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Pratt R, Barsness CB, Lin J, Desai J, Fordyce K, Ghebre R, Hassan F, Ibrahim A, Ramer T, Szpiro A, Weiner BJ, Xiong S, Yohe S, Winer RL. Integrating HPV self-collect into primary care to address cervical cancer screening disparities. Prev Med Rep 2024; 38:102599. [PMID: 38292027 PMCID: PMC10825356 DOI: 10.1016/j.pmedr.2024.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Human papillomavirus (HPV) self-collect shows promise to increase cervical cancer screening rates in underscreened populations, such as Somali patients, but little is known about how to integrate such an approach in primary care. In this study, primary care providers and staff who provide primary care services to Somali women were asked for their views on integrating HPV self-collect into routine care to address cervical cancer screening disparities. Thirty primary care providers and staff participated in semi-structured interviews exploring their views on HPV self-collect and their anticipated needs or barriers to implementing this approach into the clinic generally and with specific patient populations, such as Somali women. A thematic analysis using the constructivist version of grounded theory was undertaken. Providers and staff anticipate positive patient reaction to the option of HPV self-collect, and were interested in using this approach both for Somali patients and for all patients in general. HPV self-collect was viewed as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting primary HPV testing and HPV self-collect specifically, sharing concerns about effectiveness of self-collect and the lack of a physical exam. Providers felt clinic-wide staff education and patient education, along with strategies to address disparities, such as cultural and linguistic tailoring would be needed for successful implementation. Integrating HPV self-collect as an option in the cervical cancer screening process in a primary care clinical encounter offers considerable opportunity to address health disparities and may benefit all patients.
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Biswas MR, Shah Z. Extracting factors associated with vaccination from Twitter data and mapping to behavioral models. Hum Vaccin Immunother 2023; 19:2281729. [PMID: 38013461 PMCID: PMC10760324 DOI: 10.1080/21645515.2023.2281729] [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: 03/07/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
Social media platform, particularly Twitter, is a rich data source that allows monitoring of public opinions and attitudes toward vaccines.Established behavioral models like the 5C psychological antecedents model and the Health Belief Model (HBM) provide a well-structured framework for analyzing shifts in vaccine-related behavior. This study examines if the extracted data from Twitter contains valuable insights regarding public attitudes toward vaccines and can be mapped to two behavioral models. This study focuses on the Arab population, and a search was carried out on Twitter using: ' تلقيحي OR تطعيم OR تطعيمات OR لقاح OR لقاحات' for two years from January 2020 to January 2022. Then, BERTopicmodeling was applied, and several topics were extracted. Finally, the topics were manually mapped to the factors of the 5C model and HBM. 1,068,466 unique users posted 3,368,258 vaccine-related tweets in Arabic. Topic modeling generated 25 topics, which were mapped to the 15 factors of the 5C model and HBM. Among the users, 32.87%were male, and 18.06% were female. A significant 55.77% of the users were from the MENA (Middle East and North Africa) region. Twitter users were more inclined to accept vaccines when they trusted vaccine safety and effectiveness, but vaccine hesitancy increased due to conspiracy theories and misinformation. The association of topics with these theoretical frameworks reveals the availability and diversity of Twitter data that can predict behavioral change toward vaccines. It allows the preparation of timely and effective interventions for vaccination programs compared to traditional methods.
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Affiliation(s)
- Md. Rafiul Biswas
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Zubair Shah
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Widdershoven V, Reijs RP, Eskes A, Verhaegh-Haasnoot A, Hoebe CJPA. Maternal pertussis vaccination behavior: Psychosocial, attitudinal and organizational factors. Vaccine 2023; 41:7469-7475. [PMID: 37951791 DOI: 10.1016/j.vaccine.2023.11.013] [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: 05/27/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND In December 2019, the maternal pertussis vaccination (MPV) became part of the Dutch National Immunization Program. This study aims to study MPV behavior and associated psychosocial, attitudinal and organizational factors of pertussis vaccination behavior during pregnancy in the Netherlands. METHODS We conducted a cross-sectional survey among pregnant women and recent mothers, up to six months post-partum. The primary outcome measure of this study was MPV behavior. Associations between psychosocial, attitudinal and organizational factors and MPV behavior were assessed using univariate and multivariate binary logistic regression analysis. RESULTS In total 1348 participants filled out the questionnaire, including 1282 (95.1%) MPV acceptors and 66 (4.9%) MPV refusers. The most important factors associated with MPV behavior were: attitude (aOR: 10.19; 95%CI: 4.30-24.16), outcome expectations (aOR: 8.94; 95%CI: 3.60-22.21), omission bias (aOR: 0.11; 95%CI: 0.02-0.59) and physical accessibility (aOR: 7.44; 95%CI: 3.37-16.46). CONCLUSION Pregnant women make their decision about the MPV primarily based on attitudinal and psychosocial factors, such as outcome expectations and attitude. A combination and variation of different messages, about the advantages (effectiveness) and disadvantages (side effects) of maternal vaccination, can be used in reaching pregnant women with a positive and negative attitude about the MPV. In addition, strategies to increase MPV uptake should not only focus on providing information, but also decrease experienced practical barriers, such as poor physical accessibility, in people that are intended to receive the MPV but are not getting vaccinated.
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Affiliation(s)
- Veja Widdershoven
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, PO Box 33, 6400 AA Heerlen, the Netherlands.
| | - Rianne P Reijs
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Youth Health Care, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
| | - Annika Eskes
- Department of Youth Health Care, Public Health Service Hollands Noorden, Alkmaar, the Netherlands
| | - Amanja Verhaegh-Haasnoot
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, PO Box 33, 6400 AA Heerlen, the Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, PO Box 33, 6400 AA Heerlen, the Netherlands; Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, the Netherlands
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Jin SW, Lee Y, Lee S, Jin H, Brandt HM. Factors Associated with College Students' Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study. Vaccines (Basel) 2023; 11:1124. [PMID: 37376513 DOI: 10.3390/vaccines11061124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Human papillomavirus (HPV) vaccination protects against six types of cancer-cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18-26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students' perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population.
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Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, Memphis, TN 38152, USA
- Department of Medical Humanities and Social Science, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Media Arts, Yonsei University, Seoul 03722, Republic of Korea
| | - Yeonggeul Lee
- Social Science Research, University of Seoul, Seoul 02504, Republic of Korea
| | - Sohye Lee
- Loewenberg College of Nursing, The University of Memphis, Memphis, TN 38152, USA
| | - Haeun Jin
- Northside Hospital Duluth, Duluth, GA 30096, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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Jin SW, Lattimore DC, Harlin E, Davis L, Erholtz V, Brandt HM. Medical and public health professionals' perceived facilitators and barriers of human papillomavirus (HPV) vaccination among African American adolescents in Shelby County, Tennessee. BMC Health Serv Res 2023; 23:469. [PMID: 37165427 PMCID: PMC10173571 DOI: 10.1186/s12913-023-09415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/12/2023] Open
Abstract
Human papillomavirus (HPV) infects nearly 85% of sexually active Americans during their lifetime, causing most cervical and five other cancers. Routine HPV vaccination is recommended for adolescents to prevent HPV-attributable cancers, but HPV vaccination coverage remains low, especially in Tennessee. In 2021, 54.6% of the population in Shelby County, Tennessee was Black or African American, reporting higher rates of new cervical cancer cases than other counties in Tennessee. While medical and public health professionals (HPs) play a critical role in promoting vaccination coverage, little is known about the factors HPs perceive to influence HPV vaccination for this population. This study sought to explore HPs' perceived facilitators and barriers of HPV vaccination among African American adolescents. Qualitative individual interviews with 26 HPs in Shelby County were conducted between October 2019 and February 2020. Interpretive content analysis of the interview data guided by the socio-ecological model revealed several important themes regarding the facilitators and barriers across the individual, interpersonal, and community levels. At the individual level, parental vaccine hesitancy emerged as a leading barrier to HPV vaccination, while appropriate education facilitated the vaccination. At the interpersonal level, a lack of strong provider recommendations impeded HPV vaccination, whereas improved communication skills with patients facilitated the vaccination. Finally, the community-level barriers included a lack of education and social/religious norms; the community-level facilitators included community outreach efforts. HPs should consider development of comprehensive community-based approaches that leverage the facilitators and barriers at multiple levels to increase HPV vaccination among African American adolescents in this region.
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Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA.
- Department of Medical Humanities and Social Science, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Media Arts , Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | | | - Eric Harlin
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA
| | - Levonna Davis
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA
| | - Virginia Erholtz
- The University of Memphis, 226 McCord Hall, Memphis, TN, 38152, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, 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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Moore E, Bauer SC, Rogers A, McFadden V. An Opportunity in Cancer Prevention: Human Papillomavirus Vaccine Delivery in the Hospital. Hosp Pediatr 2022; 12:e157-e162. [PMID: 35419598 DOI: 10.1542/hpeds.2021-006302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Pediatric hospitalizations are a missed opportunity for delivery of the human papilloma virus (HPV) vaccination. In this study, the authors' aim was to increase HPV vaccination rates among adolescents cared for by the pediatric hospital medicine (PHM) service at our academic children's hospital. METHODS This quality improvement (QI) study included adolescents ≥13 years who were discharged from PHM. Interventions included: modification of discharge order sets to include vaccination status and provider training seminars regarding the delivery of the HPV vaccine. Follow-up materials were distributed to providers by e-mail. The primary outcome measure was adolescent HPV vaccination rates. Secondary outcome measures were adolescent meningococcal vaccination rates and accuracy of immunization status documentation. The balancing measure was length of stay (LOS). Data were collected via chart review. Statistical process control charts were used to analyze for special cause variation. RESULTS From May 2019 through February 2020, 440 patients were included in this analysis. Throughout the study, HPV and meningococcal vaccination rates increased from a baseline median of 4.6% to 21.2% and 8.3% to 26.6%, respectively. HPV vaccination was not significantly associated with sex, HPV dose due, or admitting service. Accuracy of immunization status documentation and LOS remained unchanged. CONCLUSIONS Using QI methodology we were successful in increasing HPV and meningococcal vaccination rates among hospitalized adolescents. Considering the relationship of these 2 vaccines is a potential topic of future work. Discerning the correct immunization status at time of admission may be a potential opportunity for improvement in future work.
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Affiliation(s)
| | - Sarah Corey Bauer
- Medical College of Wisconsin, Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin
| | - Amanda Rogers
- Medical College of Wisconsin, Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin
| | - Vanessa McFadden
- Medical College of Wisconsin, Department of Pediatrics, Section of Hospital Medicine, Milwaukee, Wisconsin
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Okuhara T, Ishikawa H, Ueno H, Okada H, Kato M, Kiuchi T. Readability assessment of vaccine information: A systematic review for addressing vaccine hesitancy. PATIENT EDUCATION AND COUNSELING 2022; 105:331-338. [PMID: 34090717 DOI: 10.1016/j.pec.2021.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Vaccine hesitancy is a problem attracting growing attention and concern. Communication can be an effective tool to counteract vaccine hesitancy and promote optimal vaccine uptake. Readability has been recognized as one of the more important aspects of health communication for achieving good health literacy. We reviewed studies of readability assessment in the area of vaccine communication. METHODS We conducted a systematic literature search in September 2020, using four online databases (Medline, CINAHL, PsycArticles, and PsycINFO). We included studies that assessed the readability level of online and offline vaccine information materials. RESULTS We found 12 articles that were appropriate for inclusion. Ten of the studies were published after 2016. The readability levels of the majority of the materials assessed were found to be difficult and higher than 8th-grade level. CONCLUSION Readability assessments of vaccine information are scarce. The limited evidence shows that the readability level of vaccine information supplied by health care providers is more difficult to read than recommended. More studies on the readability of vaccine information are recommended. PRACTICE IMPLICATIONS Difficulty reading vaccine information may influence attitudes toward acceptance of or hesitancy to take vaccines. It is recommended that health care professionals use guidelines and tools to create easy-to-read vaccine information.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hirono Ishikawa
- School of Public Health, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Haruka Ueno
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, 2-5-4, Higashi-ikebukuro, Toshima-ku, Tokyo 170-8445, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mio Kato
- School of Public Health, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Netfa F, King C, Davies C, Rashid H, Tashani M, Booy R, Skinner SR. Knowledge, Attitudes, and Perceptions of the Arabic-Speaking Community in Sydney, Australia, toward the Human Papillomavirus (HPV) Vaccination Program: A Qualitative Study. Vaccines (Basel) 2021; 9:vaccines9090940. [PMID: 34579177 PMCID: PMC8473026 DOI: 10.3390/vaccines9090940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Little is known about acceptability of the human papillomavirus (HPV) vaccine among parents of adolescents from culturally and linguistically diverse backgrounds in Australia. This study aimed to explore the knowledge and attitudes of parents from Arabic backgrounds towards HPV vaccination offered to their children in the national school-based vaccination program. Methods: Qualitative interviews were conducted in Western Sydney, with parents of adolescents from Arabic backgrounds. Recruitment was via informal personal contacts and passive snowballing. Face-to-face semi-structured interviews were conducted in Arabic. These were audio-recorded, transcribed, and translated into English. Thematic analysis was used to identify emerging themes. Results: Commonly identified themes across fifteen interviews included: (1) lack of awareness and knowledge of HPV and its vaccination, (2) awareness and understanding of the government vaccination information sheet, (3) parents’ preferences for information provision, (4) the role of parents’ religious beliefs in forming attitudes about HPV vaccination, and (5) lost opportunities to educate parents about HPV vaccination during general practitioner (GP) visits. Conclusion: The findings point to the need to address cultural, language, and communication barriers to improve awareness and acceptability of HPV vaccination in the Arabic community. Educational strategies should be tailored to this community based on their specific information needs and preferences.
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Affiliation(s)
- Faeza Netfa
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Correspondence: or ; Tel.: +61-2-9351-2222; Fax: +61-29845-1418
| | - Catherine King
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Faculty of Medicine, University of Tripoli, Tripoli 13275, Libya
| | - Robert Booy
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - S. Rachel Skinner
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
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Reñosa MDC, Wachinger J, Bärnighausen K, Aligato MF, Landicho-Guevarra J, Endoma V, Landicho J, Bravo TA, Demonteverde MP, Guevarra JR, de Claro Iii N, Inobaya M, Adam M, Chase RP, McMahon SA. How can human-centered design build a story-based video intervention that addresses vaccine hesitancy and bolsters vaccine confidence in the Philippines? A mixedmethod protocol for project SALUBONG. BMJ Open 2021; 11:e046814. [PMID: 34108166 PMCID: PMC8190986 DOI: 10.1136/bmjopen-2020-046814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Since the onset of a dengue vaccine controversy in late 2017, vaccine confidence has plummeted in the Philippines, leading to measles and polio outbreaks in early 2019. This protocol outlines a human-centered design (HCD) approach to co-create and test an intervention that addresses vaccine hesitancy (VH) via narrative and empathy with and among families and healthcare workers. METHODS AND ANALYSIS: 'Salubong' is a Filipino term that means to welcome someone back into one's life, reinforcing notions of family ties and friendships. We apply this sentiment to vaccines. Following the phases of HCD, guided by a theoretical framework, and drawing from locally held understandings of faith and acceptance, we will conduct in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Filipino communities that witnessed dramatic increases in measles cases in recent years. During qualitative engagements with caretakers, providers, and policymakers, we will collect narratives about family and community perceptions of childhood vaccinations, public health systems and opportunities to restore faith. IDIs and FGDs will continuously inform the development of (and delivery mechanisms for) story-based interventions. Once developed, we will test our co-created interventions among 800 caretakers and administer a VH questionnaire prior to and immediately following the intervention encounter. We will use the feedback gained through the survey and Kano-style questionnaires to further refine the intervention. Considering the data collection challenges posed by the ongoing COVID-19 pandemic, we have developed workarounds to conduct data collection primarily online. We will use systematic online debriefings to facilitate comprehensive participation of the full research team. ETHICS AND DISSEMINATION Ethical approval has been granted by the Institutional Review Board of the Research Institute for Tropical Medicine (number 2019-44) and Ethical Commission of Heidelberg University, Faculty of Medicine (S-833/2019). Study findings will be disseminated in scientific conferences and published in peer-reviewed journals.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jerric Rhazel Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nicanor de Claro Iii
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Marianette Inobaya
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Oliveira CR, Ortiz AM, Sheth SS, Shapiro ED, Niccolai LM. Effectiveness of HPV vaccine by age at vaccination and number of doses: protocol for a population-based matched case-control study. BMJ Open 2021; 11:e043093. [PMID: 33875441 PMCID: PMC8057558 DOI: 10.1136/bmjopen-2020-043093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In 2006, the first human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration in the USA based on pre-licensure clinical trials that found it to be highly efficacious at preventing persistent infection and precancerous, high-grade cervical lesions (HGCLs) caused by viral types the vaccine protects against. However, the real-world effectiveness of HPV vaccines as used in clinical practice may be quite different from the efficacy found in pre-licensure clinical trials. More than 10 years have passed since the introduction of the vaccine programme. It is critical to determine if the full benefits of HPV are being realised in real-world settings. METHODS AND ANALYSIS The objectives of this study were to estimate the effectiveness of HPV vaccines as used in real-world clinical settings and to determine the degree to which the vaccine's effectiveness varies based on age at the time of immunisation and the number of doses received. The study will be a population-based, matched case-control study. Cases will be women with newly diagnosed HGCL associated with HPV types 16 and 18. Matched controls will be women with a normal Pap test result, matched individually to cases in a 2:1 ratio by age, a practice and date of testing. Medical records will be reviewed to determine dates of receipt of the HPV vaccine for all participants. We will use multivariate conditional logistic regression to control for potential confounders. ETHICS AND DISSEMINATION This protocol presents minimal risk to the subjects. This protocol has received approval from the Institutional Review Board of Yale University (HIC: 1502015308), and a Health Insurance Portability and Accountability Act (HIPAA) Waiver of Authorisation has been granted to allow investigators to recruit subjects for the study. Findings will be disseminated through peer-reviewed, open-access scientific journals and conference presentations.
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Affiliation(s)
- Carlos R Oliveira
- Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sangini S Sheth
- Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eugene D Shapiro
- Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Linda M Niccolai
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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13
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Emerson A, Allison M, Saldana L, Kelly PJ, Ramaswamy M. Collaborating to offer HPV vaccinations in jails: results from a pre-implementation study in four states. BMC Health Serv Res 2021; 21:309. [PMID: 33827560 PMCID: PMC8028758 DOI: 10.1186/s12913-021-06315-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Correctional facilities are an underutilized venue for reaching young adults who have not vaccinated for human papillomavirus (HPV). The objective of this study was to identify factors that are associated with jail and local health department (LHD) interest in partnering to offer HPV vaccinations to young adults in jail. METHODS Consolidated framework for implementation research (CFIR)-guided surveys were conducted with jail administrators in Iowa, Kansas, Missouri, and Nebraska, September 2017-October 2018. Jail survey data were analyzed using chi square distribution and relative risk regression. Using data from sister surveys conducted with LHD administrators in the same counties (results previously reported), we identified characteristics of counties in which both the jail and LHD indicated interest in collaborating to offer HPV vaccinations in the jail. RESULTS Jail survey response was 192/347 (55.3%). Surveys with LHDs yielded 237/344 (68.9%) responses. Eleven communities were identified where both the jail and LHD expressed interest. Only "any vaccines provided in jail" predicted shared interest (RR: 5.36; CI: 2.52-11.40; p < .01). For jail administrators, offering other vaccines was 3 times (CI:1.49-6.01; p < .01) and employing a nurse 1.65 times more likely (CI: 1.20-2.28; p < .01) to predict interest in collaborating to offer HPV vaccination. Open-ended responses indicated that managing linkages and stakeholder investment were areas of emphasis where collaborations to provide vaccinations in the jails had been previously implemented. CONCLUSIONS Interest in jail-LHD partnerships to provide HPV vaccinations in jails exists in the Midwest but will require building-out existing programs and linkages and identifying and strengthening shared values, goals, and benefits at all levels.
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Affiliation(s)
- Amanda Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
| | - Molly Allison
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, 66506, USA
| | - Lisa Saldana
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, Oregon, 97401, USA
| | - Patricia J Kelly
- Jefferson School of Nursing, Thomas Jefferson University, Center City Campus, 901 Walnut Street, 8th Floor, Philadelphia, PA, 19107, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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14
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Bernard-Genest MP, Ruel-Laliberté J, Lapointe-Milot K. Effect of educative reminder telephone calls on human papillomavirus immunization rate: A randomized controlled trial. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211003821. [PMID: 33779417 PMCID: PMC8010846 DOI: 10.1177/17455065211003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Human papillomavirus coverage varies widely among women depending on their race, incomes, geographical location and education level. OBJECTIVE To evaluate whether reminder educative phone calls increase human papillomavirus vaccination rates in adult women aged 18-45 with high-risk factors of cervical cancer. DESIGN We conducted a single-blind randomized controlled trial in patients who consulted at a Canadian tertiary center in October 2019 during National Cervical Cancer Awareness Week. INTERVENTIONS We randomized women to receive three standardized educative phone calls or standard care. MAIN OUTCOME MEASURE We assessed the immunization rate at 6 months. RESULTS A total of 130 patients were randomized of which 62 patients were randomized to the intervention. Eight patients (15.4%) got immunized at 6 months in the intervention group as compared to seven (11.7%) in the control group (p = 0.5645). The main barrier to vaccination reported by non-immunized patients at 6 months was the cost of vaccination (42.3%). CONCLUSION Reminder educative phone calls did not increase human papillomavirus vaccination rates in adult women with risk factors of cervical cancer.ISRCTN registration number: ISRCTN58518971.
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Affiliation(s)
| | - Jessica Ruel-Laliberté
- Jessica Ruel-Laliberté, Department of Obstetrics & Gynaecology, Division of Gynecologic Oncology, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - Korine Lapointe-Milot
- Department of Obstetrics & Gynaecology, Division of Gynecologic Oncology, Université de Sherbrooke, Sherbrooke, QC, Canada
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Khan MS, Savoy M. Impact of Human Papillomavirus Vaccination in Reducing Cancer. Prim Care 2020; 47:529-537. [DOI: 10.1016/j.pop.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Lee HY, Beltran R, Kim NK, Lee DK. Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women. Cancer Nurs 2020; 42:458-467. [PMID: 30624249 DOI: 10.1097/ncc.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students. OBJECTIVE This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework. METHODS Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey. RESULTS Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests. CONCLUSION Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students. IMPLICATION FOR PRACTICE Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group-specific preventive care.
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Affiliation(s)
- Hee Yun Lee
- Author Affiliations: School of Social Work, University of Alabama, Tuscaloosa (Dr Lee); and School of Social Work (Ms Beltran), Department of Educational Psychology (Mr Kim), and School of Medicine (Mr Lee), University of Minnesota, Twin Cities
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Scarinci IC, Hansen B, Kim YI. HPV vaccine uptake among daughters of Latinx immigrant mothers: Findings from a cluster randomized controlled trial of a community-based, culturally relevant intervention. Vaccine 2020; 38:4125-4134. [PMID: 32354671 DOI: 10.1016/j.vaccine.2020.03.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We examined the efficacy of a culturally relevant, community-based HPV vaccination intervention among Latinx immigrant mothers with daughters aged 9-12 in Alabama. METHODS We conducted a cluster-randomized controlled trial with "place of residence" (e.g., apartment complexes, trailer parks) as the unit of randomization that evaluated two interventions: 1) promotion of HPV vaccination and 2) promotion of healthy eating and appropriate nutrition label interpretation. Identical baseline/post/7-month follow up questionnaires were completed by all participants and both interventions consisted of four group sessions and one individual session. A total of 40 locations were randomized with 317 mother-daughter dyads enrolled in the study between May 2013 and October 2017. RESULTS A total of 278 mother-daughter dyads met full eligibility and initiated the intervention/control participation. Retention rate overall was 93.2% (92.6% for the intervention arm and 93.7% for the control arm). Daughters in the intervention arm were significantly more likely to receive one, two, and three doses of HPV vaccine than daughters in the control arm p < 0.001). In multivariate analyses, mothers in the intervention arm had a six times greater odds of vaccinating daughters with the first dose (OR = 5.96, 95% CI: 3.38, 10.49), eight times greater odds of vaccinating daughters with the second dose (OR = 8.09, 95% CI: 4.0, 16.35), and more than 16 times greater odds of completing the three-dose HPV vaccine series than mothers in the control arm after adjusting for mother's age, time in the U.S., income, and daughter's health insurance status (OR = 16.5, 95% CI: 5.73, 47.48). Only perceived risk of their daughters' future HPV infection remained significant as a predictor of three-dose HPV vaccination completion (OR = 0.69, 95% CI: 0.23, 2.1). CONCLUSIONS A theory-driven, culturally-relevant intervention developed through extensive formative assessments in collaboration with community members can effectively promote HPV vaccination among 9-12 years of age daughters of Latina immigrants.
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Affiliation(s)
- Isabel C Scarinci
- University of Alabama at Birmingham, Division of Preventive Medicine, 1717 11th Ave South, Birmingham, AL 35205, United States.
| | - Barbara Hansen
- University of Alabama at Birmingham, Division of Preventive Medicine, 1717 11th Ave South, Birmingham, AL 35205, United States.
| | - Young-Il Kim
- University of Alabama at Birmingham, Division of Preventive Medicine, 1717 11th Ave South, Birmingham, AL 35205, United States.
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Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening. J Immigr Minor Health 2019; 22:87-95. [DOI: 10.1007/s10903-019-00881-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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The human papilloma vaccine: A time for NP leadership. Nurse Pract 2018; 43:49-55. [PMID: 29927817 DOI: 10.1097/01.npr.0000534943.29252.6f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The human papilloma virus (HPV) causes approximately 30,700 annual cancer cases of the cervix, vulva, vagina, penis, oral cavity, and anus. Nurse practitioners can use their unique relationships with patients to advocate for the HPV vaccine. The purpose of this article is to update NPs on current knowledge regarding the HPV vaccine while providing appropriate information necessary for counseling patients and parents.
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Chhabra R, Chisolm DJ, Bayldon B, Quadri M, Sharif I, Velazquez JJ, Encalada K, Rivera A, Harris M, Levites-Agababa E, Yin HS. Evaluation of Pediatric Human Papillomavirus Vaccination Provider Counseling Written Materials: A Health Literacy Perspective. Acad Pediatr 2018; 18:S28-S36. [PMID: 29502634 DOI: 10.1016/j.acap.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/19/2017] [Accepted: 08/05/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective. METHODS A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations. Materials were assessed for the following: 1) readability (Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Fry), 2) suitability (understandability and actionability) (Suitability Assessment of Materials; Patient Education Materials Assessment Tool for Printable Materials), and 3) coverage of 8 key content areas (recommended by Centers for Disease Control and Prevention). Semistructured interviews were conducted with English-speaking parents or caregivers of children 9 to 17 years of age from 3 pediatric clinics (New York, Ohio, Illinois) serving predominantly low-income families to assess perceptions and usefulness of 4 handouts selected for review. RESULTS Thirty-eight documents were assessed. Mean ± standard deviation (SD) reading grade level was 9.4 ± 2; 10.5% (n = 4) had a reading level of 6th grade or below; 68.4% (n = 26) were considered not suitable. Mean understandability was 41.7% and mean actionability was 20.7%. Only 5.3% (n = 2) addressed all 8 content areas mean ± SD (number of areas = 6.7 ± 1.2). Brochure comprehensiveness and inclusion of a personal story were cited as factors that would be helpful in influencing parents to vaccinate against HPV. CONCLUSIONS Few written materials for HPV vaccination counseling were optimal from a health literacy best practices perspective. Content comprehensiveness was important for informed decision making.
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Affiliation(s)
- Rosy Chhabra
- Department of Pediatrics, Albert Einstein College of Medicine/Montefiore, Bronx, NY.
| | - Deena J Chisolm
- The Ohio State University Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Barbara Bayldon
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Maheen Quadri
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Iman Sharif
- Department of Pediatrics, Sunset Park Family Health Center, NYU Langone, Brooklyn, NY
| | - Jessica J Velazquez
- Department of Pediatrics, NYU School of Medicine-Bellevue Hospital, New York, NY
| | - Karen Encalada
- Department of Pediatrics, NYU School of Medicine-Bellevue Hospital, New York, NY
| | - Angelic Rivera
- Department of Pediatrics, Albert Einstein College of Medicine/Montefiore, Bronx, NY
| | - Millie Harris
- The Ohio State University Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | | | - H Shonna Yin
- Department of Pediatrics, NYU School of Medicine-Bellevue Hospital, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY
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Reno JE, O'Leary S, Garrett K, Pyrzanowski J, Lockhart S, Campagna E, Barnard J, Dempsey AF. Improving Provider Communication about HPV Vaccines for Vaccine-Hesitant Parents Through the Use of Motivational Interviewing. JOURNAL OF HEALTH COMMUNICATION 2018; 23:313-320. [PMID: 29474117 DOI: 10.1080/10810730.2018.1442530] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Human papillomavirus (HPV) vaccine uptake is below that of other routine adolescent vaccines. This is due in part to the fact that the HPV vaccine is often not routinely recommended by providers to all eligible adolescents. While providers' recommendations are crucial, even a strongly stated recommendation can be insufficient among HPV vaccine-hesitant parents. Providers must be prepared to respond to parental concerns following giving the recommendation for the HPV vaccine. This paper presents the analysis of implementation of an intervention aimed at improving provider communication with HPV vaccine-hesitant parents. Healthcare providers and staff at eight pediatric and family medicine clinics received communication training that included motivational interviewing (MI) techniques. Process evaluation in the form of serial surveys, as well as program evaluation in the form of focus groups with participating providers and staff, assessed the perceived efficacy of the intervention. Outcomes included time spent discussing the HPV vaccine during clinical visits, providers' self-efficacy for addressing parental HPV vaccine hesitancy, and their general perceptions of the effectiveness of MI techniques. Overall, findings indicate the intervention improved providers' communication with HPV vaccine-hesitant parents and providers reported the use of MI played a central role in improved HPV vaccine acceptance. Lessons learned and recommendations for future interventions are also discussed.
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Affiliation(s)
- Jenna E Reno
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Sean O'Leary
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Kathleen Garrett
- b Department of Behavioral & Behavioral Health , University of Colorado Denver , USA
| | - Jennifer Pyrzanowski
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Steven Lockhart
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Elizabeth Campagna
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Juliana Barnard
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
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Beltran R, Simms T, Lee HY, Kwon M. HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity. J Community Health 2018; 41:603-11. [PMID: 26696118 DOI: 10.1007/s10900-015-0135-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.
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Affiliation(s)
- Raiza Beltran
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
| | - Tina Simms
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Melissa Kwon
- Asian American Studies, University of Minnesota, Twin Cities, 778 Social Sciences Building 267 - 19th Avenue South, Minneapolis, MN, 55455, USA
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Otanez S, Torr BM. Ethnic and Racial Disparities in HPV Vaccination Attitudes. J Immigr Minor Health 2017; 20:1476-1482. [DOI: 10.1007/s10903-017-0685-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McDonald YJ, Goldberg DW, Scarinci IC, Castle PE, Cuzick J, Robertson M, Wheeler CM. Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico. J Rural Health 2017; 33:382-392. [PMID: 27557124 PMCID: PMC5939944 DOI: 10.1111/jrh.12202] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. METHODS Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect. FINDINGS Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001). CONCLUSION Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
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Affiliation(s)
- Yolanda J McDonald
- Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas
| | - Daniel W Goldberg
- Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas
- Department of Computer Science & Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, Texas
| | - Isabel C Scarinci
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmigham, Alabama
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Michael Robertson
- Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Cosette M Wheeler
- Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Maertens JA, Jimenez-Zambrano AM, Albright K, Dempsey AF. Using Community Engagement to Develop a Web-Based Intervention for Latinos about the HPV Vaccine. JOURNAL OF HEALTH COMMUNICATION 2017; 22:285-293. [PMID: 28276945 DOI: 10.1080/10810730.2016.1275890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV) infection is pervasive among sexually active women and men, and Hispanic women are at particularly high risk as they have higher rates of invasive cervical cancer compared to other racial or ethnic groups in the United States. There is a need for interventions to increase HPV vaccination among this high-risk population. This study investigated how to modify a previously developed web-based intervention that provided individually tailored information about HPV to improve its use among the Latino population. A community-oriented modification approach incorporated feedback from a community advisory committee, and focus groups among the Latino population, to modify the intervention. Several themes emerged including a need for basic information about HPV and HPV vaccination, changes to make the intervention appear less clinical, and incorporation of information addressing barriers specific to the Latino community. This work was done in preparation for a randomized trial to assess the impact of this modified intervention on HPV vaccination attitudes and uptake among Latino young adults and parents of adolescents. If effective, our intervention could be a resource for reducing HPV vaccination concerns, improving immunization rates, and educating Latinos about HPV and the HPV vaccine outside of the time boundaries of the traditional clinical encounter.
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Affiliation(s)
- Julie A Maertens
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Andrea M Jimenez-Zambrano
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Karen Albright
- b Department of Sociology and Criminology , University of Denver , Denver , Colorado , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
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Pratt R, Mohamed S, Dirie W, Ahmed N, VanKeulen M, Ahmed H, Raymond N, Okuyemi K. Views of Somali women and men on the use of faith-based messages promoting breast and cervical cancer screening for Somali women: a focus-group study. BMC Public Health 2017; 17:270. [PMID: 28320350 PMCID: PMC5359974 DOI: 10.1186/s12889-017-4182-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening rates for breast and cervical cancer for Muslim women in the United States are low, particularly for first-generation immigrants. Interpretations of the Muslim faith represent some of the barriers for breast and cervical cancer screening. Working to understand how faith influences breast and cervical screening for Somali women, and working with the community to identify and utilize faith-based assets for promoting screening, may lead to life-saving changes in screening behaviors. METHODS We partnered with an Imam to develop faith-based messages addressing the concerns of modesty and predetermination and promoting cancer testing and screening. A total of five focus groups were convened, with 34 Somali women (three groups) and 20 Somali men (two groups). Each focus group first discussed participant views of breast and cervical cancer screening in general and then viewed and discussed video clips of the Imam delivering the faith-based messages. RESULTS Both Somali women and men had an overwhelmingly positive response to the faith-based messages promoting breast and cervical cancer screening. The faith-based messages appeared to reinforce the views of those who were already inclined to see screening positively, with participants describing increased confidence to engage in screening. For those who had reservations about screening, there was feedback that the faith-based messages had meaningfully influenced their views. CONCLUSIONS Somali immigrant women and men found faith-based messages addressing topics of predestination and modesty and encouraging the use of screening and treatment to be both acceptable and influential. Faith can play an important role as an asset to promote breast and cervical cancer screening, and there may be substantial benefits to adding faith-based messaging to other interventions that focus on improving screening uptake. This may help to address health disparities for Somali women in this area.
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Affiliation(s)
- Rebekah Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA.
| | | | - Wali Dirie
- Islamic Civil Society of America, Minneapolis, USA
| | - Nimo Ahmed
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | | | - Huda Ahmed
- Program in Health Disparities Research, University of Minnesota, Minneapolis, USA
| | - Nancy Raymond
- Powell Center for Women's Health, Department of Psychiatry, University of Minnesota, Minneapolis, USA
| | - Kola Okuyemi
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
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Human Papillomavirus Vaccination Among Adults and Children in 5 US States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21:573-83. [PMID: 26035648 DOI: 10.1097/phh.0000000000000271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT The Centers for Disease Control and Prevention Advisory Committee for Immunization Practices has recommended human papillomavirus (HPV) vaccines for use in children and young adults for preventing HPV-related diseases, but HPV vaccine coverage is low in the United States. OBJECTIVE To assess HPV vaccination among US adults and children and to identify characteristics associated with HPV vaccination. METHODS We used the 2010 Behavioral Risk Factors Surveillance System data to examine HPV vaccine initiation and completion among adults aged 18 to 26 years and children aged 9 to 17 years in 5 US states. We performed a multivariate logistic regression to evaluate factors associated with HPV vaccination. RESULTS We assessed the HPV vaccination status of 706 women and 560 men and 2201 girls and 2292 boys. In 2010, a total of 258 (41.6%) women and 21 (4.3%) men had initiated HPV vaccination. Of those vaccinated women, 182 (75%) completed the 3-dose vaccine series. Rural residence (adjusted odds ratio [aOR] = 0.37) and not having a Papanicolaou test (aOR = 0.44) were negatively associated with HPV vaccine initiation among women. Women who were aged 18 to 20 years (aOR = 2.93) were more likely to complete HPV vaccination. A total of 612 (24.6%) girls and 86 (5.2%) boys received 1 or more doses of HPV vaccines; 308 (50.3%) vaccinated girls and 14 (10.8%) vaccinated boys completed the vaccine series. Younger age (9-12 years: aOR = 0.09) and not receiving a seasonal influenza vaccine (aOR = 0.44) were negatively related to HPV vaccine initiation in girls. Girls were less likely to initiate and complete HPV vaccination if their parents did not have a routine checkup within 1 year. CONCLUSION HPV vaccination in the United States remains below the Healthy People 2020 objective (80%). To increase HPV vaccination, strategies still need to focus on improving access to HPV vaccines and utilization of health services.
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Kish JK, Rolin AI, Zou Z, Cucinelli JE, Tatalovich Z, Saraiya M, Altekruse SF. Prioritizing US Cervical Cancer Prevention With Results From a Geospatial Model. J Glob Oncol 2016; 2:275-283. [PMID: 28413829 DOI: 10.1200/jgo.2015.001677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine if differences in screening and vaccination patterns across the population may accentuate ethnic and geographic variation in future burden of disease. METHODS Using Cancer in North America data provided by the North American Association of Central Cancer Registries, county cervical cancer incidence trends from 1995 to 2009 were modeled for the entire United States using ecologic covariates. Rates for health service areas were also modeled by ethnicity. State-level incidence was mapped together with Papanicolaou (Pap) screening, past 3 years (women ≥ 18 years old), and three-dose human papillomavirus (HPV) vaccine coverage (girls 13 to 17 years old) to identify potential priority areas for preventive services. RESULTS US cervical cancer incidence decreased more during the periods 1995 to 1999 and 2000 to 2004 than during the period 2005 to 2009. During these 15 years, the most affected areas became increasingly confined to Appalachia, the lower Mississippi Valley, the Deep South, Texas, and Florida. Hispanic and black women experienced a higher incidence of cervical cancer than both white and Asian and Pacific Islander women during each period. Women in 10 of 17 states/districts with a high incidence (≥ 8.14/100,000) reported low Pap testing (< 78.5%), HPV vaccine coverage (< 33.9%), or both prevention technologies. CONCLUSION The decline in cervical cancer incidence has slowed in recent years. Access to HPV vaccination, targeted screening, and treatment in affected populations is needed to reduce cervical cancer disparities in the future.
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Affiliation(s)
| | | | - Zhaohui Zou
- Information Management Services, Silver Spring, MD
| | | | | | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, GA
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Berenson AB, Rahman M, Hirth JM, Rupp RE, Sarpong KO. A human papillomavirus vaccination program for low-income postpartum women. Am J Obstet Gynecol 2016; 215:318.e1-9. [PMID: 26899907 PMCID: PMC4988928 DOI: 10.1016/j.ajog.2016.02.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/28/2016] [Accepted: 02/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effective interventions are needed to address the low rate of human papillomavirus (HPV) vaccination in the United States, particularly among girls and women 16-26 years old. Counseling and offering the vaccine to postpartum patients could be an effective strategy to increase uptake among young women who did not complete the 3-dose series at an earlier age. OBJECTIVE The purpose of this evaluation was to assess the effectiveness of a multicomponent program designed for postpartum women that used patient navigators (PNs) and reminders for follow-up visits to improve uptake and completion of the HPV vaccine series. STUDY DESIGN As part of standard care, patients ≤26 years of age from Galveston County, Texas, who delivered an infant from November 2012 through June 2014 at a public hospital were counseled and offered the HPV vaccine postpartum. PNs assisted with scheduling follow-up injections during postpartum or well-child visits. A program evaluation was conducted after 20 months. RESULTS Of 1038 patients approached, only 161 (15.5%) had previously completed the vaccine series. Of the 877 patients who had not completed the series, 661 (75.4%) received at least 1 dose postpartum, with 575 patients receiving their first dose and 86 receiving their second or third doses. By April 2015, initiation rates had increased as a result of this program from 25.4% before the program was initiated to 80.8% and completion rates from 15.5-65.1%. Missed appointments for injections were less likely among those who received text message reminders and more likely among those with ≥2 prior pregnancies. Those who were Hispanic or had received an influenza vaccination in the last year were more likely to initiate and complete the series through this program. Patients who missed ≥1 follow-up appointments were less likely to complete the vaccine series. CONCLUSION Offering the HPV vaccine postpartum dramatically increased initiation rates among postpartum patients. PN and text messages ensured that a high percentage completed all 3 doses.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
| | - Mahbubur Rahman
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Richard E Rupp
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
| | - Kwabena O Sarpong
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
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Richards MJ, Peters M, Sheeder J. Human Papillomavirus Vaccine: Continuation, Completion, and Missed Opportunities. J Pediatr Adolesc Gynecol 2016; 29:117-21. [PMID: 26300233 DOI: 10.1016/j.jpag.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/24/2015] [Accepted: 08/14/2015] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To examine human papillomavirus (HPV) series completion in older adolescents and assess vaccination completion opportunities missed by providers. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic medical records were queried for women 18-24 years old who initiated the HPV vaccine in the Adolescent Medicine, Young Mother's, or Family Planning clinics at Children's Hospital Colorado from January 1, 2010-December 31, 2012. Clinic visits during appropriate dosing intervals of HPV vaccine at which the second (4-14 weeks after first dose) or third (21-40 weeks after first dose and >12 weeks after second dose) doses were not administered were counted as "missed opportunities." RESULTS A total of 1072 female adolescents initiated the HPV series during the study period; 20.9% completed the series within 1 year. Of these, 33.7% who did not receive their second dose had at least 1 missed opportunity and 25.5% who received the second but not the third had a missed opportunity. Women who initiated the vaccine in the Family Planning clinic were less likely to have missed opportunities than those in other adolescent clinics (36.2% vs 56.4%; P < .001). CONCLUSION A significant number of female adolescents who initiated the HPV vaccine attended clinic visits at which opportunities for vaccine continuation and completion were missed. This emphasizes the importance of provider awareness of vaccine updates at every adolescent visit. Our overall completion rate is significantly lower than published rates and might reflect older adolescents' inexperience in managing their own preventive health care. Our results clearly identify the need for provider and patient interventions to improve vaccine series completion.
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Affiliation(s)
- Molly J Richards
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Marissa Peters
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanelle Sheeder
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Moore AR, Buchanan ND, Fairley TL, Lee Smith J. Public Health Action Model for Cancer Survivorship. Am J Prev Med 2015; 49:S470-6. [PMID: 26590641 PMCID: PMC4776752 DOI: 10.1016/j.amepre.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 12/17/2022]
Abstract
Long-term objectives associated with cancer survivors have been suggested by Healthy People 2020, including increasing the proportion of survivors living beyond 5 years after diagnosis and improving survivors' mental and physical health-related quality of life. Prior to reaching these objectives, several intermediate steps must be taken to improve the physical, social, emotional, and financial well-being of cancer survivors. Public health has a role in developing strategic, actionable, and measurable approaches to facilitate change at multiple levels to improve the lives of survivors and their families. The social ecological model has been used by the public health community as the foundation of multilevel intervention design and implementation, encouraging researchers and practitioners to explore methods that promote internal and external changes at the individual, interpersonal, organizational, community, and policy levels. The survivorship community, including public health professionals, providers, policymakers, survivors, advocates, and caregivers, must work collaboratively to identify, develop, and implement interventions that benefit cancer survivors. The National Action Plan for Cancer Survivorship highlights public health domains and associated strategies that can be the impetus for collaboration between and among the levels in the social ecological model and are integral to improving survivor outcomes. This paper describes the Public Health Action Model for Cancer Survivorship, an integrative framework that combines the National Action Plan for Cancer Survivorship with the social ecological model to demonstrate how interaction among the various levels may promote better outcomes for survivors.
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Affiliation(s)
- Angela R Moore
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia.
| | | | | | - Judith Lee Smith
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
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Tiro JA, Sanders JM, Pruitt SL, Stevens CF, Skinner CS, Bishop WP, Fuller S, Persaud D. Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial. Pediatrics 2015; 136:850-9. [PMID: 26482674 PMCID: PMC7313721 DOI: 10.1542/peds.2015-1563] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects. METHODS Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity. RESULTS Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45). CONCLUSIONS Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms).
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Affiliation(s)
- Jasmin A. Tiro
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;,Address correspondence to Jasmin A. Tiro, PhD, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390–8557, E-mail:
| | - Joanne M Sanders
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | | | - Celette Sugg Skinner
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Wendy P. Bishop
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Sobha Fuller
- Parkland Health and Hospital System, Dallas, Texas
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Development of a Cost-Effective Educational Tool to Promote Acceptance of the HPV Vaccination by Hispanic Mothers. J Community Health 2015; 41:468-75. [DOI: 10.1007/s10900-015-0116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chan A, Brown B, Sepulveda E, Teran-Clayton L. Evaluation of fotonovela to increase human papillomavirus vaccine knowledge, attitudes, and intentions in a low-income Hispanic community. BMC Res Notes 2015; 8:615. [PMID: 26514184 PMCID: PMC4625467 DOI: 10.1186/s13104-015-1609-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/19/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It has nearly been a decade since the introduction of the vaccine against human papillomavirus (HPV), yet vaccination rates in the United States have remained suboptimal, particularly among Hispanics. Culturally and linguistically relevant health education tools targeting Hispanics are needed to increase the current rate of HPV vaccination. This article evaluates a theory-informed, evidence-guided fotonovela (photographic short story) intervention to improve HPV vaccination knowledge, attitudes, and intention among young adults. METHODS Young adults (N = 41, aged 18-26 years) in a low-income primary care clinic in Southern California were administered pre- and post-intervention surveys to measure changes in perceived susceptibility to HPV, perceived benefit of vaccination in committed relationship, intention to vaccinate, intention to encourage social networks to vaccinate, and attitude towards vaccination. Post-intervention survey also examined attitudes towards fotonovela. Relationships between attitudes towards fotonovela and demographic characteristics were assessed with Fisher's exact test. Self-reported gains in knowledge were categorized and tabulated. Changes in perceptions and intentions were analyzed with the marginal homogeneity test. RESULTS The majority of participants were female (78.0%), Latino/Hispanic (92.7%), single (70.7%), and had at least a college education (61.0%). The mean age was 21.9 years (SD 0.4). The fotonovela was viewed as entertaining (95.1%), educational (97.6%), and easy to read (100 %). Following the intervention, Hispanic participants improved in all five variables of interest measured in the survey, including perceived susceptibility (+10.5%, p = 0.03), benefit of vaccination (+7.8%, p = 0.25), intent to vaccinate (+18.4%, p = 0.06), intent to encourage others to vaccinate (+10.5%, p = 0.14) and attitude towards vaccination (+13.1%, p = 0.05). Improvements in perceived susceptibility and attitude towards vaccination reached statistical significance (p < 0.05). The most frequent gains in knowledge were the risk of HPV infection despite condom use (N = 16) and relationship status (N = 8), three-dose vaccine administration schedule (N = 13), and burden of HPV infection among males (N = 9). CONCLUSION Results are promising because they demonstrate that health messages delivered through a narrative format can promote positive changes in knowledge, attitudes, and intentions. The fotonovela may be a powerful vehicle for HPV education, particularly among Hispanics.
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Affiliation(s)
- Alvin Chan
- School of Medicine, University of California, Irvine, Irvine, CA, USA.
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, CA, USA.
| | - Enedina Sepulveda
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, USA.
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Kram YA, Schmidt TH, Saghezchi S, Russell MD. Attitudes toward Human Papilloma Virus Vaccination and Head and Neck Cancer Prevention in a Diverse, Urban Population. Otolaryngol Head Neck Surg 2015; 153:538-43. [PMID: 25779468 DOI: 10.1177/0194599815574821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/05/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) To understand if awareness of the human papilloma virus (HPV) vaccination's potential to prevent head and neck cancer improves acceptability of the vaccine in a large urban population and (2) to identify characteristics of those in whom such discussions would have the greatest impact. STUDY DESIGN In-person, anonymous survey. SETTING Academic public hospital between March 2014 and June 2014. SUBJECTS Patients aged 12 to 24 years and their parents or guardians awaiting scheduled outpatient pediatric appointments. METHODS Demographics and modified Carolina HPV Immunization Attitudes and Beliefs Scales data were cross-analyzed, followed by univariate binomial logistic regression to identify predictors for major outcomes of interest. RESULTS More than 78% of those surveyed indicated they would be more receptive to the HPV vaccine if given strong evidence that it prevented head and neck cancer. Respondents were more likely to increase receptivity to HPV vaccination if they held the belief that they did not have enough information about the vaccine or indicated they preferred to wait because the vaccine was too new. CONCLUSION Increasing public awareness of head and neck cancer prevention with HPV vaccination could increase HPV vaccination acceptance.
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Affiliation(s)
- Yoseph A Kram
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Timothy H Schmidt
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sohail Saghezchi
- University of California, San Francisco School of Medicine, San Francisco, California, USA Department of Oral & Maxillofacial Surgery, University of California, San Francisco, California, USA
| | - Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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Zeraiq L, Nielsen D, Sodemann M. Attitudes towards human papillomavirus vaccination among Arab ethnic minority in Denmark: A qualitative study. Scand J Public Health 2015; 43:408-14. [PMID: 25754868 DOI: 10.1177/1403494815569105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge regarding the human papillomavirus (HPV) and HPV vaccine uptake among ethnic minorities is poorly explored in Denmark. The objective of this study was to explore attitudes and knowledge towards HPV vaccination among Arab mothers and their daughters. METHODS Five Arabic-speaking focus groups with mothers of vaccine-eligible girls and three focus groups with daughters were conducted. The participants were recruited through different social clubs. A phenomenological approach was used to investigate attitudes and knowledge of HPV vaccination. Meaning condensation inspired by Amedeo Giorgi was used to analyse the transcribed material. RESULTS A total of 23 women and 13 daughters were included in this study. The mothers' knowledge regarding HPV was limited to the fact that HPV can cause cervical cancer. Two focus groups mentioned that HPV is a sexually transmitted disease and none of the mothers knew that HPV also causes genital warts. Both mothers and daughters acknowledged that the daughters have deeper insight into health-related issues. A gap of knowledge between generations was identified, as mothers and daughters obtained health information from different sources: mothers used the Arabic TV channels as a source of knowledge and daughters had a range of sources, e.g. school, internet, and Western TV channels. The consequence of these differences in obtaining knowledge is that mothers and daughters lack a common language to discuss health issues. Mothers were influenced by Arabic society, while daughters had created a hybrid of Arabic and Danish. Each generation had its own reasons for accepting the vaccine. The level of HPV knowledge and awareness did not affect their uptake decision in that all the participating mothers had accepted the vaccine for their daughters. CONCLUSIONS Educational programs should target both mothers and daughters because mothers have an inadequate knowledge about HPV. This is likely to bridge the gap of knowledge between mothers and daughters, which constitutes a barrier between the generations.
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Affiliation(s)
- Lina Zeraiq
- Migrant Health Clinic, Odense University Hospital, Denmark Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic, Odense University Hospital, Denmark Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Odense University Hospital, Denmark Center for Global Health, University of Southern Denmark, Odense, Denmark
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Strohl AE, Mendoza G, Ghant MS, Cameron KA, Simon MA, Schink JC, Marsh EE. Barriers to prevention: knowledge of HPV, cervical cancer, and HPV vaccinations among African American women. Am J Obstet Gynecol 2015; 212:65.e1-5. [PMID: 24983684 PMCID: PMC4531095 DOI: 10.1016/j.ajog.2014.06.059] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/30/2014] [Accepted: 06/25/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to assess knowledge of the human papillomavirus (HPV), cervical cancer, and HPV vaccination in African American women (AAW). STUDY DESIGN This study was a quantitative cross-sectional survey of English-speaking, AAW, 18-70 years old who were recruited from a community fair in Chicago, IL. Surveys were distributed to a convenience sample to assess knowledge of HPV, cervical cancer, and the HPV vaccine. Cumulative knowledge scores were calculated for each participant, and analysis was performed to identify factors that were associated with adequate knowledge scores. RESULTS Three hundred twenty-two surveys were distributed; 242 surveys were collected, and 215 surveys met inclusion criteria. Mean knowledge score was 12.3 ± 4.2 (mean ± SD) of a maximum score of 28 (range, 3-23); 73% of participants scored <65% on the knowledge portion of the survey. Education level (P = .007), household income (P = .010), and having a child who had been offered the HPV vaccine (P = .041) were associated with adequate (≥65% accuracy) knowledge scores. CONCLUSION Knowledge of HPV, cervical cancer, and HPV vaccination was low in this urban African American adult female population. Targeted educational health programs are needed to increase awareness among these women who have the highest rate of cervical cancer mortality in the United States. Such patient educational programs must be developed by physicians and should address the cultural and literacy needs of this particular group of women. In addition, AAW exert influence on the health of their communities and are integral in health-related decision-making; thus, educating them through their health care providers will have far ranging impact.
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Affiliation(s)
- Anna E Strohl
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gricelda Mendoza
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marissa S Ghant
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, and Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julian C Schink
- Department of Obstetrics and Gynecology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Raymond NC, Osman W, O’Brien JM, Ali N, Kia F, Mohamed F, Mohamed A, Goldade KB, Pratt R, Okuyemi K. Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women. BMC Public Health 2014; 14:1188. [PMID: 25410824 PMCID: PMC4289337 DOI: 10.1186/1471-2458-14-1188] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/30/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Somali women are infrequently screened for breast or cervical cancer, and there is a paucity of evidence-based interventions to increase cancer screening in this community. In order to create a culturally relevant intervention for Somali women living in Minnesota, we sought to understand what Somali immigrant women know about breast and cervical cancer, what are the attitudes toward screening and what cultural barriers are there to screen as well as cultural factors that would facilitate screening. METHODS In partnership with a community-based organization, New American Community Services (NACS), focus groups were conducted to explore the issues described above. Two focus groups were held with younger women age 20 to 35 and two were held with women age 36 to 65. RESULTS Twenty-nine women participated in the four focus groups. The women identified 1) differences in health care seeking behavior in Somalia verses the United States; 2) cultural understanding of cancer and disease; 3) barriers to mammogram or Pap screening; 4) facilitators to seeking preventive cancer screening; and 5) risk factors for developing cancer. CONCLUSIONS Cultural misperceptions and attitudes need to be addressed in developing culturally-appropriate interventions to improve screening uptake for Somali women. A nuanced response is required to address barriers specific to younger and older groups. Culturally informed beliefs can be integrated into intervention development, preventive care and screening promotion.
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Affiliation(s)
- Nancy C Raymond
- />Department of Psychiatry and Deborah E. Powell Center for Women’s Health, University of Minnesota Medical School, Minneapolis, USA
| | - Warfa Osman
- />New American Community Services, St. Paul, USA
| | - Jennifer M O’Brien
- />Department of Psychiatry and Deborah E. Powell Center for Women’s Health, University of Minnesota Medical School, Minneapolis, USA
| | - Nora Ali
- />University of Minnesota Medical School, Minneapolis, USA
| | - Farnaaz Kia
- />University of Minnesota Medical School, Minneapolis, USA
| | | | | | | | - Rebekah Pratt
- />Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Kolawole Okuyemi
- />Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
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Hill M, Okugo G. Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting. Hum Vaccin Immunother 2014; 10:2551-6. [PMID: 25483493 PMCID: PMC4977447 DOI: 10.4161/21645515.2014.970933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/02/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022] Open
Abstract
A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P<0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P<0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer.
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Affiliation(s)
- Mandy Hill
- The University of Texas Health Science Center at Houston; Department of Emergency Medicine; School of Medicine; Houston, TX USA
| | - Glory Okugo
- The University of Texas Health Science Center at Houston; Department of Emergency Medicine; School of Medicine; Houston, TX USA
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Haesebaert J, Lutringer-Magnin D, Kalecinski J, Barone G, Jacquard AC, Leocmach Y, Régnier V, Vanhems P, Chauvin F, Lasset C. Disparities of perceptions and practices related to cervical cancer prevention and the acceptability of HPV vaccination according to educational level in a French cross-sectional survey of 18-65 years old women. PLoS One 2014; 9:e109320. [PMID: 25303180 PMCID: PMC4193774 DOI: 10.1371/journal.pone.0109320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/29/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction We aimed to study the relationships between educational level, women's knowledge about cervical cancer (CC), and acceptance of HPV vaccination for their daughters. Methods We analysed data from a quantitative (self-administrated questionnaire) and qualitative (semi-structured interviews) cross-sectional study performed in 2008 among 1,229 French 18–65-year-old women recruited by general practitioners. Women were categorized into three educational level groups: low (LEL: 43.9%), medium (MEL: 33.4%) and high (HEL: 22.6%). Results Knowledge about CC and its prevention was lower among LEL women. In the 180 mothers of 14–18-year-old daughters (99 LEL, 54 MEL, 45 HEL), acceptance of HPV vaccine was higher in LEL (60.4%) and MEL (68.6%) than in HEL mothers (46.8%). Among LEL mothers, those who were favourable to HPV vaccination were more likely to be young (OR = 8.44 [2.10–34.00]), to be vaccinated against hepatitis B (OR = 4.59 [1.14–18.52]), to have vaccinated their children against pneumococcus (OR = 3.52 [0.99–12.48]) and to present a history of abnormal Pap smear (OR = 6.71 [0.70–64.01]). Conclusion Although LEL women had poorer knowledge about CC and its prevention, they were more likely to accept HPV vaccination than HEL mothers.
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Affiliation(s)
- Julie Haesebaert
- Université Lyon 1, CNRS UMR 5558 et Centre Léon Bérard, Lyon, France
| | | | - Julie Kalecinski
- Institut de Cancérologie de la Loire et Université Jean Monnet de Saint-Étienne, IFR 143, Saint-Étienne, France
| | - Giovanna Barone
- Université Lyon 1, CNRS UMR 5558 et Centre Léon Bérard, Lyon, France
| | | | | | - Véronique Régnier
- Institut de Cancérologie de la Loire et Université Jean Monnet de Saint-Étienne, IFR 143, Saint-Étienne, France
| | - Philippe Vanhems
- Université Lyon 1, CNRS UMR 5558 et Hospices Civils de Lyon, Lyon, France
| | - Franck Chauvin
- Institut de Cancérologie de la Loire et Université Jean Monnet de Saint-Étienne, IFR 143, Saint-Étienne, France
| | - Christine Lasset
- Université Lyon 1, CNRS UMR 5558 et Centre Léon Bérard, Lyon, France
- * E-mail:
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Hill M, Okugo G. Emergency Medicine Physician Attitudes toward HPV vaccine uptake in an Emergency Department Setting. Hum Vaccin Immunother 2014. [DOI: 10.4161/hv.29634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Patel A, Stern L, Unger Z, Debevec E, Roston A, Hanover R, Morfesis J. Staying on track: a cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion. Vaccine 2014; 32:2428-33. [PMID: 24631099 DOI: 10.1016/j.vaccine.2014.02.095] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate whether automated reminders increase on-time completion of the three-dose human papillomavirus (HPV) vaccine series. METHODS Ten reproductive health centers enrolled 365 women aged 19-26 to receive dose one of the HPV vaccine. Health centers were matched and randomized so that participants received either routine follow-up (control) or automated reminder messages for vaccine doses two and three (intervention). Intervention participants selected their preferred method of reminders - text, e-mail, phone, private Facebook message, or standard mail. We compared vaccine completion rates between groups over a period of 32 weeks. RESULTS The reminder system did not increase completion rates, which overall were low at 17.2% in the intervention group and 18.9% in the control group (p=0.881). Exploratory analyses revealed that participants who completed the series on-time were more likely to be older (OR=1.15, 95% CI 1.01-1.31), report having completed a four-year college degree or more (age-adjusted OR=2.51, 95% CI 1.29-4.90), and report three or more lifetime sexual partners (age-adjusted OR=3.45, 95% CI 1.20-9.92). CONCLUSIONS The study intervention did not increase HPV vaccine series completion. Despite great public health interest in HPV vaccine completion and reminder technologies, completion rates remain low.
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Affiliation(s)
- Ashlesha Patel
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States; Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Lisa Stern
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Zoe Unger
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Elie Debevec
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Alicia Roston
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Rita Hanover
- Westport Compass, 3011 S. Plateau, Salt Lake City, UT 84109, United States.
| | - Johanna Morfesis
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
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Zhang C, Gotsis M, Jordan-Marsh M. Social media microblogs as an HPV vaccination forum. Hum Vaccin Immunother 2013; 9:2483-9. [PMID: 23842072 DOI: 10.4161/hv.25599] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The 2006 US FDA approval of the human papillomavirus (HPV) vaccine brought new hope for cancer prevention. Gardasil and Cervarix are widely available vaccines that can deter HPV infection, which causes 70% of cervical cancer. Acceptance of vaccination varies due to a lack of HPV awareness and HPV vaccine knowledge. Recent observations of the Chinese microblog "SinaWeibo" suggest a new approach to engage health professionals and consumer website bloggers. Websites that present the latest fashion, fitness or beauty news and ways to obtain "deals" have created informative blogs or online communities that appeal to female users. Some users raise health questions of their peers. Health professionals, as website bloggers, can introduce vaccine news or respond to conversations between bloggers and their followers. By transforming medical vocabulary into ordinary chat, microblogs may promote efficiency in vaccine education and communication. A web-based, interactive social media-microblog could offer an ideal platform to speed up information dissemination and increase targeted communication.
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Affiliation(s)
- Chupei Zhang
- Mork Family Department of Chemical Engineering and Materials Science; Los Angeles, CA USA
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Schmidt-Grimminger D, Frerichs L, Black Bird AE, Workman K, Dobberpuhl M, Watanabe-Galloway S. HPV knowledge, attitudes, and beliefs among Northern Plains American Indian adolescents, parents, young adults, and health professionals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:357-66. [PMID: 23564429 DOI: 10.1007/s13187-013-0468-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Native American women in the Northern Plains have a high prevalence of human papillomavirus (HPV) and high incidence of cervical disease and cervical cancer. HPV vaccination coverage is shown to be lower among nonwhite populations and disparity populations. We assessed HPV knowledge, attitudes, and beliefs towards HPV and HPV vaccination during a community-based participatory research project among tribal youth, young adults, parents, and health professionals. In 2009, we recruited a total of 73 individuals to participate in four tribal focus groups: tribal health providers, (n=10), Indian Health Service providers (n=7), young adult women ages 19-26 (n=22), girls (14-18) (n=18), and parents (n=16). Of these, 62 (84.93 %) completed a survey, which included 10 healthcare providers, 22 young adults, 14 teens, and 16 parents. We employed a qualitative thematic analysis of focus group transcript data and conducted frequency analysis of survey data, which were both reviewed and triangulated by a Community Advisory Board. Based on the results of this study, the tribal community advisory board identified local tribal settings for interventions to increase HPV vaccination coverage through health education classes and a school-based vaccination clinic. In addition to tribal community-wide education events to increase awareness of HPV disease, the HPV vaccine, provider-specific training was identified as a potential intervention. These community-based focus group findings underscore the importance of locally and cultural tailored educational interventions to further increase HPV knowledge and HPV vaccination among disparate populations like American Indian adolescent and young adult women.
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Wagholikar KB, MacLaughlin KL, Kastner TM, Casey PM, Henry M, Greenes RA, Liu H, Chaudhry R. Formative evaluation of the accuracy of a clinical decision support system for cervical cancer screening. J Am Med Inform Assoc 2013; 20:749-57. [PMID: 23564631 PMCID: PMC3721177 DOI: 10.1136/amiajnl-2013-001613] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives We previously developed and reported on a prototype clinical decision support system (CDSS) for cervical cancer screening. However, the system is complex as it is based on multiple guidelines and free-text processing. Therefore, the system is susceptible to failures. This report describes a formative evaluation of the system, which is a necessary step to ensure deployment readiness of the system. Materials and methods Care providers who are potential end-users of the CDSS were invited to provide their recommendations for a random set of patients that represented diverse decision scenarios. The recommendations of the care providers and those generated by the CDSS were compared. Mismatched recommendations were reviewed by two independent experts. Results A total of 25 users participated in this study and provided recommendations for 175 cases. The CDSS had an accuracy of 87% and 12 types of CDSS errors were identified, which were mainly due to deficiencies in the system's guideline rules. When the deficiencies were rectified, the CDSS generated optimal recommendations for all failure cases, except one with incomplete documentation. Discussion and conclusions The crowd-sourcing approach for construction of the reference set, coupled with the expert review of mismatched recommendations, facilitated an effective evaluation and enhancement of the system, by identifying decision scenarios that were missed by the system's developers. The described methodology will be useful for other researchers who seek rapidly to evaluate and enhance the deployment readiness of complex decision support systems.
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Polonijo AN, Carpiano RM. Social inequalities in adolescent human papillomavirus (HPV) vaccination: A test of fundamental cause theory. Soc Sci Med 2013; 82:115-25. [DOI: 10.1016/j.socscimed.2012.12.020] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 11/15/2022]
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Lam TK, Spitz M, Schully SD, Khoury MJ. "Drivers" of translational cancer epidemiology in the 21st century: needs and opportunities. Cancer Epidemiol Biomarkers Prev 2013; 22:181-8. [PMID: 23322363 PMCID: PMC3565029 DOI: 10.1158/1055-9965.epi-12-1262] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer epidemiology is at the cusp of a paradigm shift--propelled by an urgent need to accelerate the pace of translating scientific discoveries into health care and population health benefits. As part of a strategic planning process for cancer epidemiologic research, the Epidemiology and Genomics Research Program (EGRP) at the National Cancer Institute (NCI) is leading a "longitudinal" meeting with members of the research community to engage in an on-going dialogue to help shape and invigorate the field. Here, we review a translational framework influenced by "drivers" that we believe have begun guiding cancer epidemiology toward translation in the past few years and are most likely to drive the field further in the next decade. The drivers include: (i) collaboration and team science, (ii) technology, (iii) multilevel analyses and interventions, and (iv) knowledge integration from basic, clinical, and population sciences. Using the global prevention of cervical cancer as an example of a public health endeavor to anchor the conversation, we discuss how these drivers can guide epidemiology from discovery to population health impact, along the translational research continuum.
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Affiliation(s)
- Tram Kim Lam
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD, USA.
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Lindley LL, Elkind JS, Landi SN, Brandt HM. Receipt of the human papillomavirus vaccine among female college students in the United States, 2009. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2013; 61:18-27. [PMID: 23305541 DOI: 10.1080/07448481.2012.750607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine receipt of the human papillomavirus (HPV) vaccine among female college students by demographic/descriptive characteristics and sexual behaviors. METHODS A secondary analysis of the Spring 2009 National College Health Assessment-II was conducted with 40,610 female college students (aged 18 to 24 years) attending 4-year institutions in the United States. RESULTS Less than half (45.0%) the respondents had received the HPV vaccine. Students who were younger, white, noninternational, and sorority members, had health insurance, attended a college/university in the northeastern United States, did not have or did not live with a partner, participated in sports, ever had vaginal intercourse, had male sex partner(s) (past year), and had a gynecological examination (past year) were more likely to have received the vaccine. CONCLUSIONS To allow for appropriate intervention, additional research should investigate why certain female college students have not obtained the HPV vaccine. Efforts should be made to link college women without health insurance to no- or low-cost HPV vaccine.
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Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, George Mason University, Fairfax, Virginia 22030-4444, USA.
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Niccolai LM, Julian PJ, Bilinski A, Mehta NR, Meek JI, Zelterman D, Hadler JL, Sosa L. Geographic poverty and racial/ethnic disparities in cervical cancer precursor rates in Connecticut, 2008-2009. Am J Public Health 2013; 103:156-63. [PMID: 22515856 PMCID: PMC3518345 DOI: 10.2105/ajph.2011.300447] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations of geographic measures of poverty, race, ethnicity, and city status with rates of cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ (CIN2+/AIS), known precursors to cervical cancer. METHODS We identified 3937 cases of CIN2+/AIS among women aged 20 to 39 years in statewide surveillance data from Connecticut for 2008 to 2009. We geocoded cases to census tracts and used census data to calculate overall and age-specific rates. Poisson regression determined whether rates differed by geographic measures. RESULTS The average annual rate of CIN2+/AIS was 417.6 per 100,000 women. Overall, higher rates of CIN2+/AIS were associated with higher levels of poverty and higher proportions of Black residents. Poverty was the strongest and most consistently associated measure. However, among women aged 20 to 24 years, we observed inverse associations between poverty and CIN2+/AIS rates. CONCLUSIONS Disparities in cervical cancer precursors exist for poverty and race, but these effects are age dependent. This information is necessary to monitor human papillomavirus vaccine impact and target vaccination strategies.
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Affiliation(s)
- Linda M Niccolai
- Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, CT 06520, USA.
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