Promote HPV Vaccination Research Articles

Mean medical costs associated with vaginal and vulvar cancers for commercially insured patients in the United States and Texas

ObjectiveTo estimate the average medical costs for vaginal and vulvar cancers in a commercially insured population in the U.S. and Texas. Methods2011–2014U.S. MarketScan databases were used to estimate the average medical costs associated with vaginal and vulvar cancers. Women with newly diagnosed vaginal or vulvar cancer were matched to a comparison group without cancer using propensity score. Year 1 and year 2 costs after index diagnosis date were estimated. A generalized linear model was used to estimate the cost for censored months. The differential costs between groups were defined as the net costs associated with cancer diagnosis and treatment. ResultsThe analysis included 355 women with vaginal cancer and 997 with vulvar cancer in the U.S. The year 1 and year 2 costs for vaginal cancer were $86,995 and $51,107, respectively. The year 1 and year 2 costs for vulvar cancer were $37,657 and $19,139, respectively. The major factors associated with higher monthly vaginal and vulvar cancer costs were higher Charlson Comorbidity Index score and higher medical costs prior to cancer diagnosis. Monthly costs for vaginal and vulvar cancers decreased rapidly from month 1 to month 6 after diagnosis and then remained stable. ConclusionsSeventy to 75% of all vaginal and vulvar cancers are due to HPV infections and mean medical costs associated with these cancers are substantial. These data will serve as key cost parameters in the economic evaluation of HPV vaccination dissemination and estimation of the long-term net economic benefit of promoting HPV vaccination.

Using narrative intervention for HPV vaccine behavior change among Khmer mothers and daughters: A pilot RCT to examine feasibility, acceptability, and preliminary effectiveness

PurposeTo develop a theory-guided culturally grounded narrative intervention to promote HPV vaccination behavior and examine the feasibility, acceptability, and preliminary effectiveness of the intervention among dyads of Cambodian American mothers and daughters. MethodThe principles of community-based participatory research guided the development and evaluation and involved two phases: Phase 1: Development of storytelling narrative intervention videos which focused on a series of HPV vaccination-related messages and which integrated the narrative theory with the revised network episode model (rNEM); Phase 2: conducting the pilot RCT with 19 dyads of Khmer mothers and daughters aged from 14 to 17years to examine the feasibility and acceptability of the study. FindingsRecruitment was completed in 7months with an overall retention of 84%. The acceptability of the intervention was high, as reflected by the number of positive comments on the narrative video. Preliminary data indicate that vaccine uptake at one-month follow-up was the same (2 vs. 2) between intervention and control groups. However, daughters in the narrative intervention group reported higher intention to receive HPV vaccination within one month compared to the control group (4 vs. 1). ConclusionAll the procedures to inform a full RCT were examined, including identification of eligible participants, recruitment, randomization, intervention adherence, and short-term follow-up. The positive preliminary outcomes and feedback support the feasibility and potential effectiveness of the theory-guided narrative intervention.

Use of health education campaigns to promote HPV vaccination in teenagers

Use of health education campaigns to promote HPV vaccination in teenagers

New approach for promoting HPV vaccination in college men based on multi-theory model (MTM) of health behavior change.

New approach for promoting HPV vaccination in college men based on multi-theory model (MTM) of health behavior change.

Abstract 4221: Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States

Abstract Background The HPV vaccine prevents HPV-associated cancers and genital warts, which cause significant morbidity and mortality in the US. While the vaccine is targeted toward 11-12-year-old boys and girls, there is a catch-up vaccination range up to 26 years. However, vaccination rates are very low among eligible young adults, aged 18-26 years, and besides college-related studies, not a lot is known about factors associated with the HPV vaccine uptake in this population. The aim of this study was to assess sociodemographic factors associated with HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. Methods The National Health Interview Survey 2014-2015 was examined for young adults, aged 18-26 years (n = 7588). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of the three doses. Sociodemographic factors included age, gender, race, marital status, education, health insurance, regular provider, number of doctor visits, and geographic region. Survey-weighted multivariable logistic regression models were used to examine the socio-demographic factors that were associated with HPV vaccine uptake. Results Approximately 27% of respondents had initiated the HPV vaccine and 16% had completed the HPV vaccine. After adjusting for covariates, compared to females, males were 81% less likely to initiate HPV vaccine [(adjusted odds ratio) 0.19; (95 % confidence interval) 0.16-0.23]. Other factors associated with HPV vaccine initiation included having health insurance (1.70; 1.32-2.18), visiting the doctor’s office 6+ times (1.86; 1.48-2.34) and 1-5 times (2.09; 1.56-2.81) vs. no doctor’s office within the last 12 months, and having no high school diploma (0.46; 0.32-0.64) and having high school diploma (0.40; 0.31-0.52) vs. college degree or higher. The same factors were associated with HPV vaccine completion; but, being black (0.60; 0.44-0.83) vs. white and having no usual place of care (0.74; 0.57-0.96) were also associated with lower odds of completing the vaccine series. Conclusions Our study shows that there are sociodemographic factors associated with HPV vaccine uptake among young adults in the United States, and males, individuals with a lower education, and those without adequate healthcare access are less likely to initiate and complete the HPV vaccination. Our findings suggest it is necessary to develop targeted interventions to promote HPV vaccination among those in the catch-up age range. Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Daphne Lew, Meera Muthukrishnan, Vy T. Pham, Rebecca Rohde, Thomas Burroughs, Mark A. Varvares, Nosayaba Osazuwa-Peters. Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4221. doi:10.1158/1538-7445.AM2017-4221

Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting.

Although the HPV vaccine has been shown to be highly effective in preventing cervical dysplasia, vaccination rates remain low. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the postpartum setting. We conducted a pre-post intervention study among postpartum women ages 18-26 seen at an outpatient clinic from 09/01/2012-08/31/2013 (pre-intervention) and from 10/01/2013-03/31/2014 (post-intervention). The intervention was a drop-down menu that was inserted into the EMR postpartum note template inquiring about the patient's HPV vaccination status and whether or not the vaccine was administered at that visit. HPV vaccination uptake was compared pre and post-intervention. Of the 278 postpartum visits during the study period, 241 were eligible for analysis. There was a significant increase of the HPV vaccine uptake, from 1.2% (2/173) among pre-intervention visits to 26.5% (18/68) among post-intervention visits (p<0.001). After adjusting for age, ethnicity, insurance, and religion, HPV vaccination was significantly higher at postpartum visits during the intervention period, with an adjusted OR=93.49 [95% CI 15.29-571.52]. Among visits in which the vaccine was not given, HPV vaccination was not discussed in 46% and patients refused the vaccine in 40% of visits. An EMR prompt in the postpartum note could be an effective way to promote HPV vaccination in the postpartum setting. It will likely take a combination of strategies to optimize vaccination uptake.

Views on HPV and HPV Vaccination: The Experience at a Federal Qualified Clinic in Puerto Rico.

The purpose of this study was to understand through a quantitative assessment, the views of HPV and HPV vaccination among parents of sons from a FQHC in PR. A self-administered questionnaire was given to a convenience sample of 200 parents of sons 9-17 years old. Nearly 30% of the parents reported that their sons had initiated the HPV vaccine regimen. Health care provider recommendation was significantly associated with vaccine initiation. Among parents of unvaccinated sons, the main reason for not getting the HPV vaccine was they did not know that boys were allowed to get the vaccine. Future efforts should focus on multilevel interventions aimed to increase knowledge as well as other modified behavioral determinants in parents of young males about HPV and the vaccine. Capacity building efforts should be targeted also to increase health providers' education and communication skills to promote HPV vaccination effectively.

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial.

Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects. Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity. Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45). Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms).

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial

Overcoming barriers to HPV vaccination: A randomized clinical trial of a culturally-tailored, media intervention among African American girls

Although genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14–18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.

Actions improving HPV vaccination uptake – Results from a national survey in Italy

BackgroundIn Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26–85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake. MethodsIn 2011–2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates. ResultsWe analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (ORadj=5.9, 95%CI 2.0–17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (ORadj=7.0, 95%CI 1.2–39.8) and >1 recall for non-respondents was planned (ORadj=4.1, 95%CI 1.8–9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80–90%), instead general practitioners, women and family's healthcare services and public gynaecologists in 60–70%, cervical cancer screening services and private gynaecologists in 20–40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%). ConclusionThe synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.

27. Dissemination Strategies to Promote HPV Vaccination Among Preteen Boys: Embracing the Transition to Adolescence Through Three-way Conversations Among Provider, Parent and Preteen

27. Dissemination Strategies to Promote HPV Vaccination Among Preteen Boys: Embracing the Transition to Adolescence Through Three-way Conversations Among Provider, Parent and Preteen

Human Papillomavirus Vaccination for Men: Advancing Policy and Practice

ABSTRACT The quadrivalent HPV vaccine (HPV4) is safe and highly efficacious, and can significantly reduce the burden of HPV-related genital warts and cancers among men, in addition to promoting herd immunity. Nevertheless, HPV4 coverage among boys remains low in most settings. Research to date has focused predominantly on HPV vaccination of girls to prevent cervical cancer. Most countries with publicly funded healthcare where HPV4 is licensed cover the costs of HPV vaccination programs for girls only. We critically review the evidence for extending publicly funded HPV vaccination programs to boys in addition to girls. After an overview of research on HPV prevalence and associated cancers among men, we review cost–effectiveness studies, benefits of universal versus targeted vaccination approaches and multifaceted health equity concerns, along with directions in vaccine delivery programs and intervention research to promote HPV vaccine uptake for boys. Comprehensive evaluation of the systematic exclusion of boys from publicly financed HPV vaccination programs is warranted given tremendous public health implications of new infections and subsequent cancers that could have otherwise been averted.

HPV vaccine use among African American girls: Qualitative formative research using a participatory social marketing approach

ObjectiveTo generate recommendations for framing messages to promote HPV vaccination, specifically for African American adolescents and their parents who have not yet made a decision about the vaccine (the “Undecided” market segment). MethodsFocus groups and interviews were conducted with African American girls ages 11–18 (N=34) and their mothers (N=31), broken into market segments based on daughter's vaccination status and mother's intent to vaccinate. ResultsFindings suggested that the HPV vaccine should be presented to “Undecided” mothers and adolescents as a routine vaccine (just like other vaccines) that helps prevent cancer. Within the “Undecided” segment, we identified two sub-segments based on barriers to HPV vaccination and degree of reluctance. The “Undecided/Ready If Offered” segment would easily accept HPV vaccine if given the opportunity, with basic information and a healthcare provider recommendation. The “Undecided/Skeptical” segment would need more in-depth information to allay concerns about vaccine safety, mistrust of drug companies, and recommended age. Some mothers and girls had the erroneous perception that girls do not need the vaccine until they become sexually active. African American adolescents and their mothers overwhelmingly thought campaigns should target both girls and boys for HPV vaccination. In addition, campaigns and messages may need to be tailored for pre-teens (ages 9–12) versus teens (ages 13–18) and their parents. ConclusionsFindings pointed to the need to “normalize” the perception of HPV vaccine as just another routine vaccine (e.g., part of pre-teen vaccine package). Findings can inform social marketing campaigns targeting Undecided or ethnically diverse families.

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys

Knowledge about virus biology is crucial for us.

Medical literature generally acknowledges that persistent infection with HPV, especially types 16 and 18, is a predisposing factor for developing cervical intraepithelial neoplasia (CIN) and cervical cancer. A similar relationship was found in penile, oropharyngeal and vulvar carcinomas. It has also been established that HPV is the most common sexually transmitted virus worldwide. WHO data shows too, that globally cervical cancer is the third most common cancer in women and is responsible for about 300 000 deaths a year [1]. For these reasons, the possible prevention of cervical cancer draws enormous interest. This has seemed to become a reality after the introduction of the HPV vaccine, which induces a cell–mediated immune response preventing HPV infection for many years [2]. The idea of using an HPV vaccine in the prevention of cervical cancer seems logical, prompting many medical and public organizations to recommend vaccination of young girls as a means of reducing the incidence of cervical cancer. Nowadays, different programs of this prevention function in more than 50 countries [3]. The study presented by Deriemaeker and colleagues in this issue of CEJU deals with the public perspective of cervical cancer and HPV vaccination, using a questionnaire in a population of Belgian students. The study, with the obvious drawback of a very low response rate (13%), is however quite interesting as it draws our attention to the very hot issue of HPV vaccination. The problem is not only with the education that we, as medical professionals should give to people, but also how politics may influence medical decisions. In the New England Journal of Medicine, Colgrave presented his study of decision–making in the US legislature concerning HPV vaccine implementation. He described that medical organizations generally support the idea, but he also claimed that opponents of HPV vaccination put up many counter arguments. The first of these was concern about the vaccine's unknown long–term side–effects. Secondly, there is the lack of long–term data proving whether the vaccination really decreases the mortality rate of cervical cancer and not only prevents HPV infection. We know that the time interval from HPV infection to the development of pre–invasive cervical lesion is 7 years and to invasive cervical carcinoma is even 25–30 years. In fact, studies showing a huge possible reduction of cervical cancer mortality and cost–effectiveness of the vaccination are very appealing, but they are only projections. Other opponents argue that the process of introducing HPV vaccination was very strongly lobbied by pharmaceutical companies [4]. There are also claims that vaccination of young girls against the sexually transmitted viral infection may promote earlier initiation of sexual activity [5]. So the study of Deriemaeker, in fact, shows the result of this educational and political debate in Belgium. The opinions of a particular population were analyzed – students, including many medical students, from an open modern society with more than 50% atheists, in a wealthy country where access to the HPV vaccine is free of charge. We may therefore assume that in this group knowledge of the problem as well as the vaccination rate will be near–optimal. Any less educated, more traditional groups from poorer populations or from countries without vaccine reimbursement would be less aware of the problem and more reluctant to vaccinate against HPV. The data showing that 82% of respondents were aware of the link between HPV and cervical cancer, and a 62% vaccination rate overall, with 82% under 21 years of age, are very encouraging So the conclusion of the study is, that in Belgium the debate in the well–educated, young part of society has been won by proponents of HPV vaccination. It is even more visible in medical students who, because of their future profession will probably confer the message to the general public On the other hand, we may suspect that much is to be done to promote HPV vaccination in other populations. It is especially important because HPV vaccination is to play a more important role in populations where other forms of cervical cancer prevention such as access to good gynecological care, and cytological screening are not so easily or widely available.

A Recommendation to Use the Diffusion of Innovations Theory to Understand School Nurses' Role in HPV Vaccine Uptake

Vaccinations represent one of the greatest public health achievements of the past century, but their success largely depends on populations' uptake. Seven years after its approval in 2006 for females, the HPV vaccination rates remain relatively low. Previous literature provides information about research examining U.S. physicians, pediatricians, and other healthcare providers' knowledge, attitudes, and professional practice toward the HPV vaccine. No research has yet investigated U.S. school nurses' role in educating the school community about the vaccine's benefits. Diffusion of Innovations theory is an appropriate perspective for examining school nurses as opinion leaders who can influence the uptake of the HPV vaccine for youth. This theory explains how innovations diffuse throughout a social system, and highlights the construct of opinion leadership. School nurses exhibit the characteristics of opinion leaders; therefore, Diffusion of Innovations can be a useful lens for assessing their role in efforts to promote HPV vaccination for youth.

Acceptability of HPV vaccines and perceptions related to genital warts and penile/anal cancers among men who have sex with men in Hong Kong

Men who have sex with men (MSM) are at high risk of contracting HIV and developing genital warts and penile/anal cancers. HPV vaccines are efficacious in preventing such HPV-related diseases among males and WHO recommends its use to young MSM. In a cross-sectional survey, 542 MSM were interviewed. After being briefed about the vaccines’ efficacies and the market price, the prevalence of acceptability of HPV vaccination was 29.2%. Adjusted by significant background variables, perceived high/very high chances of contracting genital warts [adjusted odds ratio (AOR)=2.04, 95%CI=1.11–3.72] and penile/anal cancers (AOR=1.89, 95%CI=1.09–3.29) among local MSM, perceived moderately high mortality rate of penile/anal cancers (AOR=1.78, 95%CI=1.13–2.81), fear toward penile/anal cancers (moderate: AOR=1.75, 95%CI=1.07–2.86; high/very high: AOR=1.82, 95%CI=1.13–2.92) and disagreement with the statement “MSM in general are not willing to take HPV vaccines” (AOR=1.82, 95%CI=1.24–2.68) were associated with the conditional acceptability. Acceptability of this new measure is reasonably high and there are rooms for improvement. Implementation trials to promote HPV vaccination by changing cognitions such as HPV-related risk perceptions, norms and perceptions toward anal/penile cancer are greatly warranted.

Development of a radionovela to promote HPV vaccine awareness and knowledge among Latino parents.

Development of a radionovela to promote HPV vaccine awareness and knowledge among Latino parents.

Unrealistic Optimism: Present and Future

Unrealistic Optimism: Present and Future