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Haeder SF, Marthey D, Skinner D. Putting Health care Where the Kids Are: US Public Attitudes About School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38857903 DOI: 10.1111/josh.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND School-based health centers (SBHCs) have been shown to offer substantial benefits to students but we know little about how the public thinks about them. We sought to assess US public attitudes about SBHCs and the provision of 7 health service lines-primary care, preventive care, vaccinations, preventive dental care, preventive vision care, mental health care, and nutrition counseling. METHODS We administered a national online survey (N = 4196) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about SBHCs as well as 7 commonly offered health services in SBHCs. We then used t-tests and weighted linear regression models to carry out our study objectives. RESULTS Unadjusted analysis revealed that more than 2 in 3 respondents supported SBHCs in general as well as the provision of all health services in SBHCs. Regression analysis indicated that ideology, partisanship, and trust in public school principals served as consistent predictors of attitudes when controlling for demographic and health characteristics. The provision of vaccinations stood out as particularly controversial. Subanalysis of parents found even higher levels of support as well as a more subdued role of ideology and partisanship. CONCLUSIONS The US public broadly supports the provision of health services in SBHCs. Our results should inform policymakers, advocates, and providers seeking to improve access to health care among school-aged children, particularly for underserved populations. Increasing knowledge about SBHCs and providing stable funding should be a priority. In the immediate future, SBHCs may offer an important buffer against ongoing Medicaid disenrollments.
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Affiliation(s)
- Simon F Haeder
- Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Road, 1266 TAMU, College Station, 77843-1266, TX
| | - Daniel Marthey
- Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Road, 1266 TAMU, College Station, 77843-1266, TX
| | - Daniel Skinner
- Department of Social Medicine, Ohio University, Heritage College of Osteopathic Medicine, 191 W Union St., Dublin, 45701, OH
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2
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Lorenzo-Pouso AI, González-Palanca S, Palmeiro-Fernández G, Dominguez-Salgado JC, Pérez-Sayáns M, González-Veiga EJ, Caponio VCA, Daley EM. Parents' perspectives on dental team as advisors to promote HPV vaccination among Spanish adolescents. J Public Health Dent 2024; 84:147-153. [PMID: 38485512 DOI: 10.1111/jphd.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Human papillomavirus (HPV) is a prevalent sexually transmitted infection responsible for many anogenital and oropharyngeal cancers. Dental care providers have the potential to influence vaccine uptake, yet little is known about how patients perceive their role in HPV education and prevention. METHODS Parents of adolescents aged 9 to 17 years (n = 375) were recruited from Valdeorras District Hospital (Galicia, Spain) to investigate parents' attitudes concerning the involvement of dental care providers in discussions related to HPV. A survey was distributed to the participants, and 343 (91.5%) were included in the analysis. RESULTS In general, nearly half of the parents reported feeling comfortable regarding discussing HPV with their dentist. Participants described more comfort with dentists than with dental hygienists. Parents' comfort levels were influenced by various social determinants of health, including education level, marital status, geographic origin, and child vaccination status (p > 0.05). CONCLUSION Parents reported varying comfort levels when discussing HPV and its vaccine with dental professionals, displaying a preference for dentists. Dental settings have the potential to promote vaccination, but the existence of ongoing barriers needs to be addressed.
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Affiliation(s)
- Alejandro Ismael Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), ORALRES Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Gerardo Palmeiro-Fernández
- Primary Health Care Unit, EOXI Ourense, Verín, and El Barco de Valdeorras, Galician Health Service, Ourense, Spain
| | | | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), ORALRES Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, Florida, USA
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3
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Morales-Campos DY, Zimet GD, Kahn JA. Human Papillomavirus Vaccine Hesitancy in the United States. Pediatr Clin North Am 2023; 70:211-226. [PMID: 36841591 DOI: 10.1016/j.pcl.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Although the US Advisory Committee on Immunization Practices recommends vaccinating adolescents against the human papillomavirus (HPV) to prevent HPV-associated cancers, vaccine initiation and completion rates are suboptimal. Parental and provider hesitancy contributes significantly to low HPV vaccine uptake. This review describes sources of HPV vaccine hesitancy using a World Health Organization framework that categorizes determinants of vaccine hesitancy as follows: contextual factors (historical, sociocultural, environmental, or political factors), individual and group factors (personal perception or influences of the social/peer environment), and vaccine/vaccination-specific issues (directly related to vaccine or vaccination).
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Affiliation(s)
- Daisy Y Morales-Campos
- Department of Mexican American and Latino/a Studies, Latino Research Institute, The University of Texas at Austin, 210 West 24th Street, GWB 1.102, F9200, Austin, TX 78712, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, USA
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4
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, Fish LJ, Williams C, Walter EB. Association of caregiver attitudes with adolescent HPV vaccination in 13 southern US states. Vaccine X 2022; 11:100181. [PMID: 35789674 PMCID: PMC9250032 DOI: 10.1016/j.jvacx.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Corresponding author at: 2200 W. Main Street, Suite 600, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
| | - Sayward E. Harrison
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B. Walter
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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5
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Thompson EL, Daley EM, Washburn T, Salisbury-Keith K, Saslow D, Fontenot HB, Zimet GD. School-entry requirements for HPV vaccination: part of the patchwork for HPV-related cancer prevention. Hum Vaccin Immunother 2021; 17:1975-1979. [PMID: 33327839 DOI: 10.1080/21645515.2020.1851130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Human papillomavirus (HPV) vaccination can prevent six types of HPV-related cancers, and approximately, 54.2% of adolescents are up-to-date with the HPV vaccine in the United States. While moderate success has been achieved with provider- and parent-focused interventions, HPV vaccination in the U.S. lags well behind desired goals. In order to maximize HPV vaccination and prevention of HPV-related cancers, it may be prudent to consider state policy approaches, such as school-entry requirements as part of the patchwork of provider, parent, and structural interventions. In this paper, we reviewed the history of efforts to implement school-entry requirements for HPV vaccine, the challenges and benefits associated with implementing these requirements, and the evidence for the effectiveness of school-entry requirements. In addition, we presented new data from Rhode Island's Immunization Information System (IIS) showing how their school-entry requirement, implemented in 2015, has impacted HPV vaccination rates. These registry data indicate that HPV vaccination rates improved significantly after the 2014-2015 school year and policy implementation, and add to the ongoing evidence supporting the value of school-entry requirements for HPV vaccination. School-entry requirements should be considered alongside other initiatives and policies for promoting HPV vaccine uptake. Taking a comprehensive systems approach to HPV vaccination is needed.
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Affiliation(s)
- Erika L Thompson
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tricia Washburn
- Office of Immunization, State of Rhode Island Department of Health, Providence, RI, USA
| | - Kim Salisbury-Keith
- Office of Immunization, State of Rhode Island Department of Health, Providence, RI, USA
| | - Debbie Saslow
- Department of Cancer Control, American Cancer Society, Atlanta, GA, USA
| | - Holly B Fontenot
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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6
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Ryan G, Avdic L, Daly E, Askelson N, Farris PE, Shannon J, McRee AL, Hanson J, Kenyon DB, Seegmiller L. Influences on HPV vaccination across levels of the social ecological model: perspectives from state level stakeholders. Hum Vaccin Immunother 2021; 17:1006-1013. [PMID: 33327850 DOI: 10.1080/21645515.2020.1839290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Nationally, human papillomavirus (HPV) vaccination rates fall short of the Healthy People 2020 goal of 80% completion. Although strategies to increase these rates exist, low rates persist. We used concept mapping with state-level stakeholders to better understand barriers and facilitators to HPV vaccination. Concept mapping is a participatory research process in which respondents brainstorm ideas to a prompt and then sort ideas into piles. We present results of the brainstorming phase. We recruited participants identified by researchers' professional connections (n = 134) via e-mail invitations from five states (Iowa, South Dakota, Minnesota, Oregon, and Washington) working in adolescent health, sexual health, cancer prevention and control, or immunization. Using Concept Systems' online software we solicited participants' beliefs about what factors have the greatest influence on HPV vaccination rates in their states. From the original sample 58.2% (n = 78) of participants completed the brainstorming activity and generated 372 statements, our team removed duplicates and edited statements for clarity, which resulted in 172 statements. We coded statements using the Social Ecological Model (SEM) to understand at what level factors affecting HPV vaccination are occurring. There were 53 statements at the individual level, 22 at the interpersonal level, 21 in community, 51 in organizational, and 25 in policy. Our results suggest that a tiered approach, utilizing multi-level interventions instead of focusing on only one level may have the most benefit. Moreover, the policy-level influences identified by participants may be difficult to modify, thus efforts should focus on implementing evidence-based interventions to have the most meaningful impact.
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Affiliation(s)
- Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lejla Avdic
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Paige E Farris
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University/Portland State University School of Public Health, Oregon Health & Science University, Bend, OR, USA
| | - Jackilen Shannon
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University/Portland State University School of Public Health, Oregon Health & Science University, Bend, OR, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jessica Hanson
- College of Education and Human Service Professions, University of Minnesota Duluth, Duluth, MN, USA
| | - DenYelle Baete Kenyon
- Sanford School of Medicine, School of Health Sciences, University of South Dakota, SD, USA
| | - Laura Seegmiller
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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Teoh D, Hill EK, Goldsberry W, Levine L, Novetsky A, Downs L. Overcoming the barriers to HPV vaccination in high-risk populations in the U.S.: A Society of Gynecologic Oncology (SGO) Review. Gynecol Oncol 2021; 161:228-235. [PMID: 33707040 DOI: 10.1016/j.ygyno.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Affiliation(s)
- D Teoh
- University of Minnesota, Minneapolis, MN, USA
| | - E K Hill
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - L Levine
- University of Texas at Rio Grande Valley, Edinburg, TX, USA
| | | | - L Downs
- Park Nicolett Health Services, St. Louis Park, MN, USA.
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8
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Hawks JR, Nara A, Wells KJ, Ferrand JL, Walsh-Buhi ER. Gardasil on Twitter: A Content Mining Study Examining Message, Context, and Source Characteristics of Human Papilloma Virus (HPV) Vaccine-Related Tweets. Health (London) 2020. [DOI: 10.4236/health.2020.129081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Hoss A, Meyerson BE, Zimet GD. State statutes and regulations related to human papillomavirus vaccination. Hum Vaccin Immunother 2019; 15:1519-1526. [PMID: 31241406 PMCID: PMC6746494 DOI: 10.1080/21645515.2019.1627817] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A cross-sectional analysis of human papillomavirus (HPV) vaccine statutes and regulations from states and the District of Columbia in the United States (U.S.) was conducted from September–November 2018 to advance analyses of policy impact on HPV vaccination uptake. A search was conducted using WestlawNext, a legal research database. Statutes and regulations relevant to the study were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions. Of the 212 laws identified by the initial search string, 93 (43.9%) reference HPV vaccination in statute or regulation. An additional three laws were added following subsequent review. There was a total of 52 statutes and 44 regulations from 34 states and the District of Columbia. Most laws were related to developing and distributing HPV vaccination materials for parents, and mechanisms to fund and reimburse for the vaccination. This study can be used by policymakers in jurisdictions that are considering establishing HPV vaccination promotion interventions in state law and highlighting the limited statutory and regulatory efforts that have been implemented to promote HPV vaccination. Importantly, this study can also be used to conduct evaluations of the efficacy of statutory and regulatory strategies in increasing HPV vaccination rates.
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Affiliation(s)
- Aila Hoss
- a Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law , Indianapolis , Indiana
| | - Beth E Meyerson
- b Department of Applied Health Science and the Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington , Bloomington , Indiana.,c Center for HPV Research, Indiana University Purdue University Indianapolis , Indianapolis , Indiana
| | - Gregory D Zimet
- c Center for HPV Research, Indiana University Purdue University Indianapolis , Indianapolis , Indiana.,d Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine , Indianapolis , Indiana
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10
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Abed Elhadi Shahbari N, Gesser-Edelsburg A, Mesch GS. Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel. J Med Internet Res 2019; 21:e13373. [PMID: 31102371 PMCID: PMC6543802 DOI: 10.2196/13373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use. OBJECTIVE The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. METHODS The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). RESULTS The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). CONCLUSIONS The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.
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11
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Cook EE, Venkataramani AS, Kim JJ, Tamimi RM, Holmes MD. Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors. Pediatrics 2018; 142:e20180458. [PMID: 30104422 PMCID: PMC6317562 DOI: 10.1542/peds.2018-0458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite preventive health benefits of the human papillomavirus (HPV) vaccination, uptake in the United States remains low. Twenty-four states have enacted legislation regarding HPV vaccination and education. One reason these policies have been controversial is because of concerns that they encourage risky adolescent sexual behaviors. Our aim in this study is to determine if state HPV legislation is associated with changes in adolescent sexual behaviors. METHODS This is a difference-in-difference study in which we use data on adolescent sexual behaviors from the school-based state Youth Risk Behavior Surveillance System from 2001 to 2015. Sexual behaviors included ever having sexual intercourse in the last 3 months and condom use during last sexual intercourse. We compared changes in sexual behaviors among high school students before and after HPV legislation to changes among high school students in states without legislation. RESULTS A total of 715 338 participants reported ever having sexual intercourse in the last 3 months, and 217 077 sexually active participants reported recent condom use. We found no substantive or statistically significant associations between HPV legislation and adolescent sexual behaviors. Recent sexual intercourse decreased by 0.90 percentage points (P = .21), and recent condom use increased by 0.96 percentage points (P = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses. CONCLUSIONS Implementation of HPV legislation was not associated with changes in adolescent sexual behaviors in the United States. Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation.
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Affiliation(s)
| | - Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
| | - Jane J Kim
- Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Rulla M Tamimi
- Departments of Epidemiology and
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle D Holmes
- Departments of Epidemiology and
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Head KJ, Biederman E, Sturm LA, Zimet GD. A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States. Hum Vaccin Immunother 2018; 14:1626-1635. [PMID: 29359986 PMCID: PMC6067847 DOI: 10.1080/21645515.2018.1430539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A. Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Pierre-Victor D, Stephens DP, Omondi A, Clarke R, Jean-Baptiste N, Madhivanan P. Barriers to HPV Vaccination Among Unvaccinated, Haitian American College Women. Health Equity 2018; 2:90-97. [PMID: 29904749 PMCID: PMC5994833 DOI: 10.1089/heq.2017.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Haitian women residing in the United States are disproportionately affected by cervical cancer. Human papillomavirus (HPV) vaccine has been licensed in the United States since 2006. Vaccination rates are less than optimal overall, and the rates are particularly low among young black women. We investigated barriers to HPV vaccination in a sample of Haitian American college women. Methods: Thirty self-identified Haitian American women, aged 17-26 years, were recruited from a large university campus in southeastern United States (n=30). They completed in-depth face-to-face interviews. The research team analyzed the transcripts using thematic analysis. Results: More than half of the participants (n=18) had not yet initiated the HPV vaccine series. Most of the unvaccinated participants stated that they had received a provider recommendation for the vaccine. Lack of provider recommendation, negative vaccine perception and attitudes, and side effect concerns constituted barriers to vaccination. Conclusions: Haitian American college women at high risk of cervical cancer have cited several barriers to HPV vaccination, with the most prominent being lack of physician recommendation. Healthcare providers should continue recommending the vaccine to college women as many of them may not have received a recommendation. When recommending the HPV vaccine, discussions should be framed with the intent to positively influence HPV vaccine perceptions and ultimately vaccine attitudes.
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15
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Turiho AK, Okello ES, Muhwezi WW, Katahoire AR. Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: a qualitative study. BMC Res Notes 2017; 10:431. [PMID: 28854964 PMCID: PMC5577844 DOI: 10.1186/s13104-017-2749-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination has been perceived in diverse ways some of which encourage its uptake while others could potentially deter its acceptability. This study explored community member’s perceptions about HPV vaccination in Ibanda district and the implications of the perceptions for acceptability of HPV vaccination. The study was conducted following initial vaccination of adolescent schoolgirls in the district between 2008 and 2011. Methods This qualitative study employed focus group discussions (FGDs) and key informant interviews (KIIs). FGDs were conducted with schoolgirls and parents/guardians and KIIs were conducted with school teachers, health workers and community leaders. Transcripts from the FGDs and KIIs were coded and analyzed thematically using ATLAS.ti (v. 6). Results The HPV vaccination was understood to safely prevent cervical cancer, which was perceived to be a severe incurable disease. Vaccinations were perceived as protection against diseases like measles and polio that were known to kill children. These were major motivations for girls’ and parents’ acceptance of HPV vaccination. Parents’ increased awareness that HPV is sexually transmitted encouraged their support for vaccination of their adolescent daughters against HPV. There were reports however of some initial fears and misconceptions about HPV vaccination especially during its introduction. These initially discouraged some parents and girls but over the years with no major side effects reported, girls reported that they were willing to recommend the vaccination to others and parents also reported their willingness to get their daughters vaccinated without fear. Health workers and teachers interviewed however explained that, some concerns stilled lingered in the communities. Conclusions The perceived benefits and safety of HPV vaccination enhanced girls’ and parents’ acceptability of HPV vaccination. The initial rumors, fears and concerns about HPV vaccination that reportedly discouraged some girls and parents, seemed to have waned with time giving way to more favourable perceptions regarding HPV vaccination although the study still found that a few concerns still lingered on and these have implications for HPV vaccination acceptability.
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Ward JK, Crépin L, Bauquier C, Vergelys C, Bocquier A, Verger P, Peretti-Watel P. ‘I don’t know if I’m making the right decision’: French mothers and HPV vaccination in a context of controversy. HEALTH RISK & SOCIETY 2017. [DOI: 10.1080/13698575.2017.1299856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeremy K. Ward
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- LIED, Paris Diderot University, Paris, France
| | - Laure Crépin
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- Department of Social Sciences, Ecole Normale Supérieure de Cachan, Cachan, France
| | - Charlotte Bauquier
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- GRePS, Lumière Lyon 2 University, Lyon, France
| | - Chantal Vergelys
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
| | - Aurélie Bocquier
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
| | - Pierre Verger
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille University-INSERM-IRD, SESSTIM (Economy and Social Sciences, Health Care Systems and Societies), Marseille, France
- ORS PACA (Southeastern Health Regional Observatory), Marseille, France
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17
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Change Suboptimal Tactics and Promote a National Mandatory Human Papillomavirus Vaccination Program. J Low Genit Tract Dis 2016; 20:348-351. [DOI: 10.1097/lgt.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Engels KS. Biopower, Normalization, and HPV: A Foucauldian Analysis of the HPV Vaccine Controversy. THE JOURNAL OF MEDICAL HUMANITIES 2016; 37:299-312. [PMID: 26438668 DOI: 10.1007/s10912-015-9361-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article utilizes the Foucauldian concepts of biopower and normalization to give an analysis of the debate surrounding the controversial administration of the HPV vaccine to adolescents. My intention is not to solve the problem, rather to utilize a Foucauldian framework to bring various facets of the issue to light, specifically the way the vaccine contributes to strategies of power in reference to how young adults develop within relationships of power. To begin, the article provides an overview of the Foucauldian concepts of biopower and normalization, including how these two strategies of power were present in the administration of the smallpox vaccine in the 19th century. Next, information about HPV and the history of the current controversy in the United States is presented. Lastly, the article presents an analysis of the strategies of biopower and normalization present in the debate on HPV, including an emphasis on how the vaccination is similar to, and different from, 19th century smallpox vaccination. It also explores the way that mechanisms of disease control affect and are affected by individual subjects, in this case, adolescents.
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Affiliation(s)
- Kimberly S Engels
- Marquette University, 2434 North 68th Street, Wauwatosa, WI, 53213, USA.
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Calo WA, Gilkey MB, Shah PD, Moss JL, Brewer NT. Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study. Cancer Epidemiol Biomarkers Prev 2016; 25:1317-25. [PMID: 27543621 DOI: 10.1158/1055-9965.epi-15-1159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements. METHODS A national sample of 1,501 parents of 11- to 17-year-old children completed a web-based survey between November 2014 and January 2015. Analyses used multivariable logistic regression to assess correlates of support for school-entry requirements for HPV vaccination. RESULTS Overall, 21% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea," and 54% disagreed. If school-entry requirements included opt-out provisions, agreement increased to 57%, and only 21% disagreed. Parents more often agreed with requirements without opt-out provisions if they were Hispanic [OR = 1.53; 95% confidence interval (CI), 1.05-2.22], believed HPV vaccine was as or more important than other adolescent vaccines (OR = 2.76; 95% CI, 1.98-3.83), or believed HPV vaccine was effective for preventing cervical cancer (OR = 2.55; 95% CI, 1.93-3.37). Parents less often agreed if they resided in Midwest states or believed that HPV vaccine was being pushed to make money for drug companies (both P < 0.05). CONCLUSION Opt-out provisions almost tripled parents' support for HPV vaccine school-entry requirements. Our findings suggest that race/ethnicity, attitudes about HPV vaccine, and region of residence may influence support for requirements without opt-out provisions. IMPACT Opt-out provisions greatly increase parent support of school-entry requirements for HPV vaccination but may make them ineffective. Cancer Epidemiol Biomarkers Prev; 25(9); 1317-25. ©2016 AACR.
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Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts. Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Moss
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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20
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Wilson KL, Smith ML, Rosen BL, Pulczinski JC, Ory MG. HPV Vaccination Status and Mandate Support for School-Aged Adolescents Among College Females. J Sch Nurs 2016; 33:232-245. [PMID: 27470309 DOI: 10.1177/1059840516659764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire during February to March 2011. This descriptive study utilizes χ2 tests and t-tests to compare participant responses. HPV-related knowledge scores were 8.08 out of 11 points. Those who initiated HPV vaccination were significantly younger, single, engaged in sex, were sexually active, and had a Pap test. Participants who had more friends receiving the vaccine were significantly more likely to support mandates for 9-11 and 12-17 years and were more likely to complete the HPV vaccination cycle. Findings suggest the importance of educational programs adopted and delivered by school nurses, which aim to improve student knowledge and reduce misconceptions related to the HPV vaccine and vaccination mandates.
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Affiliation(s)
- Kelly L Wilson
- 1 Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- 2 Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA.,3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
| | - Brittany L Rosen
- 4 School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Jairus C Pulczinski
- 3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
| | - Marcia G Ory
- 3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
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21
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Ward JK. Rethinking the antivaccine movement concept: A case study of public criticism of the swine flu vaccine's safety in France. Soc Sci Med 2016; 159:48-57. [PMID: 27173740 DOI: 10.1016/j.socscimed.2016.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Abstract
In this article I discuss the definition of "the Antivaccine Movement" using the case of the French controversy over the safety of the 2009 pandemic flu vaccine. I show that the group of main actors who criticized the vaccine's safety is heterogeneous. This heterogeneity can be found in the type of arguments mobilized to question the vaccine's safety and in these actors' likelihood of being involved in any vaccine-related controversies. I show that only a minority of these actors rejected vaccination in general and mobilized against all vaccination campaigns. Most of these actors only occasionally mobilized against a given vaccine or vaccination campaign and they did so to promote a political or cultural agenda that went beyond the vaccine itself. Using these results, I argue that in order to better understand how vaccine-related controversies emerge and why some activists devote time and resources to spread vaccine-critical arguments, social scientists should use three distinct concepts to refer to vaccine criticism: The Antivaccine Movement, the Marginally Antivaccine Movements and the Occasionally Vaccine Critical Movements. To do so would enable social scientists and public health experts to better understand the different ways in which vaccination can become politicized and the evolution of this politicization.
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Affiliation(s)
- Jeremy K Ward
- INSERM, (UMR912: SESSTIM), 13006, Marseille, France; Aix Marseille University, (UMR_S912, IRD), 13006, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France; Paris Diderot University (UMR8236: LIED), 75013, Paris, France.
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22
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Califano S, Calo WA, Weinberger M, Gilkey MB, Brewer NT. Physician support of HPV vaccination school-entry requirements. Hum Vaccin Immunother 2016; 12:1626-32. [PMID: 26900726 DOI: 10.1080/21645515.2016.1149275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
School-entry requirements in the US have led to high coverage for several vaccines, but few states and jurisdictions have adopted these policies for human papillomavirus (HPV) vaccination. Because physicians play a key role in advocating for vaccination policies, we assessed physician support of requiring HPV vaccine for school entry and correlates of this support. Participants were a national sample of 775 physicians who provide primary care, including vaccines, to adolescents. Physicians completed an online survey in 2014 that assessed their support for school-entry requirements for HPV vaccination of 11 and 12 y olds. We used multivariable logistic regression to assess correlates of support for these requirements. The majority of physicians (74%) supported some form of school-entry requirements, with or without opt-out provisions. When opt-out provisions were not specified, 47% agreed that laws requiring HPV vaccination for school attendance were a "good idea." Physicians more often agreed with requirements, without opt-out provisions, if they: had more years in practice (OR=1.49; 95% CI: 1.09-2.04), gave higher quality HPV vaccine recommendations (OR=2.06; 95% CI: 1.45-2.93), believed that having requirements for Tdap, but not HPV, vaccination undermined its importance (OR=3.33; 95% CI: 2.26-4.9), and believed HPV vaccination was as or more important than other adolescent vaccinations (OR=2.30; 95% CI: 1.65-3.18). In conclusion, we found that many physicians supported school-entry requirements for HPV vaccination. More research is needed to investigate the extent to which opt-out provisions might weaken or strengthen physician support of HPV vaccination school-entry requirements.
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Affiliation(s)
- Sophia Califano
- a Department of Internal Medicine , VA Medical Center , Durham , NC , USA
| | - William A Calo
- b Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Morris Weinberger
- b Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Melissa B Gilkey
- c Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Noel T Brewer
- d Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,e Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
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23
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Kasting ML, Wilson S, Dixon BE, Downs SM, Kulkarni A, Zimet GD. A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine. Vaccine 2016; 34:1331-4. [PMID: 26859240 DOI: 10.1016/j.vaccine.2016.01.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 12/14/2022]
Abstract
The 9-valent Human Papillomavirus (HPV) vaccine, 9vHPV, was licensed in the U.S. in December, 2014. We assessed healthcare provider (HCP) awareness of the newly approved vaccine and identified questions HCPs have about the vaccine. As part of a larger study, we used semi-structured interviews to ask 22 pediatric HCPs about their awareness of 9vHPV, questions they have about the vaccine, and questions they anticipate from patients and parents. Interviews were audio-recorded and transcribed then analyzed using inductive content analysis. Over half were aware of the vaccine but few HCPs claimed to be familiar with it. HCPs indicated several questions with common themes pertaining to efficacy, side effects, and cost. Only half of HCPs believed patients or parents would have questions. The results suggest strategies and areas for health systems and public health organizations to target in order to resolve unmet educational needs among HCPs regarding 9vHPV.
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Affiliation(s)
- Monica L Kasting
- Indiana University Fairbanks School of Public Health, Department of Epidemiology, 1050 Wishard Blvd, RG5, Indianapolis, IN 46202, USA.
| | - Shannon Wilson
- Indiana University School of Medicine, Department of Pediatrics, 410 W 10th Street Suite 1001, Indianapolis, IN 46202, USA.
| | - Brian E Dixon
- Indiana University Fairbanks School of Public Health, Department of Epidemiology, 1050 Wishard Blvd, RG5, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, USA; Center for Health Information and Communication Department of Veterans Affairs Veterans Health Administration Health Services Research and Development Service, CIN 13-416 1481 W. 10th St, 11H, Indianapolis, IN 46202, USA.
| | - Stephen M Downs
- Indiana University School of Medicine, Department of Pediatrics, 410 W 10th Street Suite 1001, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, USA.
| | - Amit Kulkarni
- Merck & Co., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W 10th Street Suite 1001, Indianapolis, IN 46202, USA.
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Handler MZ, Handler NS, Majewski S, Schwartz RA. Human papillomavirus vaccine trials and tribulations: Clinical perspectives. J Am Acad Dermatol 2016; 73:743-56; quiz 757-8. [PMID: 26475534 DOI: 10.1016/j.jaad.2015.05.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/20/2015] [Accepted: 05/23/2015] [Indexed: 01/05/2023]
Abstract
Human papillomavirus (HPV) affects hundreds of millions of people worldwide and is associated with both benign and malignant neoplasms in men and women. It is a double-stranded DNA virus with an icosahedral capsid. Forty HPV types are known to infect mucosal keratinocytes. If not cured by the immune system, the infection can lead to genital warts, mucosal dysplasia, or cancer. The most common oncogenic types are 16 and 18. The vaccine to prevent HPV and its associated morbidity and mortality has existed since 2006. Several variations protect against an increasing number of HPV types. The recommended vaccination age is before sexual exposure; administration of the vaccine to children has been controversial. This continuing medical education review evaluates the current HPV vaccines available to clinicians. Part I focuses on the debate over who should be vaccinated, at what age, and in which populations.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey
| | - Nancy S Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska
| | - Slawomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Robert A Schwartz
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pediatrics, Rutgers University New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers University New Jersey Medical School, Newark, New Jersey; School of Public Affairs and Administration, Rutgers University, Newark, New Jersey.
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25
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Lee A, Wong MCS, Chan TT, Chan PKS. A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine. BMC Public Health 2015; 15:935. [PMID: 26392084 PMCID: PMC4578840 DOI: 10.1186/s12889-015-2269-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background A high coverage of human papillomavirus (HPV) vaccination is required to achieve a clinically significant reduction in disease burden. Countries implementing free-of-charge national vaccination program for adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary on-site school-based mass vaccination programs have demonstrated high coverage. Here, we tested whether this could be an option for countries without a government-supported vaccination program as in Hong Kong. Method A Home-School-Doctor model was evolved based on extensive literature review of various health promotion models together with studies on HPV vaccination among adolescent girls. The outcome measure was uptake of vaccination. Factors associated with the outcome were measured by validated surveys in which 4,631 students from 24 school territory wide participated. Chi-square test was used to analyze association between the categorical variables and the outcome. Multivariate analysis was performed to identify independent variables associated with the outcome with vaccine group as case and non-vaccine group as control. Results In multivariate analysis, parental perception of usefulness of the Home-School-Doctor model had a very high odds ratio for uptake of HPV vaccination (OR 26.6, 95 % CI 16.4, 41.9). Paying a reasonable price was another independent factor associated with increased uptake (OR 1.71, 95 % CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination). For parents and adolescents who were not sure where to get vaccination, this model was significantly associated with improved uptake rate (OR 1.66, 95 % CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70, 95 % CI 0.55, 0.88), allowing daughters to make their own decisions (OR 0.49, 95 % CI 0.38, 0.64) and not caring much about daughters’ social life (95 % CI 0.45, 0.92) were factors associated with a lower uptake. Discussion The findings of this study have added knowledge on how a school-based vaccination program would improve vaccine uptake rate even when the users need to pay. Our findings are consistent with other study that the most acceptable way to achieve high uptake of HPV vaccine is to offer voluntary school-based vaccination. Conclusion A model of care incorporating the efforts and expertise of academics and health professionals working closely with school can be applied to improve the uptake of vaccine among adolescent girls. Subsidized voluntary school-based vaccination scheme can be an option.
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Affiliation(s)
- Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Tracy T Chan
- Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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26
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Turiho AK, Muhwezi WW, Okello ES, Tumwesigye NM, Banura C, Katahoire AR. Human Papillomavirus (HPV) Vaccination and Adolescent Girls' Knowledge and Sexuality in Western Uganda: A Comparative Cross-Sectional Study. PLoS One 2015; 10:e0137094. [PMID: 26327322 PMCID: PMC4556485 DOI: 10.1371/journal.pone.0137094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022] Open
Abstract
The purpose of the study was to investigate the influence of human papillomavirus (HPV) vaccination on adolescent girls' knowledge of HPV and HPV vaccine, perception of sexual risk and intentions for sexual debut. This cross-sectional comparative study was conducted in Ibanda and Mbarara districts. Data was collected using a standardized self-administered questionnaire and analyzed using the Statistical Package for the Social Sciences computer software. Univariate, bivariate, and logistic regression analyses were conducted with significance level set at p < .05. Results showed that HPV vaccination was associated with being knowledgeable (Crude OR: 5.26, CI: 2.32-11.93; p = 0.000). Vaccination against HPV did not predict perception of sexual risk. Knowledge was low (only 87/385 or 22.6% of vaccinated girls were knowledgeable), but predicted perception of a high sexual risk (Adjusted OR: 3.12, CI: 1.37-3.63; p = 0.008). HPV vaccination, knowledge and perceived sexual risk did not predict sexual behaviour intentions. High parental communication was associated with adolescent attitudes that support postponement of sexual debut in both bivariate and multiple regression analyses. In conclusion, findings of this study suggest that HPV vaccination is not likely to encourage adolescent sexual activity. Influence of knowledge on sexual behaviour intentions was not definitively explained. Prospective cohort studies were proposed to address the emerging questions.
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Affiliation(s)
| | | | | | | | - Cecil Banura
- Child Health and Development Center, Makerere University, Kampala, Uganda
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Abstract
Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refuse vaccination. Compulsory vaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally similar to firing a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators' religious and refusal rights to everyone else's rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercive vaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement.
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Affiliation(s)
- Jessica Flanigan
- Leadership Studies, and Philosophy, Politics, Economics, and Law, University of Richmond, 28 Westhampton Way, Richmond, VA, 23173, USA,
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28
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Perkins RB, Lin M, Silliman RA, Clark JA, Hanchate A. Why are U.S. girls getting meningococcal but not human papilloma virus vaccines? Comparison of factors associated with human papilloma virus and meningococcal vaccination among adolescent girls 2008 to 2012. Womens Health Issues 2015; 25:97-104. [PMID: 25747517 DOI: 10.1016/j.whi.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Human papilloma virus (HPV) vaccination rates in the United States remain low, compared with other recommended adolescent vaccines. We compared factors associated with intention to receive and receipt of HPV and meningococcal vaccines and completion of the HPV vaccine series among U.S. adolescent girls. METHODS Secondary analysis of data from the National Immunization Survey-Teen for 2008 through 2012 was performed. Multivariable logistic modeling was used to determine factors associated with intent to receive and receipt of HPV and meningococcal vaccination, completion of the HPV vaccine series among girls who started the series, and receipt of HPV vaccination among girls who received meningococcal vaccination. FINDINGS Provider recommendation increased the odds of receipt and intention to receive both HPV and meningococcal vaccines. Provider recommendation was also associated with a three-fold increase in HPV vaccination among girls who received meningococcal vaccination (p<.001), indicating a relationship between provider recommendation and missed vaccine opportunities. However, White girls were 10% more likely to report provider recommendation than Black or Hispanic girls (p<.01), yet did not have higher vaccination rates, implying a role for parental refusal. No factors predicted consistently the completion of the HPV vaccine series among those who started. CONCLUSION Improving provider recommendation for co-administration of HPV and meningococcal vaccines would reduce missed opportunities for initiating the HPV vaccine series. However, different interventions may be necessary to improve series completion.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
| | - Mengyun Lin
- Department of Medicine, Division of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Rebecca A Silliman
- Department of Medicine, Division of Geriatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jack A Clark
- Boston University School of Public Health, Edith Nourse Rogers Veterans Hospital, Boston, Massachusetts
| | - Amresh Hanchate
- Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
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Newman PA, Lee SJ, Rudy ET, Diamant A, Duan N, Nakazono T, Nakazano T, Cunningham WE. Endorsement of compulsory HIV vaccination policy among populations at high risk of HIV exposure (LA VOICES). PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:428-35. [PMID: 24464325 DOI: 10.1007/s11121-014-0463-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Compulsory vaccination is a frequently implemented policy option for ensuring comprehensive vaccine coverage. Ongoing controversies around human papillomavirus vaccine dissemination, and suboptimal coverage, suggest the value of assessing acceptability of compulsory vaccinations-particularly among likely target populations-in advance of their public availability to support evidence-informed interventions. With the first HIV vaccine to demonstrate partial efficacy in a large-scale clinical trial, we examined individual characteristics and attitudes associated with support for compulsory HIV vaccination policy among a diverse, representative sample of adults attending probable HIV vaccine dissemination venues in a large urban county. Participants were recruited using three-stage probability sampling from likely venues for future HIV vaccine dissemination. We used Audio-CASI to administer a 60-min structured questionnaire. Items included endorsement of compulsory HIV vaccination policy, sociodemographic characteristics, injecting drug use, vaccine attitudes and perceived HIV risk. Among 1,225 participants (mean age = 36.8 years; 55.6 % males, 37.6 % non-English speaking Hispanic, 78.8 % heterosexual, 25.7 % injection drug users), almost half (48.2 %) endorsed a compulsory HIV vaccination policy. Non-English speaking Hispanics compared to whites, participants with less than high school education, higher positive vaccine attitude scores and higher perceived HIV risk were significantly more likely, and people who inject drugs significantly less likely to endorse compulsory HIV vaccination. Public health interventions to promote positive vaccine attitudes and accurate perceptions of HIV risk among vulnerable populations, and strategies tailored for people who inject drugs, may build support for compulsory HIV vaccination policy and promote broad HIV vaccine coverage.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada, M5S 1 V4,
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Laugesen MJ, Mistry R, Carameli KA, Ribisl KM, Needleman J, Bastani R. Early policy responses to the human papillomavirus vaccine in the United States, 2006-2010. J Adolesc Health 2014; 55:659-64. [PMID: 24928803 DOI: 10.1016/j.jadohealth.2014.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the policies state governments pursued and enacted across the United States in the 5-year period after the U.S. Food and Drug Administration licensed the human papillomavirus (HPV) vaccine in 2006, including the timing and number of bills introduced, the policies proposed, and the legislative success of HPV vaccine policy proposals. METHODS Content abstraction and analysis of state-level HPV vaccine-related bills across the 50 states and the District of Columbia introduced between 2006 and 2010. RESULTS All but five states (Alaska, Delaware, Idaho, New Hampshire, and Wyoming) introduced HPV vaccine bills between 2006 and 2010. Two-thirds of all bills were introduced in 2007. In all, 141 bills were introduced and 23% or 32 bills were enacted. Of the bills that were enacted, 43.8% provided information for parents and schools about the vaccine; 37.5% provided public financing for HPV vaccines; 34.4% were classified as other policies; 25% created awareness campaigns; 25% required private insurance coverage of the HPV vaccination; 12.5% included voluntary vaccination, and 9.4% mandated vaccination for school entry. One bill reversed prior mandatory vaccination policies. Overall, 91% of enacted HPV vaccine bills did not refer to mandated vaccinations but adopted alternate policy strategies in response to the availability of the new HPV vaccine. CONCLUSIONS Nationwide, states responded to the new HPV vaccine by introducing policies designed to increase the availability of information about the vaccine, provide funding, and regulate private insurance coverage rather than require vaccination for school entry.
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Affiliation(s)
- Miriam J Laugesen
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kelley A Carameli
- National Center for Organization Development, Veterans Health Administration, Cincinnati, Ohio
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Griffee K, O’Keefe SL, Beard KW, Young DH, Kommor MJ, Linz TD, Swindell S, Stroebel SS. Human Sexual Development is Subject to Critical Period Learning: Implications for Sexual Addiction, Sexual Therapy, and for Child Rearing. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/10720162.2014.906012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vaccines to promote and protect sexual health: Policy challenges and opportunities. Vaccine 2014; 32:1610-5. [DOI: 10.1016/j.vaccine.2013.09.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/09/2013] [Accepted: 09/23/2013] [Indexed: 11/22/2022]
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Casciotti DM, Smith KC, Andon L, Vernick J, Tsui A, Klassen AC. Print news coverage of school-based human papillomavirus vaccine mandates. THE JOURNAL OF SCHOOL HEALTH 2014; 84:71-81. [PMID: 25099421 PMCID: PMC4672723 DOI: 10.1111/josh.12126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 12/20/2012] [Accepted: 01/19/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. METHODS We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005 to 2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. RESULTS Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. CONCLUSIONS If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages and promote informed decision-making by parents and students.
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Affiliation(s)
- Dana M Casciotti
- Program Analyst, , National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894
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Casciotti DM, Smith KC, Tsui A, Klassen AC. Discussions of adolescent sexuality in news media coverage of the HPV vaccine. J Adolesc 2013; 37:133-43. [PMID: 24439619 DOI: 10.1016/j.adolescence.2013.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
Given the sexually transmitted nature of human papillomavirus (HPV), some worry the HPV vaccine will create a false sense of security and promote adolescent sexual activity. Media coverage of vaccines can influence social norms, parental attitudes, and vaccine acceptance; in this paper we examine U.S. news media messages related to sexuality and HPV vaccination. Drawing on a structured analysis of 447 articles published during 2005-2009, we qualitatively analyzed a purposive sample of 49 articles discussing adolescent health behaviors related to HPV vaccination. Commonly, articles discussed vaccination in the context of abstinence-only versus comprehensive sexual health education; cited research findings to support vaccination or sex education; argued against connecting vaccination to promiscuous behavior; but included fear-inducing messages. Media messages concerning health behaviors related to HPV vaccination tended to support government and parental involvement in sex education, and dismiss concerns linking vaccination to sexual activity, while also presenting the vaccine as lifesaving.
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Affiliation(s)
- Dana M Casciotti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 726, Baltimore, MD 21205, USA.
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, N. Wolfe Street, Room W4041, Baltimore, MD 21205, USA.
| | - Ann C Klassen
- Department of Community Health and Prevention, Drexel University School of Public Health, 3215 Market Street, Room 435, Philadelphia, PA 19104, USA.
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Zimet GD, Buffler P. Prevention of human papillomavirus-related diseases: Impediments to progress. Prev Med 2013; 57:407-8. [PMID: 23954187 DOI: 10.1016/j.ypmed.2013.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th St., HS1001, Indianapolis, IN 46202, USA.
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Committee opinion no.564: ethical issues with vaccination for the obstetrician-gynecologist. Obstet Gynecol 2013; 121:1144-1150. [PMID: 23635768 DOI: 10.1097/01.aog.0000429661.39212.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of the growing importance of infectious disease prevention in the individual patient and the larger community, it is vital that Fellows of the American College of Obstetricians and Gynecologists be prepared to navigate the practical and ethical challenges that come with vaccination. Health care professionals have an ethical obligation to keep their patients' best interests in mind by following evidence-based guidelines to encourage patients to be vaccinated and to be vaccinated themselves. College Fellows should counsel their patients about vaccination in an evidence-based manner that allows patients to make an informed decision about the use of these agents in their health care. The Centers for Disease Control and Prevention reports that no evi-dence exists of risk to the fetus from vaccinating pregnant women with noninfectious virus or bacterial vaccines or toxoids. Mandatory vaccination of health care professionals may be an ethically justified strategy in cases in which the harm to patients and the general population is believed to outweigh the autonomy of individual physicians.
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Perkins RB, Tipton H, Shu E, Marquez C, Belizaire M, Porter C, Clark JA, Pierre-Joseph N. Attitudes toward HPV vaccination among low-income and minority parents of sons: a qualitative analysis. Clin Pediatr (Phila) 2013; 52:231-40. [PMID: 23362316 DOI: 10.1177/0009922812473775] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the attitudes of low-income and minority parents/guardians toward vaccinating sons against human papillomavirus (HPV). METHODS In 2010-2011, we conducted qualitative interviews with 68 black, 24 white, and 28 Latino parents/guardians of sons. We identified attitudes related to HPV vaccination, vaccine mandates for males and females, and adolescent male sexuality using constructs from the Health Belief Model and methods based in grounded theory. RESULTS Most participants were concerned that their sons could be exposed to HPV through sexual experimentation and believed that the consequences of HPV infection could be severe; thus, 75% would accept HPV vaccine for their sons. Yet the lack of efficacy and safety information specifically pertaining to males posed barriers. More black (73%) and Latino (86%) than white (44%) participants supported school-entry requirements for HPV vaccination. CONCLUSIONS Low-income and minority parents/guardians were generally receptive toward vaccinating their sons against HPV; racial/ethnic differences emerged regarding school-entry mandates.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
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Velan B, Boyko V, Lerner-Geva L, Ziv A, Yagar Y, Kaplan G. Individualism, acceptance and differentiation as attitude traits in the public's response to vaccination. Hum Vaccin Immunother 2012; 8:1272-82. [PMID: 22894959 PMCID: PMC3579908 DOI: 10.4161/hv.21183] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The attitude of the general public to vaccination was evaluated through a survey conducted on a representative sample of the Israeli population (n = 2,018), in which interviewees were requested to express their standpoints regarding five different vaccination programs. These included: pandemic influenza vaccination, seasonal influenza vaccination, travel vaccines, Human Papilloma Virus vaccine and childhood vaccinations. Analysis of the responses reveal three major attitude traits: a) acceptance, characterized by the opinion that targets should be vaccinated; b) individualism, characterized by the opinion that vaccination should be left to personal choice; and c) differentiation, characterized by the tendency to express different attitudes when addressing different vaccination programs. Interestingly, direct opposition to vaccination was found to be a minor attitude trait in this survey. Groups within the population could be defined according to their tendency to assume these different attitudes as Acceptors, Judicious-acceptors, Differentiators, Soft-individualists, and Hard-individualists. These groups expressed different standpoints on all five vaccination programs as well as on other health recommendations, such as screening for early detection of cancer. Attitude traits could be also correlated, to a certain extent, with actual compliance with vaccination programs. Interestingly, attitudes to vaccination were not correlated with social profiles related to income or education, although younger individuals exhibited higher degrees of individualism and differentiation. Taken together, all this is in accordance with the current social settings, underlining the individual's tendency for critical evaluation and self-stirring. This should be taken into consideration by health authorities involved in vaccination programs.
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Affiliation(s)
- Baruch Velan
- Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel.
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Bugenske E, Stokley S, Kennedy A, Dorell C. Middle school vaccination requirements and adolescent vaccination coverage. Pediatrics 2012; 129:1056-63. [PMID: 22566425 DOI: 10.1542/peds.2011-2641] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if middle school vaccination requirements are associated with higher coverage for adolescent vaccines. METHODS School entry requirements for receipt of vaccination for school entry or education of parents for 3 vaccines recommended for adolescents: tetanus/diphtheria-containing (Td) or tetanus/diphtheria/acellular pertussis (TdaP), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccines in place for the 2008-2009 school year were reviewed for the 50 states and the District of Columbia. Vaccination coverage levels for adolescents 13 to 17 years of age by state requirement status and change in coverage from 2008 to 2009 were assessed by using the 2008-2009 National Immunization Survey-Teen. RESULTS For the 2008-2009 school year, 32 states had requirements for Td/TdaP (14 specifically requiring TdaP) and none required education; 3 states required MenACWY vaccine and 10 others required education; and 1 state required HPV vaccine and 5 required education. Compared with states with no requirements, vaccination requirements were associated with significantly higher coverage for MenACWY (71% vs 53%, P < .001) and Td/TdaP (80% vs 70%, P < .001) vaccines. No association was found between education-only requirements and coverage levels for MenACWY and HPV vaccines. States with new 2008-2009 vaccination requirements (n = 6, P = .04) and states with preexisting vaccination requirements (n = 26, P = .02) for Td/TdaP experienced a significant increase in TdaP coverage over states with no requirements. CONCLUSIONS Middle school vaccination requirements are associated with higher coverage for Td/TdaP and MenACWY vaccines, whereas education-only requirements do not appear to increase coverage levels for MenACWY or HPV vaccines. The impact on coverage should continue to be monitored as more states adopt requirements.
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Affiliation(s)
- Erin Bugenske
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-19, Atlanta, GA 30333, USA.
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Risk perceptions after human papillomavirus vaccination in HIV-infected adolescents and young adult women. J Adolesc Health 2012; 50:464-70. [PMID: 22525109 PMCID: PMC3336095 DOI: 10.1016/j.jadohealth.2011.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine risk perceptions (perceived risk of human papillomavirus [HPV], perceived risk of other sexually transmitted infections [STIs], and need for safer sexual behaviors) and to determine factors associated with these risk perceptions after HPV vaccination. METHODS Data were collected at the baseline visit of an HPV-6, -11, -16, -18 vaccine clinical trial in 16-23-year-old HIV-infected young women (N = 99). Immediately after receiving the first vaccine dose, participants completed a confidential questionnaire that included three 5-item scales measuring perceived risk of HPV, perceived risk of other STIs, and need for safer sexual behaviors. Linear and logistic regression models were used to examine associations between baseline characteristics (demographic characteristics; cluster of differentiation antigen 4 (CD4(+)) count; HIV viral load; knowledge about HPV and HPV vaccines; sexual behaviors; and STI diagnosis) and each measure of risk perceptions. RESULTS Most participants perceived themselves to be at lower risk for HPV (mean scale score = 19.5/50), most perceived that they were not at lower risk for other STIs (mean = 31.2/50), and the vast majority reported that there was still a need for safer sexual behaviors after vaccination (mean = 43.1/50). Multivariate analyses indicated that knowledge about HPV and HPV vaccines was associated with perceived need for safer sexual behaviors (OR = 1.05, 95% CI = 1.0-1.1). CONCLUSIONS Although almost all young women in this study believed that safer sexual behaviors were still important after HPV vaccination, a subset believed they were at less risk for STIs other than HPV. Educational interventions are needed to prevent misperceptions and promote healthy behaviors after vaccination.
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Mishra A, Graham JE. Risk, choice and the ‘girl vaccine’: Unpacking human papillomavirus (HPV) immunisation. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2011.641524] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Default policies and parents' consent for school-located HPV vaccination. J Behav Med 2012; 35:651-7. [PMID: 22271328 DOI: 10.1007/s10865-012-9397-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 01/03/2012] [Indexed: 10/14/2022]
Abstract
While defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of two default policies on parents' consent to have their adolescent sons hypothetically receive HPV vaccine at school. A national sample of 404 parents of adolescent sons participated in an online 3 × 2 between-subjects factorial experiment. Factors varied the default consent policy (opt-in, opt-out, or neutral) and the number of vaccines sons would receive (HPV vaccine alone or along with two other recommended adolescent vaccines). Among parents wanting to get their sons HPV vaccine in the next year, consent was higher in the opt-in condition (compared to the opt-out condition) or if other recommended adolescent vaccines would be included. Default policies had no effect among parents undecided about HPV vaccination. Parents' consent for school-located HPV vaccination may be higher when presented as an opt-in decision and other vaccines are included.
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Smith JS, Brewer NT, Chang Y, Liddon N, Guerry S, Pettigrew E, Markowitz LE, Gottlieb SL. Acceptability of school requirements for human papillomavirus vaccine. HUMAN VACCINES 2011; 7:952-7. [PMID: 22024912 PMCID: PMC3360068 DOI: 10.4161/hv.7.9.15995] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 06/25/2011] [Accepted: 07/04/2011] [Indexed: 11/19/2022]
Abstract
We characterized parental attitudes regarding school HPV vaccination requirements for adolescent girls. Study participants were 866 parents of 10–18 y-old girls in areas of North Carolina with elevated cervical cancer incidence. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Approximately half (47%) of parents agreed that laws requiring HPV immunization for school attendance "are a good idea" when opt-out provisions were not mentioned. Far more agreed that "these laws are okay only if parents can opt out if they want to" (84%). Predictors of supporting requirements included believing HPV vaccine is highly effective against cervical cancer (OR = 2.5, 95% CI:1.7–.0) or is more beneficial if provided at an earlier age (OR = 16.1, 95% CI:8.4–1.0). Parents were less likely to agree with vaccine requirements being a good idea if they expressed concerns related to HPV vaccine safety (OR = 0.3, 95% CI:0.1–.5), its recent introduction (OR = 0.3, 95% CI:0.2–.6). Parental acceptance of school requirements appears to depend on perceived HPV vaccine safety and efficacy, understanding of the optimal age for vaccine administration, and inclusion of opt-out provisions.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA.
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Sheinfeld Gorin SN, Glenn BA, Perkins RB. The human papillomavirus (HPV) vaccine and cervical cancer: uptake and next steps. Adv Ther 2011; 28:615-39. [PMID: 21818672 DOI: 10.1007/s12325-011-0045-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Indexed: 02/03/2023]
Abstract
Infection with a high-risk type of the human papillomavirus (HPV) is a major contributing factor in the vast majority of cervical cancers. Dissemination of the HPV vaccine is critical in reducing the risk of the disease. This descriptive review of HPV vaccine uptake in papers published between 2006 and 2011 focuses on studies conducted in girls and young women. In the United States, rates of immunization as per the protocol for teens (age 13-17 years) range from 6% to 75% and those for young women (age 18-26 years) range from 4% to 79%, although the samples and data collection methods vary. The epidemiology of HPV, the mechanisms of action, protocols for vaccine immunization, rates of uptake, and barriers to vaccination at the policy, provider, and patient levels are reviewed. Various intervention techniques are described, and policy-level programs, such as legislation supporting mandates, subsidized public education, and cost-reduction initiatives, are also explored. Increased distribution of the HPV vaccine in school-based clinics, evidencebased scripts for provider counseling of young patients and their parents, concurrent immunizations to adolescents, prevention visits, greater patient education and outreach, and the dissemination of academic detailing can help to boost vaccine uptake, particularly in underresourced communities. Population-based surveillance is necessary for robust estimates of uptake over time. Additional research is needed to comprehensively examine socio-demographic, psychosocial, and sociocultural factors that predict vaccine uptake according to the protocol. Increased study of the vaccine's long-term effectiveness, in both males and females and among extended age groups, is warranted.
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Graham JE, Mishra A. Global challenges of implementing human papillomavirus vaccines. Int J Equity Health 2011; 10:27. [PMID: 21718495 PMCID: PMC3143925 DOI: 10.1186/1475-9276-10-27] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 06/30/2011] [Indexed: 12/02/2022] Open
Abstract
Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening.
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Affiliation(s)
- Janice E Graham
- Department of Bioethics, Dalhousie University, Faculty of Medicine, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Amrita Mishra
- Technoscience and Regulation Research Unit, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada
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Manhart LE, Burgess-Hull AJ, Fleming CB, Bailey JA, Haggerty KP, Catalano RF. HPV vaccination among a community sample of young adult women. Vaccine 2011; 29:5238-44. [PMID: 21640775 DOI: 10.1016/j.vaccine.2011.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/01/2011] [Accepted: 05/09/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist. METHODS A community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22. RESULTS Nineteen percent of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4-3.2) and intention to vaccinate (APR 1.4; 1.1-1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4-0.9) or intention to vaccinate (APR 0.5; 0.4-0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5-0.9). CONCLUSIONS HPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology and Center for AIDS Research, University of Washington, Seattle, WA 98104, USA.
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Robitz R, Gottlieb SL, De Rosa CJ, Guerry SL, Liddon N, Zaidi A, Walker S, Smith JS, Brewer NT, Markowitz LE. Parent attitudes about school requirements for human papillomavirus vaccine in high-risk communities of Los Angeles, California. Cancer Epidemiol Biomarkers Prev 2011; 20:1421-9. [PMID: 21551243 DOI: 10.1158/1055-9965.epi-10-1236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) immunization requirements for school entry could increase HPV vaccine uptake but are controversial. This study assessed parents' attitudes about HPV immunization requirements. METHODS During October 2007 to June 2008, we conducted telephone surveys with 484 parents of girls attending middle/high schools serving communities in Los Angeles County with elevated cervical cancer rates. RESULTS Parents were mostly Hispanic (81%) or African American (15%); 71% responded in Spanish. Many parents did not know if HPV vaccine works well (42%) or is unsafe (41%). Overall, 59% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea." In multivariable analysis, African Americans and Hispanics responding in English were less likely than Hispanics responding in Spanish to agree (aOR 0.1, 95% CI: 0.1-0.3; aOR 0.4, 95% CI: 0.2-0.8, respectively). Parents were less likely to agree with these laws if they did not believe the vaccine works well (aOR 0.2, 95% CI: 0.1-0.5) but more likely to agree if they believed the vaccine is not "too new for laws like these" (aOR 4.5, 95% CI: 2.6-8.0). Agreement with laws increased to 92% when including agreement that "these laws are okay only if parents can opt out." CONCLUSIONS In this at-risk community, more than half of the parents agreed with HPV immunization requirements generally, and the vast majority agreed when including opt-out provisions. IMPACT Support for HPV vaccine requirements may depend on race/ethnicity and inclusion of opt-out provisions. Information about vaccine efficacy and safety may increase support and reduce uncertainty about HPV vaccine in high-risk populations.
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Affiliation(s)
- Rachel Robitz
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Dempsey AF, Schaffer SE. Human papillomavirus vaccination rates and state mandates for tetanus-containing vaccines. Prev Med 2011; 52:268-9. [PMID: 21195727 PMCID: PMC3062651 DOI: 10.1016/j.ypmed.2010.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/16/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to examine nationally the association between school mandates for adolescent tetanus-containing vaccines (Td and/or Tdap) and adolescent female human papillomavirus (HPV) vaccination. METHODS Each state was categorized by whether a school mandate for adolescent Td and/or Tdap vaccines was enacted. Mean HPV vaccine series initiation levels among adolescent females were compared between each mandate category. RESULTS Mean HPV vaccine series initiation levels were significantly lower in states without Td/Tdap vaccine mandates than in those with mandates (42.9% vs. 47.3%; p=0.004). CONCLUSIONS School mandates for adolescent Td/Tdap vaccination may have a carry-over effect on HPV vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, 300 North Ingalls, Rm 6E08, Ann Arbor, MI 48109-5456, USA.
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Gollust SE, Dempsey AF, Lantz PM, Ubel PA, Fowler EF. Controversy undermines support for state mandates on the human papillomavirus vaccine. Health Aff (Millwood) 2011; 29:2041-6. [PMID: 21041746 DOI: 10.1377/hlthaff.2010.0174] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
State actions requiring adolescent girls to receive the human papillomavirus (HPV) vaccine created controversy following the vaccine's approval in 2006. Some health professionals worried that the controversy might dampen public support for those state policies and for other school immunizations in general. We fielded an experimental Internet survey to determine how controversy affects attitudes about vaccines. We discovered that public support for the HPV vaccine mandates wanes when the public is informed that the policies are controversial. However, the experimental survey also revealed that exposure to this policy controversy did not spill over and reduce public support for immunizations in general.
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