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Chandeying N, Thongseiratch T. EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review. Vaccines (Basel) 2024; 12:739. [PMID: 39066377 PMCID: PMC11281632 DOI: 10.3390/vaccines12070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes.
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Affiliation(s)
- Nutthaporn Chandeying
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Therdpong Thongseiratch
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90100, Thailand
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Petagna CN, Perez S, Hsu E, Greene BM, Banner I, Bednarczyk RA, Escoffery C. Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia. BMC Cancer 2024; 24:592. [PMID: 38750439 PMCID: PMC11094994 DOI: 10.1186/s12885-024-12351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination protects against HPV-associated cancers and genital warts. Healthy People 2030 goal for HPV vaccine uptake is 80%, but as of 2021, only 58.5% of adolescents are up to date in Georgia. The purpose of the study is to assess the attitudes, vaccine practices, facilitators, and barriers to receiving the HPV vaccine in southwest Georgia. METHODS We conducted 40 semi-structured interviews in the United States from May 2020-Feburary 2022 with three different audiences (young adults, parents, and providers and public health professionals) guided by the P3 (patient-, provider-, practice-levels) Model. The audiences were recruited by multiple methods including fliers, a community advisory board, Facebook ads, phone calls or emails to schools and health systems, and snowball sampling. Young adults and parents were interviewed to assess their perceived benefits, barriers, and susceptibility of the HPV vaccine. Providers and public health professionals were interviewed about facilitators and barriers of patients receiving the HPV vaccine in their communities. We used deductive coding approach using a structured codebook, two coders, analyses in MAXQDA, and matrices. RESULTS Out of the 40 interviews: 10 young adults, 20 parents, and 10 providers and public health professionals were interviewed. Emerging facilitator themes to increase the uptake of the HPV vaccine included existing knowledge (patient level) and community outreach, providers' approach to the HPV vaccine recommendations and use of educational materials in addition to counseling parents or young adults (provider level) and immunization reminders (practice level). Barrier themes were lack of knowledge around HPV and the HPV vaccine (patient level), need for strong provider recommendation and discussing the vaccine with patients (provider level), and limited patient reminders and health education information around HPV vaccination (practice level). Related to socio-ecology, the lack of transportation and culture of limited discussion about vaccination in rural communities and the lack of policies facilitating the uptake of the HPV vaccine (e.g., school mandates) were described as challenges. CONCLUSION These interviews revealed key themes around education, knowledge, importance of immunization reminders, and approaches to increasing the HPV vaccination in rural Georgia. This data can inform future interventions across all levels (patient, provider, practice, policy, etc.) to increase HPV vaccination rates in rural communities.
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Affiliation(s)
- Courtney N Petagna
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Stephen Perez
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Erica Hsu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Brenda M Greene
- Southwest Health District, 8-2, Division of Public Health, Georgia Department of Public Health, Albany, GA, 31710, USA
| | - Ionie Banner
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Kong WY, Oh NL, Kennedy KL, Carlson RB, Liu A, Ozawa S, Brewer NT, Gilkey MB. Identifying Healthcare Professionals With Lower Human Papillomavirus (HPV) Vaccine Recommendation Quality: A Systematic Review. J Adolesc Health 2024; 74:868-877. [PMID: 38231146 PMCID: PMC11031337 DOI: 10.1016/j.jadohealth.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Strengthening healthcare professionals' (HCPs) communication is an evidence-based approach to increasing human papillomavirus (HPV) vaccine uptake among adolescents. To better target future interventions, we sought to synthesize evidence on HCP subgroups who most need to improve their HPV vaccine recommendation quality. METHODS We searched five databases for quantitative studies published from 2012 to 2022 on HPV vaccine recommendation quality, including recommendation consistency and strength, for United States adolescents. Two coders independently abstracted data from each eligible study, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We summarized variation in recommendation quality by clinical and HCP characteristics. RESULTS The 28 eligible studies indicated that relatively low proportions of HCPs used higher-quality recommendation practices (median: 61% across 30 measures) and that recommendation quality varied across HCP subgroups. The most consistent findings were that more pediatric HCPs used higher-quality recommendations than family medicine HCPs (8 of 11 studies, 2-60 percentage point difference) and that HPV-related knowledge was associated with higher recommendation quality (four of seven studies). Most studies observed no differences in recommendation quality by clinical role (e.g., provider vs. nurse) or HCP demographics (e.g., gender, age, race/ethnicity). DISCUSSION Studies suggest a substantial need to improve HCPs' recommendation quality, with opportunities for targeting future interventions.
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Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Nul Loren Oh
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca B Carlson
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy Liu
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Petagna CN, Perez S, Hsu E, Greene BM, Banner I, Bednarczyk RA, Escoffery C. Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia. RESEARCH SQUARE 2024:rs.3.rs-3979079. [PMID: 38496559 PMCID: PMC10942563 DOI: 10.21203/rs.3.rs-3979079/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Human papillomavirus (HPV) vaccination protects against HPV-associated cancers and genital warts. Healthy People 2030 goal for HPV vaccine uptake is 80%, but as of 2021, only 58.5% of adolescents are up to date in Georgia. The purpose of the study is to assess the attitudes, vaccine practices, facilitators, and barriers to receiving the HPV vaccine in southwest Georgia. Methods We conducted 40 semi-structured interviews with three different audiences (young adults, parents, and providers and public health professionals) guided by the P3 (patient-, provider-, practice-levels) model and used deductive coding approach. Young adults and parents were interviewed to assess their perceived benefits, barriers, and susceptibility of the HPV vaccine. Providers and public health professionals were interviewed about facilitators and barriers of patients receiving the HPV vaccine in their communities. Results Out of the 40 interviews: 10 young adults, 20 parents, and 10 providers and public health professionals were interviewed. Emerging facilitator themes to increase the uptake of the HPV vaccine included existing knowledge (patient level), providers' approach to the HPV vaccine recommendations (provider level) and immunization reminders (practice level). Barrier themes were lack of knowledge around HPV and the HPV vaccine (patient level), need for strong provider recommendation and discussing the vaccine with patients (provider level), and limited patient reminders and information (practice level). Conclusions These interviews revealed key themes around education, knowledge, importance of immunization reminders, and approaches to increasing the HPV vaccination in rural Georgia. This data can inform future interventions across all levels (patient, provider, practice, policy, etc.) to increase HPV vaccination rates in rural communities.
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Meadows RJ, Gehr AW, Lu Y, Maynard G, Akpan IN, Taskin T, Fulda KG, Patel D, Matches S, Ojha RP, Thompson EL. Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system. Prev Med Rep 2024; 39:102660. [PMID: 38426039 PMCID: PMC10901897 DOI: 10.1016/j.pmedr.2024.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). Methods We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. Results Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. Conclusion Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.
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Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Aaron W. Gehr
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Yan Lu
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Grace Maynard
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- North Texas Primary Care Practice-Based Research Network (NorTex), Department of Family Medicine and Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Divya Patel
- Department of Epidemiology, Human Genetics and Environmental Science, UTHealth Houston School of Public Health in Austin, Austin, TX, USA
| | - Sarah Matches
- Department of Pediatrics & Women’s Health, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rohit P. Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Kong WY, Queen TL, Gottfredson O'Shea N, Heisler-MacKinnon J, Liu A, Ozawa S, Brewer NT, Gilkey MB. Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals. Prev Med 2024; 179:107841. [PMID: 38160884 PMCID: PMC10872220 DOI: 10.1016/j.ypmed.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Presumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. METHODS In 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. RESULTS Participants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04-0.28, all p < 0.05). CONCLUSION To better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.
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Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Nisha Gottfredson O'Shea
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Amy Liu
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Sachiko Ozawa
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina, United States of America; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
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Chandra M, Osaghae I, Talluri R, Shete S. Barriers to human papillomavirus vaccine uptake: role of state religiosity and healthcare professionals' participation in a state vaccine program. JNCI Cancer Spectr 2023; 7:pkad068. [PMID: 37698997 PMCID: PMC10575682 DOI: 10.1093/jncics/pkad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Despite the known benefits of preventing human papillomavirus (HPV)-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date. METHODS Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen's parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. RESULTS The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.50 to 0.78; moderate religiosity AOR = 0.68, 95% CI = 0.55 to 0.85) and up-to-date (high religiosity AOR = 0.69, 95% CI = 0.56 to 0.85; moderate religiosity AOR = 0.74, 95% CI = 0.61 to 0.91) than states with low religiosity. At the meso level, when none of their healthcare professionals ordered vaccine from the state, teens had lower odds of initiation (AOR = 0.68, 95% CI = 0.53 to 0.87) and up-to-date (AOR = 0.76, 95% CI = 0.60 to 0.95) than teens whose healthcare professionals ordered vaccine from the state. In addition, race and ethnicity, age, mother's education level, household income, well-child examination status, and doctor's recommendation were significantly associated with HPV vaccine uptake. CONCLUSION A multiprong approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare professionals' access and enrollment in state vaccine initiatives, such as the Vaccine for Children program.
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Affiliation(s)
- Monalisa Chandra
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Shaw J, Hanley S, Sitnik E, Berry W, Blatt S, Seserman M, Formica MK. Attitudes towards HPV Vaccination Policy Strategies to Improve Adolescent Vaccination Coverage among Pediatric Providers in New York State. Vaccines (Basel) 2023; 11:1359. [PMID: 37631926 PMCID: PMC10457785 DOI: 10.3390/vaccines11081359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Pediatric providers' stances on HPV vaccination-related policies are largely unknown. To gain insight into pediatric providers' perspectives and potential recommendations for directed policy, we conducted a cross-sectional survey of the American Academy of Pediatrics members in New York. Almost all providers expressed confidence in discussing the HPV vaccine with patients (98.6%, n = 72). Among common barriers to vaccination, providers listed parental safety concerns (n = 60, 82.2%), vaccination not being required for school entry (n = 59, 80.8%), and moral opposition to vaccination (n = 48, 65.8%). Among all respondents, 29 (39.7%), 13 (17.8%), and 2 (2.7%) agreed the vaccine should be required for middle, high, and tertiary school entry, respectively. Support for pharmacist-provision of the vaccine varied, with 31 (42.5%) providers expressing support. Most providers supported adolescent self-consent to vaccination, (n = 67, 91.8%). Providers continued to encounter barriers to HPV vaccination and indicated support of HPV vaccination mandates for school entry, pharmacist provision of the vaccine, and adolescent self-consent to vaccination.
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Affiliation(s)
- Jana Shaw
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY 13201, USA
| | - Samantha Hanley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13201, USA; (S.H.); (E.S.); (M.K.F.)
| | - Elana Sitnik
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13201, USA; (S.H.); (E.S.); (M.K.F.)
| | - Winter Berry
- Department of Pediatrics, Division of General Pediatrics, Upstate Pediatric and Adolescent Center, SUNY Upstate Medical University, Syracuse, NY 13201, USA; (W.B.); (S.B.)
| | - Steven Blatt
- Department of Pediatrics, Division of General Pediatrics, Upstate Pediatric and Adolescent Center, SUNY Upstate Medical University, Syracuse, NY 13201, USA; (W.B.); (S.B.)
| | - Michael Seserman
- American Cancer Society, Northeast Region, One Penny Lane, Latham, NY 12110, USA;
| | - Margaret K. Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13201, USA; (S.H.); (E.S.); (M.K.F.)
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13201, USA
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9
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Osaghae I, Chandra M, Talluri R, Shete S. Individual, systemic and state factors associated with provider recommendation of HPV vaccination: Findings from NIS-Teen, 2020. Hum Vaccin Immunother 2023; 19:2239678. [PMID: 37550623 PMCID: PMC10408691 DOI: 10.1080/21645515.2023.2239678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27-1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61-2.74), and teens whose mothers had college, some college or at least a high school education compared to those with less than high school education. In addition to individual factors, provider recommendation of HPV vaccination was higher in hospitals (AOR: 1.51; 95% CI: 1.00-2.29) and STD/school/teen clinics (AOR: 2.47; 95% CI: 1.05-5.78) compared to public facilities. However, the odds of provider recommendation were lower when none of the teen's providers ordered vaccines from the state compared to when all teen providers ordered vaccines from the state (AOR: 0.69; 95% CI: 0.52-0.93). Moreover, the state's mean prevalence of provider recommendations of HPV vaccination was 7.2% lower (Coefficient: -0.072; 95% CI: -0.107 - -0.036) in states with high religious ideology compared to those with low religious ideology. Interventions to increase provider recommendation of HPV vaccination should take a multiprong and comprehensive approach that addresses religious and systemic barriers to HPV vaccination recommendation.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monalisa Chandra
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Zhu Y, Lin YY, Li R, He C, Lairson DR, Deshmukh AA, Sonawane K. Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties. Ann Fam Med 2023; 21:344-346. [PMID: 37487718 PMCID: PMC10365861 DOI: 10.1370/afm.2990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/27/2023] [Accepted: 02/23/2023] [Indexed: 07/26/2023] Open
Abstract
The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by 3rd-party payers is a critical enabling factor for clinicians to continue offering vaccines. This study found that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a $1 increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Reimbursement for HPV vaccine costs by private payers is adequate; however, return margins are small for non-pediatric specialties.
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Affiliation(s)
- Yenan Zhu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas
| | - Cara He
- Baylor College of Medicine, Baylor Universiry, Houston, Texas
| | - David R Lairson
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ashish A Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
| | - Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina
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11
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Ellingson MK, Bednarczyk RA, O’Leary ST, Schwartz JL, Shapiro ED, Niccolai LM. Understanding the Factors Influencing Health Care Provider Recommendations about Adolescent Vaccines: A Proposed Framework. J Behav Med 2023; 46:356-365. [PMID: 35194726 PMCID: PMC8862696 DOI: 10.1007/s10865-022-00296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
Health care provider recommendations are among the most important factors influencing parents' decisions to vaccinate their adolescents. However, delivery of high-quality health care provider recommendations for vaccination is not universal. There is wide variation in the strength, timeliness and consistency of the delivery of recommendations for all adolescent vaccines. The factors that influence health care providers' recommendations are multi-level and can be conceptualized in much the same way as vaccine acceptance among parents. Health care providers are influenced by their own attitudes and beliefs about a vaccine and also by the patient they are treating and by the community in which they practice as well as state and national level vaccine policy. We propose a multi-level framework for understanding the factors that influence health care providers' recommendations at the individual, interpersonal and community level to both develop and adapt interventions to improve providers' recommendations.
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Affiliation(s)
- Mallory K. Ellingson
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA USA
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Sean T. O’Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Jason L. Schwartz
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT 06520 USA
| | - Eugene D. Shapiro
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520 USA
| | - Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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13
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Garbutt J, Wang R, Graham S, McKay V, Haire-Joshu D, Barker A, Liu L. Provider and Practice Factors Associated With On-Time HPV Vaccination in Primary Care. Acad Pediatr 2022; 23:800-807. [PMID: 36592791 DOI: 10.1016/j.acap.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2018, only one third of girls and boys completed the 2-dose series of the human papillomavirus vaccine by their 13th birthday, the target for on-time vaccination. The study objective was to identify key patient, provider and practice-level factors associated with on-time vaccination in the primary care setting. METHODS We examined data from 20 primary care pediatric practices (89 providers) in St. Louis including: the percentage of eligible patients with on-time vaccination assessed from medical records; providers' knowledge, attitudes and behaviors regarding on-time vaccination assessed with a survey; and practice-level strategies used to optimize vaccine delivery assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased on-time vaccination were identified using logistic regression, controlling for clustering within providers. RESULTS Completion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95% confidence interval [CI], 41.36%-44.86%) and varied among practices (7.39%-64.24%) and among providers (2.63%-82.50%). Independent predictors for higher completion of on-time vaccination included more frequent use by providers of the announcement style for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider self-efficacy to deliver the vaccine according to guideline recommendations if parents were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10, 1.31). CONCLUSIONS Provider and practice-level factors were identified that may represent modifiable targets for improvement in on-time vaccine uptake. Future research is needed to test interventions built on these findings.
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Affiliation(s)
- Jane Garbutt
- Department of Medicine and Department of Pediatrics, Washington University School of Medicine (J Garbutt), St. Louis, Mo.
| | - Ruoyun Wang
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Sharon Graham
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Virginia McKay
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Debra Haire-Joshu
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Abigail Barker
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine (L Liu), St. Louis, Mo
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14
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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15
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Lake PW, Head KJ, Christy SM, DeMaria AL, Thompson EL, Vadaparampil ST, Zimet GD, Kasting ML. Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists. Prev Med Rep 2022; 27:101801. [PMID: 35518719 PMCID: PMC9061621 DOI: 10.1016/j.pmedr.2022.101801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/15/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates in the U.S. are relatively low. Provider recommendation rates for HPV vaccination often vary by patient age and relationship status. Obstetrician/gynecologists (OB/GYNs) represent a key provider group that can recommend the HPV vaccine. This study examined differences in OB/GYN recommendation of HPV vaccination for inpatient postpartum patients by age, parity, and marital status. Data were collected from OB/GYNs nationally via a cross-sectional survey. Participants were randomized to two vignette groups (23-year-old patient or 33-year-old patient). Within each group, participants received 4 vignettes that were identical except for patient marital status (married/not in a committed relationship) and number of children (first/third child), and were asked to indicate HPV vaccination recommendation likelihood on a scale of 0 (definitely would not) to 100 (definitely would). A 2 × 2 × 2 general linear model with repeated measures was used to examine main and interaction effects of patient age, relationship status, and parity. 207 OB/GYNs were included in the final analyses. Recommendation was high for 23-year-old patients (range: 64.5-84.6 out of 100). When marital status and parity were held constant, recommendation likelihood was higher for the younger vs. older patient and was also higher for patients not in a committed relationship, compared to married patients (all p-values < 0.001). Differences in recommendation exist when considering age and relationship status, which provides insight into OB/GYN clinical decision-making. Findings highlight the need to address barriers to HPV vaccination recommendation, including awareness of risk factors to consider when recommending the vaccine.
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Affiliation(s)
- Paige W. Lake
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, USA
| | - Andrea L. DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Erika L. Thompson
- Department of Health Behavior & Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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16
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Anuforo B, McGee-Avila JK, Toler L, Xu B, Kohler RE, Manne S, Tsui J. Disparities in HPV vaccine knowledge and adolescent HPV vaccine uptake by parental nativity among diverse multiethnic parents in New Jersey. BMC Public Health 2022; 22:195. [PMID: 35093050 PMCID: PMC8800253 DOI: 10.1186/s12889-022-12573-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Background Suboptimal human papillomavirus (HPV) vaccination rates persist among adolescents in the United States (U.S.). New Jersey (NJ), among the top, most racially/ethnically diverse states in the U.S., had among the lowest HPV vaccine initiation rates, prior to 2018. This study examined parental HPV vaccine knowledge and adolescent HPV vaccine initiation among multiethnic parents in NJ, where access to language concordant HPV vaccine information and vaccination services may differ, for immigrant parents. Methods We surveyed parents of adolescents (ages 11–18) at community events in NJ to examine parental HPV vaccine knowledge and adolescent HPV vaccine uptake. Vaccine knowledge was assessed using an 11-item question stem that covered vaccine efficacy, gender recommendation, vaccine protection, and myths. Multivariable models assessed the association of parent nativity on HPV vaccine knowledge scores and adolescent HPV vaccine initiation, controlling for sociodemographic factors. Results Of the 77 parents, most parents (84%) were aware of the HPV vaccine. However, knowledge scores were low and differed by parent nativity. Non-U.S. born parents had significantly lower knowledge scores − 1.7 [− 3.1, − 0.4] and lower odds of adolescent children initiating the HPV vaccine 0.3 [0.1, 0.9] compared to U.S.-born parents after adjusting demographic characteristics. Conclusions Our findings reveal that parental HPV vaccine knowledge remains low among suburban dwelling, immigrant parents, even though they have higher education and access to health care. Multilevel strategies to reduce missed opportunities for HPV vaccine education among parents and HPV vaccination for adolescents are needed, including for suburban, immigrant communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12573-7.
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17
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Askelson N, Ryan G, McRee AL, Farris PE, Shannon J, Hanson J, Kenyon DB, Daly E, Avdic L. Using concept mapping to identify opportunities for HPV vaccination efforts: Perspectives from the Midwest and West Coast. EVALUATION AND PROGRAM PLANNING 2021; 89:102010. [PMID: 34555736 PMCID: PMC8557125 DOI: 10.1016/j.evalprogplan.2021.102010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/11/2021] [Accepted: 09/02/2021] [Indexed: 05/07/2023]
Abstract
Human papillomavirus (HPV) infection significantly contributes to the burden of cancer in the United States, despite the existence of a highly effective vaccine. While numerous interventions to address vaccination uptake exist, vaccination rates remain low. We conducted a concept mapping exercise to solicit perspectives on barriers and facilitators to HPV vaccination from state-level stakeholders in five states in the Midwest and West Coast of the U.S. We identified 10 clusters of barriers and facilitators based on participants' statements. For rural areas specifically, clusters rated as most important included education and provider influence; those rated as most feasible were education and coordinated/consistent messaging. Our results suggest that a combination of important (but potentially more difficult to implement) strategies, combined with those rated as most feasible (but potentially less impactful) may be beneficial. Our findings highlight similarities across diverse states, suggesting that states can learn from each other and work together to improve HPV vaccination rates. Using concept mapping proved to be an efficient way to collect information from diverse, stakeholders in different locations, and is a methodology that could be used for program planning in areas beyond HPV vaccination.
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Affiliation(s)
- Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Dr, Iowa City, IA 52245, USA
| | - Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Dr, Iowa City, IA 52245, USA.
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota Medical School, 717 Delaware St SE, Minneapolis, MN 55414, USA
| | - Paige E Farris
- Oregon Health & Science University/ Portland State University School of Public Health, Oregon Health & Science University, 250 NW Franklin Ave., Ste. 302, Bend, 97702, USA
| | - Jackilen Shannon
- Oregon Health & Science University/ Portland State University School of Public Health, Oregon Health & Science University, 250 NW Franklin Ave., Ste. 302, Bend, 97702, USA
| | - Jessica Hanson
- College of Education and Human Service Professions, University of Minnesota Duluth, 110 Sports & Health Center, 1216 Ordean Court, Duluth, MN 55812, USA
| | - DenYelle Baete Kenyon
- Sanford School of Medicine, School of Health Sciences, 414 E. Clark Street, Vermillion, SD 57069, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Dr, Iowa City, IA 52245, USA
| | - Lejla Avdic
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Dr, Iowa City, IA 52245, USA
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18
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Suryadevara M, Bonville CA, Cibula DA, Domachowske JB. Multi-component cancer prevention awareness program to improve adolescent HPV vaccine uptake. Hum Vaccin Immunother 2021; 17:1052-1058. [PMID: 33064046 DOI: 10.1080/21645515.2020.1812316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We introduced a multi-component cancer prevention awareness program to primary care practices across New York State to evaluate its impact on adolescent human papillomavirus (HPV) vaccination rates. METHODS Eight pediatric and three family medicine practices were recruited to participate in this program. On-site training sessions were provided for all practice providers and staff to discuss the importance of HPV vaccine and cancer prevention and teach strategies for delivering a strong vaccine recommendation. Each practice received a study-specific booklet that included HPV vaccine information and other commonly provided cancer prevention guidance. These booklets were distributed to all adolescents and their parents during well visits over a one-year period. Practice specific and county-wide HPV vaccination rates were assessed before and 12 months after the program training session. RESULTS One year after program initiation, aggregate data show statistically higher vaccine series initiation rates among 11-12 and 13-18-year-olds and higher vaccine series completion rates among 13-18-year-olds. The greatest and most consistent improvements were seen in vaccine initiation rates for the 11-12-year-old cohort. Disparities in vaccine uptake were observed by gender and medical specialty. CONCLUSION Cancer prevention education targeting providers, office staff, patients, and parents, improved adolescent HPV vaccine series initiation rates.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Cynthia A Bonville
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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19
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Koskan A, Stecher C, Helitzer D. College males' behaviors, intentions, and influencing factors related to vaccinating against HPV. Hum Vaccin Immunother 2021; 17:1044-1051. [PMID: 33054675 PMCID: PMC8018407 DOI: 10.1080/21645515.2020.1819101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/31/2020] [Indexed: 01/22/2023] Open
Abstract
In the US, individuals between ages 18 and 26 have the highest incidence of new human papillomavirus (HPV) infections, the most common sexually transmitted infection worldwide. HPV infection can cause genital warts, and persistent infection with cancerous strains can develop into multiple types of cancers. In 2011, the Centers for Disease Control and Prevention recommended that both men and women receive the vaccine. However, young adult men, including college-aged men, have been slow to initiate and complete the vaccine series. Our cross-sectional study, guided by the Theory of Planned Behavior, explores college men's vaccination uptake and series completion behaviors and their intentions to vaccinate. Using logistic regression, we examined how students' attitudes, perceived behavioral control, and subjective norms impacted their HPV vaccine-related behaviors and intentions. Subjective norms, followed by perceived behavioral control to communicate with a provider about the HPV vaccine, had the largest impact on students' HPV vaccine uptake and completion behaviors and intentions to vaccinate. Both subjective norms and positive attitudes about the vaccine impacted students' intentions to vaccinate against HPV. Based on these findings, we make various recommendations including campus interventions and policies that could increase HPV vaccine uptake and completion behaviors among college men.
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Affiliation(s)
- Alexis Koskan
- Arizona State University, College of Health Solutions, Phoenix, AZ, USA
| | - Chad Stecher
- Arizona State University, College of Health Solutions, Phoenix, AZ, USA
| | - Deborah Helitzer
- Arizona State University, College of Health Solutions, Phoenix, AZ, USA
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20
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Daniel CL, McLendon L, Green CL, Anderson KJ, Pierce JY, Perkins A, Beasley M. HPV and HPV Vaccination Knowledge and Attitudes Among Medical Students in Alabama. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:168-177. [PMID: 31502236 DOI: 10.1007/s13187-019-01613-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In addition to being the most common sexually transmitted infection, the human papillomavirus (HPV) is associated with six types of cancer in men and women. The HPV vaccine provides long-lasting, effective protection from high-risk HPV infection, thus serving as a means of cancer prevention. An effective healthcare provider recommendation is well-established as the most significant influence on HPV vaccine uptake, and, as emerging providers, it is critical that medical students receive comprehensive training in this area. However, the type and extent of such training for current medical students in the USA is unclear. An online survey assessing HPV and HPV vaccine knowledge, attitudes, and vaccine status was distributed to all medical students at an Alabama university. Scales were developed to assess composite HPV and HPV knowledge scores and HPV vaccination intentions. Of those age-eligible, 32.1% reported completion of the HPV vaccine series while 15.2% reported partial completion. Knowledge of both HPV and HPV vaccination significantly increased with program year (p < 0.0001 and p = 0.0069, respectively); however, there were knowledge gaps across all years regarding HPV-associated cancers. Attitudes and intentions showed a similar association, with more advanced students demonstrating more positive attitudes toward HPV vaccination (p = 0.0003). There is a need within the current curriculum to include more education and training on HPV, HPV vaccination, and counseling-particularly for students in the first 2 years of their program. Implementation of a classroom module or interactive workshop would likely improve knowledge and attitudes, better preparing students for their future role as potential immunizers.
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Affiliation(s)
- Casey L Daniel
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA.
| | - Lane McLendon
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Chelsea L Green
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Katie J Anderson
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Jennifer Y Pierce
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Allen Perkins
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Mark Beasley
- University of Alabama at Birmingham Ryals School of Public Health, 1665 University Boulevard, Birmingham, AL, 35223, USA
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21
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. "There's Always Next Year": Primary Care Team and Parent Perspectives on the Human Papillomavirus Vaccine. Hum Vaccin Immunother 2020; 16:1814-1823. [PMID: 32048896 DOI: 10.1080/21645515.2019.1710410] [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: 12/29/2022] Open
Abstract
Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.
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Affiliation(s)
- Julie H T Dang
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Susan L Stewart
- Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, University of California , Sacramento, CA, USA
| | - Dean A Blumberg
- Davis Health Department of Pediatrics, University of California , Sacramento, CA, USA
| | - Hector P Rodriguez
- Berkeley, School of Public Health, Division of Health Policy and Management, University of California , Berkeley, CA, USA
| | - Moon S Chen
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
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22
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Ford ME, Cannady K, Nahhas GJ, Knight KD, Chavis C, Crawford B, Malek AM, Martino E, Frazier S, Gathers A, Lawton C, Cartmell KB, Luque JS. Assessing an intervention to increase knowledge related to cervical cancer and the HPV vaccine. Adv Cancer Res 2020; 146:115-137. [PMID: 32241386 DOI: 10.1016/bs.acr.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human papillomavirus (HPV) infection is the primary risk factor for cervical cancer. While the HPV vaccine significantly reduces the risk of HPV infection and subsequent cervical cancer diagnosis, underuse is linked to lack of knowledge of its effectiveness in preventing cervical cancer. The purpose of this study was to evaluate a cancer educational intervention (titled "MOVENUP") to improve knowledge of cervical cancer, HPV, and the HPV vaccine among predominantly African American communities in South Carolina. The MOVENUP cancer educational intervention was conducted among participants residing in nine South Carolina counties who were recruited by community partners. The 4.5-h MOVENUP cancer educational intervention included a 30-min module on cervical cancer, HPV, and HPV vaccination. A six-item investigator-developed instrument was used to evaluate pre- and post-intervention changes in knowledge related to these content areas. Ninety-three percent of the 276 participants were African American. Most participants reporting age and gender were 50+ years (73%) and female (91%). Nearly half of participants (46%) reported an annual household income <$40,000 and 49% had not graduated from college. Statistically significant changes were observed at post-test for four of six items on the knowledge scale (P<0.05), as compared to pre-test scores. For the two items on the scale in which statistically significant changes were not observed, this was due primarily due to a baseline ceiling effect.
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Affiliation(s)
- Marvella E Ford
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Associate Director, Population Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC United States; SmartState Endowed Chair in Cancer Disparities Research, South Carolina State University, Orangeburg, SC, United States.
| | - Kimberly Cannady
- Academic Affairs Faculty, Medical University of South Carolina, Charleston, SC, United States
| | - Georges J Nahhas
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States; Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Kendrea D Knight
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Courtney Chavis
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brittney Crawford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Angela M Malek
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Erica Martino
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Starr Frazier
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Antiqua Gathers
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Claudia Lawton
- Institute of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - John S Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, United States
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23
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Zimet GD, Osazuwa-Peters N. There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination. Hum Vaccin Immunother 2020; 15:1459-1464. [PMID: 31365327 PMCID: PMC6746479 DOI: 10.1080/21645515.2019.1640559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Zimet
- a Department of Pediatrics, School of Medicine, Indiana University , Indianapolis , IN , USA
| | - Nosayaba Osazuwa-Peters
- b Department of Otolaryngology-Head and Neck Surgery, Saint Louis University , St Louis , MO , USA
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