1
|
Brooks EM, Fugate-Laus K, Webel B, Naavaal S. Perceptions of a State-Level HPV Vaccine Mandate and Exemption Option in Rural Virginia: A Qualitative Study. Vaccines (Basel) 2024; 12:401. [PMID: 38675783 PMCID: PMC11054131 DOI: 10.3390/vaccines12040401] [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: 02/15/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with community leaders. Interviews asked about knowledge, beliefs, and attitudes concerning the HPV vaccine and mandate. Interviews were recorded, transcribed, and thematically analyzed. Despite healthcare provider support for the mandate, there was widespread confusion over the school-entry policy and concern that the exemption option undermined vaccination efforts. Understanding variations in community-level perceptions and response to school-based vaccination mandates is crucial for designing effective public health strategies. Findings suggest statewide vaccination initiatives should preemptively identify low uptake areas and provide targeted information to communities. Future mandates should avoid the use of ambiguous and contradictory language in vaccine-related legislation.
Collapse
Affiliation(s)
- E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kendall Fugate-Laus
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| |
Collapse
|
2
|
Asempah E, Wiktorowicz ME. Understanding HPV Vaccination Policymaking in Rwanda: A Case of Health Prioritization and Public-Private-Partnership in a Low-Resource Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6998. [PMID: 37947556 PMCID: PMC10649882 DOI: 10.3390/ijerph20216998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Rwanda is the first African country to implement a national HPV vaccination program in 2011. This study sought to clarify the HPV vaccination policymaking process in Rwanda through the lens of Kingdon's multiple stream framework and Foucault's concept of governmentality. Perspectives of policymakers engaged in HPV vaccination policy were gathered from published sources, along with key informant interviews. Rwanda's track record of successful vaccination programs enabled by a culture of local accountability created public and private sector incentives. Effective stakeholder engagement, health priority setting, and resource mobilization garnered locally and through international development aid, reflect indicators of policy success. The national HPV policymaking process in Rwanda unfolded in a relatively cohesive and stable policy network. Although peripheral stakeholder resistance and a constrained national budget can present a threat to policy survival, the study shows that such factors as the engagement of policy entrepreneurs within a policy network, private sector incentives, and international aid were effective in ensuring policy resolution.
Collapse
Affiliation(s)
- Eric Asempah
- School of Health Policy & Management, Faculty of Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada;
| | | |
Collapse
|
3
|
Abstract
Although the US Advisory Committee on Immunization Practices recommends vaccinating adolescents against the human papillomavirus (HPV) to prevent HPV-associated cancers, vaccine initiation and completion rates are suboptimal. Parental and provider hesitancy contributes significantly to low HPV vaccine uptake. This review describes sources of HPV vaccine hesitancy using a World Health Organization framework that categorizes determinants of vaccine hesitancy as follows: contextual factors (historical, sociocultural, environmental, or political factors), individual and group factors (personal perception or influences of the social/peer environment), and vaccine/vaccination-specific issues (directly related to vaccine or vaccination).
Collapse
Affiliation(s)
- Daisy Y Morales-Campos
- Department of Mexican American and Latino/a Studies, Latino Research Institute, The University of Texas at Austin, 210 West 24th Street, GWB 1.102, F9200, Austin, TX 78712, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, USA
| |
Collapse
|
4
|
Abstract
Persistent human papillomavirus infection is the central cause of cervical cancer, the leading cause of cancer death among women worldwide. Clear evidence from both randomized trials and population based studies shows that vaccination against human papillomavirus reduces the incidence of cervical pre-cancer. These data suggest that the vaccine reduces the incidence of cervical cancer. However, human papillomavirus vaccine coverage is inadequate in all countries, especially in low and middle income countries where disease burden is highest. Supply side strategies to improve coverage include increasing the availability of low cost vaccines, school located delivery, single dose vaccine schedules, and development of vaccines that do not need refrigeration. Demand side strategies include enhancing provider recommendations, correcting misinformation, and public awareness campaigns. The near elimination of cervical cancer is achievable through increased uptake of human papillomavirus vaccination and efforts to increase screening for cervical cancer, especially when enacted to reduce disparities in across the world.
Collapse
Affiliation(s)
- Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Siobhan O'Connor
- Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Carla J Chibwesha
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
5
|
Calo WA, Lennon RP, Ruffin Iv MT, Keller C, Spanos K, D'Souza G, Kraschnewski JL. Support for HPV vaccine school-entry requirements in the United States: The role of exemption policies. Vaccine 2022; 40:7426-7432. [PMID: 36030125 DOI: 10.1016/j.vaccine.2022.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/23/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
In the United States (U.S.), only five states or territories require human papillomavirus (HPV) vaccination for school attendance, even though almost all U.S. jurisdictions have debated adopting this type of policy. In this U.S. based study, we sought to estimate the level of support for HPV vaccine school-entry requirements with varying exemption policies and documentation procedures to obtain exemptions. Between July and August 2019, we conducted a web-based survey with a national sample of 1,109 U.S. parents of 11- to 17-year-olds. The survey assessed support for four school-entry vaccine requirement policies: without exemption or with exemption for medical, religious or philosophical reasons. Analyses used multivariable logistic regression to assess correlates of support for each policy. Overall, 38% of parents agreed with laws requiring HPV vaccination for school attendance without exemptions. When including exemption provisions, agreement increased to 45% for philosophical reasons, 50% for religious reasons, and 59% for medical reasons. Parents more often agreed on requirements without any exemptions if they were female (OR = 1.37, 95% CI:1.01-1.87), their child had initiated HPV vaccination (OR = 2.05, 95% CI:1.50-2.87), reported high levels of vaccine confidence (OR = 2.41, 95% CI:1.77-3.27), or reported having values similar to those of the people in their community (OR = 1.85, 95% CI:1.39-2.47). Parents more often agreed with requirements that included religious or philosophical exemptions if they reported having values similar to their community or high levels of psychological reactance (all p <.05). Many parents also supported requiring a written notice signed by a health care provider (40%) or religious leader (49%) to obtain a medical or religious exemption, respectively. In conclusion, exemption policies greatly increase parent support of school-entry requirements for HPV vaccination but may decrease their impact in practice. A large number of U.S. parents support strict documentation to obtain exemptions, signaling a promising area of policymaking to strengthen vaccine policies for school attendance.
Collapse
Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Mack T Ruffin Iv
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Chelsea Keller
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Katherine Spanos
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Gail D'Souza
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
6
|
Moving vaccination beyond partisan politics. Vaccine 2022; 40:3815-3817. [PMID: 35644670 PMCID: PMC9135489 DOI: 10.1016/j.vaccine.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
|
7
|
Wheelock A, Ives J. Vaccine confidence, public understanding and probity: time for a shift in focus? JOURNAL OF MEDICAL ETHICS 2022; 48:250-255. [PMID: 33687913 DOI: 10.1136/medethics-2020-106805] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
Lack of vaccine confidence can contribute to drops in vaccination coverage and subsequent outbreaks of diseases like measles and polio. Low trust in vaccines is attributed to a combination of factors, including lack of understanding, vaccine scares, flawed policies, social media and mistrust of vaccine manufacturers, scientists and decision-makers. The COVID-19 crisis has laid bare societies' vulnerability to new pathogens and the critical role of vaccines (and their acceptability) in containing this and future pandemics. It has also put science at the forefront of the response, with several governments relying on academics to help shape policy and communicate with the public. Against this backdrop, protecting public trust in scientists and scientific output is arguably more important than ever. Yet, conflicts of interest (CoI) in biomedical research remain ubiquitous and harmful, and measures to curb them have had limited success. There is also evidence of bias in industry-sponsored vaccine studies and academics are voicing concerns about the risks of working in a CoI prevalent research area. Here, we set out to challenge established thinking with regard to vaccine confidence, by shifting the gaze from a deficit in public understanding towards probity in research relationships and suggesting an alternative and perhaps complementary strategy for addressing vaccine mistrust. We argue that a concerted effort needs to be made to revisit the norms that undergird contemporary vaccine research, coupled with a willingness of all stakeholders to reimagine those relationships with an emphasis on demonstrating trustworthiness and probity.
Collapse
Affiliation(s)
- Ana Wheelock
- Department of Surgery and Cancer, Imperial College London, London, UK
- Business School, Kingston University, Kingston-Upon-Thames, London, UK
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
8
|
Arguments in favor of and against the HPV vaccine school-entry requirement in Puerto Rico: a content analysis of newspaper media. Cancer Causes Control 2021; 32:793-802. [PMID: 33913078 DOI: 10.1007/s10552-021-01431-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Vaccine requirements are effective population-based strategies to increase vaccination rates. In 2018, Puerto Rico's DOH announced that the HPV vaccine would be required for school entrance. This study explored arguments in favor of and against the HPV vaccine school-entry requirement in PR. METHODS We conducted a content analysis of two Puerto Rican newspapers. Articles (n = 286) published between 1/1/2015 and 7/31/2018 containing the Spanish terms for "HPV" and "human papillomavirus" were included. Data were summarized using descriptive statistics. Articles that mentioned the HPV vaccine school-entry requirement (n = 33) were reviewed qualitatively using applied thematic analysis. RESULTS The top five primary focus areas were education about HPV and the HPV vaccine, advertisements promoting the HPV vaccine, general vaccine information, cervical cancer and screening information, and the HPV vaccine school-entry requirement. Of the 33 articles that mentioned the requirement, 61% presented arguments in favor, 15% presented arguments against, 12% presented both arguments, and 12% only mentioned the existence of the requirement or were the DOH announcement. Arguments in favor centered on cancer prevention, high rates of HPV-associated cancers, and population wellness. Arguments against included worries about sexual transmission of HPV, HPV vaccine's side effects, issues related to the policy (e.g., mandatory), and lack of education. CONCLUSION Understanding reasons people support or oppose an HPV vaccine school-entry requirement is important for the policy processes to be successful. Education efforts must continue to change the HPV vaccine narrative. Messages should be crafted to educate and gain support among parents and stakeholders towards this population-based cancer prevention strategy.
Collapse
|
9
|
Vázquez-Otero C, Daley EM, Vamos CA, Romero-Daza N, Beckstead J, Tyson DM. The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico. QUALITATIVE HEALTH RESEARCH 2021; 31:859-870. [PMID: 33733935 PMCID: PMC8081062 DOI: 10.1177/1049732321991507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico's HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews (n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations' leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza's case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.
Collapse
Affiliation(s)
- Coralia Vázquez-Otero
- Harvard T.H. Chan School of Public Health and Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
10
|
Teoh D, Hill EK, Goldsberry W, Levine L, Novetsky A, Downs L. Overcoming the barriers to HPV vaccination in high-risk populations in the U.S.: A Society of Gynecologic Oncology (SGO) Review. Gynecol Oncol 2021; 161:228-235. [PMID: 33707040 DOI: 10.1016/j.ygyno.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Affiliation(s)
- D Teoh
- University of Minnesota, Minneapolis, MN, USA
| | - E K Hill
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - L Levine
- University of Texas at Rio Grande Valley, Edinburg, TX, USA
| | | | - L Downs
- Park Nicolett Health Services, St. Louis Park, MN, USA.
| |
Collapse
|
11
|
Tabler J, Mykyta L, Schmitz RM, Kamimura A, Martinez DA, Martinez RD, Flores P, Gonzalez K, Marquez A, Marroquin G, Torres A. Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.-Mexico Border. J Community Health 2020; 44:127-136. [PMID: 30094723 DOI: 10.1007/s10900-018-0562-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
U.S.-Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43-3.68), PR 1.88 (1.04-3.41), respectively] and sexual partners met online [PR 3.73 (1.00-14.06), PR 19.98 (5.70-70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60-3.87), AOR 1.52 (1.11-2.07), AOR 1.97 (1.20-3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.
Collapse
Affiliation(s)
- Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E. University Ave., Laramie, WY, 82071, USA.
| | - Laryssa Mykyta
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA.,Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Rachel M Schmitz
- Department of Sociology, Oklahoma State University, Stillwater, OK, USA
| | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Paloma Flores
- Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Karina Gonzalez
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Alvaro Marquez
- Center for Survey Research and Policy Analysis, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Gladys Marroquin
- Department of Sociology, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Andy Torres
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
| |
Collapse
|
12
|
Constable C, Caplan A. Comparison of the implementation of human papillomavirus and hepatitis B vaccination programs in the United States: Implications for future vaccines. Vaccine 2019; 38:954-962. [PMID: 31843271 DOI: 10.1016/j.vaccine.2019.11.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
Vaccines for two viruses which cause cancer, human papillomavirus (HPV) and hepatitis B virus (HBV), are recommended for all children in the United States. Numerous parallels exist between the two vaccines in addition to their roles in cancer prevention, including transmission through sexual contact, multiple doses needed for series completion, and vaccine administration in adolescence for HPV and in the initial phase of the HBV vaccination program. All of these factors were viewed as potential barriers to achieving high rates of coverage, yet the ultimate success of the HBV vaccination program led to predictions that similarly high rates of coverage could be achieved for the HPV vaccine. However, currently, only the recommendation for HBV vaccination is supported by mandates for school entry in most states. Uptake of the HPV vaccine has lagged far behind U.S. goals for public health promotion. The aim of this paper is to examine factors which may account for the divergent pathways of the two vaccines. Four main factors are identified: logistical challenges of vaccine administration, attitudes of parents and healthcare providers, safety concerns, and cost. For each factor examined, recommendations are offered to confront similar barriers likely to arise for future vaccines. The authors conclude that gender-neutral state mandates coupled with school-located vaccination programs, stronger gender-neutral messaging from pharmaceutical companies and healthcare providers, and younger age of vaccine administration, if approved, present the most promising approaches to improving uptake of the HPV vaccine, and similar vaccines down the road.
Collapse
Affiliation(s)
- Catherine Constable
- Department of Medicine, New York University School of Medicine, NY, NY, United States; Division of Ethics, Department of Population Health, New York University School of Medicine, NY, NY, United States.
| | - Arthur Caplan
- Division of Ethics, Department of Population Health, New York University School of Medicine, NY, NY, United States
| |
Collapse
|
13
|
Hoss A, Meyerson BE, Zimet GD. State statutes and regulations related to human papillomavirus vaccination. Hum Vaccin Immunother 2019; 15:1519-1526. [PMID: 31241406 PMCID: PMC6746494 DOI: 10.1080/21645515.2019.1627817] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A cross-sectional analysis of human papillomavirus (HPV) vaccine statutes and regulations from states and the District of Columbia in the United States (U.S.) was conducted from September–November 2018 to advance analyses of policy impact on HPV vaccination uptake. A search was conducted using WestlawNext, a legal research database. Statutes and regulations relevant to the study were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions. Of the 212 laws identified by the initial search string, 93 (43.9%) reference HPV vaccination in statute or regulation. An additional three laws were added following subsequent review. There was a total of 52 statutes and 44 regulations from 34 states and the District of Columbia. Most laws were related to developing and distributing HPV vaccination materials for parents, and mechanisms to fund and reimburse for the vaccination. This study can be used by policymakers in jurisdictions that are considering establishing HPV vaccination promotion interventions in state law and highlighting the limited statutory and regulatory efforts that have been implemented to promote HPV vaccination. Importantly, this study can also be used to conduct evaluations of the efficacy of statutory and regulatory strategies in increasing HPV vaccination rates.
Collapse
Affiliation(s)
- Aila Hoss
- a Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law , Indianapolis , Indiana
| | - Beth E Meyerson
- b Department of Applied Health Science and the Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington , Bloomington , Indiana.,c Center for HPV Research, Indiana University Purdue University Indianapolis , Indianapolis , Indiana
| | - Gregory D Zimet
- c Center for HPV Research, Indiana University Purdue University Indianapolis , Indianapolis , Indiana.,d Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine , Indianapolis , Indiana
| |
Collapse
|
14
|
Kieslich K. Addressing vaccination hesitancy in Europe: a case study in state-society relations. Eur J Public Health 2019; 28:30-33. [PMID: 30383256 PMCID: PMC6209815 DOI: 10.1093/eurpub/cky155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In light of recent outbreaks of diseases such as measles in Europe, policymakers and public health practitioners are seeking strategies to address anti-vaccination attitudes and to increase immunization rates. Identifying effective strategies that will not further alienate vaccination sceptics raises challenges that go to the heart of relations between the state and society. Drawing on accounts of state–society relations, this article discusses how the problem of vaccination hesitancy might be explained from a political science perspective. Discourse-analytical approaches emphasize the importance of storylines, politics and social context in explaining a range of phenomena. Given the number and strength of prevailing discourses in groups with anti-vaccination sentiments, the literature on discourse coalitions can offer perspectives on the challenges that arise in designing strategies to address vaccine hesitancy. Paying closer attention to individual reasons why parents are vaccine hesitant might allow for designing strategies that are more suited to address concerns. However, given the pervasiveness of the discourses of anti-vaccination movements, challenges in reaching citizens who are sceptical of vaccines will remain.
Collapse
|
15
|
Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
16
|
Carhart MY, Schminkey DL, Mitchell EM, Keim-Malpass J. Barriers and Facilitators to Improving Virginia's HPV Vaccination Rate: A Stakeholder Analysis With Implications for Pediatric Nurses. J Pediatr Nurs 2018; 42:1-8. [PMID: 30219293 PMCID: PMC6140351 DOI: 10.1016/j.pedn.2018.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite the evidence, the availability since 2006, and strong recommendations from many professional organizations, the human papillomavirus (HPV) vaccine has had a low uptake rate nationally and these trends have been even lower in the state of Virginia. DESIGN AND METHODS We explored key stakeholders' perspectives on factors influencing HPV vaccination in central and southern Virginia organized within the socio-ecological model (SEM) framework. We conducted semi-structured key informant interviews with 31 stakeholders involved in HPV vaccination or cancer prevention. RESULTS Stakeholders identified barriers at all SEM levels: Knowledge gaps and sexuality concerns (parent-child dyad level), time constraint and inconsistent recommendation (interpersonal level), lack of leadership and informational support (organizational and community level), and an ineffective mandate (policy level). Facilitators identified were realistic/receptive attitude (parent-child dyad level), provider's strong recommendation and educational support (interpersonal level), team approach and useful data (organizational level), educational outreach and community resources (community level), and support from federal and professional organizations (policy level). CONCLUSIONS The stakeholder analysis provided an environmental scan of the barriers and facilitators so that an effective HPV vaccination strategy can be planned and implemented in the Commonwealth of Virginia by public health nurses.
Collapse
Affiliation(s)
- Miev Y Carhart
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | | | - Emma M Mitchell
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Jessica Keim-Malpass
- University of Virginia School of Nursing, Charlottesville, VA, USA; University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA, USA.
| |
Collapse
|
17
|
Cook EE, Venkataramani AS, Kim JJ, Tamimi RM, Holmes MD. Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors. Pediatrics 2018; 142:e20180458. [PMID: 30104422 PMCID: PMC6317562 DOI: 10.1542/peds.2018-0458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite preventive health benefits of the human papillomavirus (HPV) vaccination, uptake in the United States remains low. Twenty-four states have enacted legislation regarding HPV vaccination and education. One reason these policies have been controversial is because of concerns that they encourage risky adolescent sexual behaviors. Our aim in this study is to determine if state HPV legislation is associated with changes in adolescent sexual behaviors. METHODS This is a difference-in-difference study in which we use data on adolescent sexual behaviors from the school-based state Youth Risk Behavior Surveillance System from 2001 to 2015. Sexual behaviors included ever having sexual intercourse in the last 3 months and condom use during last sexual intercourse. We compared changes in sexual behaviors among high school students before and after HPV legislation to changes among high school students in states without legislation. RESULTS A total of 715 338 participants reported ever having sexual intercourse in the last 3 months, and 217 077 sexually active participants reported recent condom use. We found no substantive or statistically significant associations between HPV legislation and adolescent sexual behaviors. Recent sexual intercourse decreased by 0.90 percentage points (P = .21), and recent condom use increased by 0.96 percentage points (P = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses. CONCLUSIONS Implementation of HPV legislation was not associated with changes in adolescent sexual behaviors in the United States. Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation.
Collapse
Affiliation(s)
| | - Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
| | - Jane J Kim
- Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Rulla M Tamimi
- Departments of Epidemiology and
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle D Holmes
- Departments of Epidemiology and
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
18
|
Bayefsky MJ. The Ethical Case for Mandating HPV Vaccination. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:501-510. [PMID: 30147003 DOI: 10.1177/1073110518782957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When the HPV vaccine was released over a decade ago, there was intense opposition to mandating the vaccine, including among bioethics and legal scholars. Some of the original concerns are now obsolete, while other objections continue to present an obstacle to mandating the vaccine. This essay responds to earlier critiques of mandatory HPV vaccination and offers a series of arguments in support of a vaccine mandate. The first section briefly addresses initial concerns that are no longer relevant. The second section makes the ethical case for mandating HPV vaccination, based on three principles: 1) the best interests of children, 2) solidarity, and 3) health equity. The final section addresses concerns related to implementation of the vaccine, including the validity of linking vaccination to school entry. The essay concludes that we have a moral imperative to protect children from the leading cause of cervical cancer, and that mandating HPV vaccination is the best way to ensure that children of all backgrounds receive the vaccine before they have been exposed to the virus.
Collapse
Affiliation(s)
- Michelle J Bayefsky
- Michelle J. Bayefsky, B.A., is a medical student at Harvard Medical School. Previously she was a post-baccalaureate fellow in the Department of Bioethics of the National Institutes of Health, where her work focused on topics related to reproduction, genomics policy, and public health
| |
Collapse
|
19
|
Miller K, Dilley SE, Huh WK. Lessons learned from domestic and international human papillomavirus vaccination programs: a review. Am J Obstet Gynecol 2018; 218:467-473. [PMID: 28888586 DOI: 10.1016/j.ajog.2017.08.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/15/2017] [Accepted: 08/31/2017] [Indexed: 12/17/2022]
Abstract
Since the development of the human papillomavirus vaccine, many countries have created implementation programs to bolster vaccination rates and protect their populations. Despite demonstrated efficacy with decreased human papillomavirus-related disease abroad, the vaccine's potential to prevent morbidity and mortality in the United States is not being met. The purpose of this review is to discuss strategies of both international and domestic vaccination programs, their impact on human papillomavirus-related diseases, the unique obstacles faced by the United States, and future directions for success.
Collapse
|
20
|
Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
Collapse
Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
| |
Collapse
|
21
|
Daley EM, Vamos CA, Zimet GD, Rosberger Z, Thompson EL, Merrell L. The Feminization of HPV: Reversing Gender Biases in US Human Papillomavirus Vaccine Policy. Am J Public Health 2018; 106:983-4. [PMID: 27153015 DOI: 10.2105/ajph.2016.303122] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ellen M Daley
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| | - Cheryl A Vamos
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| | - Gregory D Zimet
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| | - Erika L Thompson
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| | - Laura Merrell
- Ellen M. Daley, Cheryl Vamos, Erika Thompson, and Laura Merrell are with the Department of Community and Family Health, University of South Florida, College of Public Health, Tampa. Gregory Zimet is with the Department of Adolescent Medicine, Indiana University, College of Medicine, Indianapolis. Zeev Rosberger is with the Department of Oncology, McGill University, College of Medicine, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Makarovs K, Achterberg P. Contextualizing educational differences in "vaccination uptake": A thirty nation survey. Soc Sci Med 2017; 188:1-10. [PMID: 28692824 DOI: 10.1016/j.socscimed.2017.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
This paper addresses the issue of public acceptance of vaccination with specific attention being paid to the role of education in vaccine uptake. Using Flash Eurobarometer 287 (2009) survey data and exploring it through the lens of Beck's reflexive modernization and Roger's protection motivation theories we examined how individual-level factors affect intention to get vaccinated, particularly aimed at examining whether higher education predicts more or less vaccination intention in different societies. The empirical results support an idea that at least for seasonal flu educational differences in vaccination uptake are contextual upon the reflexivity of the society in which respondent happens to live. Educated people living in more reflexive modernized countries tend to oppose vaccination against seasonal flu more that those highly educated living in less advanced societies, indicating that skeptical attitude towards science that is intrinsic to the modern post-industrial nations induces the immunization opposition among most informed and distrustful social group.
Collapse
Affiliation(s)
- Kirils Makarovs
- National Research University Higher School of Economics, Myasnitskaya St., 9/11, Office 443, 101000, Moscow, Russia.
| | | |
Collapse
|
23
|
Daley EM, Vamos CA, Thompson EL, Zimet GD, Rosberger Z, Merrell L, Kline NS. The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:142-148. [PMID: 28720448 PMCID: PMC5883212 DOI: 10.1016/j.pvr.2017.04.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.
Collapse
Affiliation(s)
- Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & Departments of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada.
| | - Laura Merrell
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA.
| | - Nolan S Kline
- Department of Anthropology, Rollins College, Winter Park, FL, USA.
| |
Collapse
|
24
|
Change Suboptimal Tactics and Promote a National Mandatory Human Papillomavirus Vaccination Program. J Low Genit Tract Dis 2016; 20:348-351. [DOI: 10.1097/lgt.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
25
|
North AL, Niccolai LM. Human Papillomavirus Vaccination Requirements in US Schools: Recommendations for Moving Forward. Am J Public Health 2016; 106:1765-70. [PMID: 27552264 DOI: 10.2105/ajph.2016.303286] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Safe and effective human papillomavirus (HPV) vaccines have been available and recommended for adolescents for a decade in the United States, yet vaccination rates remain suboptimal. School entry requirements have increased uptake of other vaccines for adolescents and made coverage more equitable. However, only 3 jurisdictions require HPV vaccine for school. We summarize the current status of HPV vaccine requirements and discuss the rationales for and against these policies. The rationales for requirements include HPV vaccine efficacy and safety, effectiveness of requirements for increasing vaccine uptake and making it more equitable, and use of requirements as "safety nets" and to achieve herd immunity. The rationales against requirements include low parental acceptance of HPV vaccine, the financial burden on educational systems and health departments, and the possibility for alternatives to increase vaccine uptake. Many challenges to HPV vaccine requirements are addressable, and we conclude with recommendations on how to approach these challenges.
Collapse
Affiliation(s)
- Anna L North
- The authors are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Linda M Niccolai
- The authors are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| |
Collapse
|
26
|
Calo WA, Gilkey MB, Shah PD, Moss JL, Brewer NT. Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study. Cancer Epidemiol Biomarkers Prev 2016; 25:1317-25. [PMID: 27543621 DOI: 10.1158/1055-9965.epi-15-1159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements. METHODS A national sample of 1,501 parents of 11- to 17-year-old children completed a web-based survey between November 2014 and January 2015. Analyses used multivariable logistic regression to assess correlates of support for school-entry requirements for HPV vaccination. RESULTS Overall, 21% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea," and 54% disagreed. If school-entry requirements included opt-out provisions, agreement increased to 57%, and only 21% disagreed. Parents more often agreed with requirements without opt-out provisions if they were Hispanic [OR = 1.53; 95% confidence interval (CI), 1.05-2.22], believed HPV vaccine was as or more important than other adolescent vaccines (OR = 2.76; 95% CI, 1.98-3.83), or believed HPV vaccine was effective for preventing cervical cancer (OR = 2.55; 95% CI, 1.93-3.37). Parents less often agreed if they resided in Midwest states or believed that HPV vaccine was being pushed to make money for drug companies (both P < 0.05). CONCLUSION Opt-out provisions almost tripled parents' support for HPV vaccine school-entry requirements. Our findings suggest that race/ethnicity, attitudes about HPV vaccine, and region of residence may influence support for requirements without opt-out provisions. IMPACT Opt-out provisions greatly increase parent support of school-entry requirements for HPV vaccination but may make them ineffective. Cancer Epidemiol Biomarkers Prev; 25(9); 1317-25. ©2016 AACR.
Collapse
Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts. Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Moss
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
27
|
Moghtaderi A, Adams S. The Role of Physician Recommendations and Public Policy in Human Papillomavirus Vaccinations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:349-359. [PMID: 26873090 DOI: 10.1007/s40258-016-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Immunization rates for human papillomavirus (HPV) infections remain low among teenagers despite strong evidence of the effectiveness of vaccines. Physician recommendations of the vaccine are far from universal. Several states have enacted policies that mandate HPV vaccination or distribute educational materials. OBJECTIVES To provide policy makers, physicians, and researchers information on the relative importance of physician recommendations and early state-level policies to promote HPV vaccinations among targeted age groups. METHODS We first use probit models to determine the strongest correlates of immunization in a nationally representative US sample of teenagers. We then use instrumental variable probit models to determine the direct role that physician recommendations play in vaccination using plausibly exogenous physician encounters that are likely not the result of more health-conscious parents seeking out information on the vaccine. RESULTS We show that children in the targeted age range who are more likely to encounter physicians for reasons other than seeking out the vaccine, such as through mandatory wellness exams or previous asthma diagnoses, are significantly more likely to get the vaccine. There is no consistent evidence that the state policies we analyze have been effective. CONCLUSION Encouraging recommendations by physicians may be the most effective path toward increasing HPV vaccination. State-level mandates and policies are yet to exhibit effectiveness.
Collapse
Affiliation(s)
- Ali Moghtaderi
- School of Medicine and Health Science, George Washington University, Washington, DC, USA
| | - Scott Adams
- Department of Economics, University of Wisconsin-Milwaukee, Bolton Hall 802, 3210 N. Maryland Ave., Milwaukee, WI, 53201, USA.
| |
Collapse
|
28
|
Durham DP, Ndeffo-Mbah ML, Skrip LA, Jones FK, Bauch CT, Galvani AP. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. Proc Natl Acad Sci U S A 2016; 113:5107-12. [PMID: 27091978 PMCID: PMC4983834 DOI: 10.1073/pnas.1515528113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.
Collapse
Affiliation(s)
- David P Durham
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511;
| | - Martial L Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Forrest K Jones
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| |
Collapse
|
29
|
Valentino K, Poronsky CB. Human Papillomavirus Infection and Vaccination. J Pediatr Nurs 2016; 31:e155-66. [PMID: 26586310 DOI: 10.1016/j.pedn.2015.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 01/16/2023]
Abstract
UNLABELLED Human papillomavirus (HPV) is an infection that can be sexually transmitted and result in health consequences including genital warts and cancers. Two vaccines, Gardasil® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] and Cervarix™ [Human Papillomavirus Bivalent (Types 16 and 18) Vaccine], have been approved for the prevention of HPV and HPV-related diseases. OBJECTIVES To explore facilitators and barriers associated with HPV vaccine utilization and compliance regarding vaccine series completion in school-aged, adolescent, and young adult females in the United States; to discuss HPV infection and highlight the safety and efficacy of the HPV vaccine; and to illustrate delivery strategies that can improve immunization rates and review implications for healthcare providers. METHODS A literature review was performed using health-related online databases (CINAHL, MEDLINE, PubMED, Web of Science, EBSCOHost and Google Scholar) and archival searching to identify current vaccination rates and factors associated with vaccine uptake. RESULTS Despite the availability of vaccines that prevent cancer, acceptance and utilization rates of both HPV vaccines are less than recommended by the Advisory Committee for Immunization Practices (ACIP). Some of the barriers to HPV vaccination include lack of provider recommendation, negative parent or patient attitudes and beliefs, cost, and missed clinical opportunities. The primary facilitator to HPV vaccination is a strong provider recommendation. CONCLUSIONS Healthcare providers can enhance HPV vaccine utilization by taking an active role with patients. Strategies include education and advocacy for receiving the vaccine, maximizing access to the HPV vaccine, and implementing new strategies for vaccine-delivery.
Collapse
|
30
|
Califano S, Calo WA, Weinberger M, Gilkey MB, Brewer NT. Physician support of HPV vaccination school-entry requirements. Hum Vaccin Immunother 2016; 12:1626-32. [PMID: 26900726 DOI: 10.1080/21645515.2016.1149275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
School-entry requirements in the US have led to high coverage for several vaccines, but few states and jurisdictions have adopted these policies for human papillomavirus (HPV) vaccination. Because physicians play a key role in advocating for vaccination policies, we assessed physician support of requiring HPV vaccine for school entry and correlates of this support. Participants were a national sample of 775 physicians who provide primary care, including vaccines, to adolescents. Physicians completed an online survey in 2014 that assessed their support for school-entry requirements for HPV vaccination of 11 and 12 y olds. We used multivariable logistic regression to assess correlates of support for these requirements. The majority of physicians (74%) supported some form of school-entry requirements, with or without opt-out provisions. When opt-out provisions were not specified, 47% agreed that laws requiring HPV vaccination for school attendance were a "good idea." Physicians more often agreed with requirements, without opt-out provisions, if they: had more years in practice (OR=1.49; 95% CI: 1.09-2.04), gave higher quality HPV vaccine recommendations (OR=2.06; 95% CI: 1.45-2.93), believed that having requirements for Tdap, but not HPV, vaccination undermined its importance (OR=3.33; 95% CI: 2.26-4.9), and believed HPV vaccination was as or more important than other adolescent vaccinations (OR=2.30; 95% CI: 1.65-3.18). In conclusion, we found that many physicians supported school-entry requirements for HPV vaccination. More research is needed to investigate the extent to which opt-out provisions might weaken or strengthen physician support of HPV vaccination school-entry requirements.
Collapse
Affiliation(s)
- Sophia Califano
- a Department of Internal Medicine , VA Medical Center , Durham , NC , USA
| | - William A Calo
- b Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Morris Weinberger
- b Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Melissa B Gilkey
- c Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Noel T Brewer
- d Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,e Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
| |
Collapse
|
31
|
Kotsopoulos N, Connolly MP, Remy V. Quantifying the broader economic consequences of quadrivalent human papillomavirus (HPV) vaccination in Germany applying a government perspective framework. HEALTH ECONOMICS REVIEW 2015; 5:23. [PMID: 26198884 PMCID: PMC4510306 DOI: 10.1186/s13561-015-0054-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
HPV infections can cause substantial burden in females and males as it is associated with several genital cancers, in addition to genital warts. Traditional economic evaluations often focus on quantifying cost-effectiveness, however, it is increasingly recognized that vaccinations may generate broader benefits not captured in cost-effectiveness analysis. Τhe aim of this study was to evaluate the broader economic consequences associated with HPV vaccination in males and females and to conduct a lifetime cost-benefit analysis of investing in universal vaccination in Germany from the perspective of government. Methodologies from generational accounting, human capital and health economics were combined to estimate the broader economic consequences of HPV vaccination including the fiscal impact for the government. A cohort model was developed simulating the medical costs and average lifetime fiscal transfers between the government and 12-year-old immunized and non-immunized males and females. To estimate tax revenue attributed to vaccination-related changes in morbidity and mortality, direct and indirect tax rates were linked to differences in age- and gender-specific earnings. Based on HPV vaccination costs, the base case cost-benefit analysis demonstrated that investing <euro>1 in universal HPV vaccination could yield <euro>1.7 in gross tax revenue over the lifetime of the cohorts. After taking into consideration the governmental transfers, universal HPV vaccination in Germany could result in incremental positive net discounted taxes (i.e. tax revenue-transfers) from <euro>62 million for the German government. The vaccination of males and females with the quadrivalent HPV vaccine is likely to have positive effects on public finances.
Collapse
Affiliation(s)
- Nikolaos Kotsopoulos
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Global Market Access Solutions (GMAS), St-Prex, Switzerland
| | - Mark P Connolly
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Global Market Access Solutions (GMAS), St-Prex, Switzerland
| | | |
Collapse
|
32
|
Kulczycki A, Qu H, Shewchuk R. Primary Care Physicians' Adherence to Guidelines and Their Likelihood to Prescribe the Human Papillomavirus Vaccine for 11- and 12-Year-Old Girls. Womens Health Issues 2015; 26:34-9. [PMID: 26344447 DOI: 10.1016/j.whi.2015.07.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/11/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inadequate physician adherence to guidelines has received scant attention as a possible cause of suboptimal human papillomavirus (HPV) vaccination rates. We assessed the extent to which primary care physicians (PCPs) adhere to clinical guidelines and their reported intentions to prescribe HPV vaccine to females in the targeted age group, and how this is influenced by perceptions of guideline clarity and other factors. METHODS We surveyed 301 PCPs to explore their sociodemographic and practice-related characteristics, beliefs, professional norms, and perceived barriers to administer HPV vaccine. Logistic regression predicted the likelihood to prescribe HPV vaccine to 11- and 12-year-old girls on an array of variables hypothesized to influence physicians' recommendations. RESULTS Only 67% of PCPs reported being likely to prescribe HPV vaccine to 11- and 12-year-old patients. PCPs were more likely to prescribe vaccine to 11- and 12-year-old girls if they believed HPV vaccine guidelines were clear (odds ratio [OR], 1.85; 95% CI, 1.03-3.35), agreed with a mandate requirement (OR, 2.39; 95% CI, 1.01-5.61), felt comfortable discussing HPV vaccination with early adolescent girls (OR, 5.10; 95% CI, 2.75-9.45), and had at least 25% of their patients using public assistance to pay for their clinic visits (OR, 3.82; 95% CI, 1.91-7.34). Practice specialty (family physicians or pediatricians) and region were not significant predictors. CONCLUSIONS PCPs exhibit moderate levels of adherence to professional guidelines regarding HPV vaccination. Potential public health benefits will not be realized without stronger efforts to improve the rates at which PCPs administer the vaccine, particularly to 11- and 12-year-olds for whom it is preferentially recommended.
Collapse
Affiliation(s)
- Andrzej Kulczycki
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Shewchuk
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
33
|
Nagler RH, Fowler EF, Gollust SE. Covering Controversy: What Are the Implications for Women's Health? Womens Health Issues 2015; 25:318-21. [PMID: 26070254 DOI: 10.1016/j.whi.2015.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Rebekah H Nagler
- School of Journalism & Mass Communication, University of Minnesota, Minneapolis, Minnesota.
| | | | - Sarah E Gollust
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| |
Collapse
|
34
|
Lillvis DF, Kirkland A, Frick A. Power and persuasion in the vaccine debates: an analysis of political efforts and outcomes in the United States, 1998-2012. Milbank Q 2014; 92:475-508. [PMID: 25199897 DOI: 10.1111/1468-0009.12075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT This article examines trends in state-level childhood vaccine policies in the United States from 1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization legislative efforts. Successful mobilization by vaccine critics during the height of the autism and thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most permissive type of exemption from vaccine mandates for public school attendance, those based on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How has vaccine critics' ability to advance preferred policies and prevent the passage of unfavorable legislation changed over time? METHODS We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to 2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate, mercury ban, and information policies) and outcome. We then mapped out the trends in vaccine policies over time. In order to contextualize the trends we identified, we also reviewed numerous primary sources and conducted interviews with stakeholders. FINDINGS In general, we found that vaccine critics' legislative success has begun to wane. In only 20 bills in our data set were vaccine critics able to change policy in their preferred direction via the legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical exemption to vaccine mandates), and the last of these was in 2007. Critics were more successful at preventing passage of proimmunization legislation, such as mandates for the human papillomavirus (HPV) vaccine. CONCLUSIONS Recent legislation in California, Oregon, and Washington that tightened philosophical exemptions by means of informational requirements suggests that vaccine politics may be entering another phase, one in which immunization supporters may be able to counter increasing opt-out rates, particularly in states with recent outbreaks and politicians favoring science-based policies.
Collapse
Affiliation(s)
- Denise F Lillvis
- University of Michigan; School of Public Health, University of Michigan
| | | | | |
Collapse
|
35
|
Laugesen MJ, Mistry R, Carameli KA, Ribisl KM, Needleman J, Bastani R. Early policy responses to the human papillomavirus vaccine in the United States, 2006-2010. J Adolesc Health 2014; 55:659-64. [PMID: 24928803 DOI: 10.1016/j.jadohealth.2014.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the policies state governments pursued and enacted across the United States in the 5-year period after the U.S. Food and Drug Administration licensed the human papillomavirus (HPV) vaccine in 2006, including the timing and number of bills introduced, the policies proposed, and the legislative success of HPV vaccine policy proposals. METHODS Content abstraction and analysis of state-level HPV vaccine-related bills across the 50 states and the District of Columbia introduced between 2006 and 2010. RESULTS All but five states (Alaska, Delaware, Idaho, New Hampshire, and Wyoming) introduced HPV vaccine bills between 2006 and 2010. Two-thirds of all bills were introduced in 2007. In all, 141 bills were introduced and 23% or 32 bills were enacted. Of the bills that were enacted, 43.8% provided information for parents and schools about the vaccine; 37.5% provided public financing for HPV vaccines; 34.4% were classified as other policies; 25% created awareness campaigns; 25% required private insurance coverage of the HPV vaccination; 12.5% included voluntary vaccination, and 9.4% mandated vaccination for school entry. One bill reversed prior mandatory vaccination policies. Overall, 91% of enacted HPV vaccine bills did not refer to mandated vaccinations but adopted alternate policy strategies in response to the availability of the new HPV vaccine. CONCLUSIONS Nationwide, states responded to the new HPV vaccine by introducing policies designed to increase the availability of information about the vaccine, provide funding, and regulate private insurance coverage rather than require vaccination for school entry.
Collapse
Affiliation(s)
- Miriam J Laugesen
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kelley A Carameli
- National Center for Organization Development, Veterans Health Administration, Cincinnati, Ohio
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
36
|
Hedden EM, Jessop AB, Field RI. An education in contrast: state-by-state assessment of school immunization records requirements. Am J Public Health 2014; 104:1993-2001. [PMID: 25122033 PMCID: PMC4167093 DOI: 10.2105/ajph.2014.302078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We reviewed the complexities of school-related immunization policies, their relation to immunization information systems (IIS) and immunization registries, and the historical context to better understand this convoluted policy system. METHODS We used legal databases (Lexis-Nexis and Westlaw) to identify school immunization records policies for 50 states, 5 cities, and the District of Columbia (Centers for Disease Control and Prevention "grantees"). The original search took place from May to September 2010 (cross-referenced in July 2013 with the list on http://www.immunize.org/laws ). We describe the requirements, agreement with IIS policies, and penalties for policy violations. RESULTS We found a complex web of public health, medical, and education-directed policies, which complicates immunization data sharing. Most (79%) require records of immunizations for children to attend school or for a child-care institution licensure, but only a few (11%) require coordination between IIS and schools or child-care facilities. CONCLUSIONS To realize the full benefit of IIS investment, including improved immunization and school health program efficiencies, IIS and school immunization records policies must be better coordinated. States with well-integrated policies may serve as models for effective harmonization.
Collapse
Affiliation(s)
- Erika M Hedden
- Erika M. Hedden and Amy B. Jessopare are with the Department of Health Policy and Public Health, University of the Sciences, Philadelphia, PA. Robert I. Field is with the School of Law and School of Public Health, Drexel University, Philadelphia, PA
| | | | | |
Collapse
|
37
|
Ferrer HB, Trotter C, Hickman M, Audrey S. Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis. BMC Public Health 2014; 14:700. [PMID: 25004868 PMCID: PMC4100058 DOI: 10.1186/1471-2458-14-700] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. METHODS We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). RESULTS Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman's access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. CONCLUSIONS Barriers to the uptake of the HPV vaccine have implications for young women's future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women's perceptions of, and involvement in, consent and decision-making.
Collapse
Affiliation(s)
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| |
Collapse
|
38
|
Nakada H, Yuji K, Tsubokura M, Ohsawa Y, Kami M. Development of a national agreement on human papillomavirus vaccination in Japan: an infodemiology study. J Med Internet Res 2014; 16:e129. [PMID: 24834471 PMCID: PMC4051745 DOI: 10.2196/jmir.2846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/12/2013] [Accepted: 04/09/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A national agreement on human papillomavirus (HPV) vaccination was achieved relatively quickly in Japan as compared to the United States and India. OBJECTIVE The objective was to identify the role of print and online media references, including references to celebrities or other informants, as factors potentially responsible for the relatively rapid national acceptance of HPV vaccination in Japan. METHODS A method of text mining was performed to select keywords, representing the context of the target documents, from articles relevant to the promotion of HPV vaccination appearing in major Japanese newspapers and Web pages between January 2009 and July 2010. The selected keywords were classified as positive, negative, or neutral, and the transition of the frequency of their appearance was analyzed. RESULTS The number of positive and neutral keywords appearing in newspaper articles increased sharply in early 2010 while the number of negative keywords remained low. The numbers of positive, neutral, and negative keywords appearing in Web pages increased gradually and did not significantly differ by category. Neutral keywords, such as "vaccine" and "prevention," appeared more frequently in newspaper articles, whereas negative keywords, such as "infertility" and "side effect," appeared more frequently in Web pages. The extraction of the positive keyword "signature campaign" suggests that vaccine beneficiaries cooperated with providers in promoting HPV vaccination. CONCLUSIONS The rapid development of a national agreement regarding HPV vaccination in Japan may be primarily attributed to the advocacy of vaccine beneficiaries, supported by advocacy by celebrities and positive reporting by print and online media.
Collapse
Affiliation(s)
- Haruka Nakada
- Institute of Medical Science, Division of Social Communication System for Advanced Clinical Research, The University of Tokyo, Tokyo, Japan.
| | | | | | | | | |
Collapse
|
39
|
Wakimizu R, Nishigaki K, Fujioka H, Maehara K, Kuroki H, Saito T, Uduki K. How adolescent Japanese girls arrive at human papilloma virus vaccination: A semistructured interview study. Nurs Health Sci 2014; 17:15-25. [DOI: 10.1111/nhs.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Rie Wakimizu
- Faculty of Medicine; University of Tsukuba; Tsukuba Japan
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
| | - Kaori Nishigaki
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- Faculty of Health Sciences; Tsukuba International University; Tsukuba Japan
| | - Hiroshi Fujioka
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- MAEHARA Pediatric Clinic; Tokyo Japan
| | - Koji Maehara
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- SOTOBO Children's Clinic; Chiba Japan
| | - Haruo Kuroki
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- Department of Pediatrics; TAKO Central Hospital; Chiba Japan
| | - Tadashi Saito
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- SHIROAMU Pediatric Clinic; Kushiro Japan
| | - Katsuya Uduki
- Faculty of Health Sciences; Tokyo Healthcare University; Tsukuba Japan
- Investigative Commission of Qualitative Study; Society of Ambulatory and General Pediatrics of Japan; Tokyo Japan
| |
Collapse
|
40
|
Affiliation(s)
- Douglas S. Diekema
- Department of Pediatrics, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington 98101;
| |
Collapse
|
41
|
Casciotti DM, Smith KC, Andon L, Vernick J, Tsui A, Klassen AC. Print news coverage of school-based human papillomavirus vaccine mandates. THE JOURNAL OF SCHOOL HEALTH 2014; 84:71-81. [PMID: 25099421 PMCID: PMC4672723 DOI: 10.1111/josh.12126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 12/20/2012] [Accepted: 01/19/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. METHODS We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005 to 2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. RESULTS Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. CONCLUSIONS If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages and promote informed decision-making by parents and students.
Collapse
Affiliation(s)
- Dana M Casciotti
- Program Analyst, , National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894
| | | | | | | | | | | |
Collapse
|
42
|
Mamo L, Epstein S. The pharmaceuticalization of sexual risk: vaccine development and the new politics of cancer prevention. Soc Sci Med 2013; 101:155-65. [PMID: 24560236 DOI: 10.1016/j.socscimed.2013.11.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 01/05/2023]
Abstract
Vaccine development is a core component of pharmaceutical industry activity and a key site for studying pharmaceuticalization processes. In recent decades, two so-called cancer vaccines have entered the U.S. medical marketplace: a vaccine targeting hepatitis B virus (HBV) to prevent liver cancers and a vaccine targeting human papillomavirus (HPV) to prevent cervical and other cancers. These viruses are two of six sexually transmissible infectious agents (STIs) that are causally linked to the development of cancers; collectively they reference an expanding approach to apprehending cancer that focuses attention simultaneously "inward" toward biomolecular processes and "outward" toward risk behaviors, sexual practices, and lifestyles. This paper juxtaposes the cases of HBV and HPV and their vaccine trajectories to analyze how vaccines, like pharmaceuticals more generally, are emblematic of contemporary pharmaceuticalization processes. We argue that individualized risk, in this case sexual risk, is produced and treated by scientific claims of links between STIs and cancers and through pharmaceutical company and biomedical practices. Simultaneous processes of sexualization and pharmaceuticalization mark these cases. Our comparison demonstrates that these processes are not uniform, and that the production of risks, subjects, and bodies depends not only on the specificities of vaccine development but also on the broader political and cultural frames within which sexuality is understood.
Collapse
Affiliation(s)
- Laura Mamo
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, HSS 358A, San Francisco, CA 94132, USA.
| | | |
Collapse
|
43
|
Wheldon CW, Buhi ER, Daley EM, Hernandez ND, Anstey EH, Kolar S, Giuliano AR. Human papillomavirus vaccine intentions among males: a test of the Parallel Processing Model. J Health Psychol 2013; 20:427-37. [PMID: 24155190 DOI: 10.1177/1359105313502693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated the cognitive and emotional reactions resulting from a human papillomavirus-related illness threat (i.e. testing positive for human papillomavirus) and the potential behavioral implications resulting from these psychosocial processes among men (N = 536). Structural equation modeling was used to explore a theoretical model explaining human papillomavirus vaccine intentions. The model fit the data well and explained 16 percent of the variance in vaccine intentions. Negative emotional response mediated the path between illness threat and vaccine intentions. Threat of genital warts was a salient concern and was positively associated with negative emotional response and subsequent vaccine intentions. Implications for vaccine promotion are discussed.
Collapse
|
44
|
Abiola SE, Colgrove J, Mello MM. The politics of HPV vaccination policy formation in the United States. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2013; 38:645-681. [PMID: 23645875 DOI: 10.1215/03616878-2208567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article explores the political dimensions of policy formation for the human papillomavirus (HPV) vaccine through case studies of six states: California, Indiana, New Hampshire, New York, Texas, and Virginia. Using thematic content analysis of semistructured key informant interviews with policy stakeholders, newspaper articles, and archival materials, we describe the trajectory of public health policy developments for HPV immunization and analyze key influences on policy outcomes through the theoretical lens of the Multiple Streams framework. Specifically, we examine factors influencing the extent to which HPV was perceived as a problem meriting policy action; political forces that facilitated and impeded policy adoption, including interest-group opposition and structural and ideological features of the states' political environments; and factors affecting which policy alternatives received consideration. We find that effective policy entrepreneurship played a critical role in determining policy outcomes. We conclude by discussing lessons from the case of HPV vaccination for future efforts to craft vaccination policies.
Collapse
|
45
|
Health care professional communication about STI vaccines with adolescents and parents. Vaccine 2013; 32:1616-23. [PMID: 23791695 DOI: 10.1016/j.vaccine.2013.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
Abstract
Vaccination of adolescents against sexually transmitted infections (STIs) is an important prevention strategy that may reduce the global burden of disease. The World Health Organization, Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and other national health agencies recommend the use of existing STI vaccines, and many countries have incorporated them into their routine vaccination schedule. Despite this, however, data indicate that STI vaccine uptake is suboptimal for a variety of reasons. Health care professionals (HCP) have been shown to have a strong beneficial effect on STI vaccine uptake, yet studies demonstrate that many HCPs fail to discuss or recommend them to adolescent patients. This review article focuses on HCP communication about STI vaccines with adolescents and their parents. It describes STI vaccine message content and delivery as well as the context in which HCPs formulate their messaging approach. It also examines other contextual factors that may shape communication about STI vaccines. Studies from many countries indicate that HCPs often possess misinformation about adolescents, including their sexual risk behaviors, as well as STIs, vaccine safety and efficacy, and STI vaccination recommendations. They also have misconceptions of parental barriers to STI vaccination. These may impact STI vaccine communication and have a negative influence on STI vaccine uptake. These findings highlight the critical need for improved HCP education related to adolescent health, sexuality, and STI vaccination. This may be particularly important in settings without an existing infrastructure or expertise in caring for this unique patient population.
Collapse
|
46
|
Hawkes D, Lea CE, Berryman MJ. Answering human papillomavirus vaccine concerns; a matter of science and time. Infect Agent Cancer 2013; 8:22. [PMID: 23758825 PMCID: PMC3691750 DOI: 10.1186/1750-9378-8-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/05/2013] [Indexed: 01/30/2023] Open
Abstract
Since the introduction of the HPV vaccine, questions have been asked about its efficacy in preventing cancer linked with HPV. Concerns about the HPV vaccine safety profile have also been raised. This paper highlights the rapidly growing body of evidence (including clinical trials and post-marketing surveillance) illustrating both the safety of the HPV vaccine, through a detailed investigation of reported adverse events, and its efficacy in reducing both HPV infections rates and the resulting drop in cervical lesions, which have been demonstrated to be good predictors of cervical cancer risk.
Collapse
Affiliation(s)
- David Hawkes
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia.
| | | | | |
Collapse
|
47
|
Gollust SE, Attanasio L, Dempsey A, Benson AM, Fowler EF. Political and news media factors shaping public awareness of the HPV vaccine. Womens Health Issues 2013; 23:e143-51. [PMID: 23557851 DOI: 10.1016/j.whi.2013.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2006, the U.S. Food and Drug Administration licensed a vaccine for the human papillomavirus (HPV) that prevents the strains of HPV that cause 70% of cervical cancers. Within months, many states introduced legislation requiring the vaccine for girls, prompting controversy and heightened political and media attention to the issue. Previous research has shown differences in HPV vaccine awareness by individual-level characteristics such as race/ethnicity, income, and education levels. We examined how individual political orientation and exposure to media coverage can also shape awareness of the vaccine. METHODS Using data from a 2009 Internet survey of 1,216 nationally representative adult respondents linked to data on state-specific news coverage, we assessed how political orientation, media exposure, and state political context predicted HPV vaccine awareness. RESULTS Younger people, women, and those with more education were significantly more likely to be aware of the vaccine. Even after controlling for these characteristics, we found that exposure to news media was associated with higher HPV vaccine awareness. Whereas liberals and conservatives were both more aware of the vaccine compared with moderates, the data are suggestive that liberals were more sensitive to news coverage. CONCLUSION These findings suggest that individual-level political identities and their interaction with the informational environment may be important factors to consider in evaluating the determinants of individuals' attitudes and behaviors related to politically charged women's health issues.
Collapse
Affiliation(s)
- Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota 55455, USA.
| | | | | | | | | |
Collapse
|
48
|
Caplan AL, Schwartz JL. Ethics. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
49
|
Bartlett JA, Peterson JA. Psychometric Evaluation of the Shared Decision-Making Instrument–Revised. West J Nurs Res 2012. [DOI: 10.1177/0193945912463267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the psychometric properties of the Shared Decision-Making Inventory–Revised (SDMI-R) to measure four constructs (knowledge, attitudes, self-efficacy, and intent) theoretically defined as vital in discussing the human papillomavirus (HPV) disease and vaccine with clients. The SDMI-R was distributed to a sample ( N = 1,525) of school nurses. Correlational matrixes denoted moderate to strong correlations, indicating adequate internal reliability. Reliability for the total instrument was satisfactory (α = .874) along with Attitude, Self-Efficacy and Intent subscales .828, .917, .891, respectively. Exploratory factor analysis revealed five components that explained 75.96% of the variance.
Collapse
|
50
|
Hedden EM, Jessop AB, Field RI. Childhood immunization reporting laws in the United States: Current status. Vaccine 2012; 30:7059-66. [DOI: 10.1016/j.vaccine.2012.09.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 08/13/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
|