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Brandt HM, Footman A, Adsul P, Ramanadhan S, Kepka D. Implementing interventions to start HPV vaccination at age 9: Using the evidence we have. Hum Vaccin Immunother 2023; 19:2180250. [PMID: 36803261 PMCID: PMC10026886 DOI: 10.1080/21645515.2023.2180250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers.
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Affiliation(s)
- Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alison Footman
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deanna Kepka
- Huntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA
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2
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Aaron KJ, Griner S, Footman A, Boutwell A, Van Der Pol B. Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis. Ann Fam Med 2023; 21:172-179. [PMID: 36973065 PMCID: PMC10042575 DOI: 10.1370/afm.2942] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2022] [Accepted: 11/21/2022] [Indexed: 03/29/2023] Open
Abstract
PURPOSE Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the 2 most frequently reported notifiable sexually transmitted infections (STIs) in the United States, and Trichomonas vaginalis (TV), although not a notifiable disease, is the most common curable non-viral STI worldwide. Women bear a disproportionate burden of these infections and testing is necessary to identify infections. Although vaginal swabs are the recommended sample type, the specimen most often used among women is urine. The objective of this meta-analysis was to assess the diagnostic sensitivity of commercially available assays for vaginal swabs vs urine specimens from women. METHODS A systematic search of multiple databases from 1995 through 2021 identified studies that (1) evaluated commercially available assays, (2) presented data for women, (3) included data obtained from the same assay on both a urine specimen and a vaginal swab from the same patient, (4) used a reference standard, and (5) were published in English. We calculated pooled estimates for sensitivity and the corresponding 95% CIs for each pathogen as well as odds ratios for any difference in performance. RESULTS We identified 28 eligible articles with 30 comparisons for CT, 16 comparisons for NG, and 9 comparisons for TV. Pooled sensitivity estimates for vaginal swabs and urine, respectively, were 94.1% and 86.9% for CT, 96.5% and 90.7% for NG, and 98.0% and 95.1% for TV (all P values <.001). CONCLUSIONS Evidence from this analysis supports the Centers for Disease Control and Prevention's recommendation that vaginal swabs are the optimal sample type for women being tested for chlamydia, gonorrhea, and/or trichomoniasis.
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Affiliation(s)
- Kristal J Aaron
- University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
| | - Stacey Griner
- University of North Texas Health Science Center School of Public Health, Fort Worth, Texas
| | - Alison Footman
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Alexander Boutwell
- University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
| | - Barbara Van Der Pol
- University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
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Cunningham-Erves J, George W, Stewart EC, Footman A, Davis J, Sanderson M, Smalls M, Morris P, Clarkson K, Lee O, Brandt HM. COVID-19 Vaccination: Comparison of Attitudes, Decision-Making Processes, and Communication among Vaccinated and Unvaccinated Black Americans. Int J Environ Res Public Health 2023; 20:3481. [PMID: 36834175 PMCID: PMC9960928 DOI: 10.3390/ijerph20043481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND COVID-19 vaccination rates remain suboptimal among Black Americans who disproportionately experience higher hospitalization and death rates than White Americans. METHODS We conducted a multi-method (interviews and surveys) study among 30 Black Americans (n = 16 vaccinated, n = 14 unvaccinated) to explore factors related to vaccination hesitancy, decision-making processes, and communication related to uptake. Participants were recruited by using community-driven approaches, including partner collaborations. Thematic analysis was used to analyze qualitative data, and descriptive and bivariate analysis was used for quantitative data. RESULTS Of those unvaccinated, 79% (n = 11) stated they were delaying and 21% (n = 3) were declining vaccination indefinitely. When asked about the likelihood of vaccine initiation in 6 months and 12 months, 29% (n = 4) and 36% (n = 5), respectively, stated that they would receive the vaccine. The following themes emerged: (1) COVID-19 vaccination hesitancy exists on a continuum; (2) varied decision-making processes for COVID-19 vaccination; (3) motivators among vaccinated individuals; (4) barriers among unvaccinated individuals; (5) retrieving and navigating vaccine information within the COVID-19 infodemic; and (6) parent perspectives on child vaccination. CONCLUSIONS Findings suggest that vaccinated and unvaccinated participants had similar and dissimilar perspectives in decision-making processes and vaccine concerns as shown in the Decision-making Processes for the COVID-19 vaccination (DePC) model. Based on these findings, future studies should further explore how factors influencing decision-making can lead to divergent outcomes for COVID-19 vaccination.
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Affiliation(s)
- Jennifer Cunningham-Erves
- Department of Internal Medicine, Meharry Medical College, School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Whitney George
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 27232, USA
| | - Elizabeth C. Stewart
- Department of Internal Medicine, Meharry Medical College, School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Alison Footman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Jamaine Davis
- Department of Biochemistry and Cancer Biology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Meredith Smalls
- Meharry Vanderbilt Alliance, 1903 Meharry Boulevard, Nashville, TN 37208, USA
| | - Phillip Morris
- Department of Internal Medicine, Meharry Medical College, School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA
| | - Kristin Clarkson
- Congregational Health & Education Network, 1818 Albion St, Nashville, TN 37208, USA
| | - Omaran Lee
- Centers for Wellbeing, P.O. Box 330191, Nashville, TN 37203, USA
| | - Heather M. Brandt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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Footman A, Kanney N, Niccolai LM, Zimet GD, Overton ET, Davies SL, Van Der Pol B. Parents' Acceptance of COVID-19 Compared to Human Papillomavirus Vaccines. J Adolesc Health 2022; 71:673-678. [PMID: 36208985 PMCID: PMC9533113 DOI: 10.1016/j.jadohealth.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The first vaccine against SARS-CoV-2 (COVID-19) for adolescents 16 years and older in the United States received Emergency Use Authorization in December 2020. Soon after its approval, parents expressed concerns about vaccine safety for adolescents. Similar concerns about vaccine safety partially explain suboptimal human papillomavirus (HPV) vaccine uptake. This qualitative study explores similarities and differences in parents' attitudes about these two vaccines. METHODS Parents were recruited through social media and at health centers in Alabama. Semi-structured interviews with parents of adolescents aged 9-17 years were conducted before and after Alabama expanded age eligibility to those 16 and older. Topics included knowledge about HPV and COVID-19 vaccines, and parents' intentions to have children vaccinated. Interviews were analyzed using thematic analysis. RESULTS From March 11, 2021 to April 24, 2021, 21 in-depth interviews were conducted. Parents discussed the importance of HPV and COVID-19 vaccines for protecting their children's health but differences between the two related to community protection. Parents were concerned about vaccine safety but media coverage about the COVID-19 vaccine led to more favorable attitudes about the benefits of vaccination, which was not observed for HPV vaccines. Instead for HPV vaccination, parents wanted their healthcare providers' opinions about the vaccine before making a vaccination decision. DISCUSSION Parents had similar concerns about HPV and COVID-19 vaccines. Although provider recommendations can improve vaccine uptake, local news reports were seen to have a positive impact on COVID-19 vaccine acceptance in lieu of provider recommendation. Disseminating information online could be beneficial to promote HPV and COVID-19 vaccines.
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Affiliation(s)
- Alison Footman
- University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama.
| | - Nita Kanney
- University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama
| | - Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Gregory D Zimet
- Indiana University, School of Medicine, Indianapolis, Indiana
| | | | - Susan L Davies
- Tulane University, School of Social Work, New Orleans, Louisiana
| | - Barbara Van Der Pol
- University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama; University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama
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5
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Griner SB, Footman A, Van Der Pol B. Mentoring Relationships in the Field of Sexually Transmitted Infections: Experiences, Observations, and Recommendations. Health Behavior Research 2022. [DOI: 10.4148/2572-1836.1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Van Gerwen O, Griner S, Davis A, Footman A, Pinto CN, Melendez JH, Tuddenham S, Exten C, Soge OO, Chakraborty P, Nenninger A, Marlowe EM, Joseph AM, McGowin CL, Seña AC, Fortenberry JD, Ghanem KG, Van Der Pol B. Summary of the Fourth Annual American Sexually Transmitted Diseases Association Workshop on Improving Sexually Transmitted Infection Control Efforts Through Cross-Sector Collaboration. Sex Transm Dis 2022; 49:588-593. [PMID: 35608091 DOI: 10.1097/olq.0000000000001651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The American Sexually Transmitted Diseases Association has, for several years, been conducting a cross-sector workshop to bring together a variety of stakeholders to develop ideas for collaboratively improving the sexually transmitted infection control efforts in the United States. In this summary, we share the content of discussions and ideas of the fourth annual workshop for future research and potential changes to practice with a focus on diagnostic capacity.
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Affiliation(s)
- Olivia Van Gerwen
- From the University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Stacey Griner
- University of North Texas Health Science Center, Fort Worth, TX
| | - Alissa Davis
- Columbia University School of Social Work, New York, NY
| | - Alison Footman
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Casey N Pinto
- Pennsylvania State University College of Medicine, Hershey, PA
| | | | | | - Cara Exten
- Pennsylvania State University College of Nursing, University Park, PA
| | - Olusegun O Soge
- Departments of Global Health and Medicine, University of Washington, Seattle, WA
| | | | | | - Elizabeth M Marlowe
- Quest Diagnostics Nichols Institute, Infectious Diseases, San Juan Capistrano, CA
| | | | - Chris L McGowin
- Medical and Scientific Affairs, Roche Diagnostic Corporation, Indianapolis, IN
| | - Arlene C Seña
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Footman A, Dagama D, Smith CH, Van Der Pol B. A Systematic Review of New Approaches to Sexually Transmitted Infection Screening Framed in the Capability, Opportunity, Motivation, and Behavior Model of Implementation Science. Sex Transm Dis 2021; 48:S58-S65. [PMID: 33938515 PMCID: PMC8284379 DOI: 10.1097/olq.0000000000001461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chlamydia and gonorrhea are 2 of the most common bacterial sexually transmitted infections (STIs) worldwide. Rising chlamydia and gonorrhea rates along with increased closing of STI clinics has led many to seek STI testing in clinical settings such as urgent cares and walk-in clinics. However, with competing priorities, providing effective and efficient STI care can be difficult in these settings. This has left a growing need for the implementation of novel STI screening programs in other clinical settings. This review summarizes previous studies that have evaluated the clinical implementation of chlamydia and gonorrhea screening programs in these settings. Literature from January 2015 to February 2020 regarding the implementation or evaluation of STI screening programs in clinical settings was reviewed. Constructs from the Capability, Opportunity, Motivation, and Behavior model were used to organize results, as this model can aid in identifying specific strategies for behavior/process change interventions. We found that multiple STI screening programs have been implemented and evaluated in 5 different countries and multiple health care facilities including sexual health clinics, urgent cares, walk-in clinics, and university health clinics. When implementing new STI screening programs, sample-first, test-and-go services and molecular point-of-care (POC) testing approaches were found to be effective in increasing screening and reducing costs and time to treatment. At the health care systems level, these programs can help reduce STI screening costs and generate additional revenue for clinics. At the provider level, clear communication and guidance can help clinical and administrative staff in adopting new screening programs. Finally, at the patient level, new programs can reduce time to treatment and travel costs in visiting clinics multiple times for testing and treatment services.
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Affiliation(s)
| | | | | | - Barbara Van Der Pol
- From the School of Public Health
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Niccolai LM, North AL, Footman A, Hansen CE. Lack of school requirements and clinician recommendations for human papillomavirus vaccination. J Public Health Res 2018; 7:1324. [PMID: 29780768 PMCID: PMC5941259 DOI: 10.4081/jphr.2018.1324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians' recommendations. DESIGN AND METHODS Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. RESULTS Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. CONCLUSIONS The current lack of school entry requirements for HPV vaccination is an important influence on clinicians' recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians' recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.
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Affiliation(s)
- Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Anna L. North
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Alison Footman
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Caitlin E. Hansen
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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