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Sathiyamoorthy A, Guay M, Chen R. Estimates and determinants of HPV non-vaccination in 14-year-old Canadians: Results from the childhood national immunization coverage survey, 2019. Hum Vaccin Immunother 2024; 20:2379090. [PMID: 39051527 PMCID: PMC11275521 DOI: 10.1080/21645515.2024.2379090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
Human papillomavirus (HPV) infections, the most common sexually transmitted infections, are associated with various health outcomes including anogenital warts and cancers. Despite significant investments in HPV vaccination programs, ensuring adequate vaccination coverage for adolescents remains a challenge in Canada. This analysis used data collected through the 2019 Childhood National Immunization Coverage Survey (CNICS) to determine national estimates of HPV non-vaccination and investigate determinants of HPV non-vaccination for adolescents aged 14-years old in Canada, both overall and stratified by gender. The primary outcome of interest was HPV vaccination status, categorized as vaccinated with at least one dose or unvaccinated. Simple and multiple logistic regression models were used to investigate determinants of HPV non-vaccination. In 2019, an estimated 19.8% of the 14-year-olds in Canada were unvaccinated for the HPV vaccine, with males having higher non-vaccination rates than females (27.0% compared to 12.9%). In the unstratified analysis, factors associated with HPV non-vaccination for 14-year-olds were gender and region of residence. These factors differed by gender - for males, region of residence and respondent's age were significant factors, whereas for females, total household income was a significant factor. These results could help public health officials and policymakers develop and implement tailored interventions to enhance the delivery of HPV vaccination programs for male and female adolescents. By targeting populations that are under-vaccinated, vaccine uptake could be better facilitated to help reduce inequalities in access to the HPV vaccine, which could also potentially reduce disparities in HPV-related health outcomes.
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Affiliation(s)
- Aranee Sathiyamoorthy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Immunization Surveillance, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mireille Guay
- Centre for Immunization Surveillance, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ruoke Chen
- Centre for Immunization Surveillance, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Liu S, Durantini MR, Calabrese C, Sanchez F, Albarracin D. A systematic review and meta-analysis of strategies to promote vaccination uptake. Nat Hum Behav 2024:10.1038/s41562-024-01940-6. [PMID: 39090405 DOI: 10.1038/s41562-024-01940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/01/2024] [Indexed: 08/04/2024]
Abstract
Although immunization can dramatically curb the mortality and morbidity associated with vaccine-preventable diseases, vaccination uptake remains suboptimal in many areas of the world. Here, in this meta-analysis, we analysed the results from 88 eligible randomized controlled trials testing interventions to increase vaccination uptake with 1,628,768 participants from 17 countries with variable development levels (for example, Human Development Index ranging from 0.485 to 0.955). We estimated the efficacy of seven intervention strategies including increasing access to vaccination, sending vaccination reminders, providing incentives, supplying information, correcting misinformation, promoting both active and passive motivation and teaching behavioural skills. We showed that the odds of vaccination were 1.5 (95% confidence interval, 1.27 to 1.77) times higher for intervention than control conditions. Among the intervention strategies, using incentives and increasing access were most promising in improving vaccination uptake, with the access strategy being particularly effective in countries with lower incomes and less access to healthcare.
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Affiliation(s)
- Sicong Liu
- School of Physical Education and Sports Science, South China Normal University, Guangzhou, China.
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marta R Durantini
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Calabrese
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - Flor Sanchez
- Department of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Dolores Albarracin
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
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Lawal S, St-Jean M, Hu Y, Bakos B, Dawar M, Thumath M, MacDonald A. Assessing sociodemographic disparities in HPV vaccine uptake among grade 6 and 9 students in the Vancouver Coastal Health region. Vaccine 2024:126147. [PMID: 39060199 DOI: 10.1016/j.vaccine.2024.07.048] [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: 02/21/2024] [Revised: 06/05/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To identify sociodemographic factors associated with HPV vaccine uptake in a universal, in-school HPV vaccination program, among grade 6 and 9 students in the regional health authority of Vancouver Coastal Health (VCH), British Columbia (BC), Canada during the 2021/22 school year. VCH operates within the southwest corner of the province of BC serving a mix of urban and rural regions. HPV vaccine is offered in school to all grade 6 students using a two-dose series, with catch up immunizations offered to students in grade 9. METHODS We conducted a cross-sectional study of grade 6 and 9 students enrolled in VCH schools for the 2021/22 school year, who also resided within the VCH region. We modelled the associations between sociodemographic explanatory variables (individual-level and group-level) and fully vaccinated outcome using a cross-classified (non-nested) multilevel model. RESULTS Among the 17,939 students eligible, 74 % were fully vaccinated for HPV. Immunization coverage was associated with grade, geographic area of residence, school category, social and material deprivation. We demonstrated that grade modified the association between material deprivation and being fully vaccinated. Grade 9 students, including those residing in more materially deprived neighbourhoods, had substantially higher odds (OR 2.01 [95 % CI 1.08, 3.75]) of being fully vaccinated relative to grade 6 students in the least materially deprived neighbourhoods. CONCLUSIONS Though publicly funded HPV vaccine is offered to all students in grade 6 and 9, in a space that maximizes programmatic access, sociodemographic factors associated with under-immunized populations were identified. This information can be leveraged for strategic targeting of resources to underimmunized schools or students to mitigate impacts. The repeat offering of HPV vaccine in an older grade (grade 9 in BC) is a key programmatic strategy to reach under-immunized populations and should be complemented by other creative approaches.
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Affiliation(s)
- Samie Lawal
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada.
| | - Martin St-Jean
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Yumian Hu
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Brendan Bakos
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Meena Dawar
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada; School of Population and Public Health, University of British Columbia, British Columbia V6T 1Z3, Canada
| | - Meaghan Thumath
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada; School of Nursing, University of British Columbia, British Columbia V6T 2B5, Canada
| | - Adrienne MacDonald
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
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Gallant AJ, Johnson C, Steenbeek A, Parsons Leigh J, Halperin SA, Curran JA. Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study. PUBLIC HEALTH IN PRACTICE 2024; 7:100505. [PMID: 38807702 PMCID: PMC11130716 DOI: 10.1016/j.puhip.2024.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Background School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views. Study design Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023. Methods The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. Results Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. Conclusions We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.
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Affiliation(s)
- Allyson J. Gallant
- Faculty of Health, Dalhousie University, 5968 College Street, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Catie Johnson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | | | | | - Scott A. Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, NS, Canada
| | - Janet A. Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Okoli GN, Neilson CJ, Grossman Moon A, Kimmel Supron H, Soos AE, Grewal A, Etsell K, Alessi-Severini S, Richardson C, Harper DM. Exploration of individual socioeconomic and health-related characteristics associated with human papillomavirus vaccination initiation and vaccination series completion among adult females: A comprehensive systematic evidence review with meta-analysis. Vaccine 2024:S0264-410X(24)00601-7. [PMID: 38796328 DOI: 10.1016/j.vaccine.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates among females are lower than the World Health Organization target and vaccination rates specifically among adult females are even much lower. METHODS We systematically evaluated individual socioeconomic and health-related characteristics associated with HPV vaccination initiation and vaccination series completion among adult females (PROSPERO: CRD42023445721). We performed a literature search on December 14, 2022, and supplemented the search on August 1, 2023. We pooled appropriate multivariable-adjusted results using an inverse variance random-effects model and expressed the results as odds ratios with associated 95 % confidence intervals. A point pooled significantly increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥ 70 % was very strongly associated. RESULTS We included 63 cross-sectional studies. There were strongly increased odds of vaccination initiation among White women compared with Black or Asian women, and those with higher education, health insurance, a history of sexually transmitted infection (STI), receipt of influenza vaccination in the preceding year, not married/cohabiting, not smoking, using contraception, and having visited a healthcare provider in the preceding year. We observed very strongly increased odds of vaccination initiation among those younger and having been born in the country of study. Similarly, there were strongly increased odds of completing the vaccination series for the same variables as initiating vaccination, except for higher education, prior STI, smoking and contraception use. Additional variables associated with strongly increased odds of vaccination series completion not seen in initiation were higher annual household income, being lesbian/bisexual, and having a primary care physician. We observed very strongly increased odds of vaccination series completion similar to vaccination initiation but including for White compared with Black women, higher education, and prior cervical cancer screening. CONCLUSIONS These individual characteristics may be the key to identifying women at increased risk of not being vaccinated against HPV and could inform targeted messaging to drive HPV vaccination.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | | | - Alexandra E Soos
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Avneet Grewal
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Katharine Etsell
- University of Michigan Medical School, University of Michigan, Michigan, USA
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Richardson
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Diane M Harper
- Departments of Family Medicine and Obstetrics & Gynecology, University of Michigan, Michigan, USA
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Fay M, Hu M, Hajizadeh M. Socioeconomic inequalities in cervical cancer mortality in Canada, 1990 and 2019: a trend analysis. Public Health 2024; 227:210-218. [PMID: 38241902 DOI: 10.1016/j.puhe.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/19/2023] [Accepted: 12/08/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE It is increasingly recognized that those of lower socioeconomic status (SES) are disproportionately affected by cancer mortality. The association between cervical cancer mortality and SES have been reported; however, it remains poorly understood in the Canadian population. Thus, this study investigates trends in income and education inequalities in cervical cancer mortality in Canada over the last three decades. STUDY DESIGN Trend analysis. METHODS A dataset constructed at the census division level (n = 280), comprising the Canadian Vital Statistics Death Database, the Canadian Census of Population, and the National Household Survey was used to measure cervical cancer mortality in Canada. Income and education inequalities in cervical cancer mortality were measured using age-standardized Concentration index (C). RESULTS Crude cervical cancer mortality rates decreased significantly during the study period. Age-standardized C values were negative for the majority of years for income and education inequalities, reaching significance in some years. Trend analyses indicated an increasing concentration of cervical cancer mortality amongst those with lower education levels. CONCLUSION Despite recent decreases in cervical cancer mortality rates, socioeconomic inequalities in cervical cancer mortality in Canada are persistent. Notably, those of lower income and education levels are disproportionately affected, underscoring an opportunity to improve clinical outcomes by addressing these inequalities.
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Affiliation(s)
- M Fay
- Faculty of Medicine, Dalhousie University, Canada
| | - M Hu
- Department of Economics, Philosophy, and Political Science, University of British Columbia, Okanagan Campus, Canada
| | - M Hajizadeh
- School of Health Administration, Dalhousie University, Canada.
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7
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Khan A, Abonyi S, Neudorf C. Barriers and facilitators in uptake of human papillomavirus vaccine across English Canada: A review. Hum Vaccin Immunother 2023; 19:2176640. [PMID: 36803510 PMCID: PMC10026928 DOI: 10.1080/21645515.2023.2176640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Human Papillomavirus (HPV) is a highly contagious sexually transmitted infection that leads to preventable cancers of the mouth, throat, cervix, and genitalia. Despite the wide availability of HPV Vaccine (HPVV) in Canada, its uptake remains suboptimal. This review aims to identify factors (barriers and facilitators) in HPV vaccine uptake across English Canada at three levels (provider, system, and patient). We explored academic and gray literature to examine factors involved in HPVV uptake and synthesized results based on interpretive content analysis. The review identified the following factors of prime significance in the uptake of the HPV vaccine (a) at the provider level, 'acceptability' of the HPV vaccine, and 'appropriateness' of an intervention (b) at the patient level, the 'ability to perceive' and 'knowledge sufficiency' (c) at the system level, 'attitudes' of different players in vaccine programming, planning and delivery. Further research is needed to conduct population health intervention research in this area.
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Affiliation(s)
- Amal Khan
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cory Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Houle SK, Alsabbagh MW, Waite NM. Herpes zoster and human papillomavirus vaccination opportunities identified using electronic prompts at the time of scheduling influenza or COVID-19 vaccines. Can Pharm J (Ott) 2023; 156:257-264. [PMID: 38222890 PMCID: PMC10786011 DOI: 10.1177/17151635231188343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/14/2023] [Indexed: 01/16/2024]
Abstract
Background Due to workload and competing priorities, vaccination-related interactions in community pharmacies tend to be more reactive than proactive. The aim of this study is to determine the proportion of users of a web-based scheduling system for influenza and COVID-19 vaccines who may be eligible for herpes zoster or human papillomavirus (HPV) vaccination and interested in discussing these vaccines with a pharmacist. Methods Individuals scheduling an influenza or COVID-19 vaccine at a pharmacy using the MedEssist platform between October 2021 and March 2022 were asked about their vaccination status against HPV (if aged 9-45) or herpes zoster (if aged ≥50). Those who were unvaccinated or unsure were asked to indicate their willingness to discuss this with a pharmacist. Logistic regression was performed to identify patient characteristics associated with responses to these screening questions. Results Among 36,659 bookings by those aged 9 to 45 and 55,728 by those aged ≥50 that included responses to screening questions, 70.1% and 55.5% were potentially unvaccinated against HPV and herpes zoster, respectively, with approximately 1 in 5 also indicating willingness to have a discussion with the pharmacist. Those scheduling appointments for COVID-19 vaccines were significantly less likely to be vaccinated against HPV or herpes zoster and less willing to discuss this with a pharmacist than those seeking influenza vaccination. Discussion Automated prompts while booking influenza or COVID-19 vaccinations have the potential to identify vaccine-willing individuals who may benefit from further discussion on their vaccination needs. Conclusion Community pharmacies can leverage available technology to support the efficient and effective identification of individuals eligible for vaccination.
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Affiliation(s)
| | | | - Nancy M. Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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10
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Cha E, Vyas V, King KD, Reifferscheid L, MacDonald SE. Inclusion of intersectionality in studies of immunization uptake in Canada: A scoping review. Vaccine 2023:S0264-410X(23)00510-8. [PMID: 37202274 DOI: 10.1016/j.vaccine.2023.04.073] [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: 09/07/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Intersectionality refers to the interconnectedness of various social locations creating unique experiences for individuals and groups, in the context of systems of privilege and oppression. As part of immunization coverage research, intersectionality allows healthcare professionals and policymakers to become aware of the constellation of characteristics contributing to low vaccine uptake. The objective of this study was to examine the application of intersectionality theory or concepts, and the appropriate use of sex and gender terminology, in Canadian immunization coverage research. MATERIALS AND METHODS The eligibility criteria for this scoping review included English or French language studies on immunization coverage among Canadians of all ages. Six research databases were searched without date restrictions. We searched provincial and federal websites, as well as the Proquest Dissertations and Theses Global database for grey literature. RESULTS Of 4725 studies identified in the search, 78 were included in the review. Of these, 20 studies included intersectionality concepts, specifically intersections of individual-level characteristics influencing vaccine uptake. However, no studies explicitly used an intersectionality framework to guide their research. Of the 19 studies that mentioned "gender", 18 had misused this term, conflating it with "sex". CONCLUSIONS Based on our findings, there is an evident lack of intersectionality framework utilization in immunization coverage research in Canada, as well as misuse of the terms "gender" and "sex". Rather than only focusing on discrete characteristics, research should explore the interaction between numerous characteristics to better understand the barriers to immunization uptake in Canada.
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Affiliation(s)
- Eunah Cha
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Vidhi Vyas
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Keith D King
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Laura Reifferscheid
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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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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Güneş Ö, Özkaya-Parlakay A, Güney AY, Güder L, Mustafaoğlu Ö, Bayraktar P, Kanık-Yüksek S, Gülhan B. A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.
Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.
Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.
Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.
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Affiliation(s)
- Ömer Güneş
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Aslınur Özkaya-Parlakay
- Department of Pediatric Infectious Diseases, Yildirim Beyazit University, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Yasin Güney
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Latife Güder
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Mustafaoğlu
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Pınar Bayraktar
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Saliha Kanık-Yüksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Belgin Gülhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
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13
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Chambers C, Gillis J, Lindsay J, Benoit AC, Kendall CE, Kroch A, Grewal R, Loutfy M, Mah A, O'Brien K, Ogilvie G, Raboud J, Rachlis A, Rachlis B, Yeung A, Yudin MH, Burchell AN. Low human papillomavirus vaccine uptake among women engaged in HIV care in Ontario, Canada. Prev Med 2022; 164:107246. [PMID: 36075492 DOI: 10.1016/j.ypmed.2022.107246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
Women living with HIV are at higher risk for human papillomavirus (HPV)-related dysplasia and cancers and thus are prioritized for HPV vaccination. We measured HPV vaccine uptake among women engaged in HIV care in Ontario, Canada, and identified socio-demographic, behavioural, and clinical characteristics associated with HPV vaccination. During annual interviews from 2017 to 2020, women participating in a multi-site, clinical HIV cohort responded to a cross-sectional survey on HPV vaccine knowledge and receipt. We used logistic regression to derive age-adjusted odds ratios and 95% confidence intervals (CI) for factors associated with self-reported vaccine initiation (≥1 dose) or series completion (3 doses). Among 591 women (median age = 48 years; interquartile range = 40-56 years), 13.2% (95%CI = 10.5-15.9%) had received ≥1 dose. Of those vaccinated, 64.6% had received 3 doses. Vaccine initiation (≥1 dose) was significantly higher among women aged 20-29 years at 31.0% but fell to 13.9% in those aged 30-49 years and < 10% in those aged ≥50 years. After age adjustment, vaccine initiation was significantly associated with being employed (vs. unemployed but seeking work), income $40,000-$59,999 (vs. <$20,000), being married/common-law (vs. single), living with children, immigrating to Canada >5 years ago (vs. immigrating ≤5 years ago), never smoking (vs. currently smoking), and being in HIV care longer (per 10 years). Similar factors were identified for series completion (3 doses). HPV vaccine uptake remains low among women living with HIV in our cohort despite regular engagement in care. Recommendations for improving uptake include education of healthcare providers, targeted community outreach, and public funding of HPV vaccination.
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Affiliation(s)
- Catharine Chambers
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Joanne Lindsay
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Anita C Benoit
- University of Toronto, Toronto, Canada; Women's College Research Institute, Toronto, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Abigail Kroch
- University of Toronto, Toronto, Canada; Ontario HIV Treatment Network, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Ramandip Grewal
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Mona Loutfy
- Women's College Research Institute, Toronto, Canada
| | - Ashley Mah
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Gina Ogilvie
- University of British Columbia, Vancouver, Canada
| | - Janet Raboud
- University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Beth Rachlis
- University of Toronto, Toronto, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Anna Yeung
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Mark H Yudin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Ann N Burchell
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
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14
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de Waal A, Racey CS, Donken R, Plotnikoff K, Dobson S, Smith L, Grennan T, Sadarangani M, Ogilvie G. Factors associated with intention to receive vaccines for bacterial sexually transmitted infections among young HPV-vaccinated Canadian women. CANADIAN JOURNAL OF PUBLIC HEALTH 2022; 113:776-785. [PMID: 35616872 PMCID: PMC9134722 DOI: 10.17269/s41997-022-00648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
Objective The aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation. Methods A 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis. Results Of the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9–23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03–8.27), chlamydia (OR = 5.27, 95% CI 3.66–7.63), and gonorrhea (OR = 5.96, 95% CI 4.15–8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29–3.19), chlamydia (OR = 2.41, 95% CI 1.50–3.90), and gonorrhea (OR = 2.29, 95% CI 1.44–3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models. Conclusion Findings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00648-2.
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Affiliation(s)
- Anna de Waal
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - C Sarai Racey
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robine Donken
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Plotnikoff
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | | | - Laurie Smith
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Troy Grennan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Women's Hospital and Health Service, Women's Health Research Institute, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.
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15
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HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol 2022; 29:3780-3792. [PMID: 35621693 PMCID: PMC9140027 DOI: 10.3390/curroncol29050303] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
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16
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HPV Vaccination: Does It Have a Role in Preventing Penile Cancer and Other Preneoplastic Lesions? Semin Oncol Nurs 2022; 38:151284. [DOI: 10.1016/j.soncn.2022.151284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Efua Sackey M, Markey K, Grealish A. Healthcare professional's promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine 2022; 40:2656-2666. [PMID: 35367068 DOI: 10.1016/j.vaccine.2022.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination coverage remains suboptimal with a global vaccination rate ranging from 12 to 90%. This review examined the approaches used by healthcare professionals in improving the uptake of HPV vaccine and reducing vaccine misconceptions among adolescents. METHODS A systematic review of literature between 2007 and 2021 was conducted using five databases: CINAHL, MEDLINE, PsycInfo, Scopus and ASSIA. Studies that examined healthcare professional's promotional strategies in improving the HPV vaccine uptake in adolescents were included. Two researchers independently reviewed study selection, data extraction, and study methodological quality. Results were analysed and synthesised using narrative synthesis. RESULTS Twelve studies met the inclusion criteria. Studies reported on effective approaches used by healthcare professionals to improve vaccine uptake including the use of multi-settings to target hard-to-reach vulnerable adolescents; consistently recommending the vaccine; and initiating the vaccine before the age of eleven. In addressing vaccine misconceptions, open-communication, motivational approaches, and sexual health education were effective strategies used. CONCLUSION This review found that healthcare professionals need to be better informed and educated on HPV vaccine to reduce their own vaccine hesitancy. Uptake of HPV vaccine can be improved by adopting better communication, engagement, supportive information resources, and training for healthcare professionals.
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Affiliation(s)
- Margaret Efua Sackey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Kathleen Markey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland; King's College London, London, UK
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18
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Oliveira PSD, Gonçalves CV, Watte G, Costa JSDD. Vaccination coverage against human papillomavirus (HPV) and associated factors in female academics from a university in southwestern Goiás, Brazil. Rev Saude Publica 2021; 55:65. [PMID: 34706041 PMCID: PMC8522710 DOI: 10.11606/s1518-8787.2021055003144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To check the coverage of the HPV vaccine in women enrolled in health courses at a university in southwest Goiás, Brazil, and the factors associated with vaccination. METHODS This is a cross-sectional study, including female university students of health courses, aged 18 years or more. A standardized and self-applying questionnaire was used. Participants who received two or more doses of the vaccine were considered immunized. Multiple analysis was performed using multinomial logistic regression. RESULT We observed that, of the 1510 participants, 473 (31.3%) had two or more doses of HPV vaccine, 167 (11.0%) one dose and 870 (57.6%) were unvaccinated. Participants under 21 years of age and in socioeconomic stratum A were 2 times more likely to have received two or more doses of the vaccine (Prevalence Ratio = 1.95; 95%CI 1.40-2.70 and Prevalence Ratio = 2.09; 95%CI 1.39-3.13, respectively). CONCLUSIONS The research revealed extensive possibility for interventions with the aim of achieving greater vaccination coverage among female university students. Even women with more knowledge and high economic stratum showed low vaccination coverage, suggesting that results of higher vaccine coverage can be obtained with vaccination carried out in a school environment.
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Affiliation(s)
| | | | - Guilherme Watte
- Universidade Católica do Rio Grande do Sul. Programa de Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia, Porto Alegre, RS, Brasil
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19
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The prevalence of human papillomavirus in paediatric tonsils in Southwestern Ontario. The Journal of Laryngology & Otology 2021; 136:243-247. [PMID: 34602108 DOI: 10.1017/s0022215121002723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Diamond LM, Clarfield LE, Forte M. Vaccinations against human papillomavirus missed because of COVID-19 may lead to a rise in preventable cervical cancer. CMAJ 2021; 193:E1467. [PMID: 34544788 PMCID: PMC8476220 DOI: 10.1503/cmaj.80082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Laura M Diamond
- Medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lauren E Clarfield
- Medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Milena Forte
- Family physician and assistant professor in the Department of Family and Community Medicine at the University of Toronto, Sinai Health System, Toronto, Ont
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21
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Litwin C, Smith L, Donken R, Krajden M, van Niekerk D, Naus M, Cook D, Albert A, Ogilvie G. High-risk HPV prevalence among women undergoing cervical cancer screening: Findings a decade after HPV vaccine implementation in British Columbia, Canada. Vaccine 2021; 39:5198-5204. [PMID: 34344555 DOI: 10.1016/j.vaccine.2021.07.009] [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: 03/24/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND British Columbia (BC) introduced a publicly funded, school-based human papillomavirus (HPV) immunization program in 2008 with the quadrivalent vaccine. In 2010/2011, a baseline evaluation of HPV prevalence was conducted among women undergoing cervical cancer screening. After 10 years of publicly funded HPV vaccination, HPV-type prevalence was re-evaluated. METHODS From August 2017 to March 2018, 1107 physicians were invited to return cytobrushes used during routine Pap screening to the Cervical Cancer Screening Laboratory for HPV testing. Only age or year of birth was collected. Specimens were screened for high-risk HPV (hrHPV) and positive samples were genotyped. HPV type prevalence was compared for females 15-22 yrs (those eligible for the school-based vaccination) and 23+ yrs (ineligible for school-based vaccination) for the 2010/2011 and the 2017/2018 data. RESULTS There were 3309 valid samples received for testing; of these, 3107 were included in the analysis. The overall hrHPV prevalence was 12.2% (95% CI 11.3-13.3) in 2010/11, and 12.0% (95% CI 10.9-13.2) in 2017/18. For the 15-22 age group, the prevalence for any hrHPV was 26.8% (95% CI 23.1-30.8) in 2010/11 and 25.4% (95% CI 15.3-37.9) in 2017/18. For those aged 15-22, HPV16 prevalence in 2010/11 was 8.8% (95% CI 6.5-11.5) and in 2017/18 was 6.3% (95% CI 1.8-15.5), with corresponding figures for HPV18 3.7% (95% CI 2.3-5.7) and 0% (95% CI 0.0-5.7), respectively. For all hrHPV types, there were no statistically significant differences between the 2010/11 and 2017/18 periods. CONCLUSIONS This study illustrates the prevalence of hrHPV in BC over time in women undergoing cervical cancer screening, where an indication of a decline in HPV16/18 is seen in vaccine eligible women.
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Affiliation(s)
- Charles Litwin
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada.
| | - Laurie Smith
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Robine Donken
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Amsterdam UMC, Vrije Universiteit, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Mel Krajden
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Monika Naus
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
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22
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Goyette A, Yen GP, Racovitan V, Bhangu P, Kothari S, Franco EL. Evolution of Public Health Human Papillomavirus Immunization Programs in Canada. Curr Oncol 2021; 28:991-1007. [PMID: 33617515 PMCID: PMC7985769 DOI: 10.3390/curroncol28010097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Since 2007, all Canadian provinces and territories have had a publicly funded program for vaccination against human papillomavirus (HPV) infection. The objective of this study was to describe the evolution of these vaccination programs. Methods: This was a targeted literature review of public HPV vaccination programs and vaccination coverage rates, based on information provided by jurisdictional public health authorities. Results: HPV vaccination of schoolgirls began in school years 2007/08 to 2010/11 with three doses of the quadrivalent HPV vaccine in all provinces except Quebec, which started with two doses. By 2018/19, all jurisdictions were vaccinating with two doses of the nonavalent vaccine in both girls and boys, except Quebec, which used a mixed vaccination schedule with one dose of the nonavalent and one dose of the bivalent vaccines. Public HPV vaccination programs in most provinces include after-school catch-up vaccination. Immunocompromised or other high-risk individuals are eligible for the HPV public vaccination program in most provinces, but policies vary by jurisdiction. In 2017/18, vaccination coverage rates in provincial HPV school-based programs varied from 62% in Ontario to 86% in Prince Edward Island in girls and from 58% in Ontario to 86% in Prince Edward Island in boys. Conclusions: Since their introduction, Canadian school-based HPV public vaccination programs have evolved from a three-dose to a two-dose schedule, from a quadrivalent to a nonavalent vaccine, and from a girls-only to a gender-neutral policy. Vaccination coverage rates have varied markedly and only Prince Edward Island and Newfoundland/Labrador have maintained rates exceeding 80%.
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Affiliation(s)
| | - Glorian P. Yen
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (G.P.Y.); (S.K.)
| | - Voica Racovitan
- Merck Canada Inc., Kirkland, QC H9H 4M7, Canada; (V.R.); (P.B.)
| | - Parambir Bhangu
- Merck Canada Inc., Kirkland, QC H9H 4M7, Canada; (V.R.); (P.B.)
| | - Smita Kothari
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (G.P.Y.); (S.K.)
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC H4A 3T2, Canada;
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Newcomer knowledge, attitudes, and beliefs about human papillomavirus (HPV) vaccination. BMC FAMILY PRACTICE 2021; 22:17. [PMID: 33421999 PMCID: PMC7797127 DOI: 10.1186/s12875-020-01360-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human Papillomavirus (HPV) is the most common sexually transmitted infection in Canada and around the world. Vaccination is an effective prevention strategy, but uptake is low, especially among newcomers to Canada. We sought to understand newcomers' knowledge, attitudes, and beliefs (KAB) on HPV and HPV vaccination and their role in HPV vaccine acceptance. METHODS Newcomers were defined as individuals born outside Canada, (i.e., individuals born in a different country, the majority of whom are immigrants or refugees, but also includes students and undocumented migrants). Eligible participants were newcomers, aged 16 or older and who could read or write in English, French or Arabic. Surveys were administered in two community health centres in Ottawa, Canada that primarily engage with newcomer populations. Follow-up interviews were conducted either at the community health centre or over the phone, depending on participants' preferences. RESULTS Fifty participants completed the survey, the majority of whom were women (74%) and spoke Arabic as their first language (54%). Seven participants completed supplemental interviews to complement their survey responses. The majority (70%) of participants had not previously heard of HPV. Less than half (46%) knew that the vaccine is effective in preventing certain types of cancer; nearly 40% incorrectly believed the vaccine could cure HPV. Qualitative interviews supported the survey findings. CONCLUSIONS Despite a lack of HPV knowledge due to cultural and language barriers, there is still a strong desire among newcomers to receive the vaccine, especially when accompanied by a physician recommendation. Cultural and language-appropriate resources are needed to help newcomers make informed vaccination decisions and promote HPV vaccine uptake.
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HPV vaccine and cervical cancer policy and policymaking research interest in sub-Saharan Africa: A scoping review. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Human papillomavirus and oral health. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:380-383. [PMID: 33447158 PMCID: PMC7799876 DOI: 10.14745/ccdr.v46i1112a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Canada is among the world leaders in oral health. Despite this, there are growing concerns about the rising rates of HPV-related mouth and throat cancers. The link between human papillomavirus (HPV) and cervical cancer is well established; fortunately, thanks to detection and vaccination, Canada has one of the lowest incidence rates of cervical cancer in the world. The HPV-related mouth and throat cancers, however, present a different picture. In Canada, about 25% to 35% of mouth and throat cancers are related to oral HPV infection; and in 2012, the incidence rate of HPV-associated oropharyngeal cancer was more than 4.5 times higher in males than females. Furthermore, HPV vaccination uptake in Canada is higher among females than males. Physicians and nurses in public health and clinical settings have a role to play in the fight against HPV transmission, as do oral health professionals. Oral health professionals can play a key role in preventing HPV infection and HPV-related oropharyngeal cancers by raising awareness, educating and offering counselling to their clients, and promoting evidence-based preventive and diagnostic interventions.
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Laserson AK, Oliffe JL, Krist J, Kelly MT. HPV Vaccine and College-Age Men: A Scoping Review. Am J Mens Health 2020; 14:1557988320973826. [PMID: 33225805 PMCID: PMC7686636 DOI: 10.1177/1557988320973826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
The human papillomavirus (HPV) potentially affects every sexually active man in the United States and Canada. In 2017, the vaccine became publicly funded in Canada for males ages 9-26, and was integrated into school vaccination programs. In 2019, HPV vaccination was recommended as routine for all U.S.-based males and females ages 9 through 26, and a shared decision for adults >26 years; however, since the approval of the vaccine in 2006 for females only, the age and dosing recommendations for males have followed a complicated and changing trajectory. Current adherence rates are low among college and university age males (18-26 years); therefore, understanding and addressing the barriers and facilitators for men's HPV vaccination is critically important. The purpose of the current scoping review is to provide a synthesis of recent literature pertaining to HPV in college and university age men, as a means to guiding health-care providers (HCPs). Drawing from 15 published articles, three thematic findings were inductively derived. Theme one, lack of awareness, was underpinned by men's knowledge deficits about their eligibility for, and the availability of HPV vaccines. Theme two, underestimating and embodying risk, included men's engagement in sexual activities while misinformed or denying the risk for contracting HPV. The third theme, strategies for increasing men's awareness, summarizes messaging strategies used to lobby young men to vaccinate. The review findings indicate gender-sensitive interventions targeting college-age men, including early, frequent, and consistent messaging on HPV are key.
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Affiliation(s)
- Alyssa K. Laserson
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Krist
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
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Morriscey C, Hajizadeh M. Income and education inequalities in cervical cancer incidence in Canada, 1992-2010. J Public Health (Oxf) 2020; 43:814-823. [PMID: 32785597 DOI: 10.1093/pubmed/fdaa128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is evidence of socioeconomic inequalities in cancer incidence in Canada and other countries globally, yet there is no study investigating socioeconomic inequalities in national cervical cancer incidence in Canada. Thus, the current study investigated income and education inequalities in the incidence of cervical cancer in Canada from 1992 to 2010. METHODS Data were derived from a linked dataset that combined cervical cancer incidence from the Canadian Cancer Registry and demographic and socioeconomic information from the Canadian Census of Population and the National Household Survey. The Concentration index approach was used to measure income and education inequalities in the incidence of cervical cancer over time. RESULTS National incidence of cervical cancer decreased significantly from 1992 to 2010. The age-standardized C was negative for the majority of years for both income and education inequalities, but the preponderance were not significant. Trend analyses of socioeconomic inequalities suggested an increasing concentration of cervical cancer incidence among less-educated females over the study period. CONCLUSIONS Over almost two decades, there were no pervasive socioeconomic inequalities in the incidence of cervical cancer in Canada. As such, policies aimed at reducing the incidence of cervical cancer should focus on the general population, irrespective of socioeconomic status.
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Affiliation(s)
- Carol Morriscey
- Faculty of Medicine, Dalhousie University, Halifax, B3H 4R2, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, B3H 4R2, Canada
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Brenner DR, Ruan Y, Shaw E, O'Sullivan D, Poirier AE, Heer E, Villeneuve PJ, Walter SD, Friedenreich CM, Smith L, De P. Age-standardized cancer-incidence trends in Canada, 1971-2015. CMAJ 2020; 191:E1262-E1273. [PMID: 31740536 DOI: 10.1503/cmaj.190355] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although cancer incidence over time is well documented in Canada, trends by birth cohort and age group are less well known. We analyzed age- and sex-standardized incidence trends in Canada for 16 major cancer sites and all cancers combined. METHODS We obtained nationally representative population-based cancer incidence data in Canada between 1971 and 2015 from the National Cancer Incidence Reporting System (1969-1992) and the Canadian Cancer Registry (1992-2015). We analyzed cancer-incidence trends, reported as annual percent change (APC) for each 10-year group from age 20 to 89 years. We also estimated age-adjusted incidence rate ratios from fitted birth cohort models. RESULTS Across most age categories, the most recent trends show significant decreases in the incidence of cervical (APC -8.8% to -0.33%), lung (men: -7.42% to -0.36%; women: -6.27% to 1.07%), bladder (women: -4.12% to -0.07%; men: -5.13% to -0.38%) and prostate cancer (-11.11% to -1.11%). Significant increasing trends were observed for kidney, thyroid and uterine cancers. Overall incidence has increased among both sexes younger than 50 years of age, with recent increases in pancreatic cancer among men, breast cancer among women and colorectal cancer among both sexes. From the birth cohort analysis, we observed increasing trends in colorectal, liver and prostate cancers among men; kidney cancer and melanoma among women; and thyroid cancer among both sexes. We observed decreasing trends in cervical and ovarian cancers, and in bladder and lung cancers among men. INTERPRETATION Cancer incidence is decreasing at many sites targeted by primary-prevention efforts, such as smoking cessation and screening programs. Substantial increases in incidence among younger populations are driven by cancers possibly associated with obesity.
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Affiliation(s)
- Darren R Brenner
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont.
| | - Yibing Ruan
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Eileen Shaw
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Dylan O'Sullivan
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Abbey E Poirier
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Emily Heer
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Paul J Villeneuve
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Stephen D Walter
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Christine M Friedenreich
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Leah Smith
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
| | - Prithwish De
- Departments of Oncology and Community Health Sciences (Brenner, Friedenreich), Cumming School of Medicine, University of Calgary; Department of Cancer Epidemiology and Prevention Research (Brenner, Ruan, Shaw, Poirier, Heer, Friedenreich), CancerControl Alberta, Alberta Health Services, Calgary, Alta.; Department of Public Health Sciences (O'Sullivan), Queen's University, Kingston, Ont.; Department of Health Sciences (Villeneuve), Carleton University, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Walter), McMaster University, Hamilton, Ont.; Canadian Cancer Society (Smith); Surveillance and Cancer Registry (De), Cancer Care Ontario, Toronto, Ont
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Cattelan L, Ghazawi FM, Le M, Savin E, Zubarev A, Lagacé F, Sasseville D, Waschke K, Litvinov IV. Investigating epidemiologic trends and the geographic distribution of patients with anal squamous cell carcinoma throughout Canada. Curr Oncol 2020; 27:e294-e306. [PMID: 32669936 PMCID: PMC7339845 DOI: 10.3747/co.27.6061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in recent decades, and various risk factors pertaining to the pathogenesis of the disease have been identified, including infection with the human papillomavirus, tobacco use, and immunosuppression. The epidemiology and distribution of anal scc throughout Canada remain poorly understood, however. Methods Using 3 population-based cancer registries, a retrospective analysis of demographic data across Canada for 1992-2010 was performed. The incidence and mortality for anal scc was examined at the levels of provinces, cities, and the forward sortation area (FSA) component (first 3 characters) of postal codes. Results During 1992-2010, 3720 individuals were diagnosed with anal scc in Canada; 64% were women. The overall national incidence rate was 6.3 cases per million population per year, with an average age at diagnosis of 60.4 years. The incidence increased over time, with significantly higher incidence rates documented in British Columbia and Nova Scotia (9.3 cases per million population each). Closer examination revealed clustering of cases in various urban centres and self-identified lgbtq communities in Toronto, Montreal, and Vancouver. Discussion This study provides, for the first time, a comprehensive analysis of the burden of anal scc in Canada, identifying susceptible populations and shedding light onto novel avenues of research to lower the incidence of anal cancer throughout the country.
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Affiliation(s)
- L Cattelan
- Department of Medicine, McGill University, Montreal, QC
| | - F M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON
| | - M Le
- Division of Dermatology, McGill University, Montreal, QC
| | - E Savin
- Division of Dermatology, McGill University, Montreal, QC
| | - A Zubarev
- Division of Dermatology, McGill University, Montreal, QC
| | - F Lagacé
- Department of Medicine, McGill University, Montreal, QC
| | - D Sasseville
- Division of Dermatology, McGill University, Montreal, QC
| | - K Waschke
- Division of Gastroenterology, McGill University, Montreal, QC
| | - I V Litvinov
- Division of Dermatology, McGill University, Montreal, QC
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Smrke A, Leung B, Srikanthan A, McDonald M, Bates A, Ho C. Distinct Features of Psychosocial Distress of Adolescents and Young Adults with Cancer Compared to Adults at Diagnosis: Patient-Reported Domains of Concern. J Adolesc Young Adult Oncol 2020; 9:540-545. [PMID: 32255694 DOI: 10.1089/jayao.2019.0157] [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: 11/13/2022] Open
Abstract
Purpose: Adolescents and young adults (AYA) (18-40) are a population of patients with cancer, who have distinctive developmental and psychosocial pressures. Using validated distress screening tools, we investigated psychosocial needs of AYA compared to older adults with cancer at diagnosis. Methods: AYA and older adult patients from British Columbia, Canada, between 2011 and 2016, who completed the Canadian Problem Checklist (CPC) and the PsychoSocial Screen for Cancer-Revised (PSSCAN-R) within 6 months of their cancer diagnosis were included in the study. Emotional, informational, physical, practical, social, and spiritual domain concerns are identified using the CPC. Psychosocial needs and distress are evaluated using the PSSCAN-R. Baseline demographics were obtained from the cancer registry. Based on gender, primary tumor site, and presence of metastasis, a 3:1 case match was performed with older adults (>40 years old). Statistical analyses included Chi square and Fisher's exact tests. Results: Two thousand and forty five AYA were case matched with 6050 older adults. Majority of patients were female (61.9%), and at diagnosis, 12.1% had metastatic disease. Top three tumor types were breast (20.4%), lymphoma (11.5%), and gastrointestinal (10.8%). The top five concerns for AYA (% AYA, % adults) were fear/worry (56.6, 42.9), understanding of illness (47.6, 41.4), sleep (35.2, 28.9), sadness (34.1, 20.0), and finances (33.8, 15.0). AYA reported higher symptoms of anxiety at baseline (% AYA, % older adults), both moderate (26.0, 19.9) and severe (26.6, 17.1) p < 0.01. Conclusion: Significant differences in psychosocial needs for AYA were seen at diagnosis across multiple domains, specifically, higher emotional, informational, physical, and financial distress. Development of supportive programming geared toward these domains early at diagnosis could benefit this distinct population.
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Affiliation(s)
- Alannah Smrke
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
| | - Bonnie Leung
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
| | - Amirrtha Srikanthan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Melanie McDonald
- Psychosocial Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
| | - Alan Bates
- Psychosocial Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
| | - Cheryl Ho
- Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
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Ghazawi FM, Lu J, Savin E, Zubarev A, Chauvin P, Sasseville D, Zeitouni A, Litvinov IV. Epidemiology and Patient Distribution of Oral Cavity and Oropharyngeal SCC in Canada. J Cutan Med Surg 2020; 24:340-349. [PMID: 32238063 DOI: 10.1177/1203475420915448] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) continue to be a major source of morbidity and mortality worldwide requiring the shared effort of numerous specialists. Tobacco and alcohol consumption have long been identified as risk factors for both OCC and OPC. In addition, human papilloma virus (HPV) is gaining its position as the main causal agent for OPC. OBJECTIVE The objective of this study is to analyze the epidemiology of OCC and OPC in Canada. METHODS Data pertaining to the year of diagnosis, the patient's sex, age at the time of diagnosis, province/territory, city and postal code of oral cavity, and oropharyngeal malignancies diagnosed during 1992-2010 were extracted from the Canadian Cancer Registry and Le Registre Québécois du Cancer. RESULTS In total, 21 685 OCC cases and 15 965 OPC cases were identified from 1992 to 2010. Of those, 84.97% were oral cavity squamous cell carcinomas (SCCs), 88.10% were oropharyngeal SCCs, and both had a significant male predominance. While oral cavity SCC incidence stabilized over the study period, oropharyngeal SCC continued to increase. Oral cavity SCC incidence increased with age, while oropharyngeal SCC incidence peaked in the 50- to 59-year age group. Detailed geographic distribution analysis of patients at the provincial/territorial, city, and postal code levels identified several patient clusters. CONCLUSIONS This work highlights important epidemiological differences in trends between oral and oropharyngeal cancers, identifies high-incidence postal codes for each malignancy, and correlates incidence/mortality with known risk factors including alcohol/tobacco use and HPV infections, therefore providing a comprehensive understanding of epidemiology for these cancers in Canada.
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Affiliation(s)
| | - Jessica Lu
- 507266 Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Evgeny Savin
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Andrei Zubarev
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Peter Chauvin
- 507266 Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Denis Sasseville
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Anthony Zeitouni
- 507266 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Ivan V Litvinov
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
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Park EY, Kim TI. Factors influencing mothers’ intention to vaccinate their elementary school sons against human papillomavirus. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2020; 26:37-48. [PMID: 36311849 PMCID: PMC9334198 DOI: 10.4069/kjwhn.2020.03.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 11/22/2022] Open
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George C, Roberts R, Brennen D, Deveaux L, Read SE. Knowledge and awareness of Human Papillomavirus (HPV) and HPV vaccines among Caribbean youth: the case of the Bahamas. Hum Vaccin Immunother 2019; 16:573-580. [PMID: 31464555 PMCID: PMC7227632 DOI: 10.1080/21645515.2019.1661205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There is a high burden of cervical cancer in the Caribbean region, particularly in the Bahamas, yet there are few studies of Human Papillomavirus (HPV) and HPV vaccine in the region. The objective of this study was to assess the knowledge and awareness of HPV and the HPV vaccine among school-aged youth (15–18 years) living in the Bahamas. Cross-sectional data were obtained from the “Getting to Zero” HIV study in the Bahamas conducted in 2014/2015 (n = 1553). The questionnaire elicited information on knowledge of HPV and HPV vaccines, using previously validated scales. Data analysis included Chi-square tests and Mann Whitney U test. In this sample of school-aged youth, only 10.7% (146/1364) had ever heard of HPV. With respect to those who were sexually active (n = 685), only 10.7% had ever heard of HPV. For those who had heard of HPV, knowledge of HPV and HPV vaccines was assessed on an HPV Knowledge and HPV Vaccine Knowledge scale, respectively. There was no statistically significant difference in mean HPV knowledge score between males and females, or HPV vaccine knowledge scores, between males and females. There was a general lack of awareness of HPV and HPV vaccines among school-aged youth in the Bahamas. This is an important gap in the HPV vaccine strategy and cancer prevention, as this is the age at which most people acquire HPV. It emphasizes the importance of developing a careful implementation plan, with an evaluation of knowledge and attitudes, in order to have an effective HPV vaccine uptake.
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Affiliation(s)
- Clemon George
- University of Ontario Institute of Technology and Faculty of Medical Sciences, Oshawa, Ontario and the University of the West Indies, Cave Hill, Barbados
| | - Robin Roberts
- UWI School of Clinical Medicine and Research, Nassau, The Bahamas
| | | | | | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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A National Survey of Canadian Adults on HPV: Knowledge, Attitudes, and Barriers to the HPV Vaccine. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1125-1133.e6. [PMID: 31239230 DOI: 10.1016/j.jogc.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Identifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public. METHODS An online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women. RESULTS The majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants. CONCLUSION Canadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.
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Smith A, Baines N, Memon S, Fitzgerald N, Chadder J, Politis C, Nicholson E, Earle C, Bryant H. Moving toward the elimination of cervical cancer: modelling the health and economic benefits of increasing uptake of human papillomavirus vaccines. ACTA ACUST UNITED AC 2019; 26:80-84. [PMID: 31043805 DOI: 10.3747/co.26.4795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The human papillomavirus (hpv) is a common sexually transmitted infection and a primary cause of cervical cancer. The Government of Canada has set a target of reaching 90% hpv vaccine coverage among adolescents by 2025. Here, we examine hpv vaccine uptake in school-based immunization programs across Canada and explore how achieving the 90% target could affect the future incidence of cervical cancer, mortality, and health system expenditures in a cohort of Canadian women. Methods Data for hpv vaccine uptake in the most recent reported school year available in each jurisdiction were provided in 2017 by jurisdictional school-based immunization programs and were used to estimate a national weighted average of 67%. The OncoSim microsimulation model (version 2.5) was used to compare 3 different levels of hpv vaccine uptake (0%, 67%, 90%) on health and economic outcomes for a hypothetical cohort of all 5- to 10-year-old girls in Canada in 2015. Results Vaccine uptake for girls in school-based programs varied from 55.0% to 92.0% in the jurisdictions reviewed. The OncoSim model projects that increasing uptake to 90% from 67% would result in a 23% reduction in cervical cancer incidence rates (to 3.1 cases from 4.0 cases per 100,000, averaged across the lifetime of the cohort) and a 23% decline in the average annual mortality rate (to 1.0 deaths from 1.3 deaths per 100,000). Finally, the model projects that the health system will incur a cost of $9 million (1% increase) during the lifetime of the cohort if uptake is increased to 90% from 67%. Costs are discounted (1.5%) and expressed in 2016 Canadian dollars. Costs reflect the payer perspective. Conclusions Our model shows that increasing hpv vaccine uptake to 90% from current levels for girls in school-based immunization programs could result in substantial reductions in the future incidence and mortality rates for cervical cancer in Canada.
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Affiliation(s)
- A Smith
- Canadian Partnership Against Cancer, Toronto, ON
| | - N Baines
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Canadian Partnership Against Cancer, Toronto, ON
| | - N Fitzgerald
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Chadder
- Canadian Partnership Against Cancer, Toronto, ON
| | - C Politis
- Canadian Partnership Against Cancer, Toronto, ON
| | - E Nicholson
- Canadian Partnership Against Cancer, Toronto, ON
| | - C Earle
- Canadian Partnership Against Cancer, Toronto, ON
| | - H Bryant
- Canadian Partnership Against Cancer, Toronto, ON
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Gantz L, Calvo A, Hess‐Holtz M, Gonzales F, Alguero L, Murphy S, Moran M, Frank LB, Chatterjee JS, Amezola de Herrera P, Baezconde‐Garbanati L. Predictors of HPV Knowledge and HPV Vaccine Awareness Among Women in Panama City, Panama. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ramsay LC, Anyiwe K, Li M, Macdonald L, Coyte PC, Sander B. Economic evaluation of a publicly funded hepatitis A travel vaccination program in Ontario, Canada. Vaccine 2019; 37:1467-1475. [PMID: 30770225 DOI: 10.1016/j.vaccine.2019.01.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hepatitis A virus (HAV) causes acute liver infection and is spread through the fecal-oral route. Travel to countries in HAV-endemic regions (e.g., Asia and Latin America) is a well-described risk factor for infection. Currently, Ontario publicly funds hepatitis A vaccination for some populations at high risk of HAV infection but not for all travellers to endemic countries. The objective of this study was to determine the cost-effectiveness of expanding publicly funded HAV vaccination to people planning travel to HAV-endemic regions, from the Ontario healthcare payer perspective. METHODS We conducted a cost-utility analysis comparing an expanded high-risk publicly-funded hepatitis A vaccination program including funded vaccine for travellers to endemic regions to the current high risk program in Ontario. A Markov state transition model was developed, including six possible health states. Model parameters were informed through targeted literature searches and included hepatitis A disease probabilities, utilities associated with health states, health system expenditures, and vaccine costs. Future costs and health outcomes were discounted at 1.5%. Primary outcomes included cost, incremental cost-effectiveness ratio (ICER) and quality adjusted life years (QALYs) over a lifetime time horizon. We conducted one-way, two-way, and probabilistic sensitivity analysis. RESULTS The expanded high risk HAV vaccine program provided few incremental health gains in the travel population (mean 0.000037 QALYs/person), at an incremental cost of $124.31. The ICER of the expanded program compared to status quo is $3,391,504/QALY gained. The conclusion of the model was robust to changes in key parameters across reasonable ranges. CONCLUSIONS The expanded vaccination program substantially exceeds commonly accepted cost-effectiveness thresholds. Further research concerning possible cost-effective implementation of high-risk travel hepatitis A vaccination should focus on a more integrated understanding of the risk of acquiring hepatitis A during travel to endemic regions (e.g., purpose, length of stay).
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Affiliation(s)
- L C Ramsay
- School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - K Anyiwe
- School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada
| | - M Li
- East China Normal University, Zhongshan N Rd, Shanghai 3663, China
| | - L Macdonald
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Public Health Ontario, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada
| | - P C Coyte
- School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Canadian Centre for Health Economics, 155 College Street, Toronto, Ontario M5T 1P8, Canada
| | - B Sander
- School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Public Health Ontario, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
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Rubens-Augustson T, Wilson LA, Murphy MS, Jardine C, Pottie K, Hui C, Stafström M, Wilson K. Healthcare provider perspectives on the uptake of the human papillomavirus vaccine among newcomers to Canada: a qualitative study. Hum Vaccin Immunother 2018; 15:1697-1707. [PMID: 30352005 PMCID: PMC6746509 DOI: 10.1080/21645515.2018.1539604] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Human papillomavirus is among the most common sexually transmitted infections in the world. Newcomers, defined in Canada as foreign-born individuals who are either immigrants or refugees, but may also include students and undocumented migrants, face numerous barriers to HPV vaccination. This study sought to understand, from the perspective of healthcare providers, barriers and facilitators to HPV vaccination, and recommendations to improve HPV vaccine uptake among newcomers. Semi-structured interviews were conducted with 10 healthcare providers between March and April 2018. Data were analyzed at the manifest level using a Qualitative Content Analysis approach. Categories of barriers to vaccination included: access, communication, knowledge, culture, and provider-related factors. Facilitators included targeted health promotion; understanding the relevance of HPV vaccination; trusting the healthcare system; and cultural sensitivity. Two overarching recommendations were to publicly fund the HPV vaccine, and enhance language- and culturally-appropriate health promotion activities. Further research should explore informational desires and needs from the perspective of newcomers to inform strategies to promote equitable HPV vaccine coverage.
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Affiliation(s)
- Taylor Rubens-Augustson
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , ON , Canada.,b Division of Social Medicine and Global Health, Lund University , Lund , Sweden
| | - Lindsay A Wilson
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Malia Sq Murphy
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Cindy Jardine
- c Faculty of Health Sciences, University of the Fraser Valley , Chilliwack , BC , Canada
| | - Kevin Pottie
- d Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada.,e Bruyère Research Institute , Ottawa , ON , Canada
| | - Charles Hui
- d Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| | - Martin Stafström
- b Division of Social Medicine and Global Health, Lund University , Lund , Sweden
| | - Kumanan Wilson
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , ON , Canada.,d Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
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Shapiro GK, Tatar O, Amsel R, Prue G, Zimet GD, Knauper B, Rosberger Z. Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons. Prev Med 2018; 116:203-210. [PMID: 30267734 DOI: 10.1016/j.ypmed.2018.09.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/13/2018] [Accepted: 09/22/2018] [Indexed: 12/20/2022]
Abstract
Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9-16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the 'decided not to vaccinate' stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom of Great Britain and Northern Ireland
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Barbel Knauper
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
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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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Henderson RI, Shea-Budgell M, Healy C, Letendre A, Bill L, Healy B, Bednarczyk RA, Mrklas K, Barnabe C, Guichon J, Bedingfield N, MacDonald S, Colquhoun A, Glaze S, Nash T, Bell C, Kellner J, Richardson R, Dixon T, Starlight J, Runner G, Nelson G. First nations people's perspectives on barriers and supports for enhancing HPV vaccination: Foundations for sustainable, community-driven strategies. Gynecol Oncol 2018; 149:93-100. [PMID: 29605057 DOI: 10.1016/j.ygyno.2017.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/17/2017] [Accepted: 12/19/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. METHODS Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vaccine. A 2017 community gathering was convened to engage First Nations community members, health directors, and health services researchers in dialogue around unique barriers and supports to HPV vaccination in Alberta. Voices of community Elders, parents, health directors, and cancer survivors (n=24) are presented as qualitative evidence to help inform intervention design. RESULTS Key findings from discussions indicate barriers to HPV vaccination include resource constraints and service infrastructure gaps, historical mistrust in healthcare systems, impacts of changing modes of communication, and community sensitivities regarding sexual health promotion. Supports were identified as strengthened inter-generational relationships in communities. CONCLUSIONS AND FUTURE DIRECTION Ongoing dialogue and co-development of community-based strategies to increase HPV vaccine uptake are required. The identification of possible barriers to HPV vaccination in a Canadian Indigenous population contributes to limited global literature on this subject and may inform researchers and policy makers who work with Indigenous populations in other regions.
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Affiliation(s)
- R I Henderson
- Department of Family Medicine, Cumming School of Medicine, Calgary, AB, Canada.
| | - M Shea-Budgell
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
| | - C Healy
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - A Letendre
- Alberta Cancer Prevention Legacy Fund, Edmonton, AB, Canada
| | - L Bill
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - B Healy
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - R A Bednarczyk
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - K Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - C Barnabe
- Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - J Guichon
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - N Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - S MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - A Colquhoun
- Alberta Ministry of Health, Edmonton, AB, Canada
| | - S Glaze
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
| | - T Nash
- Indigenous Mental Health Program, Calgary, AB, Canada
| | - C Bell
- Alberta Ministry of Health, Edmonton, AB, Canada
| | - J Kellner
- Department of Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - R Richardson
- First Nations and Inuit Health Branch, Alberta Region, Edmonton, AB, Canada
| | - T Dixon
- Elder, Eden Valley Nation, AB, Canada
| | | | - G Runner
- Elder, Tsuut'ina Nation, AB, Canada
| | - G Nelson
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
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