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Buller DB, Sussman AL, Thomson CA, Kepka D, Taren D, Henry KL, Warner EL, Walkosz BJ, Woodall WG, Nuss K, Blair CK, Guest DD, Borrayo EA, Gordon JS, Hatcher J, Wetter DW, Kinsey A, Jones CF, Yung AK, Christini K, Berteletti J, Torres JA, Barraza Perez EY, Small A. #4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2024; 13:e50392. [PMID: 38386396 PMCID: PMC10921336 DOI: 10.2196/50392] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. OBJECTIVE This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. METHODS We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. RESULTS The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. CONCLUSIONS Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50392.
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Affiliation(s)
| | - Andrew L Sussman
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Deanna Kepka
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Douglas Taren
- Section of Nutrition, University of Colorado Denver, Aurora, CO, United States
| | - Kimberly L Henry
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, CO, United States
| | - Echo L Warner
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | | | - Kayla Nuss
- Klein Buendel, Golden, CO, United States
| | - Cindy K Blair
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Evelinn A Borrayo
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | | | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Christopher F Jones
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Angela K Yung
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kaila Christini
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - John A Torres
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
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Garcia K, Iacob E, Dean-Smith M, Royce E, Alvarez G, Kepka D. Low Levels of Lifetime Pap Test Receipt Among Vulnerable Guatemalans. J Cancer Educ 2024:10.1007/s13187-024-02405-0. [PMID: 38376746 DOI: 10.1007/s13187-024-02405-0] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
Low and middle-income countries, such as Guatemala, shoulder a disproportionate share of cervical cancer, a preventable disease in high income countries. Tangible obstacles, such as lack of access to health care, cultural differences, and insufficient infrastructure, and facilitators, such as being Ladino, married, and educated, have been identified in the literature related to cervical cancer prevention. The aim of this survey was to explore barriers and facilitators to cervical cancer prevention, comparing rural Indigenous and urban Ladino populations. We surveyed 139 women in two health clinics. Participants answered questions about demographic information, cervical cancer knowledge, and health care behaviors. We analyzed survey data with four bivariate models. Our results suggest vulnerable populations, such as rural Indigenous women who are single, illiterate, and lack education, face higher cervical cancer risk. Partnerships should be formed with health promotors and lay midwives to educate and encourage vulnerable populations to prevent cervical cancer.
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Affiliation(s)
- Kimberly Garcia
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA.
| | - Eli Iacob
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | - Mari Dean-Smith
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | - Emily Royce
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
| | | | - Deanna Kepka
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT, 84112, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
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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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van Thiel Berghuijs KM, Kaddas HK, Warner EL, Fair DB, Fluchel M, Knackstedt ED, Verma A, Kepka D, Green AL, Smitherman AB, Draper L, Johnson RH, Kirchhoff AC. Vaccination practices of pediatric oncologists from eight states. BMC Health Serv Res 2023; 23:1215. [PMID: 37932718 PMCID: PMC10629174 DOI: 10.1186/s12913-023-10160-z] [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] [Received: 11/18/2022] [Accepted: 10/16/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Vaccinations are a vital part of routine childhood and adolescent preventive care. We sought to identify current oncology provider practices, barriers, and attitudes towards vaccinating childhood and adolescent cancer patients and survivors. METHODS We conducted a one-time online survey distributed from March-October 2018 to pediatric oncologists at nine institutions across the United States (N = 111, 68.8% participation rate). The survey included 32 items about vaccination practices, barriers to post-treatment vaccination, availability of vaccinations in oncology clinic, familiarity with vaccine guidelines, and attitudes toward vaccination responsibilities. Descriptive statistics were calculated in STATA 14.2. RESULTS Participants were 54.0% female and 82.9% white, with 12.6% specializing in Bone Marrow Transplants. Influenza was the most commonly resumed vaccine after treatment (7030%). About 50%-60% were familiar with vaccine guidelines for immunocompromised patients. More than half (62.7%) recommended that patients restart most immunizations 6 months to 1 year after chemotherapy. Common barriers to providers recommending vaccinations included not having previous vaccine records for patients (56.8%) or lacking time to ascertain which vaccines are needed (32.4%). Of participants, 66.7% stated that vaccination should be managed by primary care providers, but with guidance from oncologists. CONCLUSIONS Many pediatric oncologists report being unfamiliar with vaccine guidelines for immunocompromised patients and almost all report barriers in supporting patients regarding vaccines after cancer treatment. Our findings show that further research and interventions are needed to help bridge oncology care and primary care regarding immunizations after treatment.
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Affiliation(s)
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- University of Arizona Cancer Center, Tucson, AZ, 85719, USA
| | - Douglas B Fair
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT, 84108, USA
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, 84113, USA
| | - Mark Fluchel
- Seattle Children's Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Elizabeth D Knackstedt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, 84113, USA
| | - Anupam Verma
- Pediatric Specialists of Virginia, Center for Cancer and Blood Disorders, Fairfax, VA, 22031, USA
- Center for Cancer and Blood Disorders, Division of Oncology, Children's National Hospital, Washington DC, 20010, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Adam L Green
- Children's Hospital of Colorado/University Colorado, Aurora, CO, 80045, USA
| | - Andrew B Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | | | | | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT, 84108, USA
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Waters AR, Weir C, Kramer HS, van Thiel Berghuijs KM, Wu Y, Kepka D, Kirchhoff AC. Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings. J Cancer Surviv 2023:10.1007/s11764-023-01391-4. [PMID: 37147553 PMCID: PMC10629381 DOI: 10.1007/s11764-023-01391-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Survivors of childhood and adolescent cancer experience low human papillomavirus (HPV) vaccination rates-a crucial form of cancer prevention. Oncology provider recommendations may increase young survivors HPV vaccine intent, but HPV vaccination is not typically provided in the oncology setting. Thus, we explored the implementation barriers of providing the HPV vaccine in oncology. METHODS We interviewed oncology providers in a variety of specialty areas about their perceptions of the HPV vaccine and to explore barriers to recommending and administering the vaccine in their clinics. Interviews were audio recorded, quality checked, and thematically analyzed. Emergent themes were then mapped onto the Capability, Opportunity, Motivation, and Behavior (COM-B) Model and the Theoretical Domains Framework. RESULTS A total of N=24 oncology providers were interviewed. Most provided direct clinical care (87.5%) and most commonly specialized in pediatric oncology (20.8%), medical oncology (16.7%), bone marrow transplant (16.7%), and nurse coordination (16.7%). Two themes emerged within each COM-B domain. Capability: 1) educational barriers to HPV vaccination and 2) complicated post treatment HPV vaccination guidelines. MOTIVATION 1) perceived importance of HPV vaccine and 2) concern about blurred scope of practice. OPPORTUNITY 1) hospital administration and time concern barriers and 2) clinical workflow integration concerns. CONCLUSION Implementing HPV vaccination in the oncology setting has the potential to increase HPV vaccination rates among young survivors. Multi-level barriers to providing the HPV vaccine in the oncology setting were identified by participants. Leveraging existing implementation strategies may be an effective way to mitigate provider identified barriers and increase vaccination rates.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah Department of Pediatrics, Salt Lake City, UT, USA
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6
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Ou JY, Bennion N, Parker K, Fair D, Hanson HA, Kepka D, Warner EL, Ramsay JM, Kaddas HK, Kirchhoff AC. Risk Factors and Trends for HPV-Associated Subsequent Malignant Neoplasms among Adolescent and Young Adult Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2023; 32:625-633. [PMID: 37071501 PMCID: PMC10159883 DOI: 10.1158/1055-9965.epi-22-0826] [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] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Subsequent malignant neoplasms (SMN; new cancers that arise after an original diagnosis) contribute to premature mortality among adolescent and young adult (AYA) cancer survivors. Because of the high population prevalence of human papillomavirus (HPV) infection, we identify demographic and clinical risk factors for HPV-associated SMNs (HPV-SMN) among AYA cancer survivors in the SEER-9 registries diagnosed from 1976 to 2015. METHODS Outcomes included any HPV-SMN, oropharyngeal-SMN, and cervical-SMN. Follow-up started 2 months after their original diagnosis. Standardized incidence ratios (SIR) compared risk between AYA survivors and general population. Age-period-cohort (APC) models examined trends over time. Fine and Gray's models identified therapy effects controlling for cancer and demographic confounders. RESULTS Of 374,408 survivors, 1,369 had an HPV-SMN, occurring on average 5 years after first cancer. Compared with the general population, AYA survivors had 70% increased risk for any HPV-SMN [95% confidence interval (CI), 1.61-1.79] and 117% for oropharyngeal-SMN (95% CI, 2.00-2.35); cervical-SMN risk was generally lower in survivors (SIR, 0.85; 95% CI, 0.76-0.95), but Hispanic AYA survivors had a 8.4 significant increase in cervical-SMN (SIR, 1.46; 95% CI, 1.01-2.06). AYAs first diagnosed with Kaposi sarcoma, leukemia, Hodgkin, and non-Hodgkin lymphoma had increased HPV-SMN risks compared with the general population. Oropharyngeal-SMN incidence declined over time in APC models. Chemotherapy and radiation were associated with any HPV-SMN among survivors with first HPV-related cancers, but not associated among survivors whose first cancers were not HPV-related. CONCLUSIONS HPV-SMN in AYA survivors are driven by oropharyngeal cancers despite temporal declines in oropharyngeal-SMN. Hispanic survivors are at risk for cervical-SMN relative to the general population. IMPACT Encouraging HPV vaccination and cervical and oral cancer screenings may reduce HPV-SMN burden among AYA survivors.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina
| | - Natalie Bennion
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Kellee Parker
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Douglas Fair
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Heidi A Hanson
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Oak Ridge National Laboratory, United States Department of Energy, Oak Ridge, Tennessee
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Waters AR, Anderson JS, Mann K, Lopez PLV, Kepka D, Kirchhoff AC, Warner EL. Drivers of COVID-19 Vaccine Intent Among Survivors of Adolescent and Young Adult Cancer: a Mixed Method Study. J Cancer Educ 2023; 38:562-570. [PMID: 35344162 PMCID: PMC8958487 DOI: 10.1007/s13187-022-02155-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Survivors of adolescent and young adult (AYA) cancer are susceptible to severe COVID-19 outcomes due to their cancer history. Drivers of COVID-19 vaccine hesitancy and willingness are largely unexplored among AYA cancer survivors. METHODS We surveyed survivors of AYA cancer from October 2020-February 2021 who received services through an AYA cancer care program. Survey measures included vaccine hesitancy on a five-point Likert scale and an open-ended question on vaccine intent. Open-ended responses were content analyzed through two cycles of structured coding. Quantitative vaccine intent and qualitative drivers of intent were integrated during data analysis. RESULTS Of participants who responded to the open-ended vaccine intent question (N = 300), 39.0% reported COVID-19 vaccine hesitancy. Qualitative content analysis resulted in N = 517 codes and seven content categories. The most common content category associated with hesitancy included COVID-19 vaccine development, approval, and efficacy (34.5%; p value ≤ 0.001), as well as content areas including presence of misinformation about COVID-19 in the response (4.8%; p value = 0.04), the desire for more information about COVID-19/COVID-19 vaccine (6.0%; p value ≤ 0.001), and reference to political influence on participants' intent to get the vaccine (2.5%; p value = 0.005). The most common category associated with vaccine willingness was personal perceptions of COVID-19 vaccination including protecting oneself and others (36.6% of codes; p value ≤ 0.001), followed by pro-vaccine beliefs (8.3%; p value ≤ 0.001) and trust in science (3.9%; p value ≤ 0.001). CONCLUSIONS Common drivers of COVID-19 vaccine hesitancy among survivors of AYA cancer include concern about vaccine side effects and approval process, and misinformation. Cancer survivors COVID-19 vaccine uptake could be improved by focusing communication on drivers of willingness, motivational interviewing, and physician recommendations.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - John S Anderson
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Karely Mann
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Perla L Vaca Lopez
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
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Kaddas HK, Ramsay JM, Ou JY, Fair D, Kepka D, Kirchhoff AC. HPV Vaccination Initiation and Completion Among Pediatric, Adolescent, and Young Adult Cancer Survivors and a Comparison Population Sample Receiving Primary Care. J Pediatr Hematol Oncol 2023; 45:e236-e243. [PMID: 36219685 PMCID: PMC9974526 DOI: 10.1097/mph.0000000000002484] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) vaccinations can reduce pediatric, adolescent, and young adult (PAYA) cancer survivors' susceptibility to HPV-related subsequent cancers. We examined differences in HPV vaccination initiation and completion among a Utah-based cohort of PAYA cancer survivors and a cancer-free population sample. Participants received primary care at 1 of 2 health care systems during study follow-up: 2006-2016. Vaccination records were identified from these health care systems, statewide vaccination records, and an all-payer claims database. HPV vaccination initiation (1 dose) and completion (3 doses) were compared between cancer survivors (N=1579) and age-matched and sex-matched cancer-free population sample (N=4513). Individuals were 9 to 21 years old at cohort entry. Mixed-effects Poisson regression estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Relative to the population sample, cancer survivors were less likely to initiate vaccination (IRR=0.8, 95% CI: 0.73-0.98). The most severe disparity compared with the population sample for vaccine initiation (IRR=0.5, 95% CI: 0.31-0.74) or completion (IRR=0.5, 95% CI: 0.28-0.89) was observed for Hispanic survivors. PAYA cancer survivors are less likely to initiate HPV vaccination series than noncancer counterparts. Targeted interventions should be directed at PAYA survivors to raise HPV vaccination with emphasis on high-risk groups such as Hispanic survivors.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Douglas Fair
- Department of Pediatrics, University of Utah
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah
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Coronado GD, Petrik AF, Slaughter M, Kepka D, Naleway AL. Adolescents Who Have Undergone Human Papillomavirus Vaccination Are More Likely to Get a COVID-19 Vaccine. J Adolesc Health 2023; 72:985-988. [PMID: 36781325 PMCID: PMC9918864 DOI: 10.1016/j.jadohealth.2022.12.022] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE Human papillomavirus (HPV) and COVID-19 vaccination are both recommended for adolescents of ages 12-17. In May 2021, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices allowed the two vaccines to be administered concurrently. METHODS We identified adolescents of ages 12-17 using electronic health records from a large integrated delivery system. We assessed associations between socio-demographic characteristics and uptake of HPV vaccination and COVID-19 vaccination, as well as the cumulative proportion of adolescents who obtained a COVID-19 vaccine over time by HPV vaccination status. RESULTS We identified 40,819 adolescents; 65% had received any COVID-19 vaccination, and 79% had received any HPV vaccination. Adolescents who had initiated HPV vaccination had about 4-fold greater odds of having obtained a COVID-19 vaccine than those who had not (odds ratio = 4.02, 95% confidence interval = 3.81, 4.24). DISCUSSION Patterns of vaccination uptake suggest possible advantages to co-promotion of adolescent vaccines.
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Affiliation(s)
- Gloria D. Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon,Address correspondence to: Gloria D. Coronado, Ph.D., Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227
| | | | | | - Deanna Kepka
- University of Utah School of Nursing, Salt Lake City, Utah
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Warner ZC, Gilbert-Gard K, Reid B, Joseph W, Kepka D, Auguste P, Warner EL. Knowledge and awareness of colorectal cancer among a predominantly Indigenous Caribbean community. BMC Public Health 2023; 23:243. [PMID: 36737701 PMCID: PMC9898893 DOI: 10.1186/s12889-022-14810-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/05/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess awareness levels and knowledge of colorectal cancer (CRC) and CRC screening among an Indigenous Caribbean community. METHODS A community-based participatory research project was developed to perform a needs assessment of cancer prevention and education in an Indigenous non-metropolitan community in Dominica. Purposive sampling occurred at a local health clinic. Data was collected from 58 eligible patients via a 57-item structured interview. Descriptive statistics were calculated, and demographic correlates of CRC knowledge and awareness were assessed using chi-square and Fisher Exact tests. RESULTS Of 58 participants, 72.4% identified as Indigenous, and 36.5% had heard of CRC. Most respondents (96.1%) believed CRC screening to be "important," yet only 3.0% of those who were age eligible had received screening in the prior 10 years, and 12.5% knew how to get screened. More respondents with incomes over $5,000 ECD had heard of CRC (72.2%) compared to those who had not (21.7%), and those who were unsure (16.7%, p < 0.01). Among those with a family cancer history, 14.3% knew how to get tested for CRC, 60.0% did not, and 25.0% were unsure (p < 0.03). CONCLUSION Despite limited familiarity with CRC screening, participants broadly believed CRC screening to be important. Health education research is needed to develop patient-centered, culturally appropriate materials about CRC screening and prevention. Future work facilitating productive community partnerships and incorporating prevailing community traditions may align cancer prevention and education initiatives with community priorities.
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Affiliation(s)
- Zachary C. Warner
- grid.134563.60000 0001 2168 186XDepartment of Internal Medicine, University of Arizona, Tucson, USA
| | - Kacy Gilbert-Gard
- grid.134563.60000 0001 2168 186XSchool of Medicine, University of Arizona, Tucson, USA
| | - Brandon Reid
- grid.266515.30000 0001 2106 0692 Department of Family Medicine, University of Kansas Wichita, Lawrence, USA
| | | | - Deanna Kepka
- grid.223827.e0000 0001 2193 0096College of Nursing, University of Utah, Salt Lake, USA ,grid.479969.c0000 0004 0422 3447Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake, USA
| | - Priscilla Auguste
- grid.411017.20000 0001 2151 0999Department of Family Medicine, University of Arkansas for Health Sciences, Fayetteville, USA
| | - Echo L. Warner
- grid.223827.e0000 0001 2193 0096College of Nursing, University of Utah, Salt Lake, USA ,grid.479969.c0000 0004 0422 3447Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake, USA
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11
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Ou JY, Ramsay JM, Lee G, VanDerslice JA, Taddie M, Kirchhoff AC, Divver E, Akerley W, Kepka D, Hanson HA. Patterns of indoor radon concentrations, radon-hazard potential, and radon testing on a small geographic scale in Utah. J Environ Radioact 2023; 256:107046. [PMID: 36327525 DOI: 10.1016/j.jenvrad.2022.107046] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Currently, there are no publicly-available estimates of indoor radon concentration at scales smaller than the county. Radon-hazard potential soil maps that reflect underlying geologic factors can be created at small geographic scale and linked to residential and census data. We determined the association between residential radon tests and high radon-hazard potential soil at the residential and block group levels using a large Utah-based dataset. We also identified characteristics of block groups with limited tests in the dataset. METHODS We geocoded a dataset of residential radon tests obtained from 2001 to 2017 by a statewide educational program. We linked each location to maps of radon-hazard potential soil, the Environmental Protection Agency's (EPA) county radon zones. We also calculated the number of tests conducted in each block group and linked block groups to demographic data from the 2020 United States census. Log-linear and logistic models identified the association between residential home test results and 1) radon-hazard potential soil of each residence, 2) percent of residences on high radon-hazard potential soils in block groups, and 3) EPA's radon zones. We compared demographic characteristics among block groups with ≥5 or <5 residential tests in our dataset. RESULTS Approximately 42% of homes in the dataset tested ≥4 pCi/L. We found significant positive associations for residential radon test results with 1) residential location on high radon-hazard potential soil and 2) block groups with >0% of residences on high radon-hazard potential soil. EPA radon zones were not associated with residential test results. Block groups with <5 tests had higher than the statewide median percentage of Hispanic residents (OR = 2.46, 95% CI = 1.89-3.21) and were located in rural counties. DISCUSSION Radon-hazard potential soil has a significant association with residential home radon tests. More efforts are needed to improve radon testing in block groups that are rural and have greater percentages of racial minorities.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA; Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA.
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Greg Lee
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James A VanDerslice
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Marissa Taddie
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Eleanor Divver
- Radon Program, Utah Department of Environmental Quality, Salt Lake City, UT, USA
| | - Wallace Akerley
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA; College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, USA
| | - Heidi A Hanson
- Computer Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
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Ayres S, Gee A, Kim S, Hashibe M, Praag A, Kaiser D, Chang CP, Brandt HM, Kepka D. Human Papillomavirus Vaccination Knowledge, Barriers, and Recommendations Among Healthcare Provider Groups in the Western United States. J Cancer Educ 2022; 37:1816-1823. [PMID: 34236651 PMCID: PMC8745488 DOI: 10.1007/s13187-021-02047-6] [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] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
This study compared human papillomavirus (HPV) vaccination occurrences on the same day as provider recommendations at clinics in the Western United States stratified by healthcare provider groups. In addition, the relationships between provider groups' perceived challenges associated with HPV vaccination, HPV vaccination knowledge, HPV recommendation practices, and same-day HPV vaccinations and recommendations are described. Eligible participants included pediatric healthcare providers and staff with influence on patient/parental-level decisions regarding HPV vaccination. Participants filled out a 40-question survey. Results for study participants (N = 99) showed providers reported a higher number of challenges limiting HPV vaccination, higher HPV vaccination knowledge, and more favorable HPV vaccination recommendation practices compared to other healthcare team members (OTM) suggesting providers may have a better overall understanding of the HPV vaccination climate than OTMs. Clinics should examine OTMs' training, expectations, and opportunities to increase the frequency and strength of HPV vaccination recommendations to adolescent patients and parents.
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Affiliation(s)
- Shauna Ayres
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Alexandra Gee
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Seungmin Kim
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aisha Praag
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Danielle Kaiser
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital, St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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13
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Waters AR, Mann K, Vaca Lopez PL, Kepka D, Wu YP, Kirchhoff AC. HPV Vaccine Experiences and Preferences Among Young Adult Cancer Survivors and Caregivers of Childhood Cancer Survivors. J Cancer Educ 2022; 37:1519-1524. [PMID: 33740231 PMCID: PMC8454692 DOI: 10.1007/s13187-021-01992-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 05/23/2023]
Abstract
Cancer survivors are at higher risk of developing HPV-associated cancers later in life, yet their HPV vaccination rates remain lower than the general population. Improving HPV vaccination uptake among survivors is essential to preventing second malignancies. We interviewed HPV vaccine eligible adolescent and young adult (AYA) cancer survivors (18-26 years) and caregivers of HPV vaccine eligible childhood cancer survivors approaching the AYA age range (9-17 years) about their HPV vaccine experiences and preferences as informed by the HPV Vaccination Roundtable Best Practices. Interviews (N = 20) were recorded, transcribed, and analyzed using interpretive description. Of AYA survivors (n = 10), 50% had received at least one HPV vaccine dose. Of caregivers (n = 10), 30% reported their child had received at least one HPV vaccine dose. Three distinct categories emerged including (1) HPV vaccine knowledge, (2) HPV vaccination recommendation preferences, and (3) HPV vaccination reminder preferences. The first two categories were oncology focused. Participants lacked knowledge regarding HPV vaccine safety and applicability due to their complex cancer history. Most participants strongly preferred that their oncologist provide an HPV vaccine recommendation. The third category was mixed, with some participants preferring oncology-based HPV vaccine reminders while others preferred primary care-based reminders. Almost all participants preferred digital reminders (e.g., text messages). Our results suggest that oncologists play an essential role in recommending the HPV vaccine and providing information to assist survivors and caregivers with vaccine decision-making. Additionally, HPV vaccination uptake among pediatric and childhood and AYA survivors could be improved through the use of tailored, electronically delivered vaccine reminders.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Karely Mann
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Yelena P Wu
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84112, USA
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14
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Mann S, Christini K, Chai Y, Chang CP, Hashibe M, Kepka D. "Vaccine hesitancy and COVID-19 immunization among rural young adults". Prev Med Rep 2022; 28:101845. [PMID: 35669235 PMCID: PMC9159780 DOI: 10.1016/j.pmedr.2022.101845] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Rural young adults may be more averse to receiving a COVID-19 immunization than urban young adults. We aimed to assess differences in COVID-19 vaccine hesitancy for rural, compared with urban, young adults and characterize modifiable factors. This cross-sectional online survey collected demographic data, vaccination attitudes, and COVID-19 impacts from 2937 young adults, ages 18-26 years, across the western U.S. from October 2020 to April 2021. Rurality was determined by participants' zip code and classified using the rural and urban continuum codes (RUCC). Multivariable logistic regression described adjusted (age, gender, race and ethnicity, being a current student, and month of survey) odds of self-reported intent to receive the COVID-19 vaccination by rurality. Mediation analysis was used to decompose total effects into average direct effects and average causal mediation (indirect) effects. Rural participants had 40% lower odds than urban participants of intending to receive the COVID-19 vaccine after adjustments (adjusted odds ratio, 0.62 [95% CI, 0.50-0.76]). The direct effect remained (P<0.001), but was mediated by both education (8.3%, P<0.001) and month in which the survey was taken (23.5%, P<0.001). We observed a divergence after December 2020 in vaccination intent between rural and urban young adults that widened over time. Hesitancy to receive the COVID-19 vaccine was greater among rural, compared with urban young adults, and grew disproportionally after December 2020. Mediation by whether one was a current student or not suggests differences in sources of information for vaccination decision-making, and highlights areas for addressing vaccine hesitancy.
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Affiliation(s)
- Sara Mann
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kaila Christini
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Corresponding author at: 2000 Circle of Hope, Rm 4144, Salt Lake City, UT 84112, USA.
| | - Yan Chai
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
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15
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Warner ZC, Reid B, Auguste P, Joseph W, Kepka D, Warner EL. Awareness and Knowledge of HPV, HPV Vaccination, and Cervical Cancer among an Indigenous Caribbean Community. Int J Environ Res Public Health 2022; 19:5694. [PMID: 35565089 PMCID: PMC9105034 DOI: 10.3390/ijerph19095694] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
Caribbean women experience a cervical cancer incidence rate that is three times higher than that among their North American counterparts. In this study, we performed a needs assessment of the knowledge and awareness of HPV, HPV vaccination, and cervical cancer and receipt of cervical cancer screening among an indigenous Caribbean community. We purposively recruited individuals aged ≥18 from a community health care clinic (n = 58) to complete a 57-item structured interview including items on demographics, cancer history, knowledge and awareness of HPV, HPV vaccines, cervical cancer, and cervical cancer screening. Participants' mean age was 47.1 years (SD: 14.4). Most were female (74.1%), were married/partnered (51.7%), had primary education (63.8%), and identified as Kalinago (72.4%). Whereas 79.5% had heard of cervical cancer, few had heard of HPV (19.6%) or the HPV vaccine (21.8%). Among those who knew someone with cancer, 90.9% had heard of the HPV vaccine, compared with only 9.1% of those who did not know anyone with cancer (p = 0.02). Access to HPV vaccination is an immediate, cost-effective cancer prevention priority for reducing the disproportionate burden of HPV-related cancers, particularly cervical cancer, in the Caribbean. We recommend culturally targeted education interventions to improve knowledge about HPV vaccination and the link between HPV and cervical cancer.
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Affiliation(s)
- Zachary Claude Warner
- Department of Internal Medicine, University of Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724, USA
| | - Brandon Reid
- Department of Family Medicine, University of Kansas, 138 N Santa Fe Ave, Salina, KS 67401, USA;
| | - Priscilla Auguste
- Department of Family Medicine, University of Arkansas for Health Sciences, Little Rock, AR 72205, USA;
| | - Winnie Joseph
- Salybia Health Clinic, Saint David Parish, Bataka 00109, Dominica;
| | - Deanna Kepka
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Echo Lyn Warner
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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16
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Pruitt SL, Tiro JA, Kepka D, Henry K. Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics. Am J Prev Med 2022; 62:538-547. [PMID: 35125272 DOI: 10.1016/j.amepre.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described. METHODS In 2020-2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015-2017 National Immunization Survey-Teen for male and female adolescents aged 13-17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression. RESULTS Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1-2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas. CONCLUSIONS A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deanna Kepka
- College of Nursing, The University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kevin Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Pinzon LM, Velazquez A, Rutkoski H, Tay DL, Martel L, Drury C, Ayres S, Dixon B, Winkler JR, Kepka D. Cross-cultural adaptation of a Spanish version of a previously validated HPV survey that evaluates dental students' knowledge, perception and clinical practices in Latin America. BMC Oral Health 2022; 22:72. [PMID: 35287664 PMCID: PMC8922929 DOI: 10.1186/s12903-022-02108-2] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background The global incidence of oropharyngeal cancer (OPC) is increasing. Dental professionals play a key role in the detection of oral lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are underdeveloped and HPV knowledge and awareness has been reported to be low among dental students and professionals. The present study adapted and performed pretesting of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC for Latin American Spanish-speaking populations. Methods A previously developed questionnaire for English-speaking dental students was translated to Spanish. The questionnaire was administered to first year dental students at two Latin American universities with dental programs. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4. Results Data from a total of 114 students, a majority of the which were female (61%), and Hispanic/Latino(a)/Spanish (91%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach’s alpha was 0.83, 0.75, and 0.86 respectively. The Barriers subscale had a Cronbach’s alpha of 0.93, showing excellent internal consistency. The Clinical Procedures subscale, focused on factors surrounding dental students’ hypothetical clinical practice procedures, had a Cronbach’s alpha of 0.86. The Scope of Practice scale had a Cronbach’s alpha of 0.93. Conclusions Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students’ knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02108-2.
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Affiliation(s)
- Lilliam M Pinzon
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Alan Velazquez
- Universidad Autonoma de Baja California, Tijuana, Mexico
| | | | - Djin L Tay
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Lara Martel
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Carmen Drury
- Utah Department of Health, Salt Lake City, UT, USA
| | - Shauna Ayres
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Barbara Dixon
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - James R Winkler
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- College of Nursing, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
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18
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Brandt HM, Kepka D, Kirchhoff AC, Daniel CL, Bhatt NS. Human papillomavirus (HPV) vaccination is cancer prevention for childhood cancer survivors. Cancer 2022; 128:237-239. [PMID: 34606629 PMCID: PMC8738104 DOI: 10.1002/cncr.33920] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023]
Abstract
Childhood cancer survivors are at high risk for developing human papillomavirus (HPV)-associated subsequent neoplasms. Henderson et al., 2021 identified risk factors for subsequent HPV-associated malignant neoplasms among enrollees in the Childhood Cancer Survivor Study. The exacerbated risk of subsequent HPV cancers found in the study underscores the need for more stringent surveillance and tracking to inform intervention approaches to ensure maximal protection. In addition, HPV vaccination must be prioritized as part of transitional care and survivorship planning. Limited sources of data on survivor practices and outcomes results in limited information to develop guidelines and provide childhood cancer survivors with information on preventing subsequent HPV cancers. Improved efforts are needed to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors to prevent subsequent neoplasms. Childhood cancer survivors are at increased risk of developing a subsequent cancer caused by human papillomavirus or HPV. HPV is a very common and usually benign sexually transmitted infection. HPV vaccination and screening can prevent most HPV cancers. However, childhood cancer survivors have lower HPV vaccination rates than individuals without a cancer history. To help prevent subsequent HPV cancers among childhood cancer survivors, we must gather better information and work to improve HPV vaccination recommendations and acceptance. Childhood cancer survivors are at high risk for developing subsequent human papillomavirus (HPV)-associated cancers; Henderson et al., 2021, examined risk factors for subsequent malignant neoplasms associated with HPV among enrollees in the Childhood Cancer Survivor Study. Improved, targeted efforts to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors are needed.
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Affiliation(s)
- Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105
| | - Deanna Kepka
- University of Utah College of Nursing, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Anne C. Kirchhoff
- University of Utah Department of Pediatrics, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Casey L. Daniel
- University of South Alabama College of Medicine, 1660 Springhill Avenue, Mobile, AL, 36604
| | - Neel S. Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-390, Seattle, WA, 98109
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Ramsay JM, Kaddas HK, Ou JY, Kepka D, Kirchhoff AC. Missed opportunities for concomitant HPV vaccination among childhood cancer survivors. Cancer Med 2022; 11:1181-1191. [PMID: 35032104 PMCID: PMC8855920 DOI: 10.1002/cam4.4492] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 10/01/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Childhood cancer survivors are at higher risk of human papillomavirus (HPV)‐related second cancers than adolescents without cancer, yet their HPV vaccination uptake is lower. Using a statewide sample, we evaluated whether survivors are at higher risk of missed opportunities for concomitant HPV vaccination. Methods From statewide healthcare data, we identified encounters where vaccines were received. Concomitant HPV vaccine missed opportunities were defined as a vaccine encounter where the HPV vaccine was not administered, although eligibility criteria were met. From these encounters, our sample included 327 survivors identified from the Utah Cancer Registry, diagnosed 2000–2016 at ages 0–9, and a birth year and sex‐matched sample without cancer from the general population (n = 1,911). Mixed‐effects Poisson regression estimated the rate of concomitant missed opportunities per vaccine encounter and 95% confidence intervals by vaccine encounter type (all vaccines, flu shot only, or adolescent/catch‐up) from 2013 to 2016. Results Survivors had more concomitant HPV vaccine missed opportunities than the population sample (70.0% vs. 59.0%). On average, survivors were 12% more likely to have missed opportunities at vaccine encounters and 4% more likely at flu shot only encounters. The predicted excess risk of concomitant missed opportunities for survivors ranged from 0.5 per10 vaccine encounters to 1.1 per10 vaccine encounters. Higher parental education, rurality, younger first vaccine age, and chemotherapy were associated with missed opportunities. Conclusions Childhood cancer survivors have more missed opportunities for concomitant HPV vaccination than a population sample. As flu shots should be administered annually, providers have a regular opportunity to recommend and deliver the HPV vaccine to survivors. Childhood cancer survivors face a higher risk of HPV‐related cancers than adolescents without a cancer history; however, their vaccination rates tend to be lower. We assessed HPV vaccine missed opportunities among age‐eligible childhood cancer survivors and found significantly more missed opportunities for survivors than adolescents without a cancer history.
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Affiliation(s)
- Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA.,College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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20
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Ko LK, Scarinci IC, Bouchard EG, Drake BF, Rodriguez EM, Chen MS, Kepka D, Kruse-Diehr AJ, Befort C, Shannon J, Farris PE, Trentham-Dietz A, Onega T. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6529549. [PMID: 35603844 PMCID: PMC8997116 DOI: 10.1093/jncics/pkac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
Rural populations continue to experience persistent cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination. Although the National Cancer Institute and the larger cancer research community have identified rural community partnerships as the foundation for reducing the disparities, we have identified limited application of community-based participatory research in cancer prevention and control research. Guided by the Community-Based Participatory Research Conceptual Model and our collective experience, we provide a framework for a community–cancer center partnership that focuses on promoting health equity. In this commentary, we articulate that the partnership process must foster capacity for communities and cancer centers, strive for rural representation in clinical trials and biobanking, build a pipeline for dissemination and implementation research, and create a bidirectional flow of knowledge between communities and academic institutions. Authentic partnerships with rural communities should be the ultimate goal of cancer centers, and the process described in this commentary can serve as an initial platform to build capacity and continue to strive toward that goal.
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Affiliation(s)
- Linda K Ko
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center for Population Health, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Correspondence to: Linda K. Ko, PhD, Department of Health Systems and Population Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Ave NE, UW Mailbox 351621, Seattle, WA 98195, USA (e-mail: )
| | - Isabel C Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth G Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bettina F Drake
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Moon S Chen
- Division of Hematology and Oncology, School of Medicine, UC Davis and UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Deanna Kepka
- College of Nursing, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Aaron J Kruse-Diehr
- Markey Cancer Center, Cancer Prevention and Control Program, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Christie Befort
- University of Kansas Medical Center, Cancer Prevention and Control, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jackilen Shannon
- Oregon Health & Science University-Portland State University School of Public Health, Knight Cancer Institute, Portland, OR, USA
| | - Paige E Farris
- Oregon Health & Science University-Portland State University School of Public Health, Knight Cancer Institute, Portland, OR, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
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21
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Kepka D, Christini K, McGough E, Wagner A, Del Fiol G, Gibson B, Ayres S, Brandt HM, Mann S, Petrik AF, Coronado GD. Successful Multi-Level HPV Vaccination Intervention at a Rural Healthcare Center in the Era of COVID-19. Front Digit Health 2021; 3:719138. [PMID: 34713184 PMCID: PMC8521914 DOI: 10.3389/fdgth.2021.719138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: To develop and test a human papillomavirus (HPV) vaccination intervention that includes healthcare team training activities and patient reminders to reduce missed opportunities and improves the rate of appointment scheduling for HPV vaccination in a rural medical clinic in the United States. Methods: The multi-level and multi-component intervention included healthcare team training activities and the distribution of patient education materials along with technology-based patient HPV vaccination reminders for parents/caregivers and young adult patients. Missed vaccination opportunities were assessed pre- and post-intervention (n = 402 and n = 99, respectively) by retrospective chart review and compared using Pearson χ2. The patient parent/caregiver and young adult patient population (n = 80) was surveyed following the reminder messages and penalized logistic regression quantified unadjusted odds of scheduling a visit. Results: Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period (21.6 vs. 8.1%, respectively, p = 0.002). Participants who recalled receipt of a vaccination reminder had 7.0 (95% CI 2.4–22.8) times higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. The unadjusted odds of confirming that they had scheduled or were intending to schedule a follow-up appointment to receive the HPV vaccine was 4.9 (95% CI 1.51–20.59) times greater among those who had not received the vaccine for themselves or for their child. Conclusions: Results from this intervention are promising and suggest that vaccination interventions consisting of provider and support staff education and parent/caregiver and patient education materials, and reminders can reduce missed opportunities for vaccinations in rural settings.
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Affiliation(s)
- Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Kaila Christini
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Emily McGough
- Telluride Regional Medical Center, Telluride, CO, United States
| | - Anna Wagner
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Shauna Ayres
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Heather M Brandt
- St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, TN, United States
| | - Sara Mann
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Gloria D Coronado
- Kaiser Permanente Center for Health Research, Portland, OR, United States
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22
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Kepka D, Bodson J, Lai D, Sanchez-Birkhead AC, Davis FA, Lee D, Tavake-Pasi F, Napia E, Villalta J, Mukundente V, Mooney R, Coulter H, Stark LA. Diverse caregivers' HPV vaccine-related awareness and knowledge. Ethn Health 2021; 26:811-826. [PMID: 30589389 PMCID: PMC6597331 DOI: 10.1080/13557858.2018.1562052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Objectives: To assess factors associated with HPV vaccine-related awareness and knowledge among caregivers of adolescents from five ethnic community groups in Utah.Design: For this community-based participatory research study, we surveyed N = 228 caregivers of teens aged 11-17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Utah about their HPV vaccine awareness and knowledge.Results: Participants exhibited high awareness of cervical cancer (71.05%), moderate awareness of HPV (53.95%), and low awareness of the HPV vaccine (46.49%). HPV vaccine-related knowledge was mostly worse, with fewer than half the participants reporting knowing that HPV can cause cervical cancer (46.93%), that most people are infected with HPV at some point in their lives (28.95%), that HPV is asymptomatic in females (36.40%) and males (37.28%), that the HPV vaccine is recommended for adolescent females (41.67%) and males (36.40%), and that the HPV vaccine requires more than one dose (27.19%). HPV vaccine-related awareness and knowledge were significantly associated with race/ethnicity, educational attainment, income, occupation, birthplace, parents' birthplace, English usage, health insurance coverage, type of health insurance, and child having a primary care provider (all p < 0.05). HPV vaccine-related knowledge (p < 0.05) and awareness (p < 0.05) of caregivers were associated with a child in the household receiving the HPV vaccine.Conclusion: Our findings indicate a need to develop educational interventions in collaboration with diverse communities in Utah. We underscore the importance of promoting knowledge about the existence of the HPV vaccine, as well as deeper HPV vaccine-related issues (e.g. HPV risks, treatment, and recommendations).
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Affiliation(s)
- Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Djin Lai
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Community Faces of Utah, Salt Lake City, Utah, USA
| | - Ana C. Sanchez-Birkhead
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Community Faces of Utah, Salt Lake City, Utah, USA
- Hispanic Health Care Task Force, Salt Lake City, Utah, USA
| | - France A. Davis
- Community Faces of Utah, Salt Lake City, Utah, USA
- Calvary Baptist Church, Salt Lake City, Utah, USA
| | - Doriena Lee
- Community Faces of Utah, Salt Lake City, Utah, USA
- Calvary Baptist Church, Salt Lake City, Utah, USA
| | - Fahina Tavake-Pasi
- Community Faces of Utah, Salt Lake City, Utah, USA
- National Tongan American Society, Salt Lake City, Utah, USA
| | - Edwin Napia
- Community Faces of Utah, Salt Lake City, Utah, USA
- Urban Indian Center, Salt Lake City, Utah, USA
| | - Jeannette Villalta
- Community Faces of Utah, Salt Lake City, Utah, USA
- Hispanic Health Care Task Force, Salt Lake City, Utah, USA
| | - Valentine Mukundente
- Community Faces of Utah, Salt Lake City, Utah, USA
- Best of Africa, West Valley City, Utah, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Heather Coulter
- Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Louisa A. Stark
- Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Human Genetics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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23
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Waters AR, Kepka D, Ramsay JM, Mann K, Vaca Lopez PL, Anderson JS, Ou JY, Kaddas HK, Palmer A, Ray N, Tsukamoto T, Fair DB, Lewis MA, Kirchhoff AC, Warner EL. COVID-19 Vaccine Hesitancy Among Adolescent and Young Adult Cancer Survivors. JNCI Cancer Spectr 2021; 5:Pkab049. [PMID: 34195543 PMCID: PMC8239168 DOI: 10.1093/jncics/pkab049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
The study objective was to identify sociodemographic and coronavirus disease 2019 (COVID-19) factors that are associated with COVID-19 vaccine hesitancy among adolescent and young adult (AYA) cancer survivors. Eligible participants were 18 years or older and were diagnosed with cancer as an AYA (ages 15-39 years) and received services through an AYA cancer program. A total of 342 participants completed a cross-sectional survey. Our primary outcome—COVID-19 vaccine hesitancy—was surveyed as a 5-point Likert scale and operationalized as a binary outcome (agree vs hesitant). A large proportion of participants reported COVID-19 vaccine hesitancy (37.1%). In the multivariable regression, female survivors (odds ratio = 1.81, 95% confidence interval = 1.10 to 2.98) and survivors with a high school education or less (odds ratio = 3.15, 95% confidence interval = 1.41 to 7.04) reported higher odds of vaccine hesitancy compared with their male or college graduate or higher counterparts. COVID-19 vaccine hesitancy persists among AYA survivors despite their recommended priority vaccination status and higher chances of severe COVID-19 outcomes.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Joemy M Ramsay
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Karely Mann
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John S Anderson
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Judy Y Ou
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Heydon K Kaddas
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alexandra Palmer
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Mark A Lewis
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,University of Utah Department of Pediatrics, Salt Lake City, UT, USA
| | - Echo L Warner
- Arizona Cancer Center, Tucson, AZ, USA.,University of Arizona College of Nursing, Tucson, AZ, USA
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24
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Rutkoski H, Tay DL, Dixon BL, Pinzon LM, Mooney R, Winkler JR, Kepka D. A Multi-state Evaluation of Oral Health Students' Knowledge of Human Papillomavirus-Related Oropharyngeal Cancer and HPV Vaccination. J Cancer Educ 2020; 35:1017-1025. [PMID: 31222578 PMCID: PMC6923618 DOI: 10.1007/s13187-019-01561-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Human papillomavirus-related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), and fourth year dental (DS4) students' knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the USA were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi-square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n = 380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the USA, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥ 70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.
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Affiliation(s)
- Holdunn Rutkoski
- University of Nevada, Las Vegas: School of Dental Medicine, Las Vegas, NV, USA
| | - Djin L Tay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Barbara L Dixon
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Lilliam M Pinzon
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James R Winkler
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA.
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
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25
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Harris KL, Tay D, Kaiser D, Praag A, Rutkoski H, Dixon BL, Pinzon LM, Winkler JR, Kepka D. The perspectives, barriers, and willingness of Utah dentists to engage in human papillomavirus (HPV) vaccine practices. Hum Vaccin Immunother 2019; 16:436-444. [PMID: 31361179 DOI: 10.1080/21645515.2019.1649550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Including dental health providers in human papillomavirus (HPV) vaccination could reduce rising rates in HPV-associated oropharyngeal cancer (HPV-OPC). This study assessed Utah dentists' perspectives on providing HPV vaccination education and services in the dental setting. A cross-sectional, 70-item self-administered survey was conducted among a convenience sample of N = 203 practicing Utah dentists. Statistical analyses included Chi Square tests of independence, scaled scores and Cronbach's alpha coefficients. Majority of Utah dentists surveyed perceived that discussing the link between HPV and OPC and recommending the HPV vaccine is within their scope of practice, but not administration of the HPV vaccine. Dentists with >10 minutes of patient education per week were less likely to be concerned about the cultural, social norms or religious ideology of discussing HPV with their patients (p = .024). Rural dentists were more concerned about the safety and liability of the HPV vaccine (p = .011). Good internal consistency was observed survey items regarding barriers and willing to engage in HPV vaccination practices. Dental providers were interested in HPV training and patient education brochures as strategies, but less interested in administering the HPV vaccine. Dental associations support dentists' engagement in HPV education and HPV-OPC prevention. This is the first study in Utah to examine dentists' perspectives on HPV vaccination. Findings have implications for program planning, intervention development, and future research.
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Affiliation(s)
- Katherine L Harris
- Gyneocologic Oncology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - D Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - D Kaiser
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - A Praag
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - H Rutkoski
- School of Dental Medicine, University of Nevada, Las Vegas, NV, USA
| | - B L Dixon
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - L M Pinzon
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - J R Winkler
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - D Kepka
- College of Nursing, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
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26
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Martin S, Warner EL, Kirchhoff AC, Mooney R, Martel L, Kepka D. An Electronic Medical Record Alert Intervention to Improve HPV Vaccination Among Eligible Male College Students at a University Student Health Center. J Community Health 2019; 43:756-760. [PMID: 29453619 DOI: 10.1007/s10900-018-0480-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This pilot study aims to improve HPV vaccination for college aged males at a student health center. The first part of the study consisted of a focus group that assessed the barriers and facilitators of HPV vaccination among healthcare providers and clinic staff (N = 16). Providers reported missed opportunities for HPV vaccination. For the second part of the study, providers and staff reviewed medical records of patients ages 18-26 with student health insurance and with < 3 doses of the HPV vaccine at baseline (12/1/2014 to 7/31/2015) and follow-up (12/1/2015 to 7/31/2016). A computer-automated EMR alert was generated in the medical record of eligible male patients (N = 386). Z-scores were estimated for two-sample proportions to measure change in HPV vaccine rates at baseline and follow-up for males and females. HPV vaccine initiation rates increased among males (baseline: 5.2% follow-up: 25.1%, p < 0.001). This study shows that EMR alerts improved HPV vaccine initiation rates among insured college-aged males.
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Affiliation(s)
- Suzanne Martin
- University of Utah College of Nursing, Salt Lake City, UT, USA.,University of Utah Student Health Center, Salt Lake City, UT, USA
| | - Echo L Warner
- University of Utah College of Nursing, Salt Lake City, UT, USA.,Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- University of Utah College of Nursing, Salt Lake City, UT, USA.,University of Utah Department of Pediatrics, Salt Lake City, UT, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Laura Martel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- University of Utah College of Nursing, Salt Lake City, UT, USA. .,Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA.
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27
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Kepka D, Rutkoski H, Pappas L, Tay DL, Winkler JR, Dixon B, Velazquez A, Pinzon LM. US oral health students' willingness to train and administer the HPV vaccine in dental practices. Prev Med Rep 2019. [PMID: 31372330 DOI: 10.1016/j.pmedr.2019.100957)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14-3.35) and administration (OR = 3.79, 95% CI = 1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.
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Affiliation(s)
- Deanna Kepka
- Huntsman Cancer Institute, USA
- College of Nursing, University of Utah, USA
| | | | | | - Djin L Tay
- Huntsman Cancer Institute, USA
- College of Nursing, University of Utah, USA
| | | | | | - Alan Velazquez
- Facultad de Odontología, Universidad Autónoma de Baja , Baja California, Mexico
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Ou JY, Warner EL, Nam GE, Martel L, Carbajal-Salisbury S, Fuentes V, Wetter DW, Kirchhoff AC, Kepka D. Colorectal cancer knowledge and screening adherence among low-income Hispanic employees. Health Educ Res 2019; 34:400-414. [PMID: 31329867 PMCID: PMC6646949 DOI: 10.1093/her/cyz013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/28/2019] [Indexed: 05/16/2023]
Abstract
Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged ≥50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age ≥50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and ≥$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Division of Epidemiology, Department of Internal Medicine
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Gina E Nam
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Laura Martel
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Utah AIDS Education and Training Center, University of Utah, Salt Lake City, UT, USA
| | | | | | - David W Wetter
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Population Health Sciences
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Kepka D, Rutkoski H, Pappas L, Tay DL, Winkler JR, Dixon B, Velazquez A, Pinzon LM. US oral health students' willingness to train and administer the HPV vaccine in dental practices. Prev Med Rep 2019; 15:100957. [PMID: 31372330 PMCID: PMC6661379 DOI: 10.1016/j.pmedr.2019.100957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/14/2019] [Accepted: 07/16/2019] [Indexed: 12/25/2022] Open
Abstract
HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14-3.35) and administration (OR = 3.79, 95% CI = 1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.
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Affiliation(s)
- Deanna Kepka
- Huntsman Cancer Institute, USA.,College of Nursing, University of Utah, USA
| | | | | | - Djin L Tay
- Huntsman Cancer Institute, USA.,College of Nursing, University of Utah, USA
| | | | | | - Alan Velazquez
- Facultad de Odontología, Universidad Autónoma de Baja , Baja California, Mexico
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Kirchhoff AC, Mann K, Warner EL, Kaddas HK, Fair D, Fluchel M, Knackstedt ED, Kepka D. HPV vaccination knowledge, intentions, and practices among caregivers of childhood cancer survivors. Hum Vaccin Immunother 2019; 15:1767-1775. [PMID: 31116634 PMCID: PMC6746484 DOI: 10.1080/21645515.2019.1619407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The HPV vaccine is an important vaccine for childhood cancer survivors because of their risks of second cancers, yet few survivors receive it. We examined HPV vaccine knowledge among caregivers of childhood cancer survivors, whether their child had received the vaccine, and their intentions to vaccinate. Eligible participants were caregivers (mostly parents) whose child finished cancer treatment at Primary Children’s Hospital in Salt Lake City, Utah 3 to 36 months prior to the start of the study (N = 145). Additional analyses were done among caregivers whose child was age-eligible for the HPV vaccine (ages 11 and up; N = 61). We ran descriptive statistics and fit multivariable generalized linear models to identify factors associated with intention to vaccinate and HPV vaccination uptake. Among caregivers whose child had not yet gotten the HPV vaccine, approximately 30% stated they were not likely to get the vaccine for their child and the most commonly cited reason was not enough information (25.2%). Provider discussion about vaccines and side effects (relative risk (RR) = 1.85, 95% CI 1.16–2.94), along with recommendations regarding vaccines after cancer treatment (RR = 1.35, 95% CI 1.06–1.72), led to greater caregiver intention to get the HPV vaccine for their child with cancer. Approximately 40% of age-eligible survivors had gotten at least one dose of the HPV vaccine. Our findings demonstrate a need for oncology-focused interventions to educate families of childhood cancer survivors about the importance of the HPV vaccine after cancer therapy.
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Affiliation(s)
- Anne C Kirchhoff
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Karely Mann
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Echo L Warner
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA.,c College of Nursing, University of Utah , Salt Lake City , UT , USA
| | - Heydon K Kaddas
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Douglas Fair
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,d Primary Children's Hospital , Salt Lake City , UT , USA
| | - Mark Fluchel
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah , Salt Lake City , UT , USA.,d Primary Children's Hospital , Salt Lake City , UT , USA
| | - Elizabeth D Knackstedt
- e Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah , Salt Lake City , UT , USA
| | - Deanna Kepka
- b Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA.,c College of Nursing, University of Utah , Salt Lake City , UT , USA
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Warner EL, Bodson J, Mooney R, Lai D, Samadder NJ, Kepka D. Latinas' Colorectal Cancer Screening Knowledge, Barriers to Receipt, and Feasibility of Home-Based Fecal Immunochemical Testing. J Immigr Minor Health 2019. [PMID: 28646404 DOI: 10.1007/s10903-017-0615-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Latinas' high colorectal cancer (CRC) mortality makes them a priority population for CRC screening. CRC screening knowledge, perceived barriers, and feasibility of using the Fecal Immunochemical Test (FIT) was assessed among Latinas in Utah. Participants aged ≥50 (n = 95) were surveyed about knowledge and barriers to CRC screening. 27 participants completed a FIT and evaluation survey. Fisher's exact tests assessed sociodemographic correlates of CRC screening outcomes. Most participants were overdue for CRC screening (n = 81, 85%). Age, acculturation, education, and employment were significantly associated with CRC screening status and/or reasons for being overdue (e.g., not knowing about the test, cost). All participants who received a FIT completed it, felt it was easy to use, and reported they would use it again. Latinas had limited awareness of CRC, CRC screenings, and experienced barriers to CRC screening (e.g., limited access, cost), but were willing to utilize a low-cost home-based FIT.
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Affiliation(s)
- Echo L Warner
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA. .,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA.
| | - Julia Bodson
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
| | - Djin Lai
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA
| | - N Jewel Samadder
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA
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Warner EL, Mann K, Kaddas HK, Martel L, Pannier S, Knackstedt B, Fair D, Fluchel M, Kepka D, Kirchhoff AC. Caregiver Intention To Restart Vaccinations After Childhood Cancer Treatment. Cancer Epidemiol Biomarkers Prev 2019. [DOI: 10.1158/1055-9965.epi-19-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Timely vaccination after childhood cancer treatment is vital for protecting against vaccine-preventable diseases during survivorship. However, caregiver intention for restarting vaccinations, such as getting catch-up or booster vaccines, after cancer treatment is unknown. Methods: We surveyed primary caregivers ages 18 or older with a child who had completed cancer treatment in the prior 3–24 months (N = 129; participation rate = 60.3%). Participants were asked about demographics, their child's vaccination status, and healthcare factors (e.g., provider recommendations, barriers). We examined the influence of whether the oncology care team recommended catch-up or booster vaccines on caregiver intention to restart vaccines using multivariable generalized linear models. Vaccine barriers were examined by intention in chi- square tests. Results: Caregivers were primarily aged 30–49 years (82.0%), mothers (81.2%), college graduates (44.8%), married (89.1%), and Non-Hispanic (90.3%). In total, 67% of caregivers intended to restart vaccines for their child and 49.6% reported that they had a discussion with the cancer care team about catch-up or booster vaccines. Caregivers who discussed vaccines with their child's cancer care team were much more likely to report intention to restart vaccination (Relative Risk (RR) = 1.82, 95% CI 1.37–2.45). The most common barrier to restarting vaccines after cancer was not knowing which vaccines to get, which was common across both groups (intend to restart = 31% vs. did not intend = 40.5%, P = 0.29). Of caregivers, 93.1% who intended to restart vaccines felt vaccines were safe compared to 79.5% of those who did not (P = 0.02). Conclusions: Caregivers of childhood cancer survivors need guidance for restarting vaccinations after cancer treatment, including information on safety and which vaccines their child needs. Provider recommendations positively influence caregiver's intention to restart vaccines. Clinical guidelines are needed to support providers in making tailored vaccination recommendations after cancer treatment.
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Islam JY, Gruber JF, Kepka D, Kunwar M, Smith SB, Rothholz MC, Brewer NT, Smith JS. Pharmacist insights into adolescent human papillomavirus vaccination provision in the United States. Hum Vaccin Immunother 2019; 15:1839-1850. [PMID: 30550369 DOI: 10.1080/21645515.2018.1556077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
HPV vaccination coverage in the United States (US) falls short of the Healthy People 2020 goal of 80% coverage among 13-15 year-old adolescents. Pharmacies are a promising alternative vaccine delivery site that may increase access to HPV vaccination. Our objective was to assess pharmacists' insights into HPV vaccination provision to adolescents. We recruited 40 licensed pharmacists in eight states with different pharmacy vaccination laws: Alabama, California, Indiana, Kentucky, Maine, Tennessee, Texas, and Washington. Eligible pharmacists either previously provided or were currently providing HPV, tetanus-diphtheria-pertussis, or meningococcal vaccines to adolescents aged 9-17 years. Pharmacists were administered a semi-structured survey to explore insights into HPV vaccination provision. Forty-five percent of surveyed pharmacies offered HPV vaccination to adolescents. Pharmacists' reported challenges to providing HPV vaccination were parental consent (28%), tracking and patient recall (17%), perceived stigma of vaccination (17%), and education about or promotion of vaccination (17%). Pharmacists offering HPV vaccination sent patient reminders for vaccines with multiple doses (89%) and utilized telephone reminders (72%). Pharmacists informed patients' primary care providers of HPV vaccination doses most commonly through fax (72%) and updating electronic medical records (22%). One-third of pharmacists reported vaccination provision using the state immunization information system (IIS). Seventy-five percent reported vaccination rates could be increased at their respective pharmacy. Pharmacies are underutilized, although highly accessible, for HPV vaccination in the US. National efforts should expand educational programs to improve public awareness of in-pharmacy HPV vaccination, and improve the utilization of state IIS for reporting immunization coverage of adolescents by pharmacists.
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Affiliation(s)
- Jessica Y Islam
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joann F Gruber
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Deanna Kepka
- b College of Nursing & Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Manju Kunwar
- c Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Sara B Smith
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - Noel T Brewer
- e Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,f UNC Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
| | - Jennifer S Smith
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,f UNC Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
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Abstract
BACKGROUND In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code. METHODS We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17 years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses). RESULTS HPV vaccination was lower among girls from isolated small rural towns (≥1 dose 51.0%; ≥3 doses 30.0%) and small rural towns (≥1 dose 50.2%; ≥3 doses 26.8%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). Boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI: 0.52-0.88) and completion (0.63, 95% CI: 0.41-0.97) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did their counterparts from high-poverty urban areas. CONCLUSION Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.
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Affiliation(s)
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania.,Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Deanna Kepka
- College of Nursing, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Gaffney DK, Hashibe M, Kepka D, Maurer KA, Werner TL. Too many women are dying from cervix cancer: Problems and solutions. Gynecol Oncol 2018; 151:547-554. [PMID: 30301561 PMCID: PMC6281756 DOI: 10.1016/j.ygyno.2018.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Received: 06/18/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 12/29/2022]
Abstract
One woman dies from cervix cancer every 2 min, adding up to over 270,000 deaths globally per year. This cancer affects a young population, and hence, the loss of life is staggering. There are many aspects of prevention, screening, and care that are suboptimal. A great deal is known about HPV induced carcinogenesis, yet clinical outcomes have been stagnant over decades. There has been no improvement in cervix cancer survival in the US since the mid-1970s [1]. With increased knowledge of the disease and greater worldwide resources including prevention, screening, and improved therapeutics, there is significant promise for fewer women to die from this virally induced cancer. We focus here on the major problems in prevention, screening, and delivery of care for cervix cancer and provide concrete solutions. With appropriate focus, a major improvement in survival from cervix cancer could be achieved in a short time span.
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Affiliation(s)
- David K Gaffney
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84103, United States of America; Department of Radiation Oncology, University of Utah School of Medicine, 1950 Circle of Hope, Rm 1570, Salt Lake City, UT 84112, United States of America.
| | - Mia Hashibe
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84103, United States of America; Division of Public Health, Department of Family and Preventative Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite. A, Salt Lake City, UT 84108, United States of America
| | - Deanna Kepka
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84103, United States of America; College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, United States of America
| | - Kathryn A Maurer
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84103, United States of America; Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, United States of America
| | - Theresa L Werner
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84103, United States of America; Division of Oncology, Department of Medicine, University of Utah School of Medicine, 2000 Circle of Hope, Suite 2100, Salt Lake City, UT 84132, United States of America
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Warner EL, Martel L, Ou JY, Nam GE, Carbajal-Salisbury S, Fuentes V, Kirchhoff AC, Kepka D. A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in Utah. J Community Health 2018; 44:256-264. [DOI: 10.1007/s10900-018-0581-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE Rural and highly religious Intermountain West states demonstrate low levels of HPV vaccination uptake. The Intermountain West HPV Vaccination Coalition (IWHVC) was formed to improve HPV vaccination by enhancing collaborations between cancer centers, health departments, health clinics, religious groups, and community organizations. Coalition members' perceptions and experiences are described within. METHODS A cross-sectional online survey was distributed to the IWHVC. N = 86 responded to the online survey. Six subsequent focus groups were conducted (N = 36). Participant demographics, barriers, and facilitators of HPV vaccination were summarized. The first three focus groups were coded in an iterative manner based on a coding scheme. The final three focus groups were selectively coded for content related to five themes: barriers and facilitators to HPV vaccination, how the coalition has been useful, future directions of the coalition, and how to engage religious communities. RESULTS Participants suggested that HPV vaccination should occur in a doctor's office (70.9%), public health clinic (64.0%), or at a community health fair (58.1%). Perceived barriers included a lack of education/low knowledge about the HPV vaccine (55.8%), concerns about sexuality/promiscuity (44.2%), and not knowing the vaccine is recommended for boys (38.4%). Participants stressed the importance of gaining buy-in from religious leaders, and felt the coalition helped them advocate for HPV vaccination through networking, idea and information sharing, and voicing their community's needs. Future goals emphasized targeted outreach, sustainable funding, expanded environmental scans, gaining religious support, and policy reforms. CONCLUSIONS Targeted coalition work builds community capacity and coordinates HPV vaccination efforts. A community driven coalition approach could help improve HPV vaccination in other rural and highly religious regions.
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Affiliation(s)
- Echo L Warner
- University of Utah College of Nursing, Salt Lake City, UT, 84112, USA.
- Jonas Center for Nursing and Veterans Healthcare, New York, NY, 10021, USA.
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA.
| | - Brynn Fowler
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Laura Martel
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- University of Utah College of Nursing, Salt Lake City, UT, 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
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Kepka D, Bodson J, Lai D, Sanchez-Birkhead A, Villalta J, Mukundente V, Tavake-Pasi F, Davis FA, Lee D, Napia E, Mooney R, Coulter H, Stark LA. Factors Associated with Human Papillomavirus Vaccination Among Diverse Adolescents in a Region with Low Human Papillomavirus Vaccination Rates. Health Equity 2018; 2:223-232. [PMID: 30283871 PMCID: PMC6128445 DOI: 10.1089/heq.2018.0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: This study assesses the sociodemographic facilitators and barriers to human papillomavirus (HPV) vaccination for diverse teens in a region with low HPV vaccination rates. Materials and Methods: In this community-based participatory research study, we surveyed adult family members of teens aged 11–17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Salt Lake City, Utah. Bivariate analyses assessed associations between sociodemographic characteristics and, respectively, HPV vaccine receipt and intentions for vaccination. Barriers to vaccination were also investigated. Results: Only 20% of participants had vaccinated at least one of their children with at least one dose of the HPV vaccine. HPV vaccination was significantly related to caregiver age (p=0.035), race/ethnicity (p=0.001), educational attainment (p=0.006), annual household income (p=0.0454), years in the United States (p=0.023), and caregiver parent birthplace (p=0.008). Among caregivers with unvaccinated children, intention to vaccinate was significantly related to race/ethnicity (p=0.048 for daughters; p=0.003 for sons), caregiver parent birthplace (p=0.023 for sons), health insurance coverage (p=0.028 for daughters; p=0.047 for sons), and type of health insurance coverage (p=0.008 for sons). The most frequently cited barriers to HPV vaccination were lack of knowledge about the HPV vaccine, costs, side effects, and child not being sexually active. Conclusions: Our results show substantially lower HPV vaccine coverage than both national and state rates, signaling the urgent need for multipronged HPV vaccination interventions within these communities; strategies are discussed.
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Affiliation(s)
- Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Djin Lai
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Ana Sanchez-Birkhead
- College of Nursing, University of Utah, Salt Lake City, Utah.,Community Faces of Utah, Salt Lake City, Utah.,Hispanic Healthcare Task Force, Salt Lake City, Utah
| | - Jeannette Villalta
- Community Faces of Utah, Salt Lake City, Utah.,Hispanic Healthcare Task Force, Salt Lake City, Utah
| | - Valentine Mukundente
- Community Faces of Utah, Salt Lake City, Utah.,Best of Africa, West Valley City, Utah
| | - Fahina Tavake-Pasi
- Community Faces of Utah, Salt Lake City, Utah.,National Tongan American Society, Salt Lake City, Utah
| | - France A Davis
- Community Faces of Utah, Salt Lake City, Utah.,Calvary Baptist Church, Salt Lake City, Utah
| | - Doriena Lee
- Community Faces of Utah, Salt Lake City, Utah.,Calvary Baptist Church, Salt Lake City, Utah
| | - Edwin Napia
- Community Faces of Utah, Salt Lake City, Utah.,Urban Indian Center, Salt Lake City, Utah
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Heather Coulter
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Louisa A Stark
- School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Human Genetics, School of Medicine, University of Utah, Salt Lake City, Utah
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Rutkoski H, Fowler B, Mooney R, Pappas L, Dixon BL, Pinzon LM, Winkler J, Kepka D. Pilot Test of Survey to Assess Dental and Dental Hygiene Student Human Papillomavirus-Related Oropharyngeal Cancer Knowledge, Perceptions, and Clinical Practices. J Cancer Educ 2018; 33:907-914. [PMID: 28091963 DOI: 10.1007/s13187-017-1165-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This was the first study to develop and pilot test an assessment tool for the examination of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) knowledge, perceptions, and clinical practices of oral health students. An interdisciplinary team developed the tool using surveys that examined this topic in other populations. The tool was then pilot tested at two different dental programs. Results from the pilot informed revisions to the final version of the tool. Of the 46 student participants, 18 were first-year dental hygiene and 28 were first-year dental students. The majority of participants were female (N = 29, 63%) and ages 18 to 29 years old (N = 41, 89%). Four scales used in the questionnaire were analyzed for reliability. Of these, the HPV and HPV-OPC knowledge and the HPV vaccination knowledge scales had Cronbach alphas of 0.71 and 0.79, respectively. Questions assessing HPV and the role of dental professionals had a correlation coefficient of 0.71. Questions assessing willingness to administer vaccines in the dental office had a correlation coefficient of 0.85. Assessing oral health students' HPV-OPC knowledge, perceptions, and clinical practices are important for future assessment of possible HPV-OPC cases. Dental professionals may be optimally positioned to provide HPV patient education. The tool developed and pilot tested in this study can help schools assess their students' knowledge and guide their dental curriculum to address deficiencies. Since this topic has not been effectively examined with dental health students, the results could help improve dental education and dental care.
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Affiliation(s)
- Holdunn Rutkoski
- School of Dental Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Brynn Fowler
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Lisa Pappas
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Barbara L Dixon
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - Lilliam M Pinzon
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - James Winkler
- School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA.
- College of Nursing, Cancer Control and Population Science, University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4144, Salt Lake City, UT, 84112, USA.
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Ou JY, Kirchhoff AC, Warner EL, Martel L, Kepka D. Abstract B15: Colorectal cancer knowledge and adherence among Hispanic workers. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-b15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Hispanics report the lowest CRC screening rate of any ethnic group in the United States. Hispanics comprise 14% of Utah's population and are growing rapidly. Most of the Hispanics in Utah are foreign-born immigrants who work low-wage jobs that do not offer health benefits, making them a high-risk population for low CRC screening rates. We partnered with companies in Salt Lake County with a large Hispanic employee population to implement an educational intervention to improve knowledge of and adherence to cancer screenings. We identify demographic predictors of CRC knowledge and adherence pre-intervention, and of improvements in adherence post-intervention.
Methods: Current and previous employees of service/manual labor companies (e.g., professional cleaning, restaurants, construction) were recruited by local businesses and community organizations. Promotoras held educational sessions at the local businesses. Pre- and post-interviews measured CRC screening knowledge, adherence, demographics, and perceptions of CRC risk. Interviews were conducted in person or on the phone within 10 months of the intervention. Participants aged ≥50 were given FOBT/FIT tests. Chi-square tests examined differences in knowledge among participants and adherence preintervention. Multivariable logistic regression models identified predictors of knowledge, awareness, and adherence preintervention, and identified characteristics associated with improvements in adherence post-intervention.
Results: We recruited 307 Hispanic employees. 95% of our population were Hispanic immigrants, 88% speak Spanish, 64% make $25,000 or less a year, and 70% do not have health insurance. 40% of adults aged ≥50 were adherent to CRC screening guidelines before the intervention; after the intervention, 66% of eligible adults were adherent, with the majority of the improvement in FOBT/FIT tests. We found significant differences in initial knowledge of CRC among participants aged 18 to 49 years (51%) vs age ≥50 years (85%, p<0.01) and among English speakers (60%) compared to Spanish speakers (78%, p=0.03). Higher education was correlated with greater recognition of a CRC test (<High school=43%, ≥High school=75%, p=0.01), and identification of one guideline (<High school=79%, ≥High school=90%, p=0.02). Adherence significantly differed by insurance status (No insurance=28%, Insured=55%, p=0.01). In the regression models, older age (31-39 years: OR=4.53 [95%CI=1.46-14.01]; ≥50= 8.90 [2.61-30.35]; ref = 18-30 years) and personal risk for CRC were significantly associated with increased odds of having heard of CRC (Somewhat likely: OR=4.48 [1.94-10.34]; Likely= 3.06 [1.40-6.67]; ref = Not likely). Recognition of one CRC screening was only significantly associated with education (≥High school=3.21 [1.78-5.80]; ref = <High school). Identification of one CRC guideline was only associated with insurance (Insured=2.88 [1.05-7.90]). The only characteristic associated with adherence preintervention was insurance (Insured=3.00 [1.10-8.12]; ref = No insurance). Improvement in adherence postintervention was significantly associated with higher-income participants ($25,000 to ≥$55,000=9.59 [2.20-42.22]; $10,000 to <$25,000=2.39 [0.66-8.66]; ref=$5,000 to <$10,000), with nonsignificant improvements in males (1.88 [0.54-6.51]) compared to females.
Conclusions: Knowledge of CRC screenings among Hispanics is related to older age, education, and insurance. Providing FOBT/FIT yielded significant improvements in adherence. Ensuring that Hispanics have access to health insurance and affordable CRC screenings is a critical factor in improving CRC screenings in this vulnerable population.
Citation Format: Judy Y. Ou, Anne C. Kirchhoff, Echo L. Warner, Laura Martel, Deanna Kepka. Colorectal cancer knowledge and adherence among Hispanic workers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B15.
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Affiliation(s)
- Judy Y. Ou
- Huntsman Cancer Institute, Salt Lake City, UT
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Tolentino V, Unni E, Montuoro J, Bezzant-Ogborn D, Kepka D. Utah pharmacists' knowledge, attitudes, and barriers regarding human papillomavirus vaccine recommendation. J Am Pharm Assoc (2003) 2018; 58:S16-S23. [PMID: 29739667 DOI: 10.1016/j.japh.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate Utah community pharmacists' knowledge and attitudes toward recommendation of human papillomavirus (HPV) vaccine, to determine whether the knowledge and attitude of pharmacists regarding the HPV vaccine influence their recommendation behaviors, and to capture any self-identified barriers to recommending the HPV vaccine. DESIGN A cross-sectional anonymous 73-item survey was developed and administered to community, outpatient, and ambulatory care pharmacists. SETTING Utah. PARTICIPANTS Utah community pharmacists. MAIN OUTCOME MEASURES Recommendation of the HPV vaccine by the pharmacist, knowledge and attitude of pharmacists regarding HPV vaccine, and barriers to vaccine receipt. RESULTS The mean HPV vaccine knowledge score was 7.45 ± 2.15 (out of 13), and scores were higher when pharmacists had 4 to 6 technicians per day in the pharmacy and when they were residency trained. The mean attitude score was 24.26 ± 3.16 (out of 30). Positive attitudes were found if they had more than 1 pharmacist and 4 to 6 pharmacy technicians working at any given time in the pharmacy. Those who identified with "other Christianity" had a more positive attitude than Latter Day Saints. Although positive attitude toward the HPV vaccine was a predictor for recommending the vaccine to both boys and girls, higher knowledge was a significant predictor only in recommending the HPV vaccine for boys. Female pharmacists were more likely to recommend the HPV vaccine. The top 3 reported barriers included lack of parental knowledge, parental concerns and opposition, and lack of educational materials to provide parents. CONCLUSION Although the majority of respondents perceived HPV vaccination as useful for preventing certain types of cancer, and more than one-half of respondents reported being comfortable in recommending the vaccine, only one-third actually recommended the vaccine for girls and for boys. The results indicate the need for improving knowledge about the HPV vaccine for pharmacists, patients, and parents.
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Hashibe M, Kirchhoff AC, Kepka D, Kim J, Millar M, Sweeney C, Herget K, Monroe M, Henry NL, Lopez AM, Mooney K. Disparities in cancer survival and incidence by metropolitan versus rural residence in Utah. Cancer Med 2018. [PMID: 29533005 PMCID: PMC5911626 DOI: 10.1002/cam4.1382] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cancer disparities in rural and frontier communities are an important issue in Utah because much of Utah is sparsely populated. The aims of this study were to investigate whether there are differences in the cancer incidence and 5‐year survival rates in Utah by metropolitan/rural residence and to investigate disparities in distributions of cancer risk factors. We used cancer registry records to identify patients diagnosed with a first primary cancer in Utah between 2004 and 2008. We estimated 5‐year survival and incidence rates. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for the risk of death. There were 32,498 (86.9%) patients with cancer who lived in metropolitan counties and 4906 (13.1%) patients with cancer who lived in rural counties at the time of cancer diagnosis. Patients with cancer from rural counties were more likely to be older, American Indian/Alaskan Native, non‐Hispanic, male, and diagnosed at higher stage. Rural residents had a five‐year relative survival that was 5.2% lower than metropolitan residents and a 10% increase in risk of death (HR = 1.10, 95% CI = 1.03, 1.18) after adjustment for multiple factors. Overall, the cancer incidence rates in rural counties were lower by 11.9 per 100,000 per year (449.2 in rural counties vs. 461.1 in metropolitan counties). Cancer patients living in rural counties of Utah had different demographic characteristics as well as differences in incidence and survival rates. Further studies with individual‐level data are necessary to investigate the reasons behind these differences in cancer incidence and survival to reduce disparities.
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Affiliation(s)
- Mia Hashibe
- Department of Family and Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Department of Pediatrics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Deanna Kepka
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jaewhan Kim
- College of Health, University of Utah, Salt Lake City, Utah
| | - Morgan Millar
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | | | - Marcus Monroe
- Division of Otolaryngology, Department of Surgery, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - N Lynn Henry
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ana-Maria Lopez
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kathi Mooney
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Fowler B, Ding Q, Pappas L, Wu YP, Linder L, Yancey J, Wright J, Clayton M, Kepka D, Kirchhoff AC. Utah Cancer Survivors: A Comprehensive Comparison of Health-Related Outcomes Between Survivors and Individuals Without a History of Cancer. J Cancer Educ 2018; 33:214-221. [PMID: 27592022 PMCID: PMC5532077 DOI: 10.1007/s13187-016-1098-y] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Assessments of cancer survivors' health-related needs are often limited to national estimates. State-specific information is vital to inform state comprehensive cancer control efforts developed to support patients and providers. We investigated demographics, health status/quality of life, health behaviors, and health care characteristics of long-term Utah cancer survivors compared to Utahans without a history of cancer. Utah Behavioral Risk Factor Surveillance System (BRFSS) 2009 and 2010 data were used. Individuals diagnosed with cancer within the past 5 years were excluded. Multivariable survey weighted logistic regressions and computed predictive marginals were used to estimate age-adjusted percentages and 95 % confidence intervals (CI). A total of 11,320 eligible individuals (727 cancer survivors, 10,593 controls) were included. Respondents were primarily non-Hispanic White (95.3 % of survivors, 84.1 % of controls). Survivors were older (85 % of survivors ≥40 years of age vs. 47 % of controls). Survivors reported the majority of their cancer survivorship care was managed by primary care physicians or non-cancer specialists (93.5 %, 95 % CI = 87.9-99.1). Furthermore, 71.1 % (95 % CI = 59.2-82.9) of survivors reported that they did not receive a cancer treatment summary. In multivariable estimates, fair/poor general health was more common among survivors compared to controls (17.8 %, 95 % CI = 12.5-23.1 vs. 14.2 %, 95 % CI = 12.4-16.0). Few survivors in Utah receive follow-up care from a cancer specialist. Provider educational efforts are needed to promote knowledge of cancer survivor issues. Efforts should be made to improve continuity in follow-up care that addresses the known issues of long-term survivors that preclude optimal quality of life, resulting in a patient-centered approach to survivorship.
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Affiliation(s)
- Brynn Fowler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Qian Ding
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA
| | - Lisa Pappas
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA
| | - Yelena P Wu
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84112, USA
| | - Lauri Linder
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
- Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT, 84132, USA
| | - Jeff Yancey
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Jennifer Wright
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT, 84132, USA
| | - Margaret Clayton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA
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Kepka D, Spigarelli MG, Warner EL, Yoneoka Y, McConnell N, Balch A. Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data. Papillomavirus Res 2018; 2:128-132. [PMID: 27540595 PMCID: PMC4985178 DOI: 10.1016/j.pvr.2016.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Human papillomavirus (HPV) vaccine 3-dose completion rates among adolescent females in the US are low. Missed opportunities impede HPV vaccination coverage. Methods A population-based secondary data analysis of de-identified vaccination and demographic data from the Utah Statewide Immunization Information System (USIIS) was conducted. Records were included from 25,866 females ages 11–26 years at any time during 2008–2012 who received at least one of the following adolescent vaccinations documented in the USIIS: Tdap (Tetanus, Diphtheria, Pertussis), meningococcal, and/or influenza. A missed opportunity for HPV vaccination was defined as a clinical encounter where the patient received at least one adolescent vaccination, but not a HPV vaccine. Results Of 47,665 eligible visits, there were 20,911 missed opportunities (43.87%). Age group, race/ethnicity, and rurality were significantly associated with missed opportunity (p<0.0001). In a multivariable mixed-effects logistic regression model that included ethnicity, location and age, as fixed effects and subject as a random effect, Hispanics were less likely to have a missed opportunity than whites OR 0.59 (95% CI: 0.52–0.66), small rural more likely to have a missed opportunity than urban youth OR 1.8 (95% CI: 1.5–2.2), and preteens more likely than teens OR 2.4 (95% CI: 2.2–2.7). Conclusion Missed clinical opportunities are a significant barrier to HPV vaccination among female adolescents. Interventions targeted at providers who serve patient groups with the highest missed opportunities are needed to achieve adequate protection from HPV-associated illnesses. Impact This is one of the first studies to utilize state immunization information system data to assess missed opportunities for HPV vaccination.
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Affiliation(s)
- Deanna Kepka
- University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Correspondence to: University of Utah, College of Nursing, Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Room 4144, Salt Lake City, UT 84112, USA.University of Utah, College of Nursing, Huntsman Cancer Institute, Cancer Control and Population Sciences2000 Circle of Hope, Room 4144Salt Lake CityUT84112USA
| | - Michael G. Spigarelli
- University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W, Salt Lake City, UT 84116, USA
- University of Utah, Department of Pediatrics, 100 N Mario Capecchi Drive, Salt Lake City, UT 84132, USA
| | - Echo L. Warner
- University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Yukiko Yoneoka
- Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W, Salt Lake City, UT 84116, USA
| | - Nancy McConnell
- Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W, Salt Lake City, UT 84116, USA
| | - Alfred Balch
- University of Utah, Department of Pediatrics, 100 N Mario Capecchi Drive, Salt Lake City, UT 84132, USA
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Ou JY, Fowler B, Ding Q, Kirchhoff AC, Pappas L, Boucher K, Akerley W, Wu Y, Kaphingst K, Harding G, Kepka D. A statewide investigation of geographic lung cancer incidence patterns and radon exposure in a low-smoking population. BMC Cancer 2018; 18:115. [PMID: 29385999 PMCID: PMC5793382 DOI: 10.1186/s12885-018-4002-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality in Utah despite having the nation's lowest smoking rate. Radon exposure and differences in lung cancer incidence between nonmetropolitan and metropolitan areas may explain this phenomenon. We compared smoking-adjusted lung cancer incidence rates between nonmetropolitan and metropolitan counties by predicted indoor radon level, sex, and cancer stage. We also compared lung cancer incidence by county classification between Utah and all SEER sites. METHODS SEER*Stat provided annual age-adjusted rates per 100,000 from 1991 to 2010 for each Utah county and all other SEER sites. County classification, stage, and sex were obtained from SEER*Stat. Smoking was obtained from Environmental Public Health Tracking estimates by Ortega et al. EPA provided low (< 2 pCi/L), moderate (2-4 pCi/L), and high (> 4 pCi/L) indoor radon levels for each county. Poisson models calculated overall, cancer stage, and sex-specific rates and p-values for smoking-adjusted and unadjusted models. LOESS smoothed trend lines compared incidence rates between Utah and all SEER sites by county classification. RESULTS All metropolitan counties had moderate radon levels; 12 (63%) of the 19 nonmetropolitan counties had moderate predicted radon levels and 7 (37%) had high predicted radon levels. Lung cancer incidence rates were higher in nonmetropolitan counties than metropolitan counties (34.8 vs 29.7 per 100,000, respectively). Incidence of distant stage cancers was significantly higher in nonmetropolitan counties after controlling for smoking (16.7 vs 15.4, p = 0.02*). Incidence rates in metropolitan, moderate radon and nonmetropolitan, moderate radon counties were similar. Nonmetropolitan, high radon counties had a significantly higher incidence of lung cancer compared to nonmetropolitan, moderate radon counties after adjustment for smoking (41.7 vs 29.2, p < 0.0001*). Lung cancer incidence patterns in Utah were opposite of metropolitan/nonmetropolitan trends in other SEER sites. CONCLUSION Lung cancer incidence and distant stage incidence rates were consistently higher in nonmetropolitan Utah counties than metropolitan counties, suggesting that limited access to preventative screenings may play a role in this disparity. Smoking-adjusted incidence rates in nonmetropolitan, high radon counties were significantly higher than moderate radon counties, suggesting that radon was also major contributor to lung cancer in these regions. National studies should account for geographic and environmental factors when examining nonmetropolitan/metropolitan differences in lung cancer.
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Affiliation(s)
- Judy Y. Ou
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Brynn Fowler
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
| | - Qian Ding
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Lisa Pappas
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Kenneth Boucher
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Wallace Akerley
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
| | - Yelena Wu
- Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84112 USA
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84112 USA
| | - Kimberly Kaphingst
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
- Department of Communication, University of Utah, 255 S Central Campus Dr., Rm 2400, Salt Lake City, UT 84112 USA
| | - Garrett Harding
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
| | - Deanna Kepka
- Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112 USA
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Fowler B, Bodson J, Warner EL, Dyer J, Kepka D. Poor HPV vaccine-related awareness and knowledge among Utah Latinas overdue for recommended cancer screenings. J Community Health 2018; 41:825-37. [PMID: 26860277 DOI: 10.1007/s10900-016-0160-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individuals overdue for recommended cancer screenings may not be receiving adequate cancer prevention education. Since Latinas have the highest incidence of cervical cancer among all racial/ethnic groups, human papillomavirus (HPV) vaccination education is especially important for this population. The correlates of HPV vaccine-related awareness and knowledge were assessed among Latinas who were overdue for recommended cancer screenings. N = 206 Latinas who were overdue for recommended cancer screenings were recruited by health educators from local community groups. Bivariate analyses and multivariable regression models were used to investigate factors associated with HPV vaccine-related awareness and knowledge among participants as well as to assess correlates of HPV vaccine receipt for eligible children of participants. In multivariable regression analyses, years living in the U.S. (p = 0.05) and health insurance status (p = 0.03) were significantly related to HPV vaccine-related knowledge measures. Age (p < 0.01), birthplace (p = 0.02), years living in the U.S. (p = 0.05), annual household income (p = 0.05), cervical cancer screening status (p = 0.03), and HPV vaccine-related knowledge measures (p < 0.01) were significantly associated with HPV vaccination outcomes for eligible daughters of participants. Cervical cancer screening status (p = 0.02) and HPV vaccine-related knowledge measures (p = 0.01) were significantly associated with HPV vaccination outcomes for eligible sons of participants. Results indicate poor HPV vaccine-related awareness and knowledge among Latinas. Interventions to improve HPV vaccine-related awareness and knowledge in Utah's growing Latino population should target vulnerable individuals (e.g., not employed outside the home, less educated, less acculturated, poor, uninsured, overdue for cervical cancer screening) by using materials that are culturally sensitive, linguistically appropriate, and easily accessible.
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Affiliation(s)
- Brynn Fowler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Room 4125, Salt Lake City, UT, 84112, USA.
| | - Julia Bodson
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Room 4125, Salt Lake City, UT, 84112, USA
| | - Echo L Warner
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Room 4125, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Jane Dyer
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Room 4125, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA
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Lai D, Bodson J, Davis FA, Lee D, Tavake-Pasi F, Napia E, Villalta J, Mukundente V, Mooney R, Coulter H, Stark LA, Sanchez-Birkhead AC, Kepka D. Diverse Families' Experiences with HPV Vaccine Information Sources: A Community-Based Participatory Approach. J Community Health 2018; 42:400-412. [PMID: 27734247 DOI: 10.1007/s10900-016-0269-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N = 228). Ninenty-three of these participants also participated in ten focus groups conducted in three languages. Descriptive statistics and Fishers' Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born = 50 % vs US-born = 30 %, p < 0.05; medium acculturation = 60 % vs high acculturation = 26 %, p = 0.01), while greater proportions of US-born participants reported media sources (49 % vs foreign-born = 29 %, p < 0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p < 0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.
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Affiliation(s)
- Djin Lai
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA. .,College of Nursing, University of Utah, Salt Lake City, UT, USA.
| | - Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA
| | - France A Davis
- Community Faces of Utah, Salt Lake City, UT, USA.,Calvary Baptist Church, Salt Lake City, UT, USA
| | - Doriena Lee
- Community Faces of Utah, Salt Lake City, UT, USA.,Calvary Baptist Church, Salt Lake City, UT, USA
| | - Fahina Tavake-Pasi
- Community Faces of Utah, Salt Lake City, UT, USA.,National Tongan American Society, Salt Lake City, UT, USA
| | - Edwin Napia
- Community Faces of Utah, Salt Lake City, UT, USA.,Urban Indian Center, Salt Lake City, UT, USA
| | - Jeannette Villalta
- Community Faces of Utah, Salt Lake City, UT, USA.,Hispanic Healthcare Task Force, Salt Lake City, UT, USA
| | - Valentine Mukundente
- Community Faces of Utah, Salt Lake City, UT, USA.,Best of Africa, West Valley, UT, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA
| | - Heather Coulter
- Community Outreach and Collaboration Core, Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Louisa A Stark
- Community Outreach and Collaboration Core, Center for Clinical and Translational Science, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Department of Human Genetics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ana C Sanchez-Birkhead
- College of Nursing, University of Utah, Salt Lake City, UT, USA.,Community Faces of Utah, Salt Lake City, UT, USA.,Hispanic Healthcare Task Force, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Room 4127, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, Salt Lake City, UT, USA
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Warner EL, Ding Q, Pappas LM, Henry K, Kepka D. White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the National Immunization Study - teen. BMC Pediatr 2017; 17:200. [PMID: 29191180 PMCID: PMC5710112 DOI: 10.1186/s12887-017-0953-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/20/2017] [Indexed: 12/22/2022] Open
Abstract
Background Human Papillomavirus (HPV) vaccination coverage is below national goals in the United States. Research is needed to inform strategically designed interventions that target sociodemographic groups with underutilization of HPV vaccination. Methods Secondary data analysis of the National Immunization Survey-Teen 2013 measured association of sociodemographic factors (e.g., ethnicity/race, insurance) with HPV vaccination among females and males ages 13–17 (N = 18,959). Chi-square and multivariable Poisson regressions were conducted using survey-weighted statistics. Results Having a mother ≥35 years, a mother with some college, being of “Other” ethnicity/race, and having no providers who order vaccines from health departments was negatively associated with females initiating HPV vaccination. Having a mother with some college, being of Non-Hispanic White or “Other” ethnicity/race, and having some or no providers who order vaccines from health departments was negatively associated with males initiating HPV vaccination. These same factors were negatively associated with males completing HPV vaccination with the exception of “Other” ethnicity/race. In contrast, having an unmarried mother, being ages 15–17, having a hospital based provider, and receiving other adolescent vaccinations were positively associated with females initiating and completing HPV vaccination. Having an unmarried mother, health insurance that is not employer or union sponsored, and influenza and meningitis vaccinations was positively associated with male’s initiating HPV vaccination. For males, being 15 or 17 years old and having other adolescent vaccinations was positively associated with vaccine completion. All findings p ≤ 0.05. Conclusions Future HPV vaccination interventions may benefit from targeting certain sociodemographic groups that were negatively associated with HPV vaccination in this study.
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Affiliation(s)
- Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA. .,Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84123, USA.
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84123, USA
| | - Lisa M Pappas
- Biostatistics Center, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Kevin Henry
- Department of Geography, Temple University, 1115 Polett Walk, Philadelphia, PA, 19112, USA.,Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Avenue, Philadelphia, Pennsylvania, 19111, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA
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Bodson J, Wilson A, Warner EL, Kepka D. Religion and HPV vaccine-related awareness, knowledge, and receipt among insured women aged 18-26 in Utah. PLoS One 2017; 12:e0183725. [PMID: 28841681 PMCID: PMC5571930 DOI: 10.1371/journal.pone.0183725] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/09/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We investigate the associations between religious practice and human papillomavirus (HPV) vaccine-related awareness, knowledge, and receipt among young women in Utah. METHODS We surveyed 326 insured women aged 18-26 by mail. Fisher's Exact Tests and multivariable logistic regression models were used to evaluate the relations between religious practice and HPV vaccine-related outcomes. Data collection occurred January-December 2013; analyses were conducted June-September 2015. RESULTS Multivariable analyses reveal that when controlling for age, educational attainment, and marital status, participants who practiced an organized religion were significantly less likely to have heard of HPV (aOR = 0.25, p = 0.0123), to have heard of the HPV vaccine (aOR = 0.41, p = 0.0368), to know how HPV is spread (aOR = 0.45, p = 0.0074), to have received a provider recommendation for the HPV vaccine (aOR = 0.36, p = 0.0332), and to have received at least one (aOR = 0.50, p = 0.0073) or all three (aOR = 0.47, p = 0.0026) doses of the HPV vaccine. Bivariate analyses produce parallel results. CONCLUSIONS Results indicate that religious young women in Utah are not only under-vaccinated, but are also under-informed about HPV and the HPV vaccine. These results suggest that suboptimal vaccine coverage among religious young women may present a serious health risk for the community. Strategies for educational interventions targeted to this population are discussed.
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Affiliation(s)
- Julia Bodson
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Andrew Wilson
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States of America
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
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Warner EL, Ding Q, Pappas L, Bodson J, Fowler B, Mooney R, Kirchhoff AC, Kepka D. Health Care Providers' Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study. JMIR Cancer 2017; 3:e12. [PMID: 28801303 PMCID: PMC5572057 DOI: 10.2196/cancer.7345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/17/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. Objective The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers’ perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. Methods In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (≤10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Results Family practice providers (52.2%, 71/136; P=.001), institutional or university clinics (54.0%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers. Conclusions Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents.
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Affiliation(s)
- Echo L Warner
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lisa Pappas
- Biostatistics Core, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Julia Bodson
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Brynn Fowler
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Ryan Mooney
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Deanna Kepka
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
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