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Okoli GN, Neilson CJ, Grossman Moon A, Kimmel Supron H, Soos AE, Grewal A, Etsell K, Alessi-Severini S, Richardson C, Harper DM. Exploration of individual socioeconomic and health-related characteristics associated with human papillomavirus vaccination initiation and vaccination series completion among adult females: A comprehensive systematic evidence review with meta-analysis. Vaccine 2024; 42:125994. [PMID: 38796328 DOI: 10.1016/j.vaccine.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates among females are lower than the World Health Organization target and vaccination rates specifically among adult females are even much lower. METHODS We systematically evaluated individual socioeconomic and health-related characteristics associated with HPV vaccination initiation and vaccination series completion among adult females (PROSPERO: CRD42023445721). We performed a literature search on December 14, 2022, and supplemented the search on August 1, 2023. We pooled appropriate multivariable-adjusted results using an inverse variance random-effects model and expressed the results as odds ratios with associated 95 % confidence intervals. A point pooled significantly increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥ 70 % was very strongly associated. RESULTS We included 63 cross-sectional studies. There were strongly increased odds of vaccination initiation among White women compared with Black or Asian women, and those with higher education, health insurance, a history of sexually transmitted infection (STI), receipt of influenza vaccination in the preceding year, not married/cohabiting, not smoking, using contraception, and having visited a healthcare provider in the preceding year. We observed very strongly increased odds of vaccination initiation among those younger and having been born in the country of study. Similarly, there were strongly increased odds of completing the vaccination series for the same variables as initiating vaccination, except for higher education, prior STI, smoking and contraception use. Additional variables associated with strongly increased odds of vaccination series completion not seen in initiation were higher annual household income, being lesbian/bisexual, and having a primary care physician. We observed very strongly increased odds of vaccination series completion similar to vaccination initiation but including for White compared with Black women, higher education, and prior cervical cancer screening. CONCLUSIONS These individual characteristics may be the key to identifying women at increased risk of not being vaccinated against HPV and could inform targeted messaging to drive HPV vaccination.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | | | - Alexandra E Soos
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Avneet Grewal
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Katharine Etsell
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Richardson
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Diane M Harper
- Departments of Family Medicine and Obstetrics & Gynecology, University of Michigan, Michigan, USA
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Fisher CL, Mullis MD, McFarlane A, Hansen MD, Vilaro MJ, Bylund CL, Wiggins L, Corbitt H, Staras SAS. Promoting Rural-Residing Parents' Receptivity to HPV Vaccination: Targeting Messages and Mobile Clinic Implementation. Vaccines (Basel) 2024; 12:712. [PMID: 39066350 PMCID: PMC11281438 DOI: 10.3390/vaccines12070712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Interventions are needed to increase low HPV vaccination rates within rural areas in the United States, particularly in the state of Florida, which has the seventh highest number of HPV-related cancers. Florida also ranks low compared to other states in terms of HPV vaccination. Rural-residing parents may benefit from two evidence-based strategies to increase vaccination rates: reminder messages informing and prompting vaccination appointments and mobile clinics to reduce transportation barriers. We sought to identify parental attitudes towards (1) message features that promote rural-residing parents' receptivity to HPV vaccination; (2) parents' acceptability of three reminder message modalities (text, postcard, phone); and (3) implementation factors that promote parents' acceptability of using a mobile clinic for vaccination. We recruited 28 rural-residing parents of 9- to 12-year-old children (unvaccinated for HPV) for focus group and individual interviews and thematically analyzed transcripts. Three features promoted parents' receptivity to HPV vaccination messages: source credibility, specific information coverage, and personalization (name and birthday wishes). Parents most preferred text messages and identified three factors promoting parents' mobile clinic use: convenience and feasibility, trustworthiness, and detailed information. The findings indicate rural-residing parents' acceptability of reminder messages and mobile clinics as well as the importance of trust and feasibility when implementing these evidence-based strategies for rural-residing parents.
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Affiliation(s)
- Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - M. Devyn Mullis
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Antionette McFarlane
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Marta D. Hansen
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Melissa J. Vilaro
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA;
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Lori Wiggins
- Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA; (L.W.); (H.C.)
| | - Halie Corbitt
- Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA; (L.W.); (H.C.)
| | - Stephanie A. S. Staras
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
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Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [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] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Simko S, Hayes-Bautista TM, Givens E. Evaluation of an HPV vaccine toolkit to improve OB/GYN discussion of HPV vaccination. PUBLIC HEALTH IN PRACTICE 2024; 7:100473. [PMID: 38362262 PMCID: PMC10867569 DOI: 10.1016/j.puhip.2024.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Background HPV (Human Papillomavirus) vaccination is a safe, effective method to prevent HPV-associated disease. Racial-ethnic disparities in HPV vaccination exist, which could lead to widening gaps in cervical cancer mortality. Provider discussion of HPV vaccination has been shown to be a primary factor for increasing vaccination rates. The objective of this study is to assess provider discussion of HPV vaccination pre and post implementation of an intervention, named the HPV Vaccine Toolkit, in an Obstetrics and Gynecology (OB/GYN) clinic in Boyle Heights, Los Angeles. Study design and methods This quality improvement study occurred over four cycles of development. Its design was guided by the Theory of Planned Behavior. The toolkit components included dot phrases (pre-written phrases to speed documentation), educational posters, electronic health record prompts, HPV vaccine referral guides, and educational sessions. Chart audits and pre- and post-providers surveys were performed between 2019 and 2021 to assess for an increase in provider discussion of the HPV vaccine, as well as to evaluate the various components of the toolkit. Results Provider discussion increased over the four cycles of this intervention, with HPV vaccination discussion documented in 15 % of patients in 2019, 19 % of patients in 2020 and 47 % of patients in 2021. Gaps identified included limited discussion of vaccination at postpartum visits. Provider uncertainty of where to refer patients for the HPV vaccine decreased following the intervention. Conclusion Discussion of HPV vaccination is an important preventative strategy that can be overlooked in OB/GYN clinics. Implementation of multicomponent strategies can increase provider discussion of HPV vaccination status, although barriers to discussion remain. Improved counseling on HPV vaccination could have significant impacts on reducing HPV-related disease.
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Affiliation(s)
- Sarah Simko
- University of California at Riverside, Riverside, CA, USA
| | | | - Erica Givens
- Adventist Health White Memorial Medical Center, Los Angeles, CA, USA
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Du C, Voaklander D, Meherali S, Paudel YR, MacDonald SE. Human papillomavirus vaccine coverage among immigrant adolescents in Alberta: a population-based cohort study. Int Health 2024:ihae038. [PMID: 38785316 DOI: 10.1093/inthealth/ihae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Little is known about human papillomavirus (HPV) vaccination among immigrant children in Canada. We conducted a study in Alberta, Canada to assess HPV vaccine coverage among school-aged immigrant children compared with non-immigrant children. METHODS This cohort study analysed population-based linked administrative health data to measure HPV vaccine coverage for 346 749 school-aged children, including 31 656 immigrants. Coverage was examined at 12 y of age from 2008 to 2018 for females, and from 2014 to 2018 for males and both sexes combined; vaccine series completion was considered receipt of three doses, with initiation (one or more dose) as a supplementary analysis. Multivariable logistic regression examined the association of vaccine coverage with migration status, adjusting for sociodemographic variables. RESULTS Between 2014 and 2018, HPV vaccination coverage among immigrant children at age 12 y was significantly higher (52.58%) compared with non-immigrant children (47.41%). After controlling for place of residence, income quintile, biological sex and year, immigrant children had 1.10 greater odds (95% confidence interval 1.07 to 1.14) of receiving three doses of HPV vaccine compared with non-immigrant children. Immigrants from Asia and Africa had the highest coverage (60.25-68.78%), while immigrants from North America, Oceania and South America had the lowest coverage (39.97-48.36%). CONCLUSIONS It is encouraging that immigrant children had higher HPV vaccine coverage compared with non-immigrants. Among immigrants, routine immunization promotion strategies should be tailored based on the country of origin.
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Affiliation(s)
- Crystal Du
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Akande OW, Akande TM. Human Papillomavirus Vaccination amongst Students in a Tertiary Institution in North Central Nigeria: A Cross-sectional Study on Sociodemographic Factors Associated with Its Awareness, Uptake and Willingness to Pay. Niger Postgrad Med J 2024; 31:14-24. [PMID: 38321793 DOI: 10.4103/npmj.npmj_265_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine is effective in averting 70%-90% of all HPV-related diseases. The assessment of its awareness, uptake and willingness to pay (WTP) is important in Nigeria which is one of the developing countries where more than three-quarter of the global burden of HPV-related diseases occur. This study aimed to determine the sociodemographic factors associated with the awareness, uptake and WTP for HPV vaccine amongst undergraduates in a tertiary institution in North Central Nigeria. METHODS This was a cross-sectional study. Data were collected from randomly sampled respondents through a validated self-administered questionnaire. Descriptive statistics, Chi-square and logistic regression analyses were applied to data collected to determine the awareness, uptake and WTP for HPV vaccine and their association with sociodemographic factors. The results of inferential statistics were considered significant when P < 0.05. RESULTS A total of 240 respondents were recruited, 15.4% of the respondents had heard about HPV vaccine, 2.1% of them had received at least a dose of the vaccine, 0.4% of them had completed three doses and 35.0% of them were willing to pay for it. Marital status (adjusted odds ratio [AOR]: 10.2; 95% confidence interval [CI]: 2.840-36.635) and parity (AOR: 5.8; 95% CI: 2.314-14.565) were predictors of WTP for the HPV vaccine. CONCLUSION The evidence generated from this study suggests that there is a need to increase the awareness and uptake of the vaccine at the individual and population levels. The recent introduction of the HPV vaccine is a laudable step towards improving vaccine uptake. Public health authorities at the local, state and national levels should be empowered to develop tailored vaccine demand creation and advocacy strategies for HPV vaccine. Males should also be involved in the advocacy strategies and research on HPV vaccine.
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Affiliation(s)
- Oluwatosin Wuraola Akande
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Tanimola Makanjuola Akande
- Department of Epidemiology and Community Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
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Onyeaka HK, Muoghalu C, Deary EC, Ajayi KV, Kyeremeh E, Dosunmu TG, Jawla M, Onaku E, Nwani SP, Asante KO, Amonoo HL. The Role of Health Information Technology in Improving Awareness of Human Papillomavirus and Human Papillomavirus Vaccine Among U.S. Adults. Telemed J E Health 2023; 29:886-895. [PMID: 36394492 PMCID: PMC10277992 DOI: 10.1089/tmj.2022.0381] [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] [Received: 09/07/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective: Although human papillomavirus (HPV) vaccines prevent cancer-causing HPV infections and cervical precancers, there is suboptimal awareness and limited global accessibility of HPV and HPV vaccine. Emerging evidence suggests that health information technology (HIT) may influence HPV-related awareness and improve vaccine adoption. The objective of this study was to evaluate the link between HIT and HPV-related awareness Methods: Data were obtained from 1,866 U.S. adults aged 18-45 years who completed the 2017 and 2018 Health Information National Trends Survey. We conducted multivariable logistic regression to analyze the association between HIT utilization and HPV-related awareness. Results: Awareness of HPV and HPV vaccine were 72.7% and 67.5%, respectively. Participants who used electronic means to look up health information (adjusted odds ratio [aOR] = 3.05; p = 0.001), communicate with health care provider (aOR = 1.68; p = 0.026), look up test results (aOR = 1.94; p = 0.005), and track health costs (aOR = 1.65; p = 0.04) were more likely to report HPV awareness than those who did not. Participants who used an electronic device to look up health information (aOR = 3.10; p = 0.003), communicate with clinicians (aOR = 1.72; p = 0.008), look up test results (aOR = 1.63; p = 0.021), and track health care charges (aOR = 1.90; p = 0.006) were more likely to report HPV vaccine awareness than those who did not. Discussion and Conclusion: Our findings suggest a positive association between HIT utilization and HPV-related awareness. Given the rapid and exponential increase in mobile technology access globally, these results are encouraging and offer a potential opportunity to leverage digital technology in primary cancer prevention for HPV-related cancers, especially in low- and middle-income countries with unsophisticated health infrastructures.
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Affiliation(s)
- Henry K. Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chioma Muoghalu
- Department of Clinical Informatics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Presbyterian Hospital, Clovis, New Mexico, USA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, Texas, USA
| | - Emmanuel Kyeremeh
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | | | - Muhammed Jawla
- Department of Epidemiology, Louisiana State University School of Health Sciences, New Orleans, Louisiana, USA
| | | | - Somtochi P Nwani
- Faculty of Pharmaceutical Sciences, University of Nigeria, Enugu, Nigeria
| | | | - Hermioni L. Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Wang SM, Keegan EA, Bryan KM, Kazma J, Das KJ, Long BJ, BuAbbud A. Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients. Vaccine 2023; 41:2961-2967. [PMID: 37029002 DOI: 10.1016/j.vaccine.2023.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE We describe provider documented counseling patterns and perception regarding HPV vaccination among patients with a history of cervical dysplasia. METHODS All patients ages 21-45 who underwent colposcopy at a single academic medical center from 2018 to 2020were sent a self-administered survey through the electronic medical record patient portal to assess their attitudes regarding human papillomavirus (HPV) vaccination. Demographic information, HPV vaccination history, and documented obstetrics and gynecology provider counseling at the time of colposcopy were examined. RESULTS Of 1465patients, 434 (29.6 %) reported or had documented receipt of at least one dose of the human papillomavirus vaccine. The remainder reported they were not vaccinated or had no documentation of vaccination. Proportion of vaccinated patients was higher among White compared to Black and Asian patients (P = 0.02). On multivariate analysis, private insurance (aOR 2.2, 95 % CI 1.4-3.7) was associated with vaccinated status while Asian race (aOR 0.4, 95 % CI 0.2-0.7) and hypertension (aOR 0.2, 95 % CI 0.08-0.7) were less likely to be associated with vaccination status. Among patients with unvaccinated or unknown vaccination status, 112 (10.8 %) received documented counseling regardingcatch-up human papillomavirus vaccination at a gynecologic visit. Patients seen by a sub-specialist obstetrics and gynecologic provider were more likely to have documented provider counseling regarding vaccination compared to those seen by a generalist obstetric/gynecologist provider (26 % vs 9.8 %, p < 0.001). Patients cited lack of physician discussion (53.7 %) and the belief that they were too old to receive the HPV vaccine (48.8 %) as the main reasons for remaining unvaccinated. CONCLUSION HPV vaccination and the rate of obstetric and gynecologic provider counseling regarding HPV vaccination among patients undergoing colposcopy remains low. When surveyed, many patients with a history of colposcopy cited provider recommendation as afactor in their decision to undergo adjuvant HPV vaccination, demonstrating the importance of provider counseling in thisgroup.
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Zhao R, Prizment A, Kulasingam S. Lower human papillomavirus vaccine initiation and completion among Asian American adolescents compared to their peers: National Health and Nutritional Examination Survey 2011-2018. Cancer Causes Control 2023; 34:543-552. [PMID: 36973601 PMCID: PMC10042420 DOI: 10.1007/s10552-023-01685-z] [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: 05/30/2021] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To compare human papillomavirus (HPV) vaccination initiation and completion between Asian American adolescents and their peers. METHODS HPV vaccine initiation and completion of adolescents aged 9-17 years old were analyzed using the National Health and Nutritional Examination Survey data from 2011 to 2018. The outcomes were HPV vaccine initiation percentage among all adolescents and completion percentage among initiators. Odds ratios for initiation or completion among Hispanics, Blacks, and Asians (referred to as racial/ethnic minorities) versus Whites were compared using logistic regression, adjusted for adolescent's age, annual family income, parent education, and insurance coverage. RESULTS From 2011 to 2018, overall initiation was less than 40% among U.S. adolescents. The initiation increased among boys (from 10% in 2011-12 to over 30% in 2017-2018) but not among girls. Compared to White girls, Black and Hispanic girls were more likely, while Asian girls were less likely to initiate vaccination. Although not statistically significant, Asian girls had ORs ranging from 0.65 to 0.99 for initiation compared to White girls in each of the four survey cycles. Black and Hispanic boys were more likely to initiate vaccination compared to White boys. Initiation among Asian boys increased to 39% in the 2017-2018 survey cycle. Racial/ethnic minority girls were less likely to complete the series compared to White girls, while the opposite was seen in Black boys. CONCLUSION HPV vaccination status varies among racial/ethnic groups. Future efforts should be made to achieve the Healthy People 2020 goal of 80% vaccination among U.S. adolescents and address the gap among Asian American girls.
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Affiliation(s)
- Ran Zhao
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S 2Nd St, Minneapolis, MN, 55454, USA.
| | - Anna Prizment
- Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School Masonic Cancer Center, 420 Delaware St, MMC 480, Minneapolis, MN, 55455, USA
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S 2Nd St, Minneapolis, MN, 55454, USA
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Winn R, Winkfield K, Mitchell E. Addressing disparities in cancer care and incorporating precision medicine for minority populations. J Natl Med Assoc 2023; 115:S2-S7. [DOI: 10.1016/j.jnma.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
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Gray A, Fisher CB. Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States. Front Public Health 2023; 11:1124206. [PMID: 37139381 PMCID: PMC10150885 DOI: 10.3389/fpubh.2023.1124206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population. Methods Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions. Results Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors. Discussion In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.
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Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY, United States
- Department of Epidemiology, Florida International University, Miami, FL, United States
- *Correspondence: Aaliyah Gray,
| | - Celia B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, United States
- Center for Ethics Education, Fordham University, Bronx, NY, United States
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12
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Villavicencio A, Kelsey G, Nogueira NF, Zukerberg J, Salazar AS, Hernandez L, Raccamarich P, Alcaide ML. Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US. PLoS One 2023; 18:e0275141. [PMID: 36656804 PMCID: PMC9851547 DOI: 10.1371/journal.pone.0275141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women's HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. METHODS From April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18-45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher's exact test, studentized t-test, and multivariate logistic regression (MLR). RESULTS A total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators. CONCLUSION Findings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake.
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Affiliation(s)
- Aasith Villavicencio
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gray Kelsey
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Nicholas F. Nogueira
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Julia Zukerberg
- University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ana S. Salazar
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Lucila Hernandez
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Patricia Raccamarich
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Maria Luisa Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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13
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Pai SI, Wasserman I, Ji YD, Gilman M, Hung YP, Faquin WC, Mino-Kenudson M, Muniappan A. Pulmonary manifestations of chronic HPV infection in patients with recurrent respiratory papillomatosis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:997-1008. [PMID: 35863360 PMCID: PMC10634185 DOI: 10.1016/s2213-2600(22)00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 10/17/2022]
Abstract
Human papillomavirus (HPV) types 6 and 11 can infect the squamous epithelium of the respiratory tract. Up to 8·9% of patients with HPV-associated recurrent respiratory papillomatosis (RRP) have pulmonary involvement. Pulmonary manifestations of HPV infection are associated with considerable morbidity, in part because treatment options and management guidelines are lacking. Patients with pulmonary RRP have a 32-times increased lifetime risk of malignant transformation compared with the overall RRP population. We review the clinical and radiographic presentation, pathological features, and genetics of pulmonary RRP, and we provide management algorithms based on our clinical experience with this complex patient population. In patients with suspected pulmonary involvement, tissue-sparing procedures to address growing lesions might be warranted given the chronicity and multifocality of the disease over a patient's lifetime. However, malignant transformation of pulmonary lesion(s) warrants standard-of-care treatment for primary lung squamous cell carcinoma. Large cohort studies are needed to understand the clinical course of pulmonary RRP and to identify molecular markers of increased risk of malignant transformation in order to develop guidelines for optimal and standardised surveillance and treatment.
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Affiliation(s)
- Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Isaac Wasserman
- Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Yisi D Ji
- Harvard Medical School, Boston, MA, USA
| | - Matthew Gilman
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ashok Muniappan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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14
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Fernandez ME, Savas LS, Atkinson JS, Ricks KB, Ibekwe LN, Jackson I, Castle PE, Jobe D, Vernon SW. Evaluation of a 2-1-1 Telephone Navigation Program to Increase Cancer Control Behaviors: Results From a Randomized Controlled Trial. Am J Health Promot 2022; 36:1083-1093. [PMID: 35514063 DOI: 10.1177/08901171211041276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effectiveness of a telephone navigation intervention for increasing use of cancer control services among underserved 2-1-1 callers. DESIGN Randomized controlled trial. SETTING 2-1-1 call centers in Houston and Weslaco, Texas (located in the Rio Grande Valley near the Mexican border). PARTICIPANTS 2-1-1 callers in need of Pap test, mammography, colorectal cancer screening, smoking cessation counseling, and/or HPV vaccination for a daughter (n = 1,554). A majority were low-income and described themselves as Black or Hispanic. INTERVENTION Participants were randomly assigned to receive either a cancer control referral for the needed service(s) with telephone navigation from a trained cancer control navigator (n = 995) or a referral only (n = 559). MEASURES Uptake of each individual service and any needed service. ANALYSIS Assessed uptake in both groups using bivariate chi-square analyses and multivariable logistic regression analyses, adjusted for sociodemographic covariates. Both per-protocol and intent-to-treat approaches were used. RESULTS Both interventions increased cancer control behaviors. Referral with navigation intervention resulted in significantly greater completion of any needed service (OR = 1.38; p = .042), Pap test (OR = 1.56; p = .023), and smoking cessation counseling (OR = 2.66; p = .044), than referral-only condition. Other outcomes showed the same trend although the difference was not statistically significant: mammography (OR = 1.53; p = .106); colorectal cancer screening (OR = 1.80; p = .095); and HPV vaccination of a daughter (OR = 1.61; p = .331). CONCLUSION Adding cancer control referrals and navigation to an informational service like the 2-1-1 program can increase overall participation in cancer control services.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - John S Atkinson
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Katherine Ball Ricks
- Cecil G. Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA
| | - Lynn N Ibekwe
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Inimfon Jackson
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.,Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
| | - David Jobe
- 2-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, TX, USA
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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15
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Zubizarreta D, Beccia AL, Trinh MH, Reynolds CA, Reisner SL, Charlton BM. Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Soc Sci Med 2022; 301:114871. [PMID: 35344774 DOI: 10.1016/j.socscimed.2022.114871] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/24/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
We investigated how gender identity, sexual orientation, and race/ethnicity intersect to shape the social epidemiology of HPV vaccination initiation among U.S. college students. Cross-sectional survey data were from the National College Health Assessment (Fall, 2019-Spring, 2020; N = 65,047). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 36 social strata defined using gender identity, sexual orientation, and race/ethnicity. Bayesian multilevel logistic regression models with random intercepts for social strata were fit for HPV vaccination initiation. Intersectional models adjusted for the additive main effects to isolate intersectional interactions, controlling for age and geographic region. Social strata that included cisgender men, transgender women, and non-binary assigned-male-at-birth individuals and strata that included racial/ethnic minorities had a significantly lower likelihood of HPV vaccination initiation relative to strata including cisgender women and non-Hispanic White individuals, respectively, while strata including lesbian/gay and bisexual/pansexual/queer individuals had a significantly higher likelihood of HPV vaccination initiation relative to strata including heterosexual individuals. We also observed substantial between-stratum inequities in the predicted prevalence of HPV vaccination initiation, with estimates ranging from 59.2% for heterosexual, racial/ethnic minority, cisgender men to 87.1% for bisexual/pansexual/queer, racial/ethnic minority, non-binary assigned-female-at-birth individuals. That being said, the majority of the observed between-stratum variance was driven by additive rather than intersectional interaction effects and the discriminatory accuracy of intersectional stratification with respect to predicting HPV vaccination initiation was low. Collectively, our findings point to a need for more universal guidelines and clinician recommendations that promote HPV vaccine uptake for all adolescents, regardless of race/ethnicity, gender identity, sex-assigned-at-birth, or sexual orientation; however, utilizing an intersectional lens will ensure that resulting public health interventions address inequities and center the needs and experiences of multiply marginalized adolescents.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ariel L Beccia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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16
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Granade CJ, Lindley MC, Jatlaoui T, Asif AF, Jones-Jack N. Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence. Health Equity 2022; 6:206-223. [PMID: 35402775 PMCID: PMC8985539 DOI: 10.1089/heq.2021.0177] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations. Objective To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination. Search Methods We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles. Selection Criteria Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question. Data Collection and Analysis Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies. Results Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality). Conclusions A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amimah F. Asif
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Atlanta, Georgia, USA
| | - Nkenge Jones-Jack
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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McElfish PA, Narcisse MR, Felix HC, Cascante DC, Nagarsheth N, Teeter B, Faramawi MF. Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA. J Racial Ethn Health Disparities 2021; 8:1260-1266. [PMID: 33033889 PMCID: PMC9753349 DOI: 10.1007/s40615-020-00886-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
Research has demonstrated that the human papillomavirus (HPV) vaccine is a safe and effective way to decrease HPV-related cervical cancers; however, the vaccination rate in the USA is suboptimal. The current study examined racial and ethnic disparities in HPV vaccination among a nationally representative sample, including Native Hawaiian and Pacific Islanders (NHPI). This study also investigated the associations between nativity and vaccination, and sex differences between race/ethnicity and vaccination and nativity and vaccination. A cross-sectional study was conducted with a sample of adults aged 18-26 years drawn from the 2014 NHPI National Health Interview Survey (n = 2590) and the general 2014 National Health Interview Survey (n = 36,697). Log-binomial models were fitted to examine differences in vaccination. There was a statistically significant racial/ethnic difference in HPV vaccination (p = 0.003). More women than men were vaccinated (41.8% vs. 10.1%) (p < 0.001). There was a significant difference in HPV vaccination based on nativity: 27.4% of adults aged 18 to 26 years who were born in the USA and 27.7% born in a US territory received the HPV vaccine compared with 14.3% among those not born in the USA or a US territory (p < 0.001). The association of HPV vaccination with nativity and race/ethnicity differed by sex and showed several nuanced differences. Overall, the prevalence of HPV vaccination was low. The study's findings demonstrate the need for public health strategies to increase vaccination rates among all populations, with the critical need to identify strategies that are effective for men, racial/ethnic minorities, and immigrant women born outside the USA.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Diana C Cascante
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Ben Teeter
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Mohammed F Faramawi
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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18
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Truong-Vu KP. On-time, late, or never: Incorporating intersectionality to predict age-specific probabilities of initiating the HPV vaccine series. Soc Sci Med 2021; 287:114227. [PMID: 34482275 DOI: 10.1016/j.socscimed.2021.114227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
The HPV vaccine's effectiveness in protecting against the human papillomavirus (HPV) is dependent on both the timing of vaccine initiation (by age 12) and number of vaccine doses. This study used an intersectional approach to examine how gender and its intersection with race/ethnicity predict age-specific probabilities of initiating HPV vaccinations for boys/men and girls/women across four racial/ethnic groups: non-Latinx (NL) white, NL-Black, Latinx, and NL-Asian American. Multinomial logistic regression models-with on-time vaccination as the base outcome-examined the timing of initiating HPV vaccinations (never or late) in the 2011-2016 National Health and Nutrition Examination Survey (NHANES). This study finds that the multiplicative interaction term between gender and race/ethnicity produces significant results in the likelihood of initiating HPV vaccine uptake: NL-Asian American boys/men have the highest risk of not vaccinating on time. This finding would have been hidden with a one-dimensional analysis.
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Affiliation(s)
- Kim-Phuong Truong-Vu
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA.
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19
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Madhivanan P, Krupp K, Coudray M, Colbert B, Ruiz-Perez D, Cui H, Bokulich N, Narasimhan G, Mathee K, Cook RL, Schwebke J, Roe D. Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities. Vaccine 2021; 39:4810-4816. [PMID: 34294478 DOI: 10.1016/j.vaccine.2021.07.026] [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: 11/29/2020] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States. METHODS This sub-study obtained meta-data for 80 of the 1,365 women (18-25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1). RESULTS The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively. CONCLUSIONS Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.
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Affiliation(s)
- P Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; College of Medicine, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - K Krupp
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - M Coudray
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA; College of Medicine, University of Central Florida, Orlando, USA.
| | - B Colbert
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - D Ruiz-Perez
- Bioinformatic Research Group (BioRG), School of Computing and Information Sciences, Florida International University, Miami, USA.
| | - H Cui
- University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - N Bokulich
- Laboratory of Food Systems Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland.
| | - G Narasimhan
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - K Mathee
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - R L Cook
- College of Public Health and Health Professions, University of Florida, Gainesville, USA.
| | - J Schwebke
- College of Medicine, University of Birmingham, Alabama, USA.
| | - D Roe
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
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20
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Dike S, Freysteinson WM. Factors Associated With African American Mothers' Perceptions of Human Papillomavirus Vaccination of Their Daughters: An Integrated Literature Review. Oncol Nurs Forum 2021; 48:371-389. [PMID: 34142996 DOI: 10.1188/21.onf.371-389] [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: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION African American (AA) women have a higher mortality rate for cervical and other cancers and are less likely to have received the human papillomavirus (HPV) vaccine than White women. Mothers play a significant family role and have a unique relationship with their daughters. Mothers' positive views on HPV vaccination may enhance the HPV vaccination rate among their daughters. LITERATURE SEARCH The review was conducted by searching literature in PubMed®, CINAHL®, ScienceDirect, Ovid MEDLINE®, and ProQuest databases. The search was limited to studies conducted in the United States and published since the inception of the HPV vaccine in 2006. DATA EVALUATION Of 10,566 publications retrieved, 28 articles were included in the final sample. SYNTHESIS Factors associated with HPV vaccination were approval and disapproval of HPV vaccination from physicians, family, and friends; HPV knowledge; attitude and belief about HPV vaccination; benefits of vaccination; and challenges of and barriers to HPV vaccination. IMPLICATIONS FOR PRACTICE Understanding factors related to HPV vaccination decisions among AA mothers will inform healthcare providers of the best approach to improving vaccination rates among this high-risk population.
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21
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Ou MT, Boyarsky BJ, Zeiser LB, Po-Yu Chiang T, Ruddy J, Van Pilsum Rasmussen SE, Martin J, St Clair Russell J, Durand CM, Avery RK, Werbel WA, Cooper M, Massie AB, Segev DL, Garonzik-Wang JM. Kidney Transplant Recipient Attitudes Toward a SARS-CoV-2 Vaccine. Transplant Direct 2021; 7:e713. [PMID: 34131585 PMCID: PMC8196090 DOI: 10.1097/txd.0000000000001171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
A widely accepted severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine could protect vulnerable populations, but the willingness of solid organ transplant recipients (SOTRs) to accept a potential vaccine remains unknown. METHODS We conducted a national survey of 1308 SOTRs and 1617 non-SOTRs between November 11 and December 2, 2020 through the network of the National Kidney Foundation. RESULTS Respondents were largely White (73.2%), female (61.1%), and college graduates (56.2%). Among SOTRs, half (49.5%) were unsure or would be unwilling to receive a SARS-CoV-2 vaccine once available. Major concerns included potential side effects (85.2%), lack of rigor in the testing and development process (69.7%), and fear of incompatibility with organ transplants (75.4%). Even after the announcement of the high efficacy of the mRNA-1273 vaccine (Moderna Inc.) at the time of survey distribution, likeliness to receive a vaccine only slightly increased (53.5% before announcement versus 57.8% after the announcement). However, 86.8% of SOTRs would accept a vaccine if recommended by a transplant provider. CONCLUSIONS SOTRs reported skepticism in receiving a potential SARS-CoV-2 vaccine, even after announcements of high vaccine efficacy. Reassuringly, transplant providers may be the defining influence in vaccine acceptance and will likely have a critical role to play in promoting vaccine adherence.
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Affiliation(s)
- Michael T Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura B Zeiser
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jake Ruddy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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22
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Harrington N, Chen Y, O'Reilly AM, Fang CY. The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: a narrative review. AIMS Public Health 2021; 8:352-368. [PMID: 34017897 PMCID: PMC8116180 DOI: 10.3934/publichealth.2021027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Despite the clinically proven benefits of the human papillomavirus (HPV) vaccine in preventing cervical and other HPV-associated cancers, vaccination coverage has been suboptimal among adolescents and young adults in the United States (US), particularly among racial and ethnic minority adolescents. Historical legacies, combined with current racial/ethnic disparities in healthcare, may contribute to suboptimal uptake and completion of the HPV vaccine in part through differing levels of trust in doctors and healthcare institutions. The purpose of this narrative review was to characterize trust and its role in decision making about HPV vaccine uptake among US racial and ethnic minorities. We conducted a literature search using the PubMed database, and our search terms yielded 1176 articles. We reviewed 41 full-text articles for eligibility and included 20 articles in this review. These studies used varied measures of trust or mistrust and assessed trust in not only doctors/healthcare providers, but also other sources including pharmaceutical companies, media, and clergy. Our review findings revealed generally high levels of trust in doctors and healthcare providers, but less so in pharmaceutical companies. Mistrust of either healthcare providers, government agencies or pharmaceutical companies was consistently associated with less favorable attitudes and lower vaccine uptake. The downstream effects of mistrust may occur through selected health beliefs regarding the perceived efficacy and safety of the vaccine. Minority groups were more likely to report trust in family members, religious organizations, and media sources compared to their white counterparts. Decision making about vaccine uptake is a multilayered process that involves comparing the perceived benefits of the vaccine against its perceived risks. Understanding how trusted sources can effectively harness the tools of social and traditional media to increase knowledge and awareness may help combat misinformation about the HPV vaccine and improve engagement with diverse communities.
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Affiliation(s)
- Nicole Harrington
- Immersion Science Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Yuku Chen
- Cancer Prevention & Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alana M O'Reilly
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Carolyn Y Fang
- Cancer Prevention & Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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23
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Evans KR, Gusmano MK. Civic Learning, Science, and Structural Racism. Hastings Cent Rep 2021; 51 Suppl 1:S46-S50. [PMID: 33630337 DOI: 10.1002/hast.1229] [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] [Indexed: 11/09/2022]
Abstract
Vaccine hesitancy is a major public health challenge, and racial disparities in the acceptance of vaccines is a particular concern. In this essay, we draw on interviews with mothers of Black male adolescents to offer insights into the reasons for the low rate of vaccination against the human papillomavirus among this group of adolescents. Based on these conversations, we argue that increasing the acceptance of HPV and other vaccines cannot be accomplished merely by providing people with more facts. Instead, we must address the pervasive racial discrimination in the United States that undermines trust in social institutions, including the health care system. In the short term, it may be helpful to increase the number of clinicians of color working in the health system, but more fundamental changes are required. The U.S. must adopt and implement policies that dismantle structural racism if it hopes to produce greater trust and community-oriented thinking on behalf of people who have been exploited for centuries.
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Austin JD, Rodriguez SA, Savas LS, Megdal T, Ramondetta L, Fernandez ME. Using Intervention Mapping to Develop a Provider Intervention to Increase HPV Vaccination in a Federally Qualified Health Center. Front Public Health 2020; 8:530596. [PMID: 33392125 PMCID: PMC7775559 DOI: 10.3389/fpubh.2020.530596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: A healthcare provider's ability to give a strong recommendation for the HPV vaccine is of utmost importance in increasing HPV vaccination. To reduce the burden of HPV-related cancers, there is a critical need to develop and implement theory-based interventions aimed at strengthening healthcare providers' communication about the HPV vaccine. Methods: We used Intervention Mapping (IM) steps 1-5 to develop and implement a provider-level intervention that aligns with the priorities and needs of a large, urban Federally Qualified Health Center (FQHC). Results: In step 1, a diverse planning group identified barriers to HPV vaccination in clinical settings and generated process maps and a logic model of the problem. Step 2 outlined outcomes and provider performance objectives of the intervention and identified knowledge, skills, self-efficacy, outcome expectations, and normative beliefs as modifiable targets that need to change for providers to deliver strong recommendations for the HPV vaccine to parents and patients. In step 3, the planning group mapped the methods of persuasive communication, information, and modeling and skills training to behavioral targets and outlined the program practical applications (strategies) components, scope, and sequence. In steps 4 and 5, the planning group produced the intervention and planned for program implementation. The iterative and participatory process of IM resulted in modifications to the initial intervention that aligned with the needs of the FQHC. Discussion: IM provided a systematic, participatory, and iterative approach for developing a theory-based provider-level intervention aimed at strengthening healthcare providers' ability to provide a strong recommendation for the HPV vaccine to eligible patients and parents served by a large FQHC. IM assisted with the identification of behavioral targets and methods that move beyond HPV knowledge and reminders to create behavior change. IM can help researchers and planners describe the processes and rational behind developing interventions and may help to facilitate implementation in real-world clinical settings by tailoring intervention components to the needs of the population.
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Affiliation(s)
- Jessica D. Austin
- The University of Texas Health Science Center School of Public Health, Dallas Regional Campus, Dallas, TX, United States
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lara S. Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Tina Megdal
- Legacy Community Health, Houston, TX, United States
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
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25
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Oxidative stress markers in patient-derived non-cancerous cervical tissues and cells. Sci Rep 2020; 10:19044. [PMID: 33149215 PMCID: PMC7642372 DOI: 10.1038/s41598-020-76159-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
High-risk human papillomaviruses (HPV) are the causative agents of cervical cancer. However, not all infected women develop cervical cancer. Cervical tumorigenesis is characterized by a multifactorial etiology, with oxidative stress (OS) likely playing a major role. In addition to exogenous sources, metabolic processes also contribute to OS. In principle, variability in levels of cervical OS has the potential to influence the likelihood of conversion to cervical cancer. To ask whether such variability indeed existed, we assessed the levels of ROS and the oxidative DNA damage biomarker 8-oxodG in normal non-cancerous cervical tissues and cells obtained from women with uterovaginal pelvic organ prolapse following vaginal hysterectomy. We demonstrated five and ten-fold variability between tissues isolated from the transformation zone (TZ) and ectocervix (EC) of different women, respectively. Despite the greater variability (likely due to differences in tissue composition), the overall pattern of ROS levels in EC tissues mirrored those obtained in their corresponding TZ tissues. Our results also show that the levels of ROS in TZ tissues were always higher than or equal to those found in the respective EC tissues, providing a possible explanation for TZ tissue being the primary target for HPV infection and cervical carcinogenesis. Interestingly, primary keratinocytes isolated and cultured from these cervical specimens also displayed high variability in ROS levels, with some strongly mirroring the levels of ROS observed in their corresponding tissues, while others were less closely associated. Finally, we demonstrated that the levels of DNA damage mirrored the levels of ROS in the cultured primary cells. Understanding the factors and mechanisms that dispose certain individuals to develop cervical cancer has the potential to enable the development of approaches that make the conversion of HPV infection to cancer development even more rare.
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26
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Lama Y, Quinn SC, Nan X, Cruz-Cano R. Social media use and human papillomavirus awareness and knowledge among adults with children in the household: examining the role of race, ethnicity, and gender. Hum Vaccin Immunother 2020; 17:1014-1024. [PMID: 33121331 DOI: 10.1080/21645515.2020.1824498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Though human papillomavirus (HPV) vaccination is a safe and effective method of protecting against associated cancers, uptake rates remain low among adolescents. Few studies have examined how social media use contributes to HPV-related knowledge gaps among parents and caregivers. OBJECTIVE To investigate the association between social media use and HPV-related awareness and knowledge with a focus on differences by gender and race/ethnicity among a nationally representative sample of adults with children in the household. METHODS We used data from the Health Information National Trends (HINTS) Survey (2017-2019) (N = 2,720). Multivariate logistic regressions were used to examine the association of social media use on HPV awareness and knowledge outcomes. RESULTS Compared to non-users, engaging in one, two, three, or four social media behaviors were associated with greater HPV awareness (aOR: 2.09; 95%CI: 1.18-3.70, aOR: 2.49; 95%CI: 1.40-4.42, aOR: 2.64; 95%CI: 1.15-6.05, and aOR: 2.44; 95%CI: 1.11-5.36, respectively). Increased social media use was associated with increased HPV vaccine awareness. Men, African American, Hispanic, and Asian American respondents were less likely to be aware of HPV or HPV vaccine. Social media use was not associated with cancer knowledge. CONCLUSIONS Increased social media use is associated with an increased awareness of HPV and HPV vaccine for adults with children in the household. Social media-based efforts can be utilized to increase knowledge of the benefits of HPV vaccination as cancer prevention, which may be a precursor to reducing HPV vaccine hesitancy and encouraging uptake to decrease cancer incidence rates among vulnerable populations.
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Affiliation(s)
- Yuki Lama
- Department of Family Science, University of Maryland, College Park, MD, USA
| | | | - Xiaoli Nan
- Department of Communication, University of Maryland, College Park, MD, USA
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
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Cheng L, Wang Y, Du J. Human Papillomavirus Vaccines: An Updated Review. Vaccines (Basel) 2020; 8:vaccines8030391. [PMID: 32708759 PMCID: PMC7565290 DOI: 10.3390/vaccines8030391] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) vaccines, which were introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. In this review, we present the updated information about current HPV vaccines, focusing on vaccine coverage and efficacy. In addition, pan-gender vaccination and current clinical trials are also discussed. Currently, more efforts should be put into increasing the vaccine’s coverage, especially in low- and middle-income countries. Provision of education on HPV and vaccination is one of the most important methods to achieve this. Vaccines that target HPV types not included in current vaccines are the next stage in vaccine development. In the future, all HPV-related cancers, such as head and neck cancer, and anal cancer, should be tracked and evaluated, especially in countries that have introduced pan-gender vaccination programs. Therapeutic vaccines, in combination with other cancer treatments, should continue to be investigated.
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Buskwofie A, David-West G, Clare CA. A Review of Cervical Cancer: Incidence and Disparities. J Natl Med Assoc 2020; 112:229-232. [PMID: 32278478 DOI: 10.1016/j.jnma.2020.03.002] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer amongst women worldwide. In the United States, its incidence and mortality have been declining due to the wide scale implementation of cytological screening programs. However, there have been geographic disparities in cervical cancer, particularly in the US. OBJECTIVE This review will outline the overall incidence of cervical cancer and discuss the causes for disparities in its incidence and mortality rates. METHODS A literature review was performed from 1999 to 2020 of English language manuscripts on the incidence and reasons for disparities in mortality rates of cervical cancer. RESULTS Racial and ethnic minorities, socioeconomically disenfranchised, and those in rural areas have disparate rates of vaccination, screening and treatment of cervical cancer, leading to worse outcomes. CONCLUSIONS By addressing these disparities via increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved.
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Affiliation(s)
- Ama Buskwofie
- New York Medical College, Department of Obstetrics and Gynecology, Valhalla, NY, USA; Westchester Medical Center, Division of Gynecological Oncology, Valhalla, NY, USA
| | - Gizelka David-West
- New York Medical College, Department of Obstetrics and Gynecology, Valhalla, NY, USA; Westchester Medical Center, Division of Gynecological Oncology, Valhalla, NY, USA
| | - Camille A Clare
- New York Medical College, Department of Obstetrics and Gynecology, Valhalla, NY, USA; New York Medical College, School of Medicine, Office of Diversity and Inclusion, Valhalla, NY, USA; New York City Health + Hospitals/Metropolitan, Department of Obstetrics and Gynecology, New York, NY, USA.
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29
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Agénor M, Pérez AE, Peitzmeier SM, Borrero S. Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-Affordable Care Act era. ETHNICITY & HEALTH 2020; 25:393-407. [PMID: 29347831 DOI: 10.1080/13557858.2018.1427703] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
Objective: To ascertain the magnitude and potential mechanisms of racial/ethnic disparities in initiating and completing the 3-dose human papillomavirus (HPV) vaccine among U.S. women in the post-Affordable Care Act era.Design: Using 2015 National Health Interview Survey data, we used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between race/ethnicity and HPV vaccination initiation and completion among black, Latina, Asian, and white U.S. women aged 18-31 years, adjusting for age and geographic region. We also examined the role of socioeconomic and health care factors in potentially explaining racial/ethnic disparities in HPV vaccine uptake and stratified our analyses by age (ages 18-22 and 23-31 years).Results: The prevalence of HPV vaccination initiation and completion among U.S. women aged 18-31 years overall was 35.4% and 22.7%, respectively. We observed no statistically significant difference in the odds of HPV vaccination initiation or completion by race/ethnicity among women aged 18-22 years, adjusting for age and geographic region. Among women aged 23-31 years, Latina ([odds ratio=] 0.59; [95% confidence interval:] 0.47, 0.76) and Asian (0.51; 0.34, 0.75) women had significantly lower adjusted odds of initiating HPV vaccination compared to white women. Further, relative to white women, black (0.46; 0.32, 0.67), Latina (0.45; 0.32, 0.64), and Asian (0.46; 0.28, 0.78) women had significantly lower adjusted odds of completing HPV vaccination. Adding socioeconomic factors to the models attenuated the HPV vaccination initiation adjusted odds ratios for Latina vs. white women and the HPV vaccination completion adjusted odds ratios for both black and Latina vs. white women. The inclusion of health care factors into the models did not further attenuate these odds ratios.Conclusion: Policies and programs that promote socioeconomic equity may mitigate HPV vaccination disparities between black and Latina women and white women. Additional research is needed to identify the drivers of HPV vaccination disparities between subgroups of Asian women and white women.
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Affiliation(s)
- Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, CA, USA
| | - Sarah M Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
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30
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Exacerbating disparities?: Cervical cancer screening and HPV vaccination. Prev Med 2020; 130:105902. [PMID: 31730943 DOI: 10.1016/j.ypmed.2019.105902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
The human papillomavirus (HPV) vaccine is a powerful tool in cancer prevention. In combination with cervical cancer screening programs, this vaccine has the potential to nearly eliminate death from cervical cancer. However, this remarkable public health success can only be realized if vaccines reach those most at risk-unscreened women. Vaccinating only those already well-screened would have little impact on cervical cancer mortality, exacerbate disparities, and be a striking public health failure. We use data from the Behavioral Risk Factor Surveillance System optional Adult HPV Vaccination module between 2013 and 2016 to assess the association between HPV vaccine status and cervical cancer screening behavior. Only 27% of eligible women had received any HPV vaccination. Uninsured women were less likely to be vaccinated (aOR: 0.48, 95% CI:0.30-0.76) and less likely to be screened (aOR: 0.41, 95% CI:0.28-0.60) than insured women. Vaccinated women were more than twice as likely to be up to date on screening than unvaccinated women (aOR: 2.14, 95% CI:1.46-3.12). Younger women were 49% less likely to be up to date on screening (aOR: 0.51, 95% CI:0.37-0.71), but over 4 times more likely to be vaccinated (aOR: 4.44, 95% CI:3.20-6.17) than older women. Unvaccinated, unscreened women are at continued risk for cervical cancer. Uninsured women were most likely to be in this group. Concerted efforts should be focused on increasing vaccination and screening in this population. Cancer prevention innovations, like the HPV vaccine, must reach at-risk populations to avoid further protecting the protected and failing to reduce existing health disparities.
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31
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Murray Horwitz ME, Pace LE, Ross-Degnan D. Trends and Disparities in Sexual and Reproductive Health Behaviors and Service Use Among Young Adult Women (Aged 18-25 Years) in the United States, 2002-2015. Am J Public Health 2019; 108:S336-S343. [PMID: 30383434 DOI: 10.2105/ajph.2018.304556] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe trends in sexual and reproductive health behaviors and service utilization among young women in the United States. METHODS We analyzed data from 8835 female respondents aged 18 to 25 years from 4 cycles of the National Survey of Family Growth, a nationally representative cross-sectional survey, from 2002 to 2015. We used bivariate and multivariable logistic regression to compare rates of self-reported sexual activity, sexually transmitted infection-related care, and contraception use over time and by race/ethnicity. RESULTS Sexually transmitted infection-related care and human papilloma virus vaccination increased from 2002 to 2013-2015, whereas sexual activity and contraception use remained stable. Compared with White women, racial/ethnic minority women were less likely to report effective contraception use, and Black women were less likely to report human papilloma virus vaccination; these differences did not change over time. CONCLUSIONS Sexual and reproductive health service utilization increased from 2002 to 2015 among young women, whereas sexual activity remained stable. Overall, rates of recommended care were low, and racial and ethnic disparities persisted. Public Health Implications. Young women could benefit from clinical interventions and health policies to increase recommended care and reduce disparities.
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Affiliation(s)
- Mara E Murray Horwitz
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
| | - Lydia E Pace
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
| | - Dennis Ross-Degnan
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
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Hernandez ND, Daley EM, Young L, Kolar SK, Wheldon C, Vamos CA, Cooper D. HPV Vaccine recommendations: does a health care provider's gender and ethnicity matter to Unvaccinated Latina college women? ETHNICITY & HEALTH 2019; 24:645-661. [PMID: 28826257 DOI: 10.1080/13557858.2017.1367761] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
Objectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences. Design: Unvaccinated Latina college students (n = 187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP. Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider. Conclusions: Latinas' preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.
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Affiliation(s)
- Natalie D Hernandez
- a Department of Community Health and Preventive Medicine , Prevention Research Center, Morehouse School of Medicine , Atlanta , GA , USA
| | - Ellen M Daley
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Lauren Young
- c Arizona Department of Health Services , STD Control Program , Phoenix , AZ , USA
| | - Stephanie K Kolar
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Christopher Wheldon
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Cheryl A Vamos
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Dexter Cooper
- a Department of Community Health and Preventive Medicine , Prevention Research Center, Morehouse School of Medicine , Atlanta , GA , USA
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33
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Effects of Educational Interventions on Human Papillomavirus Vaccine Acceptability. Obstet Gynecol 2019; 134:376-384. [DOI: 10.1097/aog.0000000000003379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lennon T, Gundacker C, Nugent M, Simpson P, Magallanes NK, West C, Willis E. Ancillary Benefit of Increased HPV Immunization Rates Following a CBPR Approach to Address Immunization Disparities in Younger Siblings. J Community Health 2019; 44:544-551. [PMID: 30604221 PMCID: PMC6504598 DOI: 10.1007/s10900-018-00610-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Increasing HPV vaccination rates may decrease the disproportionately high HPV-associated disease incidence and mortality in African Americans (AA) and lower socioeconomic individuals. Data from a community-based participatory research (CBPR) study addressing immunization disparities among 19-35 month old children was analyzed to identify ancillary benefits in HPV immunization rates for adolescent siblings. Sub-study analysis inclusion criteria: AA (N = 118), 13-17 years old, younger sibling enrolled in parent study, and enrolled ≥ 9 months. Parent/caregiver interventions included: a web-based immunization toolkit with information on age-appropriate vaccines; a multimedia community outreach campaign; and reminder mailings. HPV up-to-date (UTD) status was defined as Wisconsin Immunization Registry (WIR) documentation of at least three HPV vaccines. McNemar's test compared pre/post intervention HPV status. Two dependent proportions testing compared the proportion of adolescents that became UTD in the study cohort, City of Milwaukee, and State of Wisconsin. Parents/caregivers perceived that 92% of adolescents were HPV-UTD, while only 24% had a WIR-verified HPV-UTD status. Baseline UTD status of the younger siblings 19-35 month old 4:3:1:3:3:1:4 antigen series was 63%, which increased to 86% at study completion. Adolescent's HPV-UTD immunization status increased from 30 (25%) at enrollment to 54 (46%) at study completion [p = 0.004]. A statistically significant larger proportion of adolescents became HPV-UTD in the study cohort (20%) compared to the City of Milwaukee [14%, p = 0.042] and the State of Wisconsin [14%, p = 0.046]. A culturally-tailored CBPR approach targeting parents/caregivers of younger AA children can have significant ancillary benefit to increase HPV immunization rates in adolescent siblings.
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Affiliation(s)
- Tyler Lennon
- Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Constance Gundacker
- Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, Phone: (414) 955-7656
| | - Melodee Nugent
- Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, Phone: (414) 955-7632
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226,
| | | | - Christal West
- Community Forward Team Member, 2444 North 21 Street, Milwaukee, WI. 53206,
| | - Earnestine Willis
- Department of Pediatrics, Director, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, Phone: (414) 955-4131 Fax: (414) 955-6385
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Vaccine-preventable diseases and immunisation coverage among migrants and non-migrants worldwide: A scoping review of published literature, 2006 to 2016. Vaccine 2019; 37:2661-2669. [DOI: 10.1016/j.vaccine.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
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Molokwu J, Dwivedi A, Mallawaarachchi I, Hernandez A, Shokar N. Tiempo de Vacunarte (time to get vaccinated): Outcomes of an intervention to improve HPV vaccination rates in a predominantly Hispanic community. Prev Med 2019; 121:115-120. [PMID: 30776387 DOI: 10.1016/j.ypmed.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to evaluate effects of a culturally tailored evidence-based HPV vaccine educational intervention on psychosocial factors and vaccine completion in a largely low-income Hispanic population. Our study is a prospective community based intervention utilizing a prepost design. We recruited individual's dwelling in a border community aged 18-26 years or parents/guardians of children aged 9-17 years who had not completed the HPV vaccine series. We recruited 2380 participants between June 2015 and February 2018. We included 1796 participants in the final analysis. Mean age of the sample was 22.8 years (SD2.60). Majority of participants 63.99 were female and self-identified as Hispanic (97.4%). A total of 3192 vaccines were administered with an overall vaccine completion rate of 39.8%; 31.6% among adult participants compared to 48.7% among children. The Intervention significantly improved HPV knowledge by 61.66%, HPV awareness by 19.45%, Intention to vaccinate by 13.85%. For both adults and children being born in Mexico significantly improved the odds of vaccine completion (AOR: 2.154 95% CI: 1.439-3.224), while for adults only pre-intervention perceived benefits remained significant (AOR 1.101, CI: 1.002-1.210) and in children the main factor was parental perceived susceptibility of their child (AOR: 1.257 CI: 1.001-1.578). A Community based multicomponent HPV vaccine intervention significantly improved HPV immunization rates in a largely Hispanic population. Factors that affect completion of the HPV series are different among adults and children.
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Affiliation(s)
- J Molokwu
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX 79924, USA.
| | - A Dwivedi
- Department of Biostatistics and Epidemiology, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - I Mallawaarachchi
- Department of Biostatistics and Epidemiology, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - A Hernandez
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - N Shokar
- Department of Family and Community Medicine & Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA; Department of Family and Community Medicine, Paul l. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX 79924, USA; Department of Biomedical Sciences, Paul l. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Medical Science Building, 5001 El Paso Drive, El Paso, TX 79905, USA..
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Swiecki-Sikora AL, Henry KA, Kepka D. HPV Vaccination Coverage Among US Teens Across the Rural-Urban Continuum. J Rural Health 2019; 35:506-517. [PMID: 30703854 DOI: 10.1111/jrh.12353] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code. METHODS We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17 years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses). RESULTS HPV vaccination was lower among girls from isolated small rural towns (≥1 dose 51.0%; ≥3 doses 30.0%) and small rural towns (≥1 dose 50.2%; ≥3 doses 26.8%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). Boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI: 0.52-0.88) and completion (0.63, 95% CI: 0.41-0.97) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did their counterparts from high-poverty urban areas. CONCLUSION Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.
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Affiliation(s)
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania.,Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Deanna Kepka
- College of Nursing, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Marshall C, Chavan B, Haile ZT. The moderating role of race/ethnicity on associations between insurance status and HPV vaccination among women in the USA. Int J Gynaecol Obstet 2019; 144:73-79. [PMID: 30240523 DOI: 10.1002/ijgo.12683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/03/2018] [Accepted: 09/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate associations between insurance status and HPV vaccination. METHODS The present cross-sectional study analyzed data from women aged 18-26 years who participated in the National Health and Nutritional Examination Surveys 2009-2012 in the USA. RESULTS The study included 621 women; 424 (68.3%) had some type of insurance and 198 (30.6%) had received the HPV vaccine. In the multivariable model, we found significant interactions between race/ethnicity and insurance status on receiving HPV vaccination. Compared with individuals with no insurance, non-Hispanic black women with any type of insurance demonstrated increased likelihood of HPV vaccination (adjusted odds ratio [aOR] 3.63, 95% confidence interval [CI] 1.60-8.21; P=0.002). Among Mexican Americans, there was a negative association between having some insurance and HPV vaccination (aOR 0.35, 95% CI 0.15-0.81; P=0.007). For non-Hispanic black women, the association remained significant across all insurance types (private [aOR 4.29, 95% CI 1.67-11.00; P=0.003], Medicaid [aOR 2.86, 95% CI 1.15-7.13; P=0.025], and other [aOR 4.74, 95% CI 1.06-21.15; P=0.042]). Non-Hispanic white women with insurance other than private or Medicaid had a higher likelihood of HPV vaccination compared with uninsured individuals (aOR 8.36, 95% CI 2.79-25.05; P<0.001). CONCLUSION The present findings help to identify at-risk populations less likely to receive the HPV vaccine.
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Affiliation(s)
- Colin Marshall
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Bhakti Chavan
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
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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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Carhart MY, Schminkey DL, Mitchell EM, Keim-Malpass J. Barriers and Facilitators to Improving Virginia's HPV Vaccination Rate: A Stakeholder Analysis With Implications for Pediatric Nurses. J Pediatr Nurs 2018; 42:1-8. [PMID: 30219293 PMCID: PMC6140351 DOI: 10.1016/j.pedn.2018.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite the evidence, the availability since 2006, and strong recommendations from many professional organizations, the human papillomavirus (HPV) vaccine has had a low uptake rate nationally and these trends have been even lower in the state of Virginia. DESIGN AND METHODS We explored key stakeholders' perspectives on factors influencing HPV vaccination in central and southern Virginia organized within the socio-ecological model (SEM) framework. We conducted semi-structured key informant interviews with 31 stakeholders involved in HPV vaccination or cancer prevention. RESULTS Stakeholders identified barriers at all SEM levels: Knowledge gaps and sexuality concerns (parent-child dyad level), time constraint and inconsistent recommendation (interpersonal level), lack of leadership and informational support (organizational and community level), and an ineffective mandate (policy level). Facilitators identified were realistic/receptive attitude (parent-child dyad level), provider's strong recommendation and educational support (interpersonal level), team approach and useful data (organizational level), educational outreach and community resources (community level), and support from federal and professional organizations (policy level). CONCLUSIONS The stakeholder analysis provided an environmental scan of the barriers and facilitators so that an effective HPV vaccination strategy can be planned and implemented in the Commonwealth of Virginia by public health nurses.
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Affiliation(s)
- Miev Y Carhart
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | | | - Emma M Mitchell
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Jessica Keim-Malpass
- University of Virginia School of Nursing, Charlottesville, VA, USA; University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA, USA.
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Intersectional nativity and racial/ethnic disparities in human papillomavirus vaccination initiation among U.S. women: a national population-based study. Cancer Causes Control 2018; 29:927-936. [PMID: 30120642 DOI: 10.1007/s10552-018-1069-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Overall, foreign-born women are less likely than U.S.-born women to have initiated human papillomavirus (HPV) vaccination. However, foreign-born women are a racially/ethnically diverse population, and race/ethnicity is an independent predictor of HPV vaccination. METHODS Using 2011-2015 National Health Interview Survey data, we used multivariable logistic regression to estimate odds ratios for foreign-born black, Latina, and Asian women compared to foreign-born white women and U.S.-born white women, adjusting for sociodemographic factors. We added socioeconomic factors followed by health care access indicators, which we conceptualized as potential mediators, to each model to assess whether they helped explain observed disparities. RESULTS Foreign-born Asian ([odds ratio=] 0.43; [95% confidence interval:] 0.29-0.65) and Latina (0.46; 0.32-0.68) women had significantly lower adjusted odds of initiating HPV vaccination compared to foreign-born white women. Foreign-born white (0.64; 0.45-0.90), black (0.44; 0.29, 0.67), Latina (0.29; 0.24-0.35), and Asian (0.28; 0.21-0.38) women had significantly lower adjusted odds of HPV vaccination initiation compared to U.S.-born white women. Socioeconomic factors only explained HPV vaccination initiation disparities between foreign-born Latina women and foreign-born and U.S.-born white women. Health care access indicators modestly explained disparities between foreign-born white, black, and Latina women and U.S.-born white women only. CONCLUSIONS We observed pronounced HPV vaccination initiation disparities among foreign-born women in relation to race/ethnicity and between foreign-born women from minoritized racial/ethnic backgrounds and U.S.-born white women. Research on nativity disparities in HPV vaccination should take into account race/ethnicity, and vice versa. Interventions that seek to facilitate HPV vaccination among foreign-born women are needed and should address the unique needs of those from minoritized racial/ethnic backgrounds to promote cancer equity.
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Agénor M, Pérez AE, Peitzmeier SM, Potter J, Borrero S. Human Papillomavirus Vaccination Initiation Among Sexual Orientation Identity and Racial/Ethnic Subgroups of Black and White U.S. Women and Girls: An Intersectional Analysis. J Womens Health (Larchmt) 2018; 27:1349-1358. [PMID: 29957092 DOI: 10.1089/jwh.2017.6768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. METHODS Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., ≥ one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. RESULTS The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR = 0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06-0.56), white lesbians (OR = 0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07-0.67). CONCLUSIONS Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.
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Affiliation(s)
- Madina Agénor
- 1 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Ashley E Pérez
- 2 Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing , San Francisco, California
| | - Sarah M Peitzmeier
- 3 Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing , Ann Arbor, Michigan
| | - Jennifer Potter
- 4 Department of Medicine, Harvard Medical School , Boston, Massachusetts.,5 Division of General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Sonya Borrero
- 6 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,7 Center for Health Equity Research and Promotion , VA Pittsburgh Health care System, Pittsburgh, Pennsylvania
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Impact of a clinical interventions bundle on uptake of HPV vaccine at an OB/GYN clinic. Vaccine 2018; 36:3599-3605. [PMID: 29759380 DOI: 10.1016/j.vaccine.2018.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
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Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e1-e9. [PMID: 27902559 DOI: 10.1097/phh.0000000000000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although the incidence of cervical cancer has been decreasing in the United States over the last decade, Hispanic and African American women have substantially higher rates than Caucasian women. The human papillomavirus (HPV) is a necessary, although insufficient, cause of cervical cancer. In the United States in 2013, only 37.6% of girls 13 to 17 years of age received the recommended 3 doses of a vaccine that is almost 100% efficacious for preventing infection with viruses that are responsible for 70% of cervical cancers. Implementation research has been underutilized in interventions for increasing vaccine uptake. The Consolidated Framework for Implementation Research (CFIR), an approach for designing effective implementation strategies, integrates 5 domains that may include barriers and facilitators of HPV vaccination. These include the innovative practice (Intervention), communities where youth and parents live (Outer Setting), agencies offering vaccination (Inner Setting), health care staff (Providers), and planned execution and evaluation of intervention delivery (Implementation Process). METHODS Secondary qualitative analysis of transcripts of interviews with 30 community health care providers was conducted using the CFIR to code potential barriers and facilitators of HPV vaccination implementation. RESULTS All CFIR domains except Implementation Process were well represented in providers' statements about challenges and supports for HPV vaccination. CONCLUSION A comprehensive implementation framework for promoting HPV vaccination may increase vaccination rates in ethnically diverse communities. This study suggests that the CFIR can be used to guide clinicians in planning implementation of new approaches to increasing HPV vaccine uptake in their settings. Further research is needed to determine whether identifying implementation barriers and facilitators in all 5 CFIR domains as part of developing an intervention contributes to improved HPV vaccination rates.
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Healy J, Rodriguez-Lainz A, Elam-Evans LD, Hill HA, Reagan-Steiner S, Yankey D. Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps - National Immunization Survey-Teen, 2012-2014. Vaccine 2018; 36:1743-1750. [PMID: 29483032 DOI: 10.1016/j.vaccine.2018.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND An overall increase has been reported in vaccination rates among adolescents during the past decade. Studies of vaccination coverage have shown disparities when comparing foreign-born and U.S.-born populations among children and adults; however, limited information is available concerning potential disparities in adolescents. METHODS The National Immunization Survey-Teen is a random-digit-dialed telephone survey of caregivers of adolescents aged 13-17 years, followed by a mail survey to vaccination providers that is used to estimate vaccination coverage among the U.S. population of adolescents. Using the National Immunization Survey-Teen data, we assessed vaccination coverage during 2012-2014 among adolescents for routinely recommended vaccines for this age group (≥1 dose tetanus and diphtheria toxoids and acellular pertussis [Tdap] vaccine, ≥1 dose quadrivalent meningococcal conjugate [MenACWY] vaccine, ≥3 doses human papillomavirus [HPV] vaccine) and for routine childhood vaccination catch-up doses (≥2 doses measles, mumps, and rubella [MMR] vaccine, ≥2 doses varicella vaccine, and ≥3 doses hepatitis B [HepB] vaccine). Vaccination coverage prevalence and vaccination prevalence ratios were estimated. RESULTS Of the 58,090 respondents included, 3.3% were foreign-born adolescents. Significant differences were observed between foreign-born and U.S.-born adolescents for insurance status, income-to-poverty ratio, education, interview language, and household size. Foreign-born adolescents had significantly lower unadjusted vaccination coverage for HepB (89% vs. 93%), and higher coverage for the recommended ≥3 doses of HPV vaccine among males, compared with U.S.-born adolescents (22% vs. 14%). Adjustment for demographic and socioeconomic factors accounted for the disparity in HPV but not HepB vaccination coverage. CONCLUSIONS We report comparable unadjusted vaccination coverage among foreign-born and U.S.-born adolescents for Tdap, MenACWY, MMR, ≥2 varicella. Although coverage was high for HepB vaccine, it was significantly lower among foreign-born adolescents, compared with U.S.-born adolescents. HPV and ≥2-dose varicella vaccination coverage were low among both groups.
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Affiliation(s)
- Jessica Healy
- Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, USA; Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, San Diego, CA, USA; County of San Diego Health and Human Services Agency, San Diego, CA, USA.
| | - Alfonso Rodriguez-Lainz
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, San Diego, CA, USA
| | - Laurie D Elam-Evans
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Holly A Hill
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Sarah Reagan-Steiner
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA
| | - David Yankey
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
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Male Undergraduates’ HPV Vaccination Behavior: Implications for Achieving HPV-Associated Cancer Equity. J Community Health 2018; 43:459-466. [DOI: 10.1007/s10900-018-0482-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pérez AE, Agénor M, Gamarel KE, Operario D. Nativity Disparities in Human Papillomavirus Vaccination Among U.S. Adults. Am J Prev Med 2018; 54:248-258. [PMID: 29241719 PMCID: PMC5881892 DOI: 10.1016/j.amepre.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Several studies have identified disparities in human papillomavirus (HPV)-related outcomes by nativity status (i.e., U.S.- versus foreign-born). However, few studies have explored whether vaccination differences exist by nativity status. Vaccination disparities have the potential to exacerbate HPV-related cancer disparities in the long term if left unaddressed. Therefore, the authors investigated whether there were significant differences in HPV vaccination initiation (one or more doses) and completion (three or more doses) between U.S.-born and foreign-born men and women. METHODS Using the 2011 to 2015 waves of the National Health Interview Survey, data from 15,967 U.S. men aged 18-32 years and 23,794 U.S. women aged 18-35 years were analyzed in February 2017. Multivariable logistic regression models were fit to determine whether nativity status predicted (1) HPV vaccination initiation and (2) HPV vaccination completion separately among men and women after adjusting for demographic, socioeconomic, and healthcare factors. RESULTS Compared with those born in the U.S., foreign-born men and women had lower prevalence of HPV vaccine initiation and completion. Furthermore, after controlling for covariates, foreign-born men (OR=0.63, 95% CI=0.47, 0.85) and women (OR=0.57, 95% CI=0.49, 0.66) had significantly lower adjusted odds of HPV vaccination initiation compared with their U.S.-born counterparts. Additionally, foreign-born women had significantly lower adjusted odds of HPV vaccination completion (OR=0.56, 95% CI=0.46, 0.69). CONCLUSIONS The demographic, socioeconomic, and healthcare factors included in this study did not appear to account fully for observed disparities. Future research is needed to understand other factors that may contribute to nativity status disparities in HPV vaccination.
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Affiliation(s)
- Ashley E Pérez
- Brown University School of Public Health, Providence, Rhode Island.
| | - Madina Agénor
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kristi E Gamarel
- Brown University School of Public Health, Providence, Rhode Island
| | - Don Operario
- Brown University School of Public Health, Providence, Rhode Island
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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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Berman RS, Smock L, Bair-Merritt MH, Cochran J, Geltman PL. Giving It Our Best Shot? Human Papillomavirus and Hepatitis B Virus Immunization Among Refugees, Massachusetts, 2011-2013. Prev Chronic Dis 2017. [PMID: 28641071 PMCID: PMC5484014 DOI: 10.5888/pcd14.160442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The receipt rate of hepatitis B virus vaccine among adolescents in the United States is high, while the receipt rate of human papillomavirus vaccine is low. Rates have not been closely studied among refugees, whose home countries have high rates of disease caused by these viruses. METHODS We examined human papillomavirus and hepatitis B virus immunization rates among 2,269 refugees aged 9 to 26 years who resettled in Massachusetts from 2011 through 2013. This was a secondary analysis of data from their medical screenings. We used binary logistic regression to assess characteristics associated with immunization and bivariate analyses to compare refugee immunization rates with those of the general US population. RESULTS Forty-five percent of US adolescents aged 13 to 17 years received 1 dose of human papillomavirus vaccine, compared with 68% of similarly aged refugees. Males (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.52-0.74), refugees older than 13 years (aOR, 0.74; 95% CI, 0.60-0.93), and refugees not from Sub-Saharan Africa (aOR, 0.74; 95% CI, 0.59-0.92) were less likely to receive human papillomavirus vaccine, while arrivals in 2012 through 2013 were more likely (aOR, 1.6; 95% CI, 1.3-1.9) than those arriving in 2011. Refugees older than 13 years were less likely to receive 2 doses of hepatitis B virus vaccine (aOR, 0.49; 95% CI, 0.37-0.63) than older refugees. CONCLUSION Specialized post-arrival health assessment may improve refugees' immunization rates.
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Affiliation(s)
- Rachel Stein Berman
- Department of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Laura Smock
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Megan H Bair-Merritt
- Department of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Jennifer Cochran
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Paul L Geltman
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
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Osazuwa-Peters N, Adjei Boakye E, Mohammed KA, Tobo BB, Geneus CJ, Schootman M. Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers. Prev Med 2017; 99:299-304. [PMID: 28341458 DOI: 10.1016/j.ypmed.2017.03.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/15/2017] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA; Saint Louis University Cancer Center, St. Louis, MO 63110, USA; Saint Louis University, School of Medicine, Department of Otolaryngology - Head and Neck Surgery, St. Louis, MO, USA
| | - Eric Adjei Boakye
- Saint Louis University Center for Outcomes Research (SLUCOR), Saint Louis University, St. Louis, MO, USA.
| | - Kahee A Mohammed
- Saint Louis University Center for Outcomes Research (SLUCOR), Saint Louis University, St. Louis, MO, USA
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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