Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach.

Far too few adults getting recommended vaccines

Impact of human papillomavirus vaccine in reducing genital warts: A Google Trends analysis

Background: Anal cancer disproportionally impacts gay, bisexual, and other male sexual minorities (GBM). Human Papillomavirus (HPV) vaccination is a safe and effective method to prevent anal cancer; however, coverage of HPV vaccination among adult GBM is low. Key barriers to vaccination are lack of awareness and knowledge of anal cancer, low motivation to get vaccinated, and lack of access and availability. For many young GBM, regular interactions with the healthcare system center around HIV prevention. Thus, we propose that federally qualified health centers (FQHCs) can increase uptake and reach of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The objectives of this project were to (1) assess the acceptability of integrating HPV vaccination with PrEP management and (2) determine needs for informed decision making. Methods: We conducted a web-based cross-sectional survey of unvaccinated GBM (18-45) who received PrEP care at a FQHC in Philadelphia. Data collection took place in 2021 and 2022. The main outcome was intent to initiate HPV vaccination within 12 months (5-point scale). Other measures included beliefs about HPV vaccination in PrEP care, perceived information needs, and preferred information delivery modes. Descriptive and bivariate statistics were used to analyze the data. Results: The sample (N=59) was ethnoracially diverse (50.0% non-White) and in the catchup (23.7%; 18-26 yrs.) or shared clinical decision making (76.3%; 27-45) age ranges. Most were gay identified (71.2%) cisgender men (74.6%). Just 23.7% were aware they were eligible for HPV vaccination and even fewer knew that vaccination could prevent anal cancer (11.9%). Overall vaccine intentions were high (M=3.7; SD=1.0). Intentions were 26.1% higher (M=4.4; SD=1.0) if HPV vaccination was offered during PrEP appointments. Most (88.7%) agreed that offering HPV vaccination during PrEP visits would increase the likelihood that they would get vaccinated; however, 64.4% strongly/somewhat agreed that they needed more information about HPV vaccination prior to making an informed decision. Perceived information need was inversely associated with vaccine intentions (r=-0.31, p=0.02). Most participants (>50%) indicated they wanted to know more about their risk for anal cancer and effectiveness of HPV vaccination. The majority (71.2%) preferred to get medically accurate information on anal cancer prevention from a website that they could go to on their own time. Other delivery modes were iPads at their doctor’s office (28.8%), printed information given to them by their doctor (28.8%), and text messages from a healthcare provider (25.4%). Conclusion: Offering and promoting HPV vaccination as part of PrEP management visits was highly acceptable among PrEP patients. Interventions should focus on raising awareness about anal cancer and promoting informed decision making for anal cancer prevention. Citation Format: Christopher W. Wheldon, Sarah Bass, Bradley Collins. Integrating HPV (human papillomavirus) vaccination into HIV prevention: Acceptability and information needs among PrEP (pre-exposure prophylaxis) patients at a federally qualified health center [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B052.

This descriptive cross-sectional study was designed to assess HPV vaccination coverage, intention to HPV vaccination, cervical cancer knowledge, and HPV knowledge among female middle and high school students. A applied structured questionnaire included items on sociodemographics, Ob-Gyn information, HPV vaccination coverage, and intention to HPV vaccination, cervical cancer knowledge, and HPV knowledge. In this study, among 452 adolescents 10.2% obtained HPV vaccine. 54.2% of non-vaccinated respondents intended to obtain HPV vaccination. The correct response rate of cervical cancer knowledge items ranged from 5.5% to 87.4%, and HPV knowledge items ranged from 25.2% to 89.4%. There were significant differences in cervical cancer knowledge score between intended group and not-intended group for vaccination. This results indicate the need for further education to increase knowledge of cervical cancer and HPV. It is important that mothers of adolescents are informed and encouraged HPV vaccination. Also, school health teachers and mass media should provide adequate information about HPV vaccination for students and mothers.

Global HPV vaccination programs and coverage rates: a systematic review.

BackgroundIn France, human papillomavirus (HPV) vaccination coverage varies across socioeconomic levels.AimWe aimed at assessing HPV vaccine awareness, uptake and vaccination intention among adolescents in France.MethodsIn a cluster-randomised study, 13–15-year-old students in 61 French middle schools completed a web-based questionnaire. We used multivariable logistic regression to evaluate determinants of HPV vaccine awareness, self-reported uptake and vaccination intention among unvaccinated students and interaction terms to explore effects of visits to family physician and remembering school lessons on vaccination. The French deprivation index of school municipalities served as proxy for socioeconomic levels.ResultsAmong 6,992 participants, awareness was significantly associated with parental education (odds ratio (OR) = 0.82; 95% confidence interval (CI): 0.71–0.95), language spoken at home (OR = 0.59; 95% CI: 0.52–0.66) and deprivation level (OR = 0.57; 95% CI: 0.44–0.71), regardless of physician visit or school lessons. Vaccine uptake was associated with parental education without a recent physician visit (OR = 0.31; 95% CI: 0.16–0.59, vs OR = 0.64; 95% CI: 0.52–0.78 with a visit, interaction p = 0.045). Vaccination intention among unvaccinated was associated with deprivation level (moderate-low vs low) among students not remembering school lessons on vaccination (OR = 0.17; 95% CI: 0.05-0.62, vs OR = 0.93; 95% CI: 0.51–1.67 remembering school lessons, interaction p = 0.022). Parental education was associated with vaccination intention among students reporting a physician visit (OR = 0.41; 95% CI: 0.26–0.64 vs OR = 1.05; 95% CI: 0.50–2.20 without a visit, interaction p = 0.034).ConclusionOur results suggest that healthcare and school could promote vaccination and mitigate social inequalities in HPV vaccination coverage.

Impact of the human papillomavirus vaccine in low-resource settings

Introductory sentences indicating the purposes of the study: Using a modified version of Boot Camp Translation (BCT), a validated community participatory approach, we co-created locally relevant and culturally appropriate human papillomavirus (HPV) vaccination materials and messages for parents and caregivers of HPV vaccine-eligible children in Washington state. Brief description of pertinent experimental procedures: The HPV vaccine, recommended for children starting at age 9, reduces the risk of HPV infection and HPV-related cancers. However, HPV vaccine rates are significantly lower in rural regions compared to urban areas. In partnership with Kaiser Permanente Center for Health Research, the Huntsman Cancer Institute, and Sea Mar Community Health Centers, a large federally qualified health center in Washington state, we used a modified BCT approach to elicit input from parents and caregivers of HPV-vaccine eligible children to develop materials and messages that motivate parents to vaccinate their children. Eligible participants were parents or caregivers of children between the ages of 9-15 who had at least one vaccination, spoke English or Spanish, and were able to participate in the entire BCT process. Two BCT sessions were conducted (one in English and one in Spanish), both consisting of three meetings over a four-month period. The sessions included a five-hour in-person meeting in Aberdeen, Washington (English) and Bellingham, Washington (Spanish), and two one-hour follow-up virtual calls for each language. The in-person meetings included HPV vaccine education by Sea Mar providers and an expert in HPV research, discussions on HPV knowledge, perceptions, and barriers to vaccination, and small group discussions to generate HPV messages and materials. The follow-up calls gathered feedback on drafted materials and messages. Summary of the new unpublished data: Eight parents or caregivers participated in the English session and nine participated in the Spanish session. Key themes identified to incorporate in messages and materials included: stressing the benefits of vaccination, highlighting research on the vaccine’s safety and efficacy, including statistics and images of both girls and boys, reporting local statistics, spelling out HPV in materials, and emphasizing the words “prevent” and “protection” from cancers/infections later in a child’s life. The preferred materials and dissemination methods included: fact sheets and brochures (available in the clinic, mailed home, or in school nurses’ offices), posters (displayed in the clinic lobby and exam rooms), and animated videos (played on the clinic lobby TV and texted to parents’ phones). Participants also requested live phone calls from Sea Mar to discuss the importance of the vaccine and assist with vaccine scheduling. Final materials will be showcased.Statement of conclusions: We used a modified BCT approach to incorporate participant feedback to develop HPV vaccine messages and materials and identified preferred dissemination channels for rural communities in Washington state. Citation Format: Priyanka Gautom, Jamie H. Thompson, Jennifer S. Rivelli, Ludy Villegas, Anna C. Edelmann, Katherine Vaughn, Becca Slagle, Stephen Gubler, Kaila Christini, Amanda F. Petrik, Gloria D. Coronado, Deanna Kepka. Tailoring human papillomavirus (HPV) vaccine outreach for rural and Hispanic communities in Washington state: A modified Boot Camp Translation approach [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B078.

Background: The human papillomavirus (HPV) virus is a known pathogen and carcinogen causing deadly cancers of the genitalia and head and neck. The HPV vaccine is a safe, effective cancer-preventing vaccine recommended for girls and boys at ages 11-12. Full HPV vaccine coverage is available through health insurance plans and the state of California, yet no data were readily available to describe California state-wide coverage of HPV vaccination. The Data Workgroup of the California HPV Vaccination Roundtable aimed to map State-level HPV vaccine coverage. Methods: Workgroup collected, analyzed, and mapped 2018 HPV vaccination data from the NIS-T survey, quality performance metrics from public and private health plans, and the statewide CAIR. NIS-T provides state-level estimates of routine adolescent vaccines, including HPV. Performance data were obtained from Medi-Cal and commercial health plans, administrative claims, and medical records. CAIR contains individual-level, provider-reported immunizations. HPV vaccination coverage for adolescents were estimated at the state and county level. Maps of county-level HPV vaccination and HPV-related cancer rates were built. Results: Rates of HPV-related cancers ranged from 6-12 per 100,000. Regarding HPV vaccination, there were considerable variation in the metrics and limitations of each data source, therefore estimates are not easily comparable. CAIR estimates of HPV vaccination coverage (28%) are lower than those for Medi-Cal managed care (45%) and commercial HMO members (50%). In 2018, aggregated results showed that overall 50% of 13 year old were vaccinated. We observed in the CAIR data that boys and girls are vaccinated at similar rates. However, significant county/regional HPV vaccination rates exist ranging from 9% (rural, northern) to 55% (urban, western). Northern, rural country have both the lowest HPV vaccination completion rates for 13-year-olds (9%), and the highest HPV-attributable cancer rates in the state (12 cases per 100,000 persons. Race/ethnic variations exist for HPV vaccination and HPV- related cancers–especially cervical cancer. Conclusions: This state-level data report approach may facilitate practice and policy action and help other states in developing their own reports for HPV vaccine improvements. Stakeholders are encouraged to utilize this Report when planning HPV vaccination interventions. We recommend that health systems: 1) assess HPV vaccination rates for 13-year-olds, 2) establish data exchange with CAIR, 3) implement recommended strategies to improve coverage, 4) collaborate with health plans and clinicians and 5) partner with community advocacy groups and clinic/hospital parent/patient advisory groups to improve data accuracy, as well as reduce HPV vaccine hesitance and promote at least 80% HPV vaccination completion by 2026. Citation Format: Jaime Adler, Raquel Arias, Kimlin Tam Ashing, Shauntay Davis-Patterson, Hilary Gillette-Walch, Jeffrey Klausner, Jim Knox, Beverly Mitchell, Autumn Ogden-Smith, Jane Pezua, Rita Singhal, Hoa Su. Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-273.

Background: The Latinx population in the United States faces tremendous health disparities, particularly with regards to cervical cancer. Data from the American Cancer Society show that cervical cancer incidence and mortality rates among Latinx women in the US are 40% and 26% higher than in US whites, respectively. These data are surprising considering cervical cancer is highly preventable through use of the Human Papilloma Virus (HPV) vaccination. About 70% of cervical cancer cases are the result of infection with HPV 16 or 18. The 9vHPV vaccine targets HPV 16 and 18 as well as 7 other HPV strains, and it was recently approved for use by the CDC in women through the age of 45. In 2015, only 44% of US Hispanic girls between the ages of 13 and 17 were vaccinated with all three HPV doses. Prior studies have shown that lack of information, cost, and fear are some of the main barriers that prevent Latinx women from receiving the HPV vaccination and vaccinating their children, and that these factors differ across subgroups of Latinx women. Methods: Our goal was to address these health disparities by assessing whether the Latinx population in East Los Angeles also showed low rates of HPV vaccination, and if so, why these women had not received the vaccination. We administered a promotora led survey (in Spanish) to a random sample of 89 Latinx women (aged 25-79) in East Los Angeles to assess rates of HPV vaccination in women and their children, attitudes towards the HPV vaccine, knowledge about the vaccine, and barriers to vaccination. We hypothesized that there would be differences in knowledge about the HPV vaccine, as well as differences in vaccination rates, based on age (>50) and country of origin (Mexico or other) in Latinx women. Results: We found a significant lack of knowledge about the HPV vaccine that persisted across all 89 women. None of the women surveyed had received a single dose of the HPV vaccinations themselves, either because they “did not think it was necessary,” or “did not know why it was important.” About 76% of women surveyed said they did not know what causes most cervical cancer (99% CI [65%-88%]), and of the 23% of women who said they did know what causes cervical cancer, none of the women cited HPV as a cause (99% CI [12%-35%]). Only 55% of women surveyed had heard about the HPV vaccine (99% CI [41%-68%]), and 82% of women did not understand the purpose of the HPV vaccine (99% CI [72%-93%]). However, Chi Square analysis revealed no significant age or country of origin differences in knowledge about the HPV vaccine or vaccination rates. Conclusions: These data show the need for culturally appropriate interventions that are both language specific and literacy level appropriate, in order to increase knowledge about the importance of HPV vaccination among Latinx women of East Los Angeles, particularly how it relates to cervical cancer prevention. Improved access to health education in the community could increase vaccination rates and decrease rates of cervical cancer in this population. Citation Format: Sarita Sooklal, Rosa Barahona, Lourdes Baezconde- Garbanati. Human papillomavirus vaccination rates and knowledge among Latinx women in East Los Angeles [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-274.

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Cervical cancer (CC) is the most common HPV-associated cancer, and Korean Americans (KAs) experience one of the highest CC incidence and mortality rates among Asian Americans. Awareness and knowledge of HPV and HPV vaccine are essential in preventing HPV-associated cancers; however, studies emphasize low HPV awareness and knowledge among KAs. Although HPV causes cancers in both men and women, there exist misconceptions that the HPV vaccine is only for women and not for men. Furthermore, research on HPV vaccination among KAs has been conducted mostly among women. The health belief model (HBM) is a value-expectancy theory that is used to explain and predict individual changes in health behaviors and has been used in multiple studies that aimed to understand HPV vaccination behavior. Purpose: The purpose of this study is to develop an HBM guided text messaging program to increase HPV awareness, knowledge, and HPV vaccination among Korean young adults in the U.S. Methods: A total of 10 Korean young adults between the ages of 18 and 26 completed the mixed methods study. The survey examined HPV, HPV vaccine, and cervical cancer awareness and knowledge, beliefs, and vaccination intention. The qualitative interview with cognitive response testing (CRT) of the text messages, which were preconstructed based on previous literature and six constructs of HBM, allowed participants to provide feedback on the comprehension and emotional response to the messages, and any other recommendations to improve the content and delivery of the messages. Results: All participants (N=10) indicated to have never received the HPV vaccine and most participants had no intention to receive the HPV vaccine within one year. Although most of the participants were aware of HPV and HPV vaccine, overall knowledge of HPV, HPV vaccine, and cervical cancer were low. The interviews revealed that reasons for vaccine hesitancy and non-vaccination included cost, inconvenience, and low perceived susceptibility. Especially, there was low perception of the importance of HPV vaccination for males. Overall, findings from the CRT showed that there was a clear understanding of the preconstructed text messages. There was a consensus on the duration and timing of the messages and participants provided recommendations on the content, tone, and structure of the messages. Using the HBM, participants’ feedback on HPV awareness, knowledge, and vaccination intention, the text messaging library was revised and includes a total of 9 text messages over the four days. Conclusions: This study provides important insights into the development of an educational text messaging program among Korean young adults in the U.S. Current study will build a foundation for an educational mobile health program to help increase awareness and knowledge of HPV and HPV-associated cancers, as well as HPV vaccination intention, and impact HPV-associated cancer rates among KAs through vaccination in the long term. Citation Format: Min Jeong Jeon, Daisy Le. Development of an educational text messaging program to improve human papillomavirus awareness, knowledge, and vaccination intention among Korean young adults in the U.S. [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C101.

Lessons Learned From Human Papillomavirus Vaccination to Increase Uptake of Adolescent COVID-19 Vaccination

Vaccinating Adolescents—New Evidence of Challenges and Opportunities

HPV vaccination coverage of teen girls: The influence of health care providers

Purpose: The purpose of this study is to determine the association between awareness of human papillomavirus (HPV), cervical cancer, and HPV vaccine and intention to vaccinate preteens and teens against HPV. Background: Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and results in 14 million new cases each year. Around 50% of new HPV infections occur among persons aged 15-24 years old. Cervical cancer is primarily attributable to HPV, and the yearly cost of cervical cancer screening as well as treatment of HPV-related diseases is around $8 billion. In 2009, around 35,000 HPV-related cancers were reported in the United States. The level of coverage for 3 HPV vaccine doses for females aged 13-15 years was only 30% in 2011. This is far below the 80% target coverage level set by Healthy People 2020. The 2013 National Immunization Survey-Teen found that only 50% of Maryland females aged 13-17 years and only 34.2% of male adolescents reported beginning the HPV vaccine series. According to the 2013 Maryland Cancer Data, Maryland had the 25th highest cervical cancer mortality rate from 2006-2010. During these years, more black women were diagnosed with cervical cancer than White women, and their rate of cervical cancer incidence has been increasing at a rate of 4.9% more per year than white women. We investigate the relationship between HPV, cervical cancer, and HPV vaccine awareness and intention to vaccinate preteens and teens against HPV. Methods: Utilizing the principles of community-based participatory research (CBPR), the Johns Hopkins Center to Reduce Cancer Disparities, in collaboration with its Community Advisory Groups in Baltimore City and Prince George's County, developed and implemented a survey to assess the knowledge, awareness and behavioral intentions on cervical cancer, HPV and HPV vaccine. The study was approved by the Johns Hopkins School of Medicine's Institutional Review Board and implemented between March 2015 and July 2015 in Baltimore City and Prince George's County. Four hundred and three individuals recruited through community events completed the assessment. Upon completion of the assessment, participants were given feedback on their responses to address any knowledge gap and educational materials. Binary and multinomial logistic regression were used to determine the association between awareness of HPV, cervical cancer, and HPV vaccine and intention to vaccinate children between the ages of 11 and 18 years against HPV. Results: The majority of study participants were female (78%), black or African American (87%), have at least one year of college or technical school (55%) and have an annual household income of less $20,000 (38%). Awareness of the existing of HPV vaccine is significantly associated (OR=2.54, P<0.0007, CI 1.487-4.355) with the intention to vaccinate children against HPV. We also found that individuals who never heard of the HPV vaccine are significantly less likely (OR=0.394, p<0.0007, CI 0.230-0.673) to vaccinate their children against HPV than those who have heard of the vaccine. Furthermore, those who are aware of HPV are significantly more likely to know that HPV can cause cervical cancer (OR=5.25, P<0.0001, CI 3.272-8.454) and to know that HPV is transmitted through sexual contact (OR=3.66, P<0.0001, CI 2.199-6.100) compared to those who never heard of HPV. Conclusion: Awareness of HPV, cervical cancer, and HPV vaccine are significantly associated the intention to vaccinate children between the ages of 11 and 18 years against HPV. Increasing knowledge of cervical cancer and the importance of HPV vaccination among parents and caretakers of preteens and teens have the potential to increase the rates of HPV vaccination and prevent future cervical cancers. More research is needed to explore other factors that are related to HPV vaccination. Citation Format: Ahmed Elmi, Saad Tassaduq, Olive Mbah, Ashleigh DeFries, Lee Bone, Anjani Kapadia, Theron Scott, Nichole Tuite, Adrian Dobs. Challenges and opportunities for increasing the rates of HPV vaccination. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A86.