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Xie S, Monteiro K, Gjelsvik A. Influenza vaccine during pregnancy, recommendations from healthcare providers, and race/ethnicity in the United States. Arch Gynecol Obstet 2024:10.1007/s00404-023-07366-1. [PMID: 38300355 DOI: 10.1007/s00404-023-07366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVES We examined racial/ethnic differences in the association between influenza vaccine recommendations from healthcare providers and maternal vaccination uptake. METHODS This cross-sectional study examined data from the Pregnancy Risk Assessment Monitoring System. We categorized respondents as non-Hispanic (NH) Whites, NH-Blacks, NH-Asians, American Indians/Alaska Natives, NH Other non-Whites, and Hispanics. We conducted multivariable logistical regression models to evaluate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Covariates included maternal age, marital status, education, insurance status before pregnancy, the number of previous live births, the number of prenatal care visits, and smoking status during pregnancy. RESULTS The prevalences of receiving influenza vaccine recommendations from healthcare providers and maternal vaccine were 80.01% and 50.42%, respectively. NH-Blacks are less likely to receive provider recommendations (AOR = 0.82; 95%CI 0.77-0.87) and be vaccinated (AOR = 0.76; 95%CI 0.72-0.80) than NH-Whites. Receiving provider recommendations was significantly associated with increased maternal influenza vaccine uptake (AOR = 15.50; 95% CI 14.51-16.55). The associations were significant for all racial/ethnic groups, with the highest among NH-Asians (AOR = 22.04; 95% CI 17.88-27.16) and the lowest among NH Other non-Whites (AOR = 11.07; 95% CI 8.25-14.86). Within NH-Asians, effectiveness among Chinese was highest (AOR = 29.39; 95% CI 18.10-47.71). CONCLUSIONS Racial/ethnic disparities in maternal influenza vaccine uptake and receiving vaccine recommendations from healthcare providers persisted. Further studies on the racial/ethnic disparities in maternal vaccination were warranted and tailored strategies are required to reduce this health disparity.
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Affiliation(s)
- Shuai Xie
- School of Public Health, Brown University, Providence, RI, USA.
| | | | - Annie Gjelsvik
- School of Public Health, Brown University, Providence, RI, USA
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Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
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Calderón-Mora J, Lara H, Hernandez B, Molokwu J. Factors Affecting Completion of Human Papillomavirus Vaccination Series by Gender in a Predominantly Hispanic Border Town Community. J Low Genit Tract Dis 2023; 27:161-167. [PMID: 36951986 DOI: 10.1097/lgt.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES The human papillomavirus (HPV) vaccine is recommended for females and males aged 9 to 45. Nationally, the HPV vaccination rates are lower for males than females; however, this has not been studied in a US-Mexico border community. Our study aims to report the HPV vaccination completion by gender and determine which sociodemographic factors influence vaccination. METHODS This cross-sectional study was conducted among uninsured and underinsured individuals aged between 9 and 26 years served through a community-based HPV vaccine program in El Paso, TX. Data collected included demographic information, psychosocial variables, and vaccine administration data. Descriptive statistics were used to summarize demographic data. Unadjusted t test/Fisher exact test and multivariable relative risk regression were run on significant variables to determine the association with vaccine completion by gender. RESULTS Most participants were female (63.4%), and an overall vaccine series completion was 30.67%. We found no significant difference in HPV vaccine completion rates by gender. Males who resided in the United States for more than a decade were 31% more likely to complete the vaccine series, and females who had 9 to 13 years of education had lower odds of vaccine completion. Knowledge significantly increased after the intervention for both genders (p = .002). There was no significant change in psychosocial variables from the preintervention to the immediate postintervention survey. CONCLUSIONS Our multicomponent, culturally tailored intervention may equally impact male and female participants and encourages all genders to complete their HPV vaccine series. Additional studies with a larger male sample are needed.
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Affiliation(s)
- Jessica Calderón-Mora
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Hatty Lara
- Department of Psychology, University of Arizona College of Science, Tucson, AZ
| | - Blanca Hernandez
- Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX
| | - Jennifer Molokwu
- Department of Family and Community Medicine, Cancer Prevention and Control, Department of Molecular and Translational Medicine, Center of Emphasis for Cancer, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX
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Kaddas HK, Ramsay JM, Ou JY, Fair D, Kepka D, Kirchhoff AC. HPV Vaccination Initiation and Completion Among Pediatric, Adolescent, and Young Adult Cancer Survivors and a Comparison Population Sample Receiving Primary Care. J Pediatr Hematol Oncol 2023; 45:e236-e243. [PMID: 36219685 PMCID: PMC9974526 DOI: 10.1097/mph.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) vaccinations can reduce pediatric, adolescent, and young adult (PAYA) cancer survivors' susceptibility to HPV-related subsequent cancers. We examined differences in HPV vaccination initiation and completion among a Utah-based cohort of PAYA cancer survivors and a cancer-free population sample. Participants received primary care at 1 of 2 health care systems during study follow-up: 2006-2016. Vaccination records were identified from these health care systems, statewide vaccination records, and an all-payer claims database. HPV vaccination initiation (1 dose) and completion (3 doses) were compared between cancer survivors (N=1579) and age-matched and sex-matched cancer-free population sample (N=4513). Individuals were 9 to 21 years old at cohort entry. Mixed-effects Poisson regression estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Relative to the population sample, cancer survivors were less likely to initiate vaccination (IRR=0.8, 95% CI: 0.73-0.98). The most severe disparity compared with the population sample for vaccine initiation (IRR=0.5, 95% CI: 0.31-0.74) or completion (IRR=0.5, 95% CI: 0.28-0.89) was observed for Hispanic survivors. PAYA cancer survivors are less likely to initiate HPV vaccination series than noncancer counterparts. Targeted interventions should be directed at PAYA survivors to raise HPV vaccination with emphasis on high-risk groups such as Hispanic survivors.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Douglas Fair
- Department of Pediatrics, University of Utah
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah
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Galvin AM, Garg A, Griner SB, Moore JD, Thompson EL. Health Literacy Correlates to HPV Vaccination Among US Adults Ages 27-45. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:349-356. [PMID: 35022987 PMCID: PMC8754534 DOI: 10.1007/s13187-021-02123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 06/01/2023]
Abstract
Human papillomavirus (HPV) vaccination is now available for adults aged 27-45 as a shared clinical decision. Health literacy skills (i.e., accessing, understanding, appraising, applying information) may facilitate vaccine decision-making for adults with a provider recommendation. This study assessed associations between health literacy skills and willingness to get a provider-recommended HPV vaccine among newly eligible US adults. In 2020, US participants (51% women), aged 27-45 years, were surveyed online (n = 691). The outcome was willingness (willing/not willing) to get the HPV vaccine with provider recommendation. Measures were adapted from Sørensen's multidimensional European Health Literacy Scale, which assesses health literacy among four domains (i.e., access, understanding, appraisal, application). Adjusted odds ratios were calculated for the outcome and each health literacy domain, adjusting for personal health determinants (e.g., age, sex). The sample consisted of primarily non-Hispanic (91.2%), White (74.4%), and married (60.7%) adults. Approximately 65% of participants were willing to get a provider-recommended HPV vaccine. Higher willingness to vaccinate with provider recommendation was significantly associated with increased HPV knowledge (understanding; aOR = 1.13, 95% CI 1.04, 1.24), ability to understand HPV information (understanding; aOR = 1.96, 95% CI 1.09, 3.52), increased perceived vulnerability to HPV-related cancer (appraising; aOR = 3.22, 95% CI 1.83, 5.69), and the need for more information on vaccine safety to seek vaccination (applying; aOR = 3.25; 95% CI 2.05, 5.16). Utilizing a multidimensional health literacy framework to evaluate facilitators to HPV vaccination uptake among adults aged 27-45 can help guide future interventions by targeting accurate, easy-to-understand HPV information that connects vaccination efficacy to reduction in HPV cancer risk.
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Affiliation(s)
- Annalynn M. Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107 USA
| | - Ashvita Garg
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX USA
| | - Stacey B. Griner
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107 USA
| | - Jonathan D. Moore
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX USA
| | - Erika L. Thompson
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX USA
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Villalona S, Villalona S, Reinoso D, Sukhdeo S, Stroup AM, Ferrante JM. Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin. Cancer Control 2023; 30:10732748231218088. [PMID: 38015627 PMCID: PMC10685781 DOI: 10.1177/10732748231218088] [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: 05/15/2023] [Revised: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers. OBJECTIVE The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S. METHODS We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis. RESULTS There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers. CONCLUSION Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.
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Affiliation(s)
- Seiichi Villalona
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daisy Reinoso
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Simone Sukhdeo
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Antoinette M. Stroup
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jeanne M. Ferrante
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Abouelella DK, Canick JE, Barnes JM, Rohde RL, Watts TL, Adjei Boakye E, Osazuwa-Peters N. Human papillomavirus vaccine uptake among teens before and during the COVID-19 pandemic in the United States. Hum Vaccin Immunother 2022; 18:2148825. [PMID: 36484115 PMCID: PMC9762824 DOI: 10.1080/21645515.2022.2148825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
It is unclear how the COVID-19 pandemic impacted human papillomavirus (HPV) vaccine uptake and which sociodemographic groups may have been most impacted. We aimed to assess differences in HPV vaccine uptake (initiation and completion) before and during the pandemic in the United States. We conducted a cross-sectional study using data from the 2019 to 2020 National Immunization Surveys - Teen (NIS-Teen), comparing vaccine initiation and completion rates in 2019 vs. 2020, based on confirmed reports by a healthcare provider. Weighted logistic regression analysis estimated odds of vaccine initiation and completion for both adolescent and parental characteristics. There were 18,788 adolescents in 2019 and 20,162 in 2020. There was 3.6% increase in HPV vaccine initiation (71.5% vs. 75.1%) and a 4.4% in completion (54.2% vs. 58.6%) rates from 2019 to 2020. In 2020, Non-Hispanic White teens were significantly less likely to initiate (aOR = 0.62, 95% CI: 0.49, 0.79) and complete (aOR = 0.71, 95% CI: 0.58, 0.86) vaccine uptake compared with non-Hispanic Black teens. Additionally, teens who lived above the poverty line were also less likely to initiate HPV vaccination (aOR = 0.63, 95% CI: 0.49, 0.80) or complete them (aOR = 0.73, 95% CI: 0.60, 0.90), compared to those who lived below the poverty line. During the COVID-19 pandemic in 2020, some historically advantaged socioeconomic groups such as those living above the poverty line were less likely to receive HPV vaccine. The impact of the pandemic on HPV vaccine uptake may transcend traditional access to care factors.
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Affiliation(s)
- Dina K. Abouelella
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Rebecca L. Rohde
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tammara L. Watts
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA,Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA,Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA,Duke Cancer Institute, Duke University, Durham, NC, USA,Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA,CONTACT Nosayaba Nosa Osazuwa-Peters Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South Yellow Zone 4074C DUMC 3805, Durham, NC27710-4000, USA
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Ayres S, Gee A, Kim S, Hashibe M, Praag A, Kaiser D, Chang CP, Brandt HM, Kepka D. Human Papillomavirus Vaccination Knowledge, Barriers, and Recommendations Among Healthcare Provider Groups in the Western United States. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1816-1823. [PMID: 34236651 PMCID: PMC8745488 DOI: 10.1007/s13187-021-02047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
This study compared human papillomavirus (HPV) vaccination occurrences on the same day as provider recommendations at clinics in the Western United States stratified by healthcare provider groups. In addition, the relationships between provider groups' perceived challenges associated with HPV vaccination, HPV vaccination knowledge, HPV recommendation practices, and same-day HPV vaccinations and recommendations are described. Eligible participants included pediatric healthcare providers and staff with influence on patient/parental-level decisions regarding HPV vaccination. Participants filled out a 40-question survey. Results for study participants (N = 99) showed providers reported a higher number of challenges limiting HPV vaccination, higher HPV vaccination knowledge, and more favorable HPV vaccination recommendation practices compared to other healthcare team members (OTM) suggesting providers may have a better overall understanding of the HPV vaccination climate than OTMs. Clinics should examine OTMs' training, expectations, and opportunities to increase the frequency and strength of HPV vaccination recommendations to adolescent patients and parents.
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Affiliation(s)
- Shauna Ayres
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Alexandra Gee
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Seungmin Kim
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aisha Praag
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Danielle Kaiser
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital, St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Charde SH, Warbhe RA. Human Papillomavirus Prevention by Vaccination: A Review Article. Cureus 2022; 14:e30037. [DOI: 10.7759/cureus.30037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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Ryan GW, Perry SS, Scherer A, Charlton ME, Ashida S, Gilbert PA, Askelson N. Factors contributing to missed opportunities for human papillomavirus vaccination among adolescents, ages 11 to 13, in Iowa. Vaccine X 2022; 11:100192. [PMID: 35864862 PMCID: PMC9294328 DOI: 10.1016/j.jvacx.2022.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Rates of human papillomavirus (HPV) vaccination remain low and missed opportunities for HPV vaccination are widespread. Researchers have identified factors related to HPV vaccination, but less is known about missed opportunities. Methods We used medical claims data from a large Midwestern insurance provider to explore relationships between adolescent and provider characteristics and missed opportunities for HPV vaccination. We stratified models by initiation status with adolescents who had received one or more HPV vaccinations in one group (n = 6,123) and adolescents with no record of an HPV vaccination in the other (n = 8,107). Results There were significant differences in comparisons of all variables between initiators and non-initiators. Notably, non-initiators had lower rates of vaccination for HPV and other adolescent vaccinations, and fewer well-child visits. For all adolescents, birth year, having other recommended vaccines, and number of well-child visits were significantly associated with missed opportunities. Additionally, among initiators, pediatrician as a primary care provider and being in a rural area were significantly associated. Discussion Overall, adolescents with greater healthcare utilization had more missed opportunities, indicating that, despite increased numbers of visits, providers are not taking advantage of these opportunities to vaccinate. Future research should prioritize developing a deeper understanding of why these missed opportunities are occurring and implementing new and existing strategies to prevent them. Reducing missed opportunities will help to prevent future HPV-related cancers and the significant morbidity and mortality that they can cause.
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Affiliation(s)
- Grace W. Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
- Corresponding author at: 368 Plantation St., Worcester, MA 01605, United States.
| | - Sarah S. Perry
- Department of Biostatistics, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Aaron Scherer
- Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City IA, 52242, United States
| | - Mary E. Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Paul A. Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
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Gopalani SV, Sedani AE, Janitz AE, Clifton SC, Peck JD, Comiford A, Campbell JE. Barriers and Factors Associated with HPV Vaccination Among American Indians and Alaska Natives: A Systematic Review. J Community Health 2022; 47:563-575. [PMID: 35201544 PMCID: PMC9167249 DOI: 10.1007/s10900-022-01079-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
American Indian and Alaska Native (AI/AN) persons bear a disproportionate burden of human papillomavirus (HPV)-associated cancers and face unique challenges to HPV vaccination. We undertook a systematic review to synthesize the available evidence on HPV vaccination barriers and factors among AI/AN persons in the United States. We searched fourteen bibliographic databases, four citation indexes, and six gray literature sources from July 2006 to January 2021. We did not restrict our search by study design, setting, or publication type. Two reviewers independently screened the titles and abstracts (stage 1) and full-text (stage 2) of studies for selection. Both reviewers then independently extracted data using a data extraction form and undertook quality appraisal and bias assessment using the modified Mixed Methods Appraisal Tool. We conducted thematic synthesis to generate descriptive themes. We included a total of 15 records after identifying 3017, screening 1415, retrieving 203, and assessing 41 records. A total of 21 unique barriers to HPV vaccination were reported across 15 themes at the individual (n = 12) and clinic or provider (n = 3) levels. At the individual level, the most common barriers to vaccination-safety and lack of knowledge about the HPV vaccine-were each reported in the highest number of studies (n = 9; 60%). The findings from this review signal the need to develop interventions that target AI/AN populations to increase the adoption and coverage of HPV vaccination. Failure to do so may widen disparities.
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Affiliation(s)
- Sameer V Gopalani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA.
| | - Ami E Sedani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Ashley Comiford
- Cherokee Nation Public Health, Cherokee Nation, Tahlequah, OK, 74464, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
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Lindsay AC, Delgado D, Valdez MJ, Restrepo E, Guzman YM. "I don't Think He Needs the HPV Vaccine Cause Boys Can't Have Cervical Cancer": a Qualitative Study of Latina Mothers' (Mis) Understandings About Human Papillomavirus Transmission, Associated Cancers, and the Vaccine. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:370-378. [PMID: 32654037 DOI: 10.1007/s13187-020-01824-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States and etiologically linked to several types of cancers including the cervix, vulva, vagina, penis, anus, and oropharynges. Evidence indicates certain types of HPV-associated cancers disproportionally affect Latinos in the United States. This qualitative study sought to explore Latina mothers' perceptions and understanding of HPV infection, HPV-associated cancers, and the HPV vaccination for their adolescent sons and daughters. Twenty-two individual, face-to-face interviews were conducted in 2018-2019 with mothers who had at least one child between the ages of 11 and 19 years. Data were analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Two major themes emerged from the analysis: (1) mothers' (mis) understanding about HPV infection transmission and HPV-associated cancer risk for girls and boys, and (2) mothers' (mis) understandings about the HPV vaccination for girls and boys. Results found that most mothers had inadequate understanding of HPV transmission, HPV-associated cancer risk for males, and need to vaccinate boys against the virus for their own personal health and prevention of HPV-associated cancers. Findings suggest that interventions should focus on improving Latina mothers' understanding of HPV transmission, addressing the lack or inadequate knowledge about HPV-associated cancer risk for males, as well as misconceptions about the importance of the HPV vaccination for males for their personal health and the prevention of HPV-associated cancers. Future research should quantify Latino parents' awareness, knowledge, and acceptability of the HPV vaccine for their sons and daughters.
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Affiliation(s)
- Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Denisse Delgado
- College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Madelyne J Valdez
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Emily Restrepo
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Yessica M Guzman
- Department of Public Policy and Public Affairs, McCormack Graduate School of Policy and Global Studies, University of Massachusetts-Boston, Boston, MA, USA
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Darville-Sanders G, Reinoso H, MacInnes J, Lefrancois-Gijzen E, Munroe D, Mathis M, Madden S, Hamrick J, Dickerson L, Gaddis C. An Interdisciplinary Approach to Scale Development- HPV Vaccine Communication Competency for Medical Trainees (Preprint). JMIR Form Res 2022; 6:e38164. [DOI: 10.2196/38164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
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14
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, McDonald JA, Fish LJ, Williams C, Walter EB. Predictors of HPV vaccination in the southern US: A survey of caregivers from 13 states. Vaccine 2021; 39:7485-7493. [PMID: 34742592 PMCID: PMC8685535 DOI: 10.1016/j.vaccine.2021.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
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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 Dr, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA; South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Sayward E Harrison
- South Carolina Smart State Center for Healthcare Quality, 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, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA
| | - Jodi-Ann McDonald
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, 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 Dr, Durham, NC 27710, USA; Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA; Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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15
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La EM, Garbinsky D, Hunter S, Poston S, Novy P, Ghaswalla P. National and State-Level Composite Completion of Recommended Vaccines Among Adolescents in the United States, 2015-2018. J Adolesc Health 2021; 69:762-768. [PMID: 34518068 DOI: 10.1016/j.jadohealth.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Routine adolescent vaccination recommendations in the United States include tetanus, diphtheria, and acellular pertussis, quadrivalent meningococcal conjugate vaccine, and human papillomavirus vaccines. Although coverage for these individual vaccines is known, limited data are available on composite completion for all three vaccines. METHODS This cross-sectional analysis of pooled 2015-2018 National Immunization Survey-Teen data used logistic regression to estimate model-adjusted composite vaccination completion nationally and by state among United States adolescents aged 17 years. National Immunization Survey-Teen data were combined with state-level data to estimate a multilevel model identifying factors associated with composite vaccination completion. RESULTS The pooled model-adjusted composite vaccination completion was 30.6% (95% confidence interval [CI], 30.13%-31.04%) nationally, varying from 11.3% in Idaho (6.91%-17.95%) to 56.4% (49.81%-62.82%) in Rhode Island. Individual-level factors with the greatest impact on composite completion were having a provider's recommendation for human papillomavirus vaccination (odds ratio, 3.24; 95% CI, 2.76-3.80) and a check-up visit at age 16-17 years (odds ratio, 2.35; 95% CI, 1.80-3.07), with other individual-level factors associated with completion including being Medicaid insured, female, Hispanic, or non-Hispanic black. State-level quadrivalent meningococcal conjugate vaccination mandates were also associated with an increased likelihood of composite vaccination completion (odds ratio, 1.64; 95% CI, 1.16-2.33). CONCLUSIONS Fewer than one-third of 17-year-old individuals have completed all three recommended vaccines, with rates varying by state. Although this study identified implementable strategies to improve composite completion, additional research is needed to further understand factors associated with adolescent vaccination completion.
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Affiliation(s)
| | - Diana Garbinsky
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Shannon Hunter
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Sara Poston
- GlaxoSmithKline, Philadelphia, Pennsylvania.
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16
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Shin H, Jeon S, Cho I, Park H. Factors affecting human papillomavirus (HPV) vaccination in men: A systematic literature review (Preprint). JMIR Public Health Surveill 2021; 8:e34070. [PMID: 35471242 PMCID: PMC9092232 DOI: 10.2196/34070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023] Open
Abstract
Background Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. Objective The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. Methods A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. Results In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. Conclusions To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination.
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Affiliation(s)
- Hyunjeong Shin
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Songi Jeon
- Department of Nursing, Catholic Kwandong University, Gangneung, Republic of Korea
| | - Inhae Cho
- College of Nursing, Korea University, Seoul, Republic of Korea
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17
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Harrison SE, Yelverton V, Wang Y, Ostermann J, Fish LJ, Williams CL, Vasudevan L, Walter EB. Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ). Am J Health Behav 2021; 45:810-827. [PMID: 34702429 PMCID: PMC8900988 DOI: 10.5993/ajhb.45.5.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the second factor captured perceptions of gender differences in HPV infection and vaccine recommendations. The 13-item scale and 2-factor solution displayed strong internal consistency and good model fit. Parents of vaccinated adolescents scored higher on the 13-item HPV-KQ (Mean = 8.56) than parents of unvaccinated adolescents (Mean = 6.43) (p < .001). In regression models, controlling for key covariates, parents' performance on the HPV-KQ predicted adolescent HPV vaccination (p < .001). Conclusions: Evaluation indicates the HPV-KQ is a reliable and valid tool for measuring knowledge of HPV and the HPV vaccine among parents residing in the southern US. We recommend further efforts to validate the scale with other populations.
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Affiliation(s)
- Sayward E Harrison
- Sayward E Harrison, Department of Psychology, University of South Carolina, Columbia, SC, and South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States;,
| | - Valerie Yelverton
- Valerie Yelverton, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Yunfei Wang
- Yunfei Wang, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, United States
| | - Jan Ostermann
- Jan Ostermann, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Laura J Fish
- Laura J Fish, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Cancer Institute, Durham, NC, United States
| | - Charnetta L Williams
- Charnetta L Williams, Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lavanya Vasudevan
- Lavanya Vasudevan, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Global Health Institute, Durham, NC, United States
| | - Emmanuel B Walter
- Emmanuel B Walter, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, Duke Global Health Institute, Durham, NC, and Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
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18
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Tung WC, Lin Y, Chao HW, Chen Y. HPV vaccination, information sources, and acculturation among Chinese college students aged 18-26 in the United States. Res Nurs Health 2021; 45:194-204. [PMID: 34549448 DOI: 10.1002/nur.22185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022]
Abstract
Human papillomavirus (HPV) vaccination behaviors among Chinese college students (CCS) in the United States are affected by social determinants of health. Using a self-report questionnaire and a snowball sampling technique, this cross-sectional study investigated (a) HPV vaccination practices; (b) primary social networking platforms and preferred means of receiving HPV information; and (c) the influence of acculturation on HPV vaccination, HPV information sources, and social networking use among 213 CCS aged 18-26 in the United States. About half (50.7%) had received one to three doses of an HPV vaccine, and 91.7% had received their first dose. The most popular social networking platforms were WeChat (69.5%), Instagram (58.7%), text messaging (55.4%), and Facebook (47.4%). Preferred means of receiving future HPV information included the internet, online social networking, and health professionals. Participants with high Asian identification (AI) were less likely to receive the HPV vaccine than those with high Western identification. Participants with high AI were more likely to use WeChat for their social networking but less likely to use US-based social media platforms. Acculturation, preferred social networking platforms, and sources and communication of HPV (i.e., health professionals, family members, schoolteachers, friends) influenced participants' HPV vaccination. To promote equity of access to health messages and increase HPV vaccination, future efforts should pay attention to CCS with high AI and incorporate their cultural beliefs and practices. Given that nonprofessionals (e.g., family, friends) were influential factors in HPV vaccination, it is critical to tailor interventions for CCS to the recipients and their social circles.
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Affiliation(s)
- Wei-Chen Tung
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California, USA
| | - Yuting Lin
- College of Nursing, Seattle University, Seattle, Washington, USA
| | - Hannah W Chao
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California, USA
| | - Yinghan Chen
- Department of Mathematics and Statistics, University of Nevada-Reno, Reno, Nevada, USA
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19
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Kong WY, Bustamante G, Pallotto IK, Margolis MA, Carlson R, McRee AL, Gilkey MB. Disparities in Healthcare Providers' Recommendation of HPV Vaccination for U.S. Adolescents: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2021; 30:1981-1992. [PMID: 34426414 DOI: 10.1158/1055-9965.epi-21-0733] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 01/19/2023] Open
Abstract
Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future interventions, we sought to characterize disparities in health care providers' HPV vaccine recommendation for U.S. adolescents. We systematically reviewed studies published in 2012-2019 that assessed provider HPV vaccine recommendations for adolescents aged 9-17. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified 52 eligible studies and used a standardized abstraction form to assess recommendation prevalence by adolescent demographic characteristics. Studies consistently found that fewer parents of boys than girls reported receiving HPV vaccine recommendations (14 studies, range of difference: -11 to -35 percentage points). Studies also found fewer recommendations for adolescents who were younger (2 studies, -3% to -12% points), non-White (3 studies, -5% to -7% points, females only), lower income (3 studies, -1% to -8% points), or uninsured (1 study, -21% points, males only). Studies identified geographic disparities in southern and rural areas. In conclusion, findings from this systematic review identify disparities in HPV vaccine recommendation that may contribute to suboptimal vaccine uptake. Efforts to improve providers' HPV vaccine communication should focus on increasing recommendation consistency, especially for lower-income, non-White, and rural adolescents.
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Affiliation(s)
- Wei Yi Kong
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriela Bustamante
- Medical School, University of Minnesota, Minneapolis, Minnesota.,School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Isabella K Pallotto
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marjorie A Margolis
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca Carlson
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Melissa B Gilkey
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Nasserie T, Bendavid E. Systematic identification and replication of factors associated with human papillomavirus vaccine initiation among adolescents in the United States using an environment-wide association study approach. Sex Transm Infect 2021; 98:203-209. [PMID: 34039744 DOI: 10.1136/sextrans-2021-054976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/08/2021] [Accepted: 04/25/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccination coverage is low among adolescents in the USA. Identification of factors associated with HPV vaccine initiation (receipt of ≥1 dose) is critical for improving uptake. Our objective was to systematically investigate all eligible factors available in a nationally representative sample of adolescents to identify drivers of HPV vaccine initiation using a novel methodological approach. METHODS We performed multiple cross-sectional analyses using data from the adolescent component of the National Immunization Surveys (NIS)-Teen between 2014 and 2019. Study participants were parents or caregivers of adolescents aged 13-17 years. Exposure variables measured sociodemographic and geographical characteristics, health conditions and healthcare provision. We tested the association between each factor and HPV vaccine initiation using univariate logistic regression and multivariate logistic regression adjusted for mother's age, mother's education level, mother's marital status, poverty status and adolescent's sex. We validated findings for each type of analysis within surveys, between surveys (across years 2014-2019) and across several subgroups (age, sex, poverty status and race/ethnicity). RESULTS Six factors were replicated in the multivariate analysis. Most replicated factors characterised the role of healthcare providers and healthcare-seeking behaviours. After adjustment, provider HPV recommendation remained the most strongly associated with HPV vaccine initiation (2019 NIS-Teen: OR 13.4, 95% CI 11.3 to 17.3, p<0.001). The variance explained by a full model including replicated factors was 0.39. CONCLUSIONS This is the first study to explore the association between all available factors in the NIS-Teen and HPV vaccine initiation in a systematic manner. Our study suggests that healthcare-seeking behaviours and interactions with the health system may be drivers of HPV vaccine initiation and warrant further study. Addressing these factors could improve the rate of HPV vaccine initiation among adolescents in the USA.
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Affiliation(s)
- Tahmina Nasserie
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Eran Bendavid
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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21
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Mansfield LN, Vance A, Nikpour JA, Gonzalez-Guarda RM. A systematic review of human papillomavirus vaccination among US adolescents. Res Nurs Health 2021; 44:473-489. [PMID: 33860541 DOI: 10.1002/nur.22135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/07/2022]
Abstract
The human papillomavirus (HPV) causes many anogenital and oral cancers affecting young adults in the United States. Vaccination during adolescence can prevent HPV-associated cancers, but vaccine uptake among adolescents is low and influenced by factors serving as barriers and facilitators to HPV vaccination. In this systematic review, we synthesized research using the socioecological framework model to examine individual-level, relationship-level, community-level, and societal-level factors that influence HPV vaccine initiation and completion among US adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the methodology for this review. An electronic search was conducted in January 2020 using PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest Central, Scopus, and American Psychological Association PsycInfo databases. The Joanna Briggs Institute tools were used to assess the quality for the 57 studies included in this review. The most consistent influences of HPV vaccination included age at vaccination, awareness, and knowledge about HPV vaccination, socioeconomic status, insurance status, race/ethnicity, and preventative care behaviors at the individual level. Provider recommendation, familial/peer support of vaccination, and parental health behaviors were influences at the relationship level. Although fewer findings elucidated community-level and societal-level influences, high-poverty areas, high-risk communities with large proportions of racial/ethnic minority groups, healthcare facilities servicing children, and combined health policies appear to serve as facilitators of HPV initiation and completion. Findings from this review can inform culturally relevant and age-specific interventions and multi-level policies aiming to improve HPV vaccination coverage in the United States.
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Affiliation(s)
- Lisa N Mansfield
- School of Nursing, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine and Health Services Research, National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Ashlee Vance
- Institute for Healthcare Policy and Innovation, National Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
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22
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Lama Y, Quinn SC, Nan X, Cruz-Cano R. Social media use and human papillomavirus awareness and knowledge among adults with children in the household: examining the role of race, ethnicity, and gender. Hum Vaccin Immunother 2020; 17:1014-1024. [PMID: 33121331 DOI: 10.1080/21645515.2020.1824498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Though human papillomavirus (HPV) vaccination is a safe and effective method of protecting against associated cancers, uptake rates remain low among adolescents. Few studies have examined how social media use contributes to HPV-related knowledge gaps among parents and caregivers. OBJECTIVE To investigate the association between social media use and HPV-related awareness and knowledge with a focus on differences by gender and race/ethnicity among a nationally representative sample of adults with children in the household. METHODS We used data from the Health Information National Trends (HINTS) Survey (2017-2019) (N = 2,720). Multivariate logistic regressions were used to examine the association of social media use on HPV awareness and knowledge outcomes. RESULTS Compared to non-users, engaging in one, two, three, or four social media behaviors were associated with greater HPV awareness (aOR: 2.09; 95%CI: 1.18-3.70, aOR: 2.49; 95%CI: 1.40-4.42, aOR: 2.64; 95%CI: 1.15-6.05, and aOR: 2.44; 95%CI: 1.11-5.36, respectively). Increased social media use was associated with increased HPV vaccine awareness. Men, African American, Hispanic, and Asian American respondents were less likely to be aware of HPV or HPV vaccine. Social media use was not associated with cancer knowledge. CONCLUSIONS Increased social media use is associated with an increased awareness of HPV and HPV vaccine for adults with children in the household. Social media-based efforts can be utilized to increase knowledge of the benefits of HPV vaccination as cancer prevention, which may be a precursor to reducing HPV vaccine hesitancy and encouraging uptake to decrease cancer incidence rates among vulnerable populations.
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Affiliation(s)
- Yuki Lama
- Department of Family Science, University of Maryland, College Park, MD, USA
| | | | - Xiaoli Nan
- Department of Communication, University of Maryland, College Park, MD, USA
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
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23
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Gopalani SV, Sedani AE, Janitz AE, Clifton SC, Stoner J, Peck J, Comiford A, Salvatore AL, Campbell J. HPV vaccination and Native Americans: protocol for a systematic review of factors associated with HPV vaccine uptake among American Indians and Alaska Natives in the USA. BMJ Open 2020; 10:e035658. [PMID: 32895265 PMCID: PMC7478049 DOI: 10.1136/bmjopen-2019-035658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/06/2020] [Accepted: 07/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The nine-valent human papillomavirus (HPV) vaccine could prevent an estimated 92% of the cancers attributable to HPV types targeted by the vaccine. However, uptake of the HPV vaccine among American Indian and Alaska Native (AI/AN) adolescents has been low. AI/ANs also bear a disproportionate burden of cervical and other HPV-associated cancers. Increasing HPV vaccination rates is a national priority, but reviews and national surveys on HPV vaccination factors are lacking for the AI/AN population. The objective of this systematic review is to assess factors associated with HPV vaccination among AI/ANs in the USA. METHODS AND ANALYSIS A systematic review is proposed to synthesise the current literature on HPV vaccination factors in AI/ANs from 1 July 2006 until 30 September 2019. As applicable, controlled vocabulary terms, keywords and special features (eg, limits, explode and focus) will be incorporated into database searches. To maximise the identification of relevant studies, citation indexes and databases that index dissertations, preprints and grey literature are included. Studies will be screened and selected independently in two stages. In stage 1, titles and abstracts will be screened. In stage 2, full-text articles will be screened and selected. A data extraction form and quality assessment tool will be piloted, revised and implemented. If available, measures of frequency and association will be presented. A narrative synthesis of the included studies will also be undertaken and reported. ETHICS AND DISSEMINATION As our review will use publicly available data and publications, an Institutional Review Board review will not be required. We will disseminate the findings from this review through peer-reviewed publication(s) and conference presentation(s). POTENTIAL AMENDMENTS In the event of amendments to the protocol, we will provide the date, rationale, and description of the change for each amendment. PROSPERO REGISTRATION NUMBER CRD42020156865.
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Affiliation(s)
- Sameer Vali Gopalani
- Department of Epidemiology and Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ami E Sedani
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Julie Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Peck
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ashley Comiford
- Community Health Promotion, Cherokee Nation, Tahlequah, Oklahoma, USA
| | - Alicia L Salvatore
- Value Institute, Christiana Care Health Services, Wilmington, Delaware, USA
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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24
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Yoo W, Koskan A, Scotch M, Pottinger H, Huh WK, Helitzer D. Patterns and Disparities in Human Papillomavirus (HPV) Vaccine Uptake for Young Female Adolescents among U.S. States: NIS-Teen (2008-2016). Cancer Epidemiol Biomarkers Prev 2020; 29:1458-1467. [PMID: 32345710 DOI: 10.1158/1055-9965.epi-19-1103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/09/2019] [Accepted: 04/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several studies have reported differential vaccine uptake outcomes that are associated with sociodemographic and socioeconomic characteristics, as well as provider type. However, none has examined a trend over a multiple-year span. In this study, we utilize a longitudinal data-based approach to examine state-level human papillomavirus (HPV) vaccine trends and their influences over time. METHODS We analyzed National Immunization Survey - Teen data (2008-2016) to estimate HPV vaccine initiation rate in young female adolescent ages 13-17 years old among U.S. States. We identified growth patterns using the latent class growth method and explored state-level characteristics, including socioeconomic and sociodemographic attributes, and health legislation and policy-related programs among patterns. RESULTS We identified three growth patterns, which showed gradually increasing vaccination trends but different baseline HPV uptake rates (high, moderate, low). States within Pattern 1 (highest HPV vaccination rates) included the lowest percentage of families with incomes below federal poverty level, the highest percentage of bachelor's degree or higher, and the lowest number of uninsured, while states within Pattern 3 (lowest HPV vaccination rates) included families with socioeconomic attributes along the opposite end of the spectrum. CONCLUSIONS Latent class growth models are an effective tool to be able to capture health disparities in heterogeneity among states in relation to HPV vaccine uptake trajectories. IMPACT These findings might lead to designing and implementing effective interventions and changes in policies and health care coverage to promote HPV vaccination uptake for states represented under the lowest trajectory pattern.
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Affiliation(s)
- Wonsuk Yoo
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Alexis Koskan
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Heidi Pottinger
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
| | - Warner K Huh
- Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Helitzer
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Central American Immigrant Parents' Awareness, Acceptability, and Willingness to Vaccinate Their Adolescent Children Against Human Papillomavirus: A Pilot Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082869. [PMID: 32326320 PMCID: PMC7215825 DOI: 10.3390/ijerph17082869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022]
Abstract
Despite increasing interest in understanding the factors influencing awareness and acceptability of the human papillomavirus (HPV) vaccine among Latino parents, to date limited information is available specific to Central American parents living in the United States (US). Therefore, this pilot cross-sectional study was designed to explore and assess Central American immigrant parents’ awareness, acceptability, and willingness to vaccinate their children against HPV, and interest in participating in future HPV-associated cancer prevention study. Fifty-six Central American parents, majority immigrant (96.4%; n = 54) from four countries, El Salvador—50% (n = 27); Guatemala—25.9% (n = 14); Honduras—22.2% (n = 12); and Panama—1.9% (n = 1) participated in this study. Participants completed an interviewer-administered questionnaire survey in their preferred language (i.e., Spanish or English). A little over half of the participants were mothers (57.1%; n = 32) and parents’ mean age was 43.2 years (SD = 6.4). The majority was married or cohabitating (76.8%, n = 43), and 39.3% (n = 22) reported having two children. Seventy-five percent (n = 42) of parents reported they had heard of the HPV vaccine. Fewer fathers were aware of the HPV vaccine (58.3%; n = 14 vs.87.5%, n = 28; p = 0.01) than mothers. Among parents who had heard of the HPV vaccine (n = 42), 85.7% (n = 36) reported their children had received at least one dose of the HPV vaccine. Fewer fathers reported their child had been vaccinated against HPV (64.3%, n = 9 vs. 96.4%, n = 27; p = 0.06) than mothers. Moreover, 90% of parents (n = 18) whose children were unvaccinated reported willingness to vaccinate their adolescent children against HPV if recommended by their child’s physician. Findings indicate parents’ low to moderate awareness of the HPV vaccine, and high willingness to vaccinate their adolescent children if recommended by their child’s physician. Findings also demonstrate fathers’ lower awareness and acceptability of the HPV vaccine than mothers. Despite limitations and the need for more research, findings of this pilot study serve as a valuable first step toward building a knowledge foundation that is needed for developing future studies and interventions targeting Central American immigrant parents living in the US. Future studies can build on the findings of this exploratory study with other research designs and address its limitations by having a larger sample size and accounting for additional factors associated with Central American immigrant parents’ HPV awareness, knowledge, beliefs, attitudes, and vaccine acceptability from other communities across the US.
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26
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Marchand-Ciriello L, Foustoukos A, Collins Fantasia H. Intervention to Increase Human Papillomavirus Vaccine Initiation Rates in Adolescent Males. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Teferra AA, Keller-Hamilton B, Roberts ME, Reiter PL. HPV Vaccine Coverage among Adolescent Males in Ohio: Results of a Longitudinal Study. OHIO JOURNAL OF PUBLIC HEALTH 2019; 2:15-23. [PMID: 36147558 PMCID: PMC9491334 DOI: 10.18061/ojph.v2i2.9030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine has been recommended for males in the United States since 2011, yet little is known about vaccine coverage among adolescent males in Ohio. Our longitudinal study examined HPV vaccine coverage among adolescent males in Ohio and identified predictors of vaccination. METHODS The Buckeye Teen Health Study recruited adolescent males ages 11-16 and their parents from one urban county and nine rural counties in Ohio. We report longitudinal vaccination data on 1126 adolescent males, with baseline data from 2015-2016 and follow-up data from 2017-2018. We used multivariable Poisson regression to identify predictors of HPV vaccine initiation that occurred between baseline and follow-up. RESULTS At baseline, 42.4% of parents reported their sons had initiated the HPV vaccine series. Among parents whose sons were unvaccinated at baseline, 36.3% indicated initiation at follow-up. Initiation at follow-up was more common among sons who had received influenza vaccine (RR = 1.54, 95% CI = 1.08-2.18) or whose parents indicated lack of a recent visit to a doctor as the main reason for not yet vaccinating at baseline (RR = 1.41, 95% CI = 1.02-1.95). Initiation was less common among sons whose parents had an associate's degree or some college education (RR = 0.28, 95% CI = 0.46-0.99). Main reasons for not vaccinating changed from baseline to follow-up among parents of unvaccinated sons. CONCLUSIONS Although HPV vaccine initiation increased over time, many adolescent males in Ohio remain unvaccinated. Findings can help guide future strategies for increasing HPV vaccine coverage among this population.
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Affiliation(s)
- Andreas A. Teferra
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | | | - Megan E. Roberts
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Paul L. Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
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28
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Walker TY, Elam-Evans LD, Williams CL, Fredua B, Yankey D, Markowitz LE, Stokley S. Trends in human papillomavirus (HPV) vaccination initiation among adolescents aged 13-17 by metropolitan statistical area (MSA) status, National Immunization Survey - Teen, 2013 - 2017. Hum Vaccin Immunother 2019; 16:554-561. [PMID: 31662024 PMCID: PMC7227639 DOI: 10.1080/21645515.2019.1671765] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Disparities in HPV vaccination coverage by metropolitan statistical area (MSA) status were observed in the 2016 and 2017 National Immunization Survey – Teen (NIS-Teen). In 2017, HPV vaccination initiation (≥1dose) coverage was 11 percentage points lower for adolescents living in non-MSAs (mostly rural areas) and 7 percentage points lower among those living in MSA, non-principal cities (suburban areas) compared to those living in MSA, principal cities (mostly urban areas). In order to understand how this disparity has changed over time, we examined trends in HPV vaccine initiation by MSA status from 2013 to 2017. Weighted linear regression by survey year was used to estimate annual percentage point changes in HPV vaccination initiation. The five-year average annual percentage point increases in HPV vaccination initiation coverage were 5.2 in mostly urban areas, 4.9 for suburban areas, and 5.2 for mostly rural areas. Despite increases in each MSA area, coverage in mostly rural areas was consistently and significantly lower than coverage in mostly urban areas. Coverage was significantly lower among teens living in mostly rural areas regardless of poverty status, sex, and race/ethnicity except among black, non-Hispanic adolescents. There was no significant change in the magnitude of the disparity between mostly urban areas and mostly rural areas over time (p = .98). A better understanding of the facilitators and barriers to HPV vaccination in mostly rural areas is needed to identify and implement targeted strategies to improve HPV vaccination coverage and reduce these disparities.
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Affiliation(s)
- Tanja Y Walker
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division
| | - Laurie D Elam-Evans
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division
| | - Charnetta L Williams
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division
| | | | - David Yankey
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Atlanta, GA, USA
| | - Shannon Stokley
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division
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Adjei Boakye E, Zeng W, Governor S, Nagendra S, Tobo BB, Simpson MC, Osazuwa-Peters N. Differences in human papillomavirus (HPV) vaccine uptake by nativity status among men aged 18-34 years. Prev Med Rep 2019; 16:101010. [PMID: 31799106 PMCID: PMC6883324 DOI: 10.1016/j.pmedr.2019.101010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/01/2019] [Accepted: 10/20/2019] [Indexed: 12/27/2022] Open
Abstract
Only 1 in 11 men had initiated and 1 in 30 men had completed the HPV vaccine series. Immigrants from Indian subcontinent had the lowest HPV vaccination rates. Foreign-born men who reported US citizenship had higher rates of HPV vaccination rates. Foreign-born men had lower odds of having initiated the HPV vaccination compared with US-born men.
Annually, about 16,500 HPV-associated cancers occur in the US among men. Data regarding HPV vaccine uptake among men based on nativity status (i.e., US-versus foreign-born) is limited, yet potentially important for informing interventions. We assessed differences in HPV vaccine uptake by nativity status among men aged 18–34 years in the US. The 2014–2017 National Health Interview Survey was examined for men, aged 18–34 years (n = 14,056). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of three doses. Weighted, multivariable binary logistic regression models were used to assess the association between nativity status and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare factors. Analyses were performed in July 2018. Overall, 17% of men self-identified as foreign-born, 9.9% of men had initiated the HPV vaccine, and 3.3% had completed the HPV vaccine. Among foreign-born men, Asians had the highest HPV vaccination rates whereas those from Indian subcontinental region had the lowest rates. After accounting for demographic, socioeconomic, and healthcare factors, compared to US-born men, foreign-born men were 46% (adjusted odds ratio = 0.54; 95% CI = 0.39–0.72) less likely to initiate the HPV vaccine but there was no difference between the two groups in terms of vaccine completion. We found that HPV vaccine uptake among men was very low overall, and foreign-born men had lower initiation compared to US-born men. Public health interventions which improve HPV vaccination need to be developed for all men, irrespective of nativity status.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.,Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Wenhui Zeng
- Department of Chemistry, College of Arts and Sciences, Saint Louis University, Saint Louis, MO, USA
| | - Samuel Governor
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Shreya Nagendra
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | | | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA.,Saint Louis University Cancer Center, Saint Louis, MO, USA
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30
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Williams CL, Walker TY, Elam-Evans LD, Yankey D, Fredua B, Saraiya M, Stokley S. Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey-Teen, 2016-2017. Hum Vaccin Immunother 2019; 16:562-572. [PMID: 31584312 PMCID: PMC7227662 DOI: 10.1080/21645515.2019.1670036] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The 2016 and 2017 National Immunization Surveys-Teen (NIS-Teen) highlighted disparities in human papillomavirus (HPV) vaccination coverage by metropolitan statistical area (MSA) status. Coverage with ≥1 dose of HPV vaccine was significantly lower among teens in suburban and mostly rural areas than it was among those in mostly urban areas. Reasons underlying this disparity are poorly understood; this analysis sought to identify sociodemographic factors associated with not initiating the HPV vaccine series and to determine whether these factors differed by MSA status. Using NIS-Teen data for a sample of 41,424 adolescents from the 2016 and 2017 survey years, multivariate logistic regression was utilized to assess associations between various sociodemographic factors and non-initiation of the HPV vaccine series by MSA status. Adjusted prevalence ratios and 95% confidence intervals are reported. A secondary analysis assessed missed opportunities for HPV vaccination by MSA status and estimated what coverage could be if these missed opportunities had not occurred. Most factors associated with not receiving HPV vaccine were similar across all three MSAs, including living in the South, having a mother with some college education, not having an 11–12-year-old well-child visit, and not receiving a provider recommendation for vaccination. Others were associated with non-initiation of the HPV vaccine series in only specific MSAs. Teens in suburban areas (82.2%) were more likely to miss opportunities for HPV vaccination than those in mostly urban (79.3%) areas. Coverage with ≥1 dose of HPV vaccine in all three MSAs would be substantially higher if these missed opportunities had been eliminated.
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Affiliation(s)
- Charnetta L Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tanja Y Walker
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center For Chronic Disease Prevention & Health Promotion, CDC, Atlanta, GA, USA
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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31
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Lee YY, Wang Z. Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China. PLoS One 2019; 14:e0209942. [PMID: 30625211 PMCID: PMC6326499 DOI: 10.1371/journal.pone.0209942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Attendees of sexually transmitted diseases (STD) clinics could also benefit from HPV vaccination. Healthcare providers’ recommendation is the most effective published method in motivating HPV vaccination initiation. This study was to investigate practice of recommending HPV vaccination to attendees among healthcare providers (doctors and nurses) working in public STD clinics in Hong Kong, China. Method Participants were medical doctors, registered nurses and enrolled nurses working in all eight public STD clinics in Hong Kong. All of them (29 doctors and 82 nurses) were approached by telephone. A self-administered questionnaire was mailed to them. A total of 98 completed questionnaires were received (28 doctors and 70 nurses). The study was conducted during January to May, 2018. Using recommendation of HPV vaccination to any attendees in the last year as the dependent variable, univariate and multiple logistic regression models were fitted. Results In the last 12 months, 16.3% and 36.7% of the participants had recommended HPV vaccination to any male attendees and to any female attendees of their clinics; 41.8% had recommended it to either male or female attendees. Adjusting for significant background variables (professions and years of working experience in the clinic), three constructs of the Theory of Planned Behavior were significantly associated with the dependent variable in expected directions. They were: 1) the Positive Attitude Scale (adjusted odds ratios, AOR: 1.20, 95%CI: 1.02, 1.41), 2) the Negative Attitude Scale (AOR: 0.85, 95%CI: 0.77, 0.94), and 3) the Perceived Behavioral Control Scale (AOR: 1.37, 95%CI: 1.08, 1.75). Conclusion STD clinics are ideal settings that allow healthcare providers to access individuals who are at high-risk of HPV infection and promote HPV vaccination. Health promotion targeting these healthcare providers is warranted to enhance their perceived importance of recommending HPV vaccination. Such promotion should modify their attitudes and perceived behavioral control related to recommending HPV vaccination to attendees.
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Affiliation(s)
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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