multivariate analysis was performed to identify independent variables associated with the outcome with vaccine group as case and non-vaccine group as control. Results In multivariate analysis, parental perception of usefulness of the Home-School-Doctor model had a very high odds ratio for uptake of HPV vaccination (OR 26.6, 95 % CI 16.4, 41.9). Paying a reasonable price was another independent factor associated with increased uptake (OR 1.71, 95 % CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination). For parents and adolescents who were not sure where to get vaccination, this model was significantly associated with improved uptake rate (OR 1.66, 95 % CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70, 95 % CI 0.55, 0.88), allowing daughters to make their own decisions (OR 0.49, 95 % CI 0.38, 0.64) and not caring much about daughters’ social life (95 % CI 0.45, 0.92) were factors associated with a lower uptake. Discussion The findings of this study have added knowledge on how a school-based vaccination program would improve vaccine uptake rate even when the users need to pay. Our findings are consistent with other study that the most acceptable way to achieve high uptake of HPV vaccine is to offer voluntary school-based vaccination. Conclusion A model of care incorporating the efforts and expertise of academics and health professionals working closely with school can be applied to improve the uptake of vaccine among adolescent girls. Subsidized voluntary school-based vaccination scheme can be an option.
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Affiliation(s)
- Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Tracy T Chan
- Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Skinner SR, Davies C, Cooper S, Stoney T, Marshall H, Jones J, Collins J, Hutton H, Parrella A, Zimet G, Regan DG, Whyte P, Brotherton JML, Richmond P, McCaffrey K, Garland SM, Leask J, Kang M, Braunack-Mayer A, Kaldor J, McGeechan K. HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents. BMC Public Health 2015; 15:896. [PMID: 26373926 PMCID: PMC4572679 DOI: 10.1186/s12889-015-2168-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods/Design HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. Discussion This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2168-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Rachel Skinner
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Cristyn Davies
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Spring Cooper
- CUNY School of Public Health, City University New York, New York City, NY, USA.
| | - Tanya Stoney
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Helen Marshall
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Jane Jones
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Joanne Collins
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Heidi Hutton
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Adriana Parrella
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Gregory Zimet
- Pediatrics & Clinical Psychology, Indiana University, Indianapolis, IN, USA.
| | - David G Regan
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Patti Whyte
- Deakin University, SRC Population Health, Deakin Health Economics, Melbourne, VIC, Australia.
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Peter Richmond
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia. .,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Kirsten McCaffrey
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
| | | | - John Kaldor
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
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Lefevere E, Theeten H, Hens N, De Smet F, Top G, Van Damme P. From non school-based, co-payment to school-based, free Human Papillomavirus vaccination in Flanders (Belgium): a retrospective cohort study describing vaccination coverage, age-specific coverage and socio-economic inequalities. Vaccine 2015; 33:5188-95. [PMID: 26254978 DOI: 10.1016/j.vaccine.2015.07.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
School-based, free HPV vaccination for girls in the first year of secondary school was introduced in Flanders (Belgium) in 2010. Before that, non school-based, co-payment vaccination for girls aged 12-18 was in place. We compared vaccination coverage, age-specific coverage and socio-economic inequalities in coverage - 3 important parameters contributing to the effectiveness of the vaccination programs - under both vaccination systems. We used retrospective administrative data from different sources. Our sample consisted of all female members of the National Alliance of Christian Mutualities born in 1995, 1996, 1998 or 1999 (N=66,664). For each vaccination system we described the cumulative proportion HPV vaccination initiation and completion over time. We used life table analysis to calculate age-specific rates of HPV vaccination initiation and completion. Analyses were done separately for higher income and low income groups. Under non school-based, co-payment vaccination the proportions HPV vaccination initiation and completion slowly rose over time. By age 17, the proportion HPV vaccination initiation/completion was 0.75 (95% CI 0.74-076)/0.66 (95% CI 0.65-0.67). The median age at vaccination initiation/completion was 14.4 years (95% CI 14.4-14.5)/15.4 years (95% CI 15.3-15.4). Socio-economic inequalities in coverage widened over time and with age. Under school-based, free vaccination rates of HPV vaccination initiation were substantially higher. By age 14,the proportion HPV vaccination initiation/completion was 0.90 (95% CI 0.90-0.90)/0.87 (95% CI 0.87-0.88). The median age at vaccination initiation/completion was 12.7 years (95% CI 12.7-12.7)/13.3 years (95% CI 13.3-13.3). Socio-economic inequalities in coverage and in age-specific coverage were substantially smaller.
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Affiliation(s)
- Eva Lefevere
- Herman Deleeck Centre for Social Policy, University of Antwerp, St Jacobstraat 2, 2000 Antwerp, Belgium.
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Niel Hens
- Center for Statistics (CenStat), Hasselt University, Agoralaan, Building 3, 3590 Diepenbeek, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Frank De Smet
- National Alliance of Christian Mutualities, Haachtsesteenweg 579, 1031 Brussel, Belgium; Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35 blok D, Box 7001, 3000 Leuven, Belgium.
| | - Geert Top
- Agency for Care and Health, Infectious Disease Control and Vaccinations, K. Albert II laan 35 Box 33, 1030 Brussels, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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Implementation and Evaluation of a School-Based Human Papillomavirus Vaccination Program in Rural Kentucky. Am J Prev Med 2015; 49:317-23. [PMID: 26190806 DOI: 10.1016/j.amepre.2015.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates remain marginal across the U.S., including Kentucky, a state recognized for increased HPV-related cancer burden. School-based HPV immunization programs may be a viable approach to improving vaccination initiation and completion rates among youth. Therefore, the purpose of this study was to design, implement, and evaluate a school-based HPV vaccination program conducted in rural south-central Kentucky. METHODS Guided by evidence-based approaches to increasing immunization rates, the practical expertise of school nursing staff, and a detailed study protocol, academic and health department-based investigators implemented an HPV vaccination project in two high schools during the 2012-2013 academic year; data were analyzed in 2013-2014. Rates of returned parental consent forms, parental consent/declination, and HPV vaccination rates were documented. RESULTS At the beginning of the school year, all 935 students at the two schools were given HPV vaccination parental consent forms. Five hundred eleven students returned consent forms (55% return rate), and 447 of these students were HPV vaccine naïve (87%). Of these students, 315 (70%) initiated the vaccine series, with 276 (62%) completing the entire three-dose series, so that 88% of students initiating the vaccine series successfully completed the series. In estimating rates for the entire school body, 45% of students had received all three doses by the end of the project. CONCLUSIONS Despite study design limitations, results of this project provide further evidence about school-based immunization programs as an effective strategy for improving HPV vaccination rates among Kentucky and U.S. adolescents.
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Giambi C, Del Manso M, D’Ancona F, De Mei B, Giovannelli I, Cattaneo C, Possenti V, Declich S. Actions improving HPV vaccination uptake – Results from a national survey in Italy. Vaccine 2015; 33:2425-31. [DOI: 10.1016/j.vaccine.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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Firenze A, Marsala MGL, Bonanno V, Maranto M, Ferrara C, Giovannelli L, Restivo V. Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation. Hum Vaccin Immunother 2014; 11:240-4. [PMID: 25483543 DOI: 10.4161/hv.36158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Understanding perceptions and characteristics of human papillomavirus (HPV) vaccinated and non-vaccinated girls can inform communication activities and vaccine delivery strategies. The purpose of this study was to evaluate knowledge and factors associated with HPV unvaccinated girls after five years of vaccination program implementation in Sicily, an Italian region with low vaccination coverage (<50.0%). A cross-sectional study was conducted through a questionnaire designed to assess knowledge and vaccination status of girls of 1997, 1998, 1999, and 2000 birth cohorts. The sample consisted of 350 girls who attended three high schools. Multivariable logistic regression analysis was conducted to examine predictors of vaccine refusal. The survey sample of girls shows that the 43.1% were HPV unvaccinated. A significant increased risk of being unvaccinated originated from the belief that the vaccine was too new (AdjOR = 21.08, CI95% = 2.57-172.97) and that it may cause cervical cancer (AdjOR = 4.36, CI95% = 1.26-15.07), along with having friends as a source of information on the vaccine (AdjOR = 3.67, CI95% = 1.63-8.25). A significant inverse association was observed between being unvaccinated and having Pediatrician/General practitioner as a source of information on HPV vaccine (AdjOR = 0.40, CI95% = 0.24-0.68). Many girls lack the fundamental knowledge about the HPV vaccine. The key issue is the promotion and implementation of information programs to raise awareness of girls on the importance of the vaccine.
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Affiliation(s)
- Alberto Firenze
- a Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro"; University of Palermo; Italy
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Palmer AK, Harris AL, Jacobson RM. Human papillomavirus vaccination: a case study in translational science. Clin Transl Sci 2014; 7:420-4. [PMID: 24841923 PMCID: PMC4213215 DOI: 10.1111/cts.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Each year 610,000 cases of anogenital and oropharyngeal cancers caused by human papillomavirus (HPV) occur worldwide. HPV vaccination represents a promising opportunity to prevent cancer on a global scale. The vaccine's story dates back to discoveries in chickens at the beginning of the 20th century with evidence that a cell-free filtrate could transmit the propensity to grow cancers. Later, studies with similarly derived filtrates from mammalian tumors showed that hosts could develop immunity to subsequent exposures. Epidemiologic studies linked cervical cancer to members of a family of viruses that cause papillomatosis and common warts. This led to work with DNA hybridization demonstrating a causal relationship. The formation of virus-like particles from viral capsid proteins led to the development of models for safe and effective vaccines. While much work remains with the acceptance of universal vaccination, the HPV vaccines Gardasil and Cervarix thus represent a century of successful translational research.
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Affiliation(s)
- Allyson K Palmer
- Mayo Clinic Medical Scientist Training Program, Rochester, Minnesota, USA
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Moss JL, Feld AL, O'Malley B, Entzel P, Smith JS, Gilkey MB, Brewer NT. Opportunities for increasing human papillomavirus vaccine provision in school health centers. THE JOURNAL OF SCHOOL HEALTH 2014; 84:370-8. [PMID: 24749919 PMCID: PMC4325977 DOI: 10.1111/josh.12158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/21/2013] [Accepted: 11/01/2013] [Indexed: 05/09/2023]
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions. METHODS We conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine. RESULTS Centers had heterogeneous policies and procedures. Out-of-pocket costs for children and youth to receive privately purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all ps < .05). CONCLUSIONS Although school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low-cost interventions to increase HPV vaccine uptake among adolescents.
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Affiliation(s)
- Jennifer L Moss
- Doctoral Student, , Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440
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School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes. J Adolesc Health 2014; 54:282-8. [PMID: 24560036 DOI: 10.1016/j.jadohealth.2013.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination. METHODS During the 2010-2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh-eighth grades). RESULTS Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus-diphtheria-acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010-2011 school year, with similar results for seventh- to eighth-grade students. CONCLUSIONS Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.
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Brotherton JML, Gertig DM. Primary prophylactic human papillomavirus vaccination programs: future perspective on global impact. Expert Rev Anti Infect Ther 2013; 9:627-39. [PMID: 21819329 DOI: 10.1586/eri.11.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Of the 40 types of human papillomavirus that can infect the mucosal epithelium, four types can now be prevented using prophylactic vaccination. Two of these types (high-risk types 16 and 18) cause 70% of cervical cancers, a proportion of other genital cancers and a subset of head and neck cancers. The low-risk types 6 and 11 cause 90% of genital warts and the disease recurrent respiratory papillomatosis. Thus, if primary HPV vaccination programs can be implemented effectively, the potential for a reduction in global disease burden is great. This article considers the current issues and challenges in delivering primary HPV vaccination programs effectively and the likely impact of the vaccines in both the near and more distant future.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service Registries, Victorian Cytology Service, PO Box 310, East Melbourne, Victoria 8002, Australia.
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Abstract
PURPOSE OF REVIEW Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents with the human papillomavirus (HPV) vaccine, U.S. coverage among women remains less than 50%, with that of adolescent men below 2%. RECENT FINDINGS Ongoing studies document the efficacy and safety of the HPV vaccine. Nevertheless, misconceptions and negative attitudes persist and serve as barriers to vaccine uptake. Additionally, other factors such as age, insurance status, poverty status, and racial or ethnic background have been associated with diminished vaccine uptake and poor completion rates. Internationally, HPV vaccination programs and school-based programs have achieved increased rates of uptake and series completion. HPV vaccination coverage may also be facilitated by improving communication between physicians, parents, and adolescents as well as by addressing common misconceptions about the vaccine. SUMMARY This review highlights significant findings of recent literature on HPV vaccination of adolescent women with a special focus on uptake, series completion, communication, disparities in vaccine coverage, and other health outcomes associated with HPV vaccination.
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Gainforth HL, Cao W, Latimer-Cheung AE. Message framing and parents' intentions to have their children vaccinated against HPV. Public Health Nurs 2012; 29:542-52. [PMID: 23078425 DOI: 10.1111/j.1525-1446.2012.01038.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Framing a message in terms of the benefits of engaging in the behavior (gain frame), the costs of failing to engage in the behavior (loss frame), or both the benefits and the costs (mixed frame) can impact parents' decisions about their childrens' and adolescents' health. This study, investigated the effect of framed messages on parents' intentions to have their children vaccinated against human papillomavirus (HPV). DESIGN AND SAMPLE The study employed a 2 (gender of the parent) × 2 (gender of the child) × 3 (message frame) between-groups, quasi-experimental design. A convenience sample of 367 parents with children in Grade 5, 6, or 7 who had at least one child who had not been vaccinated against HPV. MEASURES Social-cognitive variables relating to intentions to vaccinate a child were assessed. INTERVENTION Participants were randomly assigned to read one of three framed messages about the HPV vaccine (gain, loss, or mixed). RESULTS Gain-framed messages seemed to persuade mothers of sons to speak to a doctor about the vaccine (p < .05). Framing effects were not significant for other outcomes. CONCLUSIONS Findings provide preliminary evidence that certain vaccination messages may be more effective for different parent-child dyads.
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Affiliation(s)
- Heather L Gainforth
- School of Kinesiology & Health Studies, Queen's University, Kingston, Ontario, Canada
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Kessels SJ, Marshall HS, Watson M, Braunack-Mayer AJ, Reuzel R, Tooher RL. Factors associated with HPV vaccine uptake in teenage girls: A systematic review. Vaccine 2012; 30:3546-56. [DOI: 10.1016/j.vaccine.2012.03.063] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/07/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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School-based vaccination: a systematic review of process evaluations. Vaccine 2011; 29:9588-99. [PMID: 22033031 DOI: 10.1016/j.vaccine.2011.10.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/24/2011] [Accepted: 10/13/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE School-based vaccination is becoming a more widely used method of vaccine delivery. However, evaluations of school-based vaccination program implementation have not been systematically reviewed. This paper describes the results of a systematic review of the literature on process (or implementation) evaluations of school-based vaccination delivery. METHODS Search terms: "school based vaccination" OR (("schools" OR "school") AND ("immunisation" OR "immunization" OR "vaccination")). LIMITS Humans; English language; Age: 6-18 (school-age children and adolescents); No editorials; No letters. Databases: PUBMED; Embase.com; Cochrane Database of Systematic Reviews; Cinahl; Web of Science; PsycINFO. Inclusions: Articles must have originated from an advanced economic 'developed' country, be peer-reviewed, available in English, randomised or non-randomised controlled design, published from 1970 to August 2010 and focused on vaccinations provided in the school setting and during school time which reported one or more outcomes. EXCLUSIONS qualitative or descriptive papers without any evaluation component; papers that only reported on impact evaluation (i.e. number of students vaccinated); and those published before 1970. RESULTS A total of 14 articles were identified as including some element of a process evaluation of a school-based vaccination program. Nurses, parents, teachers, and adolescents were involved in measures of procedural factors related to school-based vaccination implementation. Outcomes included return rates of consent forms; knowledge about the specific vaccine offered; attitudes toward vaccination and school-based vaccination; reasons for non-vaccination; resources, support, and procedures related to implementation; and environmental factors within the school that may impact vaccination success. Vaccination coverage was also reported in the majority of papers. CONCLUSIONS Many studies reported on the importance of ensuring all stakeholders (school nurses, parents, teachers, and adolescents) receive appropriate information and are involved in the vaccination program and implementation processes. Specific consent form dissemination procedures have demonstrated higher return rates. Further controlled studies are needed to determine the best practice approach to implementing these programs is a variety of contexts.
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Abstract
Australia commenced an ongoing school based government funded human papillomaviruses (HPV) (cervical cancer prevention) vaccination program in April 2007 for adolescent females aged 12-13 years. In addition, up to December 31, 2009, a catch-up program for young females 13-26 years of age was offered: a school-based vaccination program was used to offer HPV vaccine to girls enrolled in school (14-17 years), and general practitioners or other community health provider offered vaccine to young women aged 18-26 years. To date, only the quadrivalent vaccine (HPV 6/11/16/18) has been utilized in the funded program. Acceptance of the vaccine is high with coverage of 3 doses of the HPV vaccine in the school age cohort around 70%, and just over 30% in the older age cohort. Since the vaccination program was initiated, a reduction in new cases of genital warts of 73% among vaccine eligible age females has been evidenced in STI clinics across Australia. A reduction of 44% of new cases in young males (not a part of the free program) was also documented during this same time period, suggesting significant herd immunity. Similarly, in the state of Victoria, a small but significant decrease in high grade abnormalities in Pap screening findings has been reported in young women<18 years for the period 2007-9, as compared to pre-vaccination. Challenges for the future include how we can sustain and improve HPV vaccination coverage in young Australian women, while maintaining cervical cancer screening participation and reviewing cervical cancer screening methods.
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