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HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US. Hum Vaccin Immunother 2023; 19:2161253. [PMID: 36631995 PMCID: PMC9980633 DOI: 10.1080/21645515.2022.2161253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The US Advisory Committee on Immunization Practice recommends routine human papillomavirus (HPV) vaccination at 11-12 years of age, but states that vaccination may be initiated as early as 9 years. Our primary goal was to assess whether initiating HPV vaccination at 9-10 years of age, compared to 11-12, was associated with a higher rate of series completion by 13 years of age, and to identify factors associated with series completion by age 13. The study used vaccine claims and other data from the IBM MarketScan Commercial Claims and Encounters (privately insured) and IBM MarketScan Multi-State Medicaid (publicly insured) databases. Participants were 9-12 years of age and initiated HPV vaccination between January 2006 and December 2018 (publicly insured) or February 2019 (privately insured). Among 100,117 privately insured individuals, those initiating the HPV vaccination series at 9-10 years of age had a significantly higher series completion rate by 13 years of age than did those initiating at 11-12 years of age (76.2% versus 48.1%; p < .001). The same pattern was observed for 115,863 publicly insured individuals (70.4% versus 40.0%; p < .001). Provider and health care plan type, female sex, race/ethnicity, and wellness checks or non-HPV vaccinations during the baseline period were significantly associated with series completion by 13 years of age. Proactive initiation of HPV vaccination at 9-10 years of age was associated with higher rates of series completion by 13 years of age. These findings can inform provider education and other interventions to encourage timely HPV vaccination series completion.
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Rames JD, Frisco NA, Jiang R, Shah KP, Kahmke RR, Puscas L, Osazuwa-Peters N, Rocke DJ. Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: Toward Improvements in Completion Disparities. Otolaryngol Head Neck Surg 2023; 169:76-85. [PMID: 36939623 PMCID: PMC10293109 DOI: 10.1002/ohn.242] [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: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/11/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts. STUDY DESIGN Retrospective pre-post analysis. SETTING Academic primary care. METHODS Patients aged 9 to 26 who had initiated the HPV vaccine series from 2016 to 2021 were analyzed, based on current age-based standards. The cohort was divided based on vaccine uptake before and after the implementation of the HMR program in February 2020. The multivariate analysis estimated the odds of vaccine completion based on sociodemographic factors, and variable interactions were investigated to determine independent associations between sociodemographic factors and HMR implementation. RESULTS There were 7654 individual patients (mean age was 15.8 years; 46.7 were males; and 50.7% were white). HPV vaccine completion rates increased post-HMR implementation by 59.2% (37% pre-, and 58.9% post-HMR; p < .001) in the entire cohort. Overall, black patients (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.60, 0.70) and patients ≥18 years (aOR = 0.13; 95% CI: 0.11, 0.15) were significantly less likely to complete their vaccine series; however, this improved significantly following HMR in these groups (p < .001). Post-HMR, race, and insurance status were not independently associated with disparate vaccine completion rates, however, age was, and patients ≤14 or younger had higher odds of vaccine completion (aOR = 3.54; 95% CI: 2.91, 4.32). CONCLUSION The implementation of an HMR was associated with increased HPV vaccine uptake across age and race groups in this single-institution study. Future research should explore barriers to implementing HMRs in different health care settings.
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Affiliation(s)
- Jess D. Rames
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
- Duke University Pratt School of Engineering, Durham, North
Carolina, USA
- Mayo Clinic, Department of Plastic and Reconstructive
Surgery, Rochester, Minnesota, USA
| | - Nicholas A. Frisco
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, School of
Medicine, Duke University, Durham, North Carolina, USA
| | - Kevin P. Shah
- Department of Medicine, Duke Primary Care, Durham, North
Carolina, USA
| | - Russel R. Kahmke
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
- Duke Cancer Institute, Durham, North Carolina, USA
| | - Liana Puscas
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
| | - Nosayaba Osazuwa-Peters
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina,
Department of Population Health Sciences, Durham, North Carolina, USA
- Duke Cancer Institute, Durham, North Carolina, USA
| | - Daniel J. Rocke
- Duke University, Department of Head and Neck Surgery &
Communication Sciences, Durham, North Carolina, USA
- Duke Cancer Institute, Durham, North Carolina, USA
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Social determinants of human papillomavirus vaccine series completion among U.S. adolescents: A mixed-methods study. SSM Popul Health 2022; 18:101082. [PMID: 35493405 PMCID: PMC9038569 DOI: 10.1016/j.ssmph.2022.101082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/16/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Human papillomavirus (HPV) vaccination can significantly reduce HPV-associated cancers. In the US, two doses are recommended for vaccine completion for younger adolescents. However, series completion rates remain below the nation's goal of 80% coverage. Multi-faceted factors may influence adolescent series completion. The purpose of this study was to identify individual-level, relationship-level, and community-level factors of timely series completion among adolescents, ages 11–14, initiating the HPV vaccine series in 2017. Methods A convergent, mixed-methods design was used combining adolescent electronic health record data (n = 803) and qualitative interviews with adolescents and their parents (n = 32) to assess timely series completion within 14-months (e.g., January 2018 to February 2019). Multivariable logistic regression analysis examined individual-level and community-level factors influencing timely series completion. Directed content analysis was used to identify relevant themes and subthemes. We provided an integrative summary to assess patterns of convergence or divergence between quantitative and qualitative data. Results In the quantitative phase, 61.0% of adolescents completed the vaccine series and 47.3% completed it on-time. Higher odds of timely series completion were among younger adolescents at vaccine initiation (aOR = 1.82, 95%CI = 1.07, 3.11) and lower among adolescents who were Black (aOR = 0.57, 95%CI = 0.37, 0.89) and Hispanic (aOR = 0.54, 95%CI = 0.30, 0.95) compared to Non-Hispanic White adolescents and those without private insurance (aOR = 0.56, 95%CI = 0.37, 0.85). Qualitative findings revealed increased risk for HPV at sexual debut as a motivator for timely series completion. Family/peers and healthcare providers influenced timely series completion among minority adolescents. Community-level factors were not significantly associated with timely series completion, however, qualitative findings revealed lack of transportation as a barrier to timely series completion. Conclusion Multi-level factors continue to influence timely series completion, despite fewer doses needed for series completion. Innovative strategies are needed to improve care coordination for receiving vaccine doses, patient-provider communication about series completion and increase access to HPV vaccine. Access barriers create challenges for teens to complete the HPV vaccine series. Racial/ethnic disparities in adolescent HPV vaccine series completion exist. Family and healthcare providers influence parents' decisions for series completion. Parents and adolescents continue to misunderstand the HPV vaccine schedule. Despite barriers, parents and teens are motivated to finish the HPV vaccine series.
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Dreyer G, Botha MH, Snyman LC, Visser C, Burden R, Laubscher N, Grond B, Richter K, Becker PJ, Harvey J, van der Merwe FH. Combining cervical cancer screening for mothers with schoolgirl vaccination during human papillomavirus (HPV) vaccine implementation in South Africa: results from the VACCS1 and VACCS2 trials. Int J Gynecol Cancer 2022; 32:592-598. [PMID: 35078829 DOI: 10.1136/ijgc-2021-003079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The platform provided by human papillomavirus (HPV) vaccination for linked public health interventions to improve cervical cancer prevention remains incompletely explored. The Vaccine And Cervical Cancer Screen (VACCS) cross-sectional observation trials aimed to evaluate the efficacy of school-based HPV vaccination linked with maternal cervical cancer screening. METHODS Girls from 29 schools in two provinces in South Africa were invited in writing to receive HPV vaccination. Two approaches to informed consent were compared, namely an audiovisual presentation (VACCS1) and in written format (VACCS2). Markers of vaccine uptake and coverage were calculated, namely uptake among the invited and consented cohorts, and rates of completion and sufficient vaccination. Mothers and female guardians received educational material about cervical cancer, and either a self-sampling device or an invitation to attend existing screening facilities. Knowledge was assessed via structured questionnaires (before and after), and screening uptake was self-reported and directly assessed and compared between these approaches. RESULTS Vaccine acceptance among 5137 invited girls was similar for the two methods of consent; 99.3% of consented girls received a first dose; overall completion rate was 90.5%. More girls were vaccinated using a two-dose (974/1016 (95.9%)) than a three-dose regimen (1859/2030 (91.6%)). The questionnaire (n=906) showed poor maternal knowledge which improved significantly (p<0.05) after health education; only 54% of mothers reported any previous screening. The offer of a self-sampling device (n=2247) was accepted by 43.9% of mothers, but only 26% of those invited to screen at existing facilities (n=396) reported subsequent screening. CONCLUSIONS Successful linking of primary health interventions to control cervical cancer was demonstrated. School-based HPV vaccination, linked to health education, self-sampling, and molecular screening resulted in significant improvements in knowledge and screening.
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Affiliation(s)
- Greta Dreyer
- Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Matthys H Botha
- Obstetrics and Gynaecology, University of Stellenbosch, Stellenbosch, South Africa
| | - Leon C Snyman
- Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Cathy Visser
- Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Riekie Burden
- HPV Cervical Cancer Research Fund, Pretoria, South Africa
| | | | - Bertha Grond
- HPV Cervical Cancer Research Fund, Pretoria, South Africa
| | - Karin Richter
- Medical Virology, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Piet J Becker
- Faculty Research Office, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa.,Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Justin Harvey
- Centre for Statistical Consultation, University of Stellenbosch, Stellenbosch, South Africa
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Worsham CM, Woo J, Zimerman A, Bray CF, Jena AB. Association of Maternal Cervical Disease With Human Papillomavirus Vaccination Among Offspring. JAMA Netw Open 2021; 4:e2134566. [PMID: 34902041 PMCID: PMC8669541 DOI: 10.1001/jamanetworkopen.2021.34566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Barriers to childhood vaccination against vaccine-preventable diseases, such as those due to human papillomavirus (HPV), are well known. However, the role of salience bias-the change in perception of risk due to increased familiarity with the outcome-in decisions to vaccinate children has not been explicitly studied. OBJECTIVE To assess for salience bias in parental decisions to vaccinate children. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a time-to-event (survival) analysis to compare vaccination rates of children whose mothers had a history of cervical cancer or a cervical biopsy, who have experienced adverse vaccine-preventable outcomes, and for whom vaccination may be more salient, with a control group of children whose mothers had no such history. Participants were accrued from the MarketScan Commercial Database, including US children who turned 11 years old, when HPV vaccination is recommended, from January 1, 2014, to December 31, 2018. Data were analyzed from December 29, 2020, to September 17, 2021. EXPOSURES Maternal history of cervical cancer or cervical biopsy. MAIN OUTCOMES AND MEASURES Vaccination against HPV. RESULTS A total of 757 428 children (370 878 girls [49.0%] and 386 550 boys [51.0%]) were identified, of whom 38 366 had mothers with a history of cervical biopsy alone and 1084 had mothers with a history of cervical cancer. Overall, 54.2% of children (55.7% of girls and 52.7% of boys) received at least 1 vaccination by 16 years of age. In a time-to-event analysis, HPV vaccination did not differ between children whose mothers had cervical cancer vs those whose mothers did not (hazard ratio [HR] for girls, 0.99 [95% CI, 0.86-1.13]; HR for boys, 1.08 [95% CI, 0.94-1.24]). Maternal history of cervical biopsy was associated with a minimally increased hazard of vaccination (HR for girls, 1.06 [95% CI, 1.04-1.09]; HR for boys, 1.04 [95% CI, 1.01-1.06]). There were no clinically meaningful differences between groups for the tetanus/diphtheria/acellular pertussis and meningococcal vaccinations, which are also recommended at 11 years of age. CONCLUSIONS AND RELEVANCE In this analysis of salience bias in childhood vaccination decisions, mothers' personal history of cervical cancer or cervical biopsy was not associated with greater vaccination rates among children against HPV. These findings suggest that salience of vaccine-preventable outcomes may not have a major impact on childhood vaccine hesitancy in HPV; the role of salience should be investigated for other vaccines.
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Affiliation(s)
- Christopher M. Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
| | - Jaemin Woo
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - André Zimerman
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles F. Bray
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Islam JY, Gurbani A, Ramos S, Morgan K, Kim CJ, Richter KL, de Sanjose S, Smith JS, Vielot NA. Health Care Provider Perceptions of Facilitators and Barriers to Human Papillomavirus Vaccination Delivery in Five Countries. Sex Transm Dis 2021; 48:557-564. [PMID: 34014055 DOI: 10.1097/olq.0000000000001389] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND National human papillomavirus (HPV) vaccination programs could reduce global cervical cancer morbidity and mortality with support from health care providers. We assessed providers' perceptions of HPV vaccination in 5 countries. METHODS We identified providers from 5 countries where national HPV vaccination programs were at various stages of implementation: Argentina, Malaysia, South Africa, South Korea, and Spain. Providers authorized to administer adolescent vaccines completed an in-depth survey, reporting perceptions of barriers and facilitators to initiating and completing HPV vaccination, and logistical challenges to HPV vaccination. RESULTS Among 151 providers, common barriers to HPV vaccination initiation across all countries were parents' lack of awareness (39%), concerns about vaccine safety or efficacy (33%), and cost to patients (30%). Vaccination education campaign (70%) was the most commonly cited facilitator of HPV vaccination initiation. Common barriers to series completion included no reminder system or dosing schedule (37%), loss to follow-up or forgetting appointment (29%), and cost to patients (25%). Cited facilitators to completing the vaccine series were education campaigns (45%), affordable vaccination (32%), and reminder/recall systems (22%). Among all countries, high cost of vaccination was the most common logistical challenge to offering vaccination to adolescents (33%). CONCLUSIONS Incorporating provider insights into future HPV vaccination programs could accelerate vaccine delivery to increase HPV vaccination rates globally.
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Affiliation(s)
| | - Arshya Gurbani
- Interdisciplinary Health Communication Program, School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, St Paul's Hospital, Seoul, Korea
| | - Karin L Richter
- Department of Medical Virology, University of Pretoria, National Health Laboratory Service, Pretoria, South Africa
| | - Silvia de Sanjose
- PATH, Seattle, US & CIBER Epidemiologia y Salud Publica, Barcelona, Spain
| | | | - Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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McLendon L, Puckett J, Green C, James J, Head KJ, Yun Lee H, Young Pierce J, Beasley M, Daniel CL. Factors associated with HPV vaccination initiation among United States college students. Hum Vaccin Immunother 2021; 17:1033-1043. [PMID: 33325794 DOI: 10.1080/21645515.2020.1847583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Human papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.
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Affiliation(s)
- Lane McLendon
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jesse Puckett
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Chelsea Green
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jenna James
- Division of Cancer Control and Prevention, University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Jennifer Young Pierce
- Division of Cancer Control and Prevention, University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Casey L Daniel
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
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Hawkins SS, Horvath K, Cohen J, Pace LE, Baum CF. Associations between insurance-related affordable care act policy changes with HPV vaccine completion. BMC Public Health 2021; 21:304. [PMID: 33549075 PMCID: PMC7866643 DOI: 10.1186/s12889-021-10328-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Although all 11- or 12-year-olds in the US were recommended to receive a 3-dose series of the human papillomavirus (HPV) vaccine within a 12-month period prior to 2016, rates of completion of the HPV vaccine series remained suboptimal. The effects of the Affordable Care Act (ACA), including private insurance coverage with no cost-sharing and health insurance expansions, on HPV vaccine completion are largely unknown. The aim of this study was to examine the associations between the ACA’s 2010 provisions and 2014 insurance expansions with HPV vaccine completion by sex and health insurance type. Methods Using 2009–2015 public and private health insurance claims from Maine, New Hampshire, and Massachusetts, we identified 9-to-26-year-olds who had at least one HPV vaccine dose. We conducted a logistic regression model to examine the associations between the ACA policy changes with HPV vaccine completion (defined as receiving a 3-dose series within 12 months from the date of initiation) as well as interactions by sex and health insurance type. Results Over the study period, among females and males who initiated the HPV vaccine, 27.6 and 28.0%, respectively, completed the series within 12 months. Among females, the 2010 ACA provision was associated with a 4.3 percentage point increases in HPV vaccine completion for the privately-insured (0.043; 95% CI: 0.036–0.061) and a 5.7 percentage point increase for Medicaid enrollees (0.057; 95% CI: 0.032–0.081). The 2014 health insurance expansions were associated with a 9.4 percentage point increase in vaccine completion for females with private insurance (0.094; 95% CI: 0.082–0.107) and a 8.5 percentage point increase for Medicaid enrollees (0.085; 95% CI: 0.068–0.102). Among males, the 2014 ACA reforms were associated with a 5.1 percentage point increase in HPV vaccine completion for the privately-insured (0.051; 95% CI: 0.039–0.063) and a 3.4 percentage point increase for Medicaid enrollees (0.034; 95% CI: 0.017–0.050). In a sensitivity analysis, findings were similar with HPV vaccine completion within 18 months. Conclusions Despite low HPV vaccine completion overall, both sets of ACA provisions were associated with increases in completion among females and males. Our results suggest that expanding Medicaid across the remaining states could increase HPV vaccine completion among publicly-insured youth and prevent HPV-related cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10328-4.
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Affiliation(s)
- Summer Sherburne Hawkins
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | | | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA
| | | | - Christopher F Baum
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.,Boston College, Department of Economics, Chestnut Hill, MA, USA.,German Institute for Economic Research (DIW Berlin), Department of Macroeconomics, Berlin, Germany
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Zhou X, Sun L, Yao X, Li G, Wang Y, Lin Y. Progress in Vaccination of Prophylactic Human Papillomavirus Vaccine. Front Immunol 2020; 11:1434. [PMID: 32754157 PMCID: PMC7365840 DOI: 10.3389/fimmu.2020.01434] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
The human papillomavirus (HPV) vaccine plays an important role in preventing a series of diseases caused by HPV. Recent studies have shown that as a primary prevention measure, it can considerably prevent HPV infection and HPV-associated cervical cancer. However, studies on the safety, efficacy, and coverage of the HPV vaccine remain insufficient, especially in developing countries. Therefore, in this review, we outlined the recent studies of the HPV vaccine in terms of immunogenicity, safety, efficacy, latest vaccination concepts, and strategies. This review may provide a theoretical basis for use of the HPV vaccine.
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Affiliation(s)
- Xu Zhou
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Lihua Sun
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Xiaoxiao Yao
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Guangquan Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Yicun Wang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, China
| | - Yang Lin
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
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12
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Berenson AB, Hirth JM, Fuchs EL, Chang M, Rupp RE. An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students. Hum Vaccin Immunother 2020; 16:1139-1144. [PMID: 31809635 DOI: 10.1080/21645515.2019.1692558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Many medical students are not comfortable recommending the human papillomavirus (HPV) vaccine because they do not feel prepared to discuss it with their patients. A prior study demonstrated that this is particularly a problem among unvaccinated students. Our purpose was to determine if medical student attitudes and comfort with counseling could be improved by attending a single lecture delivered by an expert on the topic. To assess the effects of the educational program, we conducted pre- and posttests on medical students before and after a single lecture on HPV vaccination. Changes in items related to attitude and comfort were examined. Student characteristics associated with changes in scores were also examined and compared. A total of 256 medical students participated in the pre- and posttests. Before the lecture, students demonstrated low knowledge of HPV vaccination and did not feel comfortable counseling parents of younger patients. However, students <30 years of age demonstrated significant improvements after the lecture in comfort. Asian and Hispanic students showed the greatest improvement in comfort with counseling, as did students who reported they had not received the HPV vaccine. Attending a single lecture given by an expert can improve medical students' attitudes and comfort with HPV vaccine counseling, especially if the students were not vaccinated themselves. This study suggests that including material on HPV vaccination in the standard medical student curriculum could help increase physician recommendation for the HPV vaccine.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard E Rupp
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
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13
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Provider Experience Recommending HPV Vaccination Before Age 11 Years. J Pediatr 2020; 217:92-97. [PMID: 31757474 DOI: 10.1016/j.jpeds.2019.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe health care providers' experiences recommending human papillomavirus (HPV) vaccination before age 11 years as part of a multisession intervention to improve HPV vaccination coverage. STUDY DESIGN Between 2016 and 2018, we conducted 30-minute qualitative interviews with intervention participants approximately 1 month after intervention completion. Interviews explored participants' experiences with new strategies, including changing the age of routine recommendation. Thematic analysis of interview transcripts involved both deductive and inductive approaches. RESULTS Twenty-six participants at 5 clinical sites were interviewed. Most were female (88%) primary care providers (46%), and worked 1.5-3.0 clinical days weekly. Many providers described initial skepticism about recommending vaccination before age 11 years, fearing that removing the HPV vaccine from the adolescent bundle with tetanus and meningitis vaccines would decrease parental acceptance. However, providers uniformly reported high parental acceptance owing to reduced stigma relating to sexual activity and the opportunity to administer fewer shots at each visit. Providers also noted that initiating vaccination earlier increased opportunities to complete the series and decreased the need for resource-intensive vaccine recall programs. CONCLUSIONS Providers had positive experiences recommending HPV vaccination before age 11 years. Routine recommendation before age 11 years may offer advantages related to fewer shots per visit, fewer missed opportunities, and reduction of parental concerns related to sexual activity.
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14
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Factors influencing Human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid. Vaccine 2020; 38:2051-2057. [DOI: 10.1016/j.vaccine.2019.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/08/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
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15
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Gerend MA, Stephens YP, Kazmer MM, Slate EH, Reyes E. Predictors of Human Papillomavirus Vaccine Completion Among Low-Income Latina/o Adolescents. J Adolesc Health 2019; 64:753-762. [PMID: 30777636 PMCID: PMC6534422 DOI: 10.1016/j.jadohealth.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/11/2018] [Accepted: 12/04/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this longitudinal study was to identify individual and interpersonal factors associated with human papillomavirus (HPV) vaccine series completion in a sample of low-income Latina/o adolescent girls and boys. METHODS Caregiver-adolescent dyads (N = 161) were recruited from a rural Federally Qualified Health Center in southwest Florida when the adolescent (aged 11-17 years) received the first dose of HPV vaccine. Dyads completed a baseline assessment that measured demographic and cultural characteristics, past medical history, provider-patient communication, HPV knowledge, health beliefs about completing the series, and the adolescent's experience receiving the first dose. Using multivariable logistic regression, we identified caregiver- and adolescent-related factors associated with series completion (receipt of three doses of HPV vaccine within 1 year of initiation) as indicated in the adolescent's medical record and state immunization registry. RESULTS Within 1 year of initiation, 57% (n = 92) completed the three-dose series. Missed opportunities for completion were observed for 20% of the sample who returned to the clinic. Caregiver-related predictors of completion included education, self-efficacy to complete the series, and knowledge of the required number of doses. Adolescent-related predictors included age, influenza vaccination within the past 2 years, having a chronic medical condition, reason for the baseline visit, and receipt of written information about HPV vaccination from a health care provider. CONCLUSIONS Findings highlight important opportunities for improving completion of the HPV vaccine series among Latina/o adolescents. Intervention efforts should involve health care providers and parent-adolescent dyads and prioritize evidence-based strategies for reducing missed opportunities for series completion.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University (FSU), Tallahassee, Florida.
| | | | - Michelle M Kazmer
- School of Information, College of Communication and Information, Florida State University, Tallahassee, Florida
| | - Elizabeth H Slate
- Department of Statistics, College of Arts & Sciences, Florida State University, Tallahassee, Florida
| | - Elena Reyes
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University (FSU), Tallahassee, Florida
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Shah PD, Calo WA, Gilkey MB, Boynton MH, Alton Dailey S, Todd KG, Robichaud MO, Margolis MA, Brewer NT. Questions and Concerns About HPV Vaccine: A Communication Experiment. Pediatrics 2019; 143:peds.2018-1872. [PMID: 30670584 PMCID: PMC6361359 DOI: 10.1542/peds.2018-1872] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5972295740001PEDS-VA_2018-1872Video Abstract OBJECTIVES: We sought to identify effective responses to parents' questions and concerns about human papillomavirus (HPV) vaccine. METHODS In 2017-2018, we surveyed a national sample of 1196 US parents of children aged 9 to 17 years. We recorded brief videos of a pediatrician providing messages that addressed 7 HPV vaccination topics that commonly elicit questions or concerns (eg, recommended age). We randomly assigned parents to 1 of the message topics; parents then viewed 4 videos on that topic in random order and evaluated the messages. RESULTS Parents were more confident in HPV vaccine when they were exposed to messages that addressed lack of knowledge about HPV vaccine (b = 0.13; P = .01), messages that included information about cancer prevention (b = 0.11; P < .001), messages that required a higher reading level (b = 0.02; P = .01), and messages that were longer (b = 0.03; P < .001). Parents were less confident in HPV vaccine when exposed to messages in which urgency was expressed (b = -0.06; P = .005). Analyses conducted by using HPV vaccine motivation as an outcome revealed the same pattern of findings. CONCLUSIONS We provide research-tested messages that providers can use to address parents' HPV vaccination questions and concerns about 7 common topics. Important principles for increasing message effectiveness are to include information on the benefits of vaccination (including cancer prevention) and avoid expressing urgency to vaccinate when addressing parents' questions or concerns. Additionally, providers may need to be prepared to have longer conversations with parents who express concerns about HPV vaccine, especially regarding safety and side effects.
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Affiliation(s)
- Parth D. Shah
- Public Health Sciences Division, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington;,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - William A. Calo
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania;,Penn State Cancer Institute, Hershey, Pennsylvania; and
| | - Melissa B. Gilkey
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
| | - Marcella H. Boynton
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
| | | | - Karen G. Todd
- Public Health Leadership Program and,SAFEchild Advocacy Center, Raleigh, North Carolina
| | | | | | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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