Adolescent Human Papillomavirus Vaccination Research Articles

VACINAÇÃO CONTRA O HPV EM ADOLESCENTES: BENEFÍCIOS, DESAFIOS E PERSPECTIVAS - UMA REVISÃO SISTEMÁTICA

Introduction: Vaccination against the Human Papillomavirus (HPV) is a fundamental intervention for the prevention of cancers related to the virus, especially cervical cancer. Although recommended by the World Health Organization (WHO) and included in several national immunization programs, adolescent vaccination adherence still faces barriers. This systematic review aims to evaluate the benefits, challenges and prospects of HPV vaccination in adolescents, focusing on studies that address both clinical efficacy and factors influencing vaccine acceptance and coverage. Methodology: A search was conducted in the databases Latin American and Caribbean Literature in Health Sciences (LILACS) and Virtual Library in Health (VHL) to identify studies published between 2018 and 2024. Scientific studies were included that evaluated the effectiveness of vaccination, the perception of parents and adolescents, and public policies to encourage vaccination. Results and discussion: HPV vaccination shows up to 90% effectiveness in preventing infections by oncogenic strains of the virus. However, factors such as misinformation, fear of side effects and cultural resistance were identified as the main challenges for vaccine adherence. The implementation of educational campaigns and the strengthening of public policies aimed at immunization were highlighted as effective strategies to increase vaccination coverage. Conclusion: HPV vaccination in adolescents offers clear benefits in the prevention of virus-related diseases, such as cervical cancer. However, challenges such as low acceptance and misinformation about vaccine safety need to be overcome in order to maximize its effectiveness at the population scale. Coordinated actions between governments, health professionals and communities are needed to increase uptake and ensure broad and effective vaccination coverage.

Association Between a Mother's Cervical Cancer Screening and Child's Human Papillomavirus (HPV) Vaccination Status.

To investigate the association between maternal cervical cancer (CC) screening status and child human papillomavirus (HPV) vaccination uptake. To understand if child sex or social deprivation index (SDI) modify this association. We used a national cohort of children linked to at least one parent using electronic health record (EHR) data from a network of community health centers across the United States. We used SDI scores and child sex as moderating variables. We performed the analysis (1) for the whole sample (with SDI and child sex added as covariates), (2) stratified by SDI quartile (with child sex added as a covariate), and (3) stratified by SDI quartile and child sex, to examine whether associations vary by SDI quartile and by child sex. N = 52,919 linked mother-child pairs. Mother's receipt of CC screening was positively associated with the linked child's odds of receiving HPV vaccination [adjusted odds ratio (AOR) 1.39, 95% confidence interval (CI) 1.32, 1.47]. Neither sex or SDI modified this association. There were no significant differences in odds of HPV vaccination in children between SDI quartiles or between male and female children. An effective way to improve rates of HPV vaccination among children and adolescents may be to target attention towards increasing CC screening rates among mothers. Further, focusing resources and efforts on CC screenings and care of both mothers and their children may be more worthwhile than isolated efforts targeting HPV vaccination for children and adolescents.

Abstract A065: How accurate are parents' recalls? Factors affecting the concordance of parental and provider reports of HPV vaccination among African American adolescents

Abstract Objectives. Since the introduction of the human papillomavirus (HPV) vaccine in 2006, substantial efforts have been made at the national and state levels to monitor its uptake and understand the factors influencing vaccination. Most studies have focused on the acceptability and intent to vaccinate among adolescents and their parents, providing limited insights into how this understanding affects actual vaccine uptake and completion. A common method for measuring adolescents' vaccination status is parental recall. While some research has assessed the accuracy of parental recall, its implications have not been thoroughly explored. African Americans are disproportionately affected by HPV-related cancers, with higher mortality rates for cervical and oropharyngeal cancers compared to non-Hispanic whites. This study examined the accuracy of parents' reports of their adolescent children's HPV vaccination status and how this accuracy varied by socio-demographic characteristics within the Black/African American community. Methods. Data were taken from the 2015–2019 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents’ and providers’ reports of teens’ HPV vaccine initiation (at least 1 dose) and completion (3 doses) among Black/African American adolescents between the age of 13 to 17. We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic. Results: In a cohort of 68,205 adolescents (51.2% male, 95% CI: 50.4%-51.8%; 48.8% female, 95% CI: 48.2%-49.5%), parental reporting discrepancies in vaccination status were observed. Girls' parents were more likely to underreport (β=0.10, p=0.03) and overreport (β=0.10, p=0.03) vaccination status compared to boys' parents. Mothers with higher education levels were less likely to underreport, while single mothers were more likely to underreport (β=0.15, p=0.02) and overreport (β=0.17, p=0.008) vaccination status. Conclusions: Discrepancies between physician-reported and parental-reported HPV vaccination records among African American teenagers were observed, with parental reporting accuracy varying based on the child's gender and the mother's education level and marital status. Strategies to improve parental reporting accuracy and address disparities are needed to increase HPV vaccination rates and reduce HPV-related diseases in the African American community. Citation Format: Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma, Lin Zhu. How accurate are parents' recalls? Factors affecting the concordance of parental and provider reports of HPV vaccination among African American adolescents [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 A065.

Abstract A162: The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles

Abstract Objective: This study aims to investigate the association between parental barriers to healthcare access and HPV vaccination uptake among Latino adolescents in Los Angeles. Background: Human papillomavirus (HPV) induced cervical cancer (CC) remains a significant public health concern. Routine HPV vaccination has been recommended in the United States for girls since 2006 and boys since 2011 yet disparities in vaccine initiation and completion persist, particularly among Latino adolescents in Los Angeles. Methods: This cross-sectional study analyzed child data provided by mothers recruited from the Es Tiempo campaign (2016-2018). A total of 353 Latino adolescents aged 9 to 26 years were included in the sample. We used crosstabs to assess vaccine initiation and completion differences by child sex and birth order, while logistic regression models were used to evaluate the association between parental barriers to healthcare, such as lack of health insurance and access to a primary care provider (PCP), and HPV vaccination initiation. Results: Among the sample, 44% initiated the HPV vaccine, and 23% completed the series, with significantly higher rates among girls and firstborn children. Regarding barriers, lack of health insurance was associated with decreased odds of HPV vaccination uptake while access to a PCP showed a slight increase in vaccination uptake odds. Conclusion: HPV vaccination uptake among Latino adolescents in Los Angeles remains suboptimal, with disparities observed by gender and birth order. To improve public health outcomes, targeted interventions are needed to increase HPV vaccination uptake among Latino adolescent boys, and further research is needed to understand vaccine adherence patterns within families and among siblings. Moreover, while parental barriers to healthcare may influence vaccination uptake, future studies should also explore how factors like parental education level and socioeconomic status influence HPV vaccination status in combination with access barriers. Citation Format: Anju F. Kane, Lourdes Baezconde-Garbanati. The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles [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 A162.

Attitudes toward Adolescent HPV Vaccination after the COVID-19 Pandemic: A National Survey of Mothers.

In the United States, vaccination rates for many routinely recommended vaccines have recovered to pre-pandemic levels, yet human papillomavirus (HPV) vaccination rates still lag pre-pandemic levels. This study sought to uncover the potential effects of the pandemic on attitudes about the HPV vaccine, and factors associated with changes in attitudes. We conducted a national survey (n = 3968) of U.S. mothers with children aged 9-17 years. Outcome variables measured changes in attitude toward the HPV vaccine following the pandemic. Two logistic regression models identified predictors of (1) those who did not have attitude changes (always negative vs. always positive), and (2) those who reported attitude changes (change to negative vs. change to positive). Attitudes toward the HPV vaccine remained unchanged in 78.9% of participants (58.1% positive, 20.8% negative). Of the 21.1% reporting changed attitudes, 9.6% changed to positive and 11.5% to negative. Those reporting changing to a negative attitude had a greater odds of reporting conservative political views, and being unsure/undecided about vaccinating their child against HPV compared to those who reported changing to a positive attitude. Targeted strategies are needed to address erosion in confidence in the HPV vaccine and other vaccines resulting from mis- and disinformation associated with the COVID-19 pandemic and future pandemics.

Disparities in HPV Vaccination Among Adolescents by Health Care Facility Type

Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US. This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022. Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy). Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics. A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities. These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.

Improving HPV Vaccination Uptake Among Adolescents in Low Resource Settings: Sociocultural and Socioeconomic Barriers and Facilitators.

Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings

PurposeParental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County. MethodsParents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9–17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV. ResultsA total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information. DiscussionOur findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.

Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System.

Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.

Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review.

US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. PubMed, Embase, and Scopus databases. Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.

School Teachers' Perceptions of Adolescent Human Papillomavirus (HPV) Vaccination: A Systematic Review.

School nurses are uniquely positioned to educate students about immunizations, including human papillomavirus (HPV) vaccination, but schools are often without a nurse for different reasons. In lieu of nurses, teachers who closely interact with students and are traditionally well-trusted by parents may be able to communicate about HPV vaccination, alleviating parental vaccine hesitancy. This systematic review explores school teachers' perspectives on adolescent HPV vaccination and factors influencing their willingness to make vaccine recommendations. We searched three databases with appropriate medical subject headings and keywords to identify relevant studies. We reviewed fifteen studies and provided an extensive summary and a comparison of the results across the studies. Teachers had low to moderate levels of HPV knowledge with low self-efficacy to counsel parents about the HPV vaccine and expressed concerns about the vaccine condoning adolescent sexual activity, vaccine side effects, and parental disapproval. Nonetheless, some teachers showed interest in learning about vaccine effectiveness in preventing HPV-associated cancers and wanted guidance on vaccine communication with parents, viewing schools as adequate venues to promote and deliver HPV vaccines. Schools should consider educating teachers on HPV and HPV vaccination, with a focus on effective vaccine communication practices to increase adolescent HPV vaccine uptake.

Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series

BackgroundUp-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. MethodsA secondary analysis of The National Immunization Survey – Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. ResultsThe final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9–10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78–8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65–0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46–0.96). ConclusionStrong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

ABSTRACT This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9–17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers’ attitudes, information sources, and trust in those sources were associated with their adolescent’s HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

Stories to Prevent Cancer: A Pilot Study Using Cancer Survivor Narratives to Increase Human Papillomavirus Vaccine Intentions.

Human papillomavirus (HPV) vaccination rates are lower than other recommended adolescent vaccines. Cancer survivor narratives are used to promote cancer prevention and control, but little is known about their impact on adolescent HPV vaccination. This pilot study explored the feasibility and effects of a video education intervention using a cancer survivor narrative to improve parents' attitudes toward and intentions to get the HPV vaccine. This study utilized a one-group design; participants completed a pre-intervention survey, watched the video before attending their sons' wellness visits, and completed a post-intervention survey within one week of their appointment. Using the narrative persuasion framework, we developed a 4-minute video of a local HPV-related cancer survivor to promote the HPV vaccine as cancer prevention. We recruited 37 participants between June and October 2020. Participants were parents of males ages 9-17 who had not yet initiated HPV vaccination. After the video, more parents agreed that HPV vaccination is safe (pre: 66% vs. post: 82%; P = .045) and that their child's chances of getting HPV-related cancer in the future are high (pre: 24% vs. post: 46%; P = .014). Overall, 91% of parents felt the cancer survivor story helped them understand the risks of HPV cancers, and 52% said the story influenced their decision to start HPV vaccination for their child. Our findings suggest that cancer survivor narratives influence parents' vaccine opinions and understanding of their child's risk of HPV infection, leading to increased parental intent to get the HPV vaccine for their adolescent males.

Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England.

Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.

Determinante namere vakcinisanja protiv humanog papiloma virusa kod učenika

Introduction: Human papillomavirus (HPV) is the virus that is most often associated with cancers. Cervical cancer is one of the leading public health problems, especially in developing countries. In the Republic of Serbia, cervical cancer is the fifth most common cancer in the female population amongst all malignant diseases, and HPV infection is the most important risk factor for the occurrence of this disease. This study aims to identify the determinants of adolescent HPV vaccination intention. Materials and methods: The study was conducted as a cross-sectional study including a total of 748 students, aged 12 -19 years, from one high school and two elementary schools in Šabac. The research instrument was a questionnaire, particularly constructed for this study. Multiple regression analysis was applied to examine the predictive model for explaining the HPV vaccination intention in young people. Results: The proposed model explains 66% of HPV vaccination intention in young people. The strongest predictor of HPV vaccination intention in young people relates to the subjective norm, i.e., social pressure from peers and other people who are important to them. Distrust of the benefit of vaccination, concern about commercial profiteering, and belief in a "vaccine conspiracy" have a significantly smaller but statistically significant contribution in explaining HPV vaccination intention amongst our youth. Conclusion: Increasing social pressure to get vaccinated, as well as changing certain attitudes and beliefs about vaccines in general, may lead to an increase in the intention of young people to get vaccinated against HPV. Understanding the key aspects of the attitudes of young people in Serbia towards HPV vaccination opens the possibility of creating evidence-based public health policies and planning targeted health-educational interventions directed at the identified findings.

Exploring Delivery of Adolescent Preventive Health Services During the COVID-19 Pandemic: Perceptions and Experiences Shared by Healthcare Professionals

Abstract Background While unmitigated vaccine hesitancy was already growing before the emergence of COVID-19, the global pandemic has introduced additional challenges to the immunization sector. Despite the benefits, routine preventive care was forestalled by challenges related to pandemic lockdowns/quarantine, parental reluctance to seek preventative services, poor access to healthcare, loss of income and/or health insurance, and the inability of children under 12 to be immunized against the coronavirus. Considering the potential impacts caused by the pandemic’s disruption of adolescent preventative care services, we explored the experiences of adolescent healthcare providers in Tennessee and Georgia in providing care throughout the COVID-19 pandemic. Methods A series of in-depth qualitative interviews were conducted between December 2020 and May 2021 via the video conferencing platform, Zoom, among a diverse group of adolescent healthcare providers (n=16) representing 5 healthcare practices located within the southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework, guided by the grounded theory and inductive approach. Results Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all participating practices. Participants highlighted an initial decrease in patients due to the pandemic, despite the implementation of protective measures such as an increase in sanitation measures, hand washing, separation of sick and wellness visits, mask mandates, and telehealth/video conferencing opportunities. While practices continued to distribute educational materials, many removed material from their waiting rooms due to sanitary concerns related to COVID-19. Participants reported that patient-provider communications; effective use of presumptive languaging; periodic reminders/recall messages; provider’s personal recommendation on vaccine safety/efficacy; early initiation of human papillomavirus (HPV) vaccination series at 9 years; community partnerships with health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets, as well as outreach to schools and churches, served as facilitators to adolescent HPV vaccine uptake. Conclusions By exploring the perceptions and experiences of adolescent healthcare providers, our research identified key factors influencing adolescent vaccination uptake and its relatedness to the COVID-19 pandemic. We argue our findings support and encourage the development of personalized patient-provider communications, trusting relationships, effective use of presumptive languaging, and counteraction of misinformation as solutions to suboptimal preventative services and vaccination coverage rates. Implementation of these comprehensive strategies could not only ameliorate routine adolescent vaccination uptake but could also aid in the expansion of COVID-19 vaccine acceptance on a sizable scale.

Trust in Physicians in the Context of HPV Vaccination of Children from the Perspective of Social Exchange Theory: A Representative Study of Polish Parents.

The vaccination of children against human papillomavirus (HPV) effectively prevents HPV infection and HPV-related cancers in women and men. However, HPV vaccination programs are met with vaccine hesitancy, which varies between countries. The coverage in Poland is low, although introducing nationally funded HPV vaccination for girls aged 12-13 in mid-2023 may increase it. The uptake of the HPV vaccine in adolescents is highly affected by parental decisions, which in turn can be influenced by interactions with the physician. The present representative study aimed to analyze the acceptance of the HPV vaccine among Polish parents (n = 360) and the level of trust in HPV vaccination in the pediatrician/general practitioner who takes care of their children aged 9-15 years. The data were gathered in September 2022 using computer-assisted telephone interviews. Most surveyed parents reported trusting their child's physician regarding vaccine recommendations (89.2%) and vaccinated their child with all or most of the vaccines recommended by a national vaccination guideline (94.7%). However, 13.3% declared themselves as moderate or strong vaccine opponents, a group characterized by high (83.4%) distrust in physicians. There was no difference in the awareness of HPV in groups varying in trusting the physicians, but parents who trusted them were more frequently aware of the HPV vaccine. Parental willingness to vaccinate their child against HPV was highly differentiated by the level of trust in the child's physician. The results highlight that trust in physicians is a critical factor shaping decisions for children's vaccination, stressing a continuous need to improve strategies to communicate with patients.

Improving human papilloma virus vaccination rates among adolescents.

The human papilloma virus (HPV) is the leading cause of cervical cancer worldwide and is responsible for genital warts and five other types of cancers. The HPV vaccine was introduced in 2006 and demonstrated to be safe and more effective than expected, yet adolescent rates of immunization in the United States remain low. Adolescent HPV vaccine rates were below the national average, and effective vaccine recommendation strategies were not used at an urban pediatric primary care office in southern Florida. The percentage of HPV vaccine rates in this primary care office were measured among adolescents ages 13-17 years using data obtained from Florida's state vaccine registry before implementation of the intervention, after the intervention, and monthly over a 90-day period. Interventions aimed to improve vaccine rates included implementing an HPV protocol consisting of education on providing a strong bundled recommendation, appointing a vaccine champion, implementing standing vaccine orders, and educational materials. The vaccine rates among adolescents increased by 11% for the initial dose, 7% for the second dose, and 6% for the vaccine completion rate. Chi-square test demonstrated statistical significance, for the initial vaccine. A nurse practitioner-led application of an evidenced-based HPV vaccine protocol positively affected the care of adolescents in this primary care setting.

Human papillomavirus vaccine acceptance among adolescent girls in Ethiopia: a systematic review and meta-analysis

BackgroundCervical cancer is the fourth most common cancer affecting females. Human papillomavirus vaccination of adolescent girls is the primary strategy for cervical cancer prevention but in Ethiopia, it lacks emphasis. Despite different studies done and found a highly variable level of vaccine acceptance; however, there was no summarized evidence on the issues as a nation. Thus this systematic review and meta-analysis aimed to assess the pooled prevalence of human papillomavirus vaccine acceptance by adolescent girls and its associated factors in Ethiopia.MethodA systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Review manager software was used to identify factors associated with vaccine acceptance.ResultOverall, 157 articles were retrieved and finally 7 articles were included in this review. The pooled prevalence of adolescent human papillomavirus vaccine acceptance was 46.52% (95%CI; 30.47-62.57%). Subgroup analysis showed that adolescent vaccine acceptance was highest in the Oromia region and lowest in Addis Ababa. Knowledge about human papillomavirus vaccination (AOR = 3.89, 95% CI: (2.85–5.32)) and attitude (AOR = 2.65, 95% CI: (2.03– 3.44)) were significantly associated with adolescent’s vaccine acceptance.ConclusionHuman papillomavirus vaccine acceptance of adolescent girls in Ethiopia was low. Knowledge about the vaccine and attitude to vaccination were positively associated with their vaccine acceptance. Therefore, policymakers and program planners should target school-aged adolescents in increasing their awareness and changing their attitudes to enhance their vaccine acceptance in order to prevent and control cervical cancer.