HPV Vaccine Initiation Research Articles

Abstract B069: Designing a Hispanic/Latino community-driven HPV vaccine and HPV-related cancer awareness campaign for young adults and youth in Los Angeles County

Abstract Background: In Los Angeles, HPV vaccination is lowest among Hispanic/Latino (HL) youth, young adults, and HL adolescent girls of immigrant parents, despite HPV vaccination preventing more than 90% of cancers attributed to HPV infection. This study aims to address gaps in the HPV vaccine and HPV-related cancer awareness through community-driven exploration of multimedia sources and cultural tailoring of the Es Tiempo Campaign to HPV vaccine initiation materials. Methods: A mixed-methods design was used, combining quantitative surveys, qualitative listening sessions and focus groups. In May 2024, five youth between 14 and 17 years of age and seven young adults between 18 and 30 years of age who self-identified as HL were recruited through community outreach in Los Angeles. The twelve participants were surveyed and participated in two 90-minute Listening Sessions (grouped by age) to gather formative data. During the LS, participants reviewed culturally tailored designs of media materials (e.g., banners, posters) focused on HPV vaccination initiation. Focus groups with another twelve young adults gathered confirmative data. Descriptive statistics assessed demographics. Coding of transcripts identified themes. Results: Preliminary results from the Listening Sessions found that youth and young adults had similarities and differences in their preferences for receiving health information. Both age groups preferred health materials with visually appealing images and materials that could be easily found and distributed. All relied on health information provided by their providers including informational pamphlets, texts, and emails. Differences were found in whom they sought health advice from. Youths sought health advice from parents or family, while young adults did this too but only after reviewing health information first online. Both age groups identified social media, such as Instagram and TikTok as key sources for health information. However, neither group wanted to receive health information through Facebook or Twitter. Young adults wanted images showing HL patient-provider interactions, while youth preferred images of family or community. Youth liked cartoon-style images, but young adults wanted images of real HL people. For cultural tailoring, youth liked images that reflected a traditional colorful border. Young adults found this border was not representative of diverse HL communities. Conclusion: Community-driven research identified gaps in tailoring and guiding multimedia dissemination efforts for HPV vaccine initiation campaign materials among youth and young adults in the HL community. HL youth and young adults, as community informants, provided advice on multimedia platforms, design appropriateness, and comprehension. Community participation is essential to identify and create culturally competent designs at an appropriate literacy/language and age level and to produce materials for educational campaigns that are not only culturally specific but also visually appealing to the target population. Citation Format: Samantha Verganza, Patricia Escobedo, Rosa Barahona, Lourdes Baezconde-Garbanati. Designing a Hispanic/Latino community-driven HPV vaccine and HPV-related cancer awareness campaign for young adults and youth in Los Angeles County [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 B069.

Abstract A066: Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019)

Abstract Introduction: The HPV vaccination rates among Asian American adolescents were found to be below optimal levels. Understanding the high-risk demographics and the various factors influencing HPV vaccine acceptance is essential for addressing disparities and enhancing vaccination rates in this population. This study aimed to investigate HPV vaccine uptake in adolescents aged 13 to 17 across six major Asian American ethnic groups using nationally representative data. Methods: The study analyzed data from the National Immunization Survey- Teen (2015-2019), comprising 3,968 Asian American adolescents from Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese backgrounds. Provider and practice characteristics were examined alongside HPV vaccine initiation and completion rates within each subgroup. Results: Findings revealed that while the overall initiation rate among Asian American adolescents was 66.65%, significant variations existed among subgroups, ranging from 57.3% in Asian Indians to 71.22% in Chinese adolescents. Similarly, completion rates ranged from 30.89% in Asian Indians to 48.14% in Chinese adolescents, with an aggregated completion rate of 40.37% for the total Asian American sample. Household survey data generally showed lower initiation and completion rates compared to provider-reported data but still reflected subgroup disparities. Conclusion: Across all ethnic groups, a common barrier to HPV vaccination was the lack of physician recommendation. However, slight variations in this barrier were observed among subgroups. These findings underscore the importance of considering socioeconomic, cultural, and acculturation-related factors in designing effective public health and clinical interventions to promote HPV vaccination among Asian American adolescents. Citation Format: Lin Zhu, Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma. Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019) [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 A066.

A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial

BackgroundHuman papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.MethodsThe study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18–26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4–6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention.DiscussionRecruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden.Trial RegistrationNCT05057312.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs.

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states

BackgroundWe assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child.MethodsAn online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9–17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level.ResultsAnalyses were conducted using responses from 926 parents about their oldest child in the target age range (9–17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children.ConclusionsThe results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.

Boot Camp Translation using Community-Engaged messaging for adolescent Vaccination: A Cluster-Randomized trial

BackgroundRoutine vaccination coverage for adolescents living in the rural US is lower than adolescents living in urban areas. We sought to measure the effect of Boot Camp Translation (BCT), a community-based participatory intervention, on rural adolescent vaccination coverage. MethodsA cluster randomized controlled trial was performed September 2018-November 2021 involving 16 rural Colorado counties. Intervention county community members engaged in BCT to develop interventions to improve adolescent vaccination locally. Adolescent vaccination coverage was measured using the Colorado Immunization Information System. ResultsFor 11–12-year-olds, HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage was lower post- versus pre-intervention in the control and intervention groups. For 11–12-year-olds in the intervention group, there was no significant difference post- versus pre-intervention in the odds of HPV vaccine initiation (adjusted ratio of odds ratios [aROR] = 0.93, 95 %: 0.85–1.02, p = 0.10) or up-to-date HPV vaccination (aROR: 1.10, 95 % CI: 0.98–1.23, p = 0.11) compared with the control group. Among 11–12-year-olds, the decrease in the proportion vaccinated with MenACWY and Tdap in the intervention group was significantly greater than the control group. Among 13–17-year-olds, there were significant increases in HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage from pre- to post-intervention for both groups, with no significant differences between groups. Conclusion11–12-year-old vaccination coverage decreased slightly from pre- to post-intervention while 13–17-year-old vaccination coverage increased. We saw no effect from the BCT intervention. Our findings about the effectiveness of BCT for improving vaccine uptake may not be generalizable because the study coincided with the COVID-19 pandemic.Clinical Trial Registry: This study was registered with ClinicalTrials.gov, NCT03955757.

Mothers’ perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

ABSTRACT HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers’ hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Multicomponent Strategy Improves Human Papillomavirus Vaccination Rates Among Adolescents with Sickle Cell Disease

ObjectiveTo evaluate the effectiveness of a vaccine strategy bundle to increase HPV vaccine initiation and completion in a specialty clinic setting. Study DesignOur Hematology clinic utilized an implementation framework from October 1, 2018, to December 31, 2019, involving nurses, nursing coordinators, and clinicians in administering the HPV vaccination series to our adolescent sickle cell sample of nearly 500 patients. The bundle included education for staff on the need for HPV vaccine administration, provider incentives, vaccines offered to patients in SCD clinics, and verification of patients' charts of vaccine completion. ResultsFollowing the implementation of the bundle, the cumulative incidence of HPV vaccination initiation and completion improved from 28% to 46% and 7% to 49%, respectively. Both rates remained higher post-implementation as well. HPV vaccination series completion was associated with a decreased distance to the healthcare facility, lower state deprivation rank, and increased hospitalizations. ConclusionOur clinic's implementation strategy successfully improved vaccine completion rates among adolescents with SCD while continuing to educate staff, patients, and families on the importance of cancer prevention among people living with SCD.

Exploring HPV vaccine knowledge, attitudes, barriers and information sources among parents, health professionals and teachers in Kazakhstan: a mixed-methods study protocol

IntroductionHuman papillomavirus (HPV) is a prevalent sexually transmitted infection linked to certain types of malignant neoplasms, notably cervical cancer (CC). In Kazakhstan, a high prevalence of high oncogenic HPV types...

County-level correlates of completed HPV vaccination in Indiana

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9–14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9–14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

HPV Vaccination among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion.

The purpose of this study was to examine factors related to HPV vaccination initiation and completion, especially the role of health knowledge, among college students in a southern state. College students ages 17-45 (n=1,708) were analyzed in this study. Primary outcomes were HPV vaccine series initiation and completion; binary logistic regressions were performed to identify associated factors. Among total participants, students who were aware that HPV could be transmitted even without symptoms were less likely to initiate HPV vaccination. However, among students who have initiated the vaccine series, those who were aware that HPV could be transmitted without symptoms and that men should receive the HPV vaccine were more likely to complete the vaccine series. Other significant variables included age, gender, race, and international student status. Future studies are needed to investigate students' concerns regarding initiating HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series.

Abstract 753: HPV vaccine uptake in survivors of childhood and adolescent and young adult (AYA) cancer

Abstract Introduction: There will be an estimated 110,000 children and adolescents’ cancer survivors in the United States (US) in 2022. Previous studies have argued for the establishment of a specialized adolescent and young adult (AYA) oncology service to better serve their needs. Studies have demonstrated that survivors of childhood and AYA cancers remain at higher risk of developing second primary cancers over their lifetime. AYA cancer survivors are a growing part of the population and will benefit from HPV vaccination. Documenting HPV vaccine uptake among cancer survivors will facilitate interventions to improve vaccination rates in this population. Despite evidence supporting the efficacy of HPV vaccination, AYA vaccination rates are low. Furthermore, studies assessing HPV vaccination coverage in survivors of AYA cancer are lacking. Therefore, we assessed HPV vaccine initiation and completion between survivors of AYA cancer and respondents without a cancer diagnosis among 18-35-year-old in the US. Methods: We analyzed data from the 2017-2018 National Health Interview Survey, an annual cross-sectional national survey that provides information on the health of the noninstitutionalized US population. The outcome variables were HPV vaccine initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Exposure was cancer survivorship (AYA cancer survivors [respondents who were diagnosed with cancer as a child, adolescent, or young adult] vs. respondents without a cancer diagnosis). Weighted multivariable logistic regression models were used to examine the association between cancer survivorship and HPV vaccine initiation and completion, controlling for socioeconomic and healthcare access related factors. Results: A total of 2,942 respondents were included in the study, of which 242 (7.1%) were AYA cancer survivors. HPV vaccine initiation (22.5%) and completion (16.3%) among AYA cancer survivors were comparable to respondents without cancer diagnosis (initiation: 25.5%, completion: 15.3%). In the adjusted analyses, there were no significant differences in HPV vaccine initiation (P=0.6770) or completion (P=0.2001) between AYA cancer survivors and respondents without cancer diagnosis. Conclusions: HPV vaccine series initiation and completion were comparably low among AYA cancer survivors and respondents without a cancer diagnosis in our study. Low uptake of HPV vaccine among AYA cancer survivors is a more notable public health concern given their heightened immunocompromised status and elevated risk for second primary cancers. There is a need for primary care and oncology providers to encourage HPV vaccination and raise awareness of its crucial role among families of AYA cancer survivors. Citation Format: Mrudula Nair, Chaitali S. Dagli, Betelihem B. Tobo, Samantha H. Tam, Nada Al-Antary, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. HPV vaccine uptake in survivors of childhood and adolescent and young adult (AYA) cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 753.

Adolescents Who Have Undergone Human Papillomavirus Vaccination Are More Likely to Get a COVID-19 Vaccine

PurposeHuman 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. MethodsWe 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. ResultsWe 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). DiscussionPatterns of vaccination uptake suggest possible advantages to co-promotion of adolescent vaccines.

23 Identifying HPV vaccination initiation hot and cold spots and associated disparities in Texas

Over 90% of HPV-associated cancers are preventable through HPV vaccination. Only 43.5% of Texas adolescents, however, have completed the vaccine series, and the state ranks 47th in vaccination rates across the country. The goal of this study was to examine the geospatial uptake of the HPV vaccine in Texas and the associated disparities. HPV vaccine data from 2017–2021 was obtained from the Texas Department of State Health Services. Zip code-level estimates of individuals 9 years and older who received at least one HPV vaccine since 2017 in the Texas Immunization Information System (ImmTrac2) database were used to create a choropleth map. Through the Environmental Science Research Institute's (ESRI) ArcGIS Pro Version 2.2.0 software, the Cluster and Outlier Analysis Tool was used to determine a “neighborhood” around each zip code. Zip codes were subsequently demarcated as hot or cold spots (or neither) based off Local Moran's I score calculations, meaning they had a statistically significant greater or lesser concentration of vaccinations than would be expected from a random distribution. After identifying hot spots and cold spots of vaccine initiation, we explored the demographic neighborhood characteristics. 346 statistically significant hot and 374 cold spot zip codes of HPV vaccine initiation were identified (Fig. 1). The remainder of the zip codes (1115) were outliers or not part of statistically significant clusters. Hot spot zip codes, or areas of high vaccine initiation, were found along the Gulf coast, in large cities, and in less developed areas near the Texas panhandle. Cold spot zip codes were in the northern Texas panhandle, along the Texas–Louisiana border, and on the periphery of major cities. Compared to cold spot zips, hot spots had significantly higher percentages of children on public insurance, had higher poverty rates, and had higher percentages of African American and Hispanic residents.Download : Download high-res image (217KB)Download : Download full-size image In Texas, areas with higher poverty rates, increased use of public insurance, and higher percentages of minority populations had significantly higher rates of HPV vaccine initiation. This may be due to differences in patient interest in the vaccine, to vaccine access through government insurance, or to outreach efforts that have promoted the vaccine in especially vulnerable populations.

EPH109 Impact of COVID-19 Pandemic on HPV Vaccine Initiation Rates in Adolescent Girls: Projected Time to Reverse Dose Deficits in France

EPH109 Impact of COVID-19 Pandemic on HPV Vaccine Initiation Rates in Adolescent Girls: Projected Time to Reverse Dose Deficits in France

Vaccine Schedule Disparities Exist for Pediatric Patients with Sickle Cell Disease

Background: Sickle cell centers and pediatricians often work together to ensure appropriate vaccination of patients with sickle cell disease (SCD). Patients with SCD are at high risk for serious infections with encapsulated bacteria, such as Neisseria menigitidis and Streptococcus pneumoniae; thus, vaccine recommendations for pediatric patients with SCD differ from those for the general population. The University of Alabama at Birmingham Lifespan Comprehensive Sickle Cell Center (UAB) encompasses four care locations: the academic center in Birmingham and three satellite clinics (Montgomery, Opelika, Tuscaloosa). Unlike the academic center where providers are reliant on pediatricians to ensure adherence to recommended vaccines (with the exception of PPSV23), patients seen in the satellite clinics are provided with a prescription for PPSV23 and instructed to obtain it through their pediatrician. Data from prior studies suggest that pediatric patients with SCD may have lower vaccination rates than the general population. Thus, the purpose of this study was to determine adherence to recommended SCD-specific vaccination schedules among pediatric patients cared for at UAB , by: 1) determining the mean age at initiation of the HPV, MenACWY, Men B, and PPSV23 vaccines among UAB pediatric patients, compared with SCD-specific recommendations for initiation of each of these vaccines; and 2) comparing vaccination rates for HPV, MenACWY, and Men B among UAB pediatric patients age 13-17 years vs. general population peers. Methods: We performed a retrospective chart review of clinic notes and the Alabama state vaccine registry (Immunization Patient Registry with Integrated Technology [ImmPRINT]) for records of UAB patients, to determine the age at vaccine initiation and number of doses received for HPV, MenACWY, Men B, and PPSV23 vaccines for all 870 UAB patients aged 3-22 years. We calculated the mean age at which the UAB patients initiated each vaccine, the proportion of patients completing each vaccine series, and (for PPSV23) whether patients were vaccinated at UAB or at another location. We used CDC published vaccination rates for HPV, MenACWY, and MenB from 13-17-year-olds in the general population (Pingali et al., MMWR Morb Wkly Rep 2021) to compare with rates from UAB patient peers. Results: The 870 UAB patients were an average age of 12.1 ± 5.4 years; 51.5% were male and 33.9% received most of their care at satellite clinics. HPV vaccination: Mean ±SD age at HPV vaccine initiation was 11.3±1.2 years (recommended age at first dose=11 years, there are no SCD-specific guidelines for HPV vaccination); coverage for HPV vaccine series initiation and completion among 13-17-year-old UAB patients vs. general population peers was 77.8% vs. 75.1% and 58.2% vs. 58.6%, respectively (Table). Meningococcal [MenACWY] vaccination: Mean±SD age at MenACWY initiation was 11.2±1.8 years (recommended age for patients with SCD is 2 months (MenACWY Menveo) or 24 months (MenACWY Menactra); recommended age for general population is 11 years). We found that patients with SCD were 32 (95% confidence interval [CI]: 22-47) times more likely to receive MenACWY after age 11 years. Meningococcal B [MenB] vaccination: Mean age at MenB initiation was 13.5±2.3 years (recommended age for SCD patients is 10 years; vaccine is optional for general population); coverage for ≥1 MenB dose among 13-17-year-old UAB patients vs. general population peers was 17.5% vs. 28.4%, respectively. PPSV23 vaccination: Overall PPSV23 coverage for UAB patients was 70.6%; patients seen at the academic medical center were 1.5 (95%CI, 1.1-2.0) times more likely to receive PPSV23 than patients seen at a satellite clinic (75.2% vs. 59.6%, respectively). Conclusion: Adherence to SCD-specific vaccination age recommendations is poor. We found that patients with SCD were more likely to receive vaccines according to the general population vaccine schedule rather than the SCD-specific vaccine schedule. In addition, reliance on pediatricians to provide PPSV23 for satellite clinic patients resulted in lower PPSV23 vaccination rates among these patients. These data suggest a disparity in adherence to SCD-specific vaccination schedules and suggest the need to develop and test a healthcare provider-focused intervention aimed at improving adherence to the SCD-specific vaccination schedule for children with SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

HPV vaccination initiation among white, black and Middle East North African (MENA) males

ObjectivesUS males initiate HPV vaccination at older ages than females and currently have low population coverage. We aim to describe the prevalence and predictors of HPV vaccination initiation among males of White, Black, and Middle-Eastern/North-African (MENA) descent in southeast Michigan. MethodsWe conducted three community-based surveys in 2019 that provided primary data via self report. Using population weights and multivariate modeling, we measured the prevalence and predictors of HPV vaccine initiation in each race/ethnicity of men (age 18–34 years) analyzed. ResultsThe vaccine initiation rates were 44.5 % (95 % CI: 44.4, 44.6) for White men, 46.2 % (46.0, 46.4) for Black men, and 23.2 % (22.8, 23.6) for MENA men, (p < 0.001). Being a student, compared to unemployed or disabled, was significantly associated with HPV vaccine initiation across all three races/ethnicities. Married men of any race/ethnicity were unlikely to be vaccinated. MENA men born in the US and having some college education were also more likely to initiate HPV vaccination. ConclusionsWhite, Black, and MENA men are not vaccinated in accord with Healthy (Healthy People 2030, 2022) goals. Each race/ethnicity has different predictors of vaccination.

Contributors to cervical cancer disparities in American Indian/ Alaska Native women: Is sufficient research being performed in this population? (572)

<b>Objectives:</b> American Indian/Alaska Native (AIAN) women have 1.5 times the incidence and twice the mortality rate of cervical cancer compared to Non-Hispanic White (NHW) women. This disparity is not limited to cervical cancer but is seen in pap smear screening and HPV vaccination uptake. There appear to be few studies in the literature specific to AI/AN women and the prevention and treatment of cervical cancer. We performed a systematic scoping review to evaluate what is known and what gaps in the literature exist related to cervical cancer and its prevention specific to AI/AN women. <b>Methods:</b> We conducted a systematic scoping review of the literature published between 1990 and 2020 regarding <i>1)</i> cervical cancer epidemiology (incidence, prevalence, and mortality); <i>2)</i> cervical cancer screening and prevention (HPV status, HPV vaccine initiation and completion, cervical cancer screening); and <i>3)</i> cervical cancer diagnoses (presence of cervical dysplasia, and cervical cancer stage) among AI/ANs. Medical Subject Headings (MeSH) terms and key search terms were developed to search PubMed and Scopus databases. Abstracts were separately reviewed and compared; disagreements were discussed, and a consensus was achieved. Data were abstracted for included articles. <b>Results:</b> Our search yielded 515 citations; 146 articles met inclusion criteria and were included in our review. The median impact factor for published articles was 2.14 (0-292). Descriptive studies represented 58.9% of all published articles, followed by observational (23.2%) and interventional studies (11.6%). Cervical cancer screen- ing/dysplasia was the most commonly published topic (50.6%), followed by epidemiologic studies (23.9%), HPV (22.6%), and invasive cancer (2.7%). The Indian Health Service (IHS) regions most heavily represented were the Alaska Area and Great Plains Area (Figure 1). Of the 110 articles in which the funding source was documented, 83.6% were federally funded, 11.8% were funded by a non-profit agency, and the remaining 4.6% were funded by a combination of federal, nonprofit, and/or private industry. <b>Conclusions:</b> AI/AN women continue to experience persistent health disparities related to severe dysplasia and cervical cancer. Our review demonstrates that AI/AN women remain understudied in the literature, with a scant 146 articles published over a 20-year period. We conclude that more resources are needed to be invested in the future to eliminate this preventable cancer in AI/AN women.

Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas.

This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).

AVPCancerFree: Impact of a digital behavior change intervention on parental HPV vaccine –related perceptions and behaviors

ABSTRACT Parent hesitancy contributes to reduced HPV vaccination rates. The HPVcancerfree app (HPVCF) was designed to assist parents in making evidence-based decisions regarding HPV vaccination. This study examined if parents of vaccine-eligible youth (11–12 yrs.) who use HPVCF in addition to usual care demonstrate significantly more positive intentions and attitudes toward HPV vaccination and greater HPV vaccination rates compared to those not using HPVCF. Clinics (n = 51) within a large urban pediatric network were randomly assigned to treatment (HPVCF + usual care) or comparison (usual care only) conditions in a RCT conducted between September 2017 and February 2019. Parents completed baseline and 5-month follow-up surveys. Participant-level analysis determined 1) change in HPV vaccination initiation behavior and related psychosocial determinants and 2) predictors of HPV vaccine initiation. Parents (n = 375) who completed baseline and 5-month follow-up surveys were female (95.2%), 40.8 (±5.8) yrs. married (83.7%), employed (68.3%), college educated (61.9%), and privately insured (76.5%). Between-group analysis of HPVCF efficacy demonstrated that parents assigned to receive HPVCF significantly increased knowledge about HPV and HPV vaccination (p < .05). Parents who accessed content within HPVCF significantly increased knowledge about HPV & HPV vaccine (p < .01) and perceived effectiveness of HPV vaccine (p < .05). Change in HPV vaccine initiation was not significant. A multivariate model to describe predictors of HPV vaccine initiation demonstrated an association with Tdap and MCV vaccination adoption, positive change in perceived effectiveness of the HPV vaccine, and reduction in perceived barriers against HPV vaccination. HPVCF appears to be a feasible adjunct to the education received in usual care visits and reinforces the value of apps to support the important persuasive voice of the health-care provider in overcoming parent HPV vaccine hesitancy.