Vaccine Series Completion Rates Research Articles

HPV Multilevel Intervention Strategies Targeting Immunization in Community Settings (HPV MISTICS): Study protocol for a hybrid 1 stepped-wedge cluster randomized trial

BackgroundThis protocol paper describes the overall design for HPV MISTICS, a multilevel intervention to increase human papillomavirus (HPV) vaccination initiation and completion rates among adolescents aged 11–17. MethodsWe will conduct a hybrid type 1 implementation-effectiveness trial using a stepped-wedge cluster randomized trial in eight federally qualified health centers (FQHCs) in Florida. Intervention components target three levels: system, providers, and parents. Outcomes will be assessed using quantitative (e.g., vaccination data, survey data) and qualitative methods (e.g., staff and parent interviews). We expect to quantify changes in HPV vaccine series initiation and completion rates for adolescents ages 11–17 in the eight FQHCs. We have hypothesized a 20-percentage point increase in HPV vaccine series initiation and a 10-percentage point increase in series completion. We also anticipate being able to explore factors at the system, provider, and patient levels as potential covariates. Implementation outcomes, barriers, and facilitators identified in the study will help characterize the implementation process and inform potential future intervention scale-up. ResultsThe project is ongoing; effectiveness and implementation outcomes will be determined following project completion. ConclusionsFindings will provide evidence of an equity-informed research design and implementation procedures that could help improve HPV vaccination rates in similar health systems.Clinical trials identifier:NCT05677360 (date registered: 2022-12-22); https://clinicaltrials.gov/study/NCT05677360?lead=Moffitt%20Cancer%20Center%20&aggFilters=status:rec&page=2&rank=17

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.

COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race/ethnicity and level of patient contact

ObjectivesTo assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. Main Outcome and Measures: Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. ResultsThe vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. Conclusions and RelevanceThese results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients.

State Policy Removing the Personal Belief Exemption for Measles, Mumps, and Rubella (MMR) School Immunization Requirement, Washington State, 2014-2022.

Objectives. To assess the impact of Washington State's 2019 Engrossed House Bill (EHB) 1638-which removed measles, mumps, and rubella (MMR) personal belief exemptions-on MMR vaccine series completion and exemption rates in K-12 students. Methods. We used interrupted time-series analyses to examine changes in MMR vaccine series completion rates before and after EHB 1638 was passed and the χ2 test for differences in exemption rates. Results. EHB 1638 implementation was associated with a 5.4% relative increase in kindergarten MMR vaccine series completion rates (95% confidence interval = 3.8%, 7.1%; P ≤ .001), and results were similar with Oregon as a control state (no change observed in Oregon; P = .68). MMR exemptions overall decreased 41% (from 3.1% in 2018-2019 to 1.8% in 2019-2020; P ≤ .001), and religious exemptions increased 367% (from 0.3% to 1.4%; P ≤ .001). Conclusions. EHB 1638 was associated with an increase in MMR vaccine series completion rates and a decrease in any MMR exemption. However, effects were partially offset by an increase in religious exemption rates. Public Health Implications. Removal of personal belief exemptions for the MMR immunization requirement only may be an effective approach to increase MMR vaccine coverage rates statewide and among underimmunized communities. (Am J Public Health. 2023;113(7):795-804. https://doi.org/10.2105/AJPH.2023.307285).

Does Bundling Matter? The Effect of Providing HPV Vaccination Before Tdap Vaccination on Timely Completion of the HPV Vaccine Series [ID: 1381348

INTRODUCTION: The American Academy of Pediatrics and American Cancer Society promote vaccine initiation at age 9 as one way to improve human papillomavirus (HPV) vaccination rates. Studies have noted increased HPV vaccine series completion rates when the series was begun before age 11. We used a national sample to assess the effect of initiating the HPV vaccine series initiation prior to the adolescent platform on timely series completion. METHODS: To explore the effect of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (unbundling) on timely series completion, we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. The cohort included 100,857 eligible children. RESULTS: Compared with adolescents who received their HPV and Tdap vaccinations concurrently, those who received HPV prior to Tdap had higher completion (adjusted odds ratio [aOR], 1.38), whereas those who received their HPV vaccination after Tdap had lower odds of HPV vaccine series completion (aOR 0.68). Other factors associated with series completion included female sex, residing in an urban (versus rural) area, residing in the Northeast, and receiving primary care from a pediatrician (versus family medicine physician). CONCLUSION: These data indicate that beginning the HPV vaccine series prior to the adolescent platform (unbundling) may improve on-time series completion.

Incomplete HPV Vaccination among Individuals Aged 27-45 Years in the United States: A Mixed-Effect Analysis of Individual and Contextual Factors.

Background: In the United States, the human papillomavirus (HPV) vaccine is approved for use in individuals up to age 45. Individuals 15 years and older require three doses of the vaccine to complete the recommended dosing series. Incomplete HPV vaccination rates (i.e., one or two doses) among those over age 26, however, remain high. This study examined the independent effects of individual- and neighborhood-level factors on incomplete HPV vaccination rates in the United States (U.S.) among those aged 27-45 years. Methods: This retrospective cohort study used administrative data from Optum's de-identified Clinformatics® Data Mart Database to identify individuals aged 27-45 years who received one or more doses of HPV vaccine between July 2019 and June 2022. Multilevel multivariable logistic regression models were applied to the data on 7662 individuals identified as being fully or partially vaccinated against HPV, nested within 3839 neighborhoods across the U.S. Results: Approximately half of the patients in this study (52.93%) were not completely vaccinated against HPV. After adjusting for all other covariates in the final model, being older than 30 years old decreased the odds of not completing the HPV vaccine series. Participants living in South-region neighborhoods of the U.S. had enhanced odds of not completing the vaccine series compared with those residing in Northeast-region neighborhoods (aOR 1.21; 95% CrI 1.03-1.42). There was significant clustering of incomplete HPV vaccination rates at the neighborhood level. Conclusions: This study revealed that individual- and neighborhood-level factors were associated with the risk of not completing the HPV vaccine series among individuals aged 27-45 years in the U.S. Interventions to improve HPV vaccination series completion rates for this age group should take into consideration both individual and contextual factors.

Quality Improvement Project to Increase Human Papillomavirus Two-Dose Vaccine Series Completion by 13 Years in Pediatric Primary Care Clinics

PurposeThe human papillomavirus (HPV) causes genitourinary and oropharyngeal cancers. The HPV vaccine is safe and effective in preventing those diseases; however, vaccine series completion rates remain low in the United States. Our quality improvement (QI) project aimed to increase HPV-vaccination series completion rates to 70% from 2017 to 2020 for the 13-year patient population in an extensive academic pediatric primary care network that serves predominantly minority and Medicaid-insured children in Columbus, OH. MethodsThe outcome measure was the percentage of 13-years Nationwide Children's Hospital Primary Care Network patients who completed the two-dose vaccine series by their 13th birthday. Four QI implemented interventions were utilized. Electronic medical records alert informed providers when the HPV vaccines are due. We studied monthly data for the network and for individual clinics using statistical process control, displaying data on a control chart. We followed two process measures, captured opportunity rate, and the number of HPV vaccines given. ResultsWe substantially increased HPV-vaccination series completion rates overall in the 13-year teen population from 27% to 65%, and three clinics reached the 70% goal for at least one quarter. Latino children had the highest completion rate of 80% and White children had the lowest completion rate at 64%. DiscussionOur QI project used four measures to improve HPV-vaccination series completion rates in the 13-year patient population that serves minority and low-income teens predominantly. Further QI studies are needed to improve HPV vaccine completion rates in teens.

Effects of the COVID-19 pandemic on self-reported 12-month pneumococcal vaccination series completion rates in Canada

ABSTRACT Routine childhood vaccination improves health and prevents morbidity and mortality from vaccine-preventable diseases. There are indications that the COVID-19 pandemic has negatively impacted immunization rates globally, but systematic studies on this are still lacking in Canada. This study aims to add knowledge on the pandemic’s effect on children’s immunization rates with pneumococcal vaccine using self-reported immunization data from CANImmunize. An interrupted time series analysis was conducted on aggregated monthly enrollment of children on the platform (2016–2021) and their pneumococcal immunization series completion rates (2016–2020). Predicted trends before and after the onset of the COVID19-related restriction (March 1, 2020) were compared by means of an Autoregressive Integrated Moving Average (ARIMA). The highest monthly enrollment was 3,474 new infant records observed in January 2020, and the lowest was 100 records in December 2021. The highest Self-reported pneumococcal immunization series completion rate was 78.89%, observed in February 2017, and the lowest was 6.94% in December 2021. Enrollment decreased by 1177.52 records (95% CI: −1865.47, −489.57), with a continued decrease of 80.84 records each month. Completion rates had an immediate increase of 14.57% (95% CI 4.64, 24.51), followed by a decrease of 3.54% each month. The onset of the COVID-19 related restrictions impacted the enrollment of children in the CANImmunize digital immunization platform and an overall decrease in self-reported pneumococcal immunization series completion rates. Our findings support efforts to increase catch-up immunization campaigns so that children who could not get scheduled immunization during the pandemic are not missed.

Determining the Impact of a Community-Based Intervention on Knowledge Gained and Attitudes Towards the HPV Vaccine in Virginia

HPV vaccination series completion rates have increased steadily in the USA, yet specific areas continue to be burdened by HPV-related cancers, including rural areas of Virginia. The primary purpose of this study is to compare the impact of an community driven educational film about HPV on intention to vaccinate and knowledge gained in urban and rural areas of Virginia. From October 2016 to September 2019, the CDC-approved documentary “Someone You Love: The HPV Epidemic” was screened and followed by a Q&A session. Intention to vaccinate and knowledge gained after seeing the DVD intervention were measured through a pre-post-survey and analyzed data using chi-squared tests. The sample included males and females of all races and ages 18+ that identified as either student, parent/guardian, and/or healthcare provider from rural and urban geographical areas. Changes in knowledge about HPV were statistically significant in two out of seven questions (p < 0.05). Changes in attitude were statistically significant in every attitude-based question about HPV (p < 0.05). There were significant differences in knowledge gained and attitudes towards the HPV vaccine when comparing urban and rural locations as well. More research is needed to explore the efficacy of community-based interventions to increase uptake and series completion of HPV vaccination, particularly in rural areas most impacted by HPV-associated cancers.

Overcoming Barriers to Human Papillomavirus Vaccination

Introduction Despite the human papillomavirus (HPV) vaccine's ability to help prevent certain types of cancer, rates of vaccination against HPV remain low, and choosing to have a child receive the HPV vaccine has become a controversial topic. The primary objective of this quality improvement project was to increase HPV vaccination rates through creating and distributing an all-in-one education and reminder system to pediatric clinic patients and their families once patients are eligible to receive the HPV vaccination. Methods Three barriers to increasing rates of HPV vaccination were identified: cost, lack of knowledge, and lack of provider recommendation. A flyer system was implemented that addressed these barriers. This flyer was given to all patients ages 11–18 years, with a strong verbal provider recommendation. Results One-sample proportion tests were run to determine significance in the differing series completion rates in 2018, 2019, and 2020. The pediatric clinic's HPV vaccination series completion rates increased significantly from 2018 to 2019. During the implementation of this flyer system, which occurred during the COVID-19 pandemic, the vaccination series completion rates decreased, but this decrease was not statistically significant. Discussion As control is gained over the pandemic, it is anticipated that regular provider visits will increase back to normal and therefore vaccination rates will recover as well. The findings from this study can be used to create or modify current practices in clinics anywhere that the HPV vaccination is administered. Future studies and trials should be implemented for a longer period, and not during a pandemic, ideally to yield more statistically significant results.

Implementation Experience With Meningococcal Serogroup B Vaccines in the United States: Impact of a Nonroutine Recommendation.

Meningococcal serogroup B (MenB) is the leading cause of invasive meningococcal disease among US adolescents and young adults, accounting for 62% of cases in 16-23-year-olds in 2018. Since 2015, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination of healthy adolescents against MenB based on shared clinical decision-making (previously called "Category B" or individual clinical decision-making). However, MenB vaccine coverage and series completion rates remain low. Herein we examine implementation experience of adolescent MenB vaccination in the United States under this nonroutine ACIP recommendation. PubMed was searched for English-language articles published after 2015 examining MenB vaccination implementation in the United States. Studies reporting MenB vaccination awareness, coverage, knowledge of recommendations and implementation barriers or access disparities were included. Identified studies provided evidence that ACIP's MenB vaccination recommendation is poorly understood and prone to misinterpretation by US healthcare providers. Parental awareness of MenB vaccines is low, and racial and socioeconomic disparities exist regarding vaccine receipt. Parents rely on providers to learn about MenB disease risk and benefits of vaccination, with provider recommendations carrying substantial weight in vaccination decisions. Five years of evidence regarding the MenB vaccination implementation experience suggest that the nonstandard recommendation for MenB vaccines is partly responsible for low vaccine coverage. Further, inconsistent implementation of ACIP recommendations could be limiting access to MenB vaccines. Providers need additional support and guidance to implement the shared clinical decision-making recommendation, in turn ensuring equitable access for vaccine-eligible adolescents to enable comprehensive protection against meningococcal disease.

Quantitative and qualitative assessment of an all-inclusive postpartum human papillomavirus vaccination program

A postpartum human papillomavirus vaccination program was locally implemented to address low initiation rates among young adults. Within 20 months, the program achieved high vaccine initiation and series completion rates. Based on the program's success, it was expanded to all 36 counties served by a public hospital. This study aimed to conduct a quantitative and qualitative evaluation to examine the success and limitations of the program when expanded from 1 county to 36 counties, many of which are home to rural and medically underserved communities. Patient navigators reviewed the electronic medical records and immunization registry records of women aged ≤26 years, who delivered an infant at the public hospital, to determine whether they needed to initiate or complete the human papillomavirus vaccine series. Eligible women were counseled and offered the human papillomavirus vaccine during their hospital stay. Patient navigators scheduled follow-up injections in addition to the mother's postpartum or her infant's well-child visits, made reminder phone calls, and rescheduled missed appointments. Descriptive statistics, including frequencies and proportions, were used for patients approached in the initial and expansion programs. Frequencies from the initial and expansion programs were examined separately. Qualitative interviews were conducted with the clinic staff to evaluate the program. The qualitative analyses were conducted using NVivo (QSR International, Melbourne, Australia, version 10). Both initial and expanded programs achieved vaccine completion rates above 70%. Of the 2631 eligible postpartum women enrolled in the initial program, 785 (30%) had already been fully vaccinated. Of the remaining 1846 women, 1265 (69%) women received their first dose, and 196 (11%) women received their second or third dose on the postpartum unit. Of the 1461 women who received at least 1 dose through the initial program, 1124 (77%) completed all 3 doses. Of the 4330 eligible postpartum women enrolled in the expanded program, 886 (21%) had already been fully vaccinated. Of the remaining 3444 women, 2284 (66%) received their first dose, and 343 (10%) received their second or third dose on the postpartum unit. Of the 2627 women receiving at least 1 dose through the expanded program, 1932 (74%) completed all 3 doses. Clinic staff interviewed felt the program benefited the postpartum unit and clinics, because it increased patient knowledge of the vaccine, increased patient volume for vaccination, and gave healthcare providers more time to focus on other tasks. Human papillomavirus vaccination on the postpartum unit is an effective way to increase catchup rates and is well accepted by healthcare providers. High completion rates can be achieved if adequate support is provided, even among patients residing in rural or underserved areas who need extensive support to access primary healthcare services. Although this particular program may be considered costly, it is overall effective because the vaccine prevents 5 different types of cancer in women. The inclusion of human papillomavirus vaccination in routine postpartum care is a relatively easy way to reach many adults not vaccinated at a younger age and could help address low vaccination rates among young women in the United States, including hard-to-reach populations.

Multi-component cancer prevention awareness program to improve adolescent HPV vaccine uptake

ABSTRACT Objective We introduced a multi-component cancer prevention awareness program to primary care practices across New York State to evaluate its impact on adolescent human papillomavirus (HPV) vaccination rates. Methods Eight pediatric and three family medicine practices were recruited to participate in this program. On-site training sessions were provided for all practice providers and staff to discuss the importance of HPV vaccine and cancer prevention and teach strategies for delivering a strong vaccine recommendation. Each practice received a study-specific booklet that included HPV vaccine information and other commonly provided cancer prevention guidance. These booklets were distributed to all adolescents and their parents during well visits over a one-year period. Practice specific and county-wide HPV vaccination rates were assessed before and 12 months after the program training session. Results One year after program initiation, aggregate data show statistically higher vaccine series initiation rates among 11–12 and 13–18-year-olds and higher vaccine series completion rates among 13–18-year-olds. The greatest and most consistent improvements were seen in vaccine initiation rates for the 11–12-year-old cohort. Disparities in vaccine uptake were observed by gender and medical specialty. Conclusion Cancer prevention education targeting providers, office staff, patients, and parents, improved adolescent HPV vaccine series initiation rates.

Effect of State Immunization Information System Centralized Reminder and Recall on HPV Vaccination Rates.

Although autodialer centralized reminder and recall (C-R/R) from state immunization information systems (IISs) has been shown to raise childhood vaccination rates, its impact on human papillomavirus (HPV) vaccination rates is unclear. In a 4-arm pragmatic randomized controlled trial across 2 states, we randomly selected practices representative of the specialty (pediatrics, family medicine, and health center) where children received care. Within each practice, patients 11 to 17.9 years old who had not completed their HPV vaccine series (NY: N = 30 616 in 123 practices; CO: N = 31 502 in 80 practices) were randomly assigned to receive 0, 1, 2, or 3 IIS C-R/R autodialer messages per vaccine dose. We assessed HPV vaccine receipt via the IIS, calculated intervention costs, and compared HPV vaccine series initiation and completion rates across study arms. In New York, HPV vaccine initiation rates ranged from 37.0% to 37.4%, and completion rates were between 29.1% and 30.1%, with no significant differences across study arms. In Colorado, HPV vaccine initiation rates ranged from 31.2% to 33.5% and were slightly higher for 1 reminder compared with none, but vaccine completion rates, ranging from 27.0% to 27.8%, were similar. On adjusted analyses in Colorado, vaccine initiation rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.07 and 1.04, respectively); completion rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.02 and 1.03, respectively). IIS-based C-R/R for HPV vaccination did not improve HPV vaccination rates in New York and increased vaccination rates slightly in Colorado.

Associations between population based voting trends during the 2016 US presidential election and adolescent vaccination rates

BackgroundPolitics play a role in the dissemination of public health information, including immunization-related issues. We aim to describe relationships between HPV vaccination rates and state voting patterns during the 2016 US presidential election. MethodsWe classified each of the 50 states as either “Red” or “Blue,” based on whether a higher proportion of the state’s casted votes were for the Republican or Democratic nominee during the 2016 US presidential election. State-specific HPV, Tdap, and meningococcal vaccination rates were obtained from the 2016-National Immunization Survey-Teen. State socio-demographic factors and HPV vaccine legislation were obtained from the US Census Bureau and National Conference of State Legislatures. Vaccination rates and socio-demographic variables were compared using independent t-tests. Multiple linear regression compared vaccination rates between “Red” and “Blue” states, adjusting for percentage of both uninsured children and educational attainment. ResultsCompared to “Blue” states, “Red” states had significantly lower unadjusted HPV vaccine series initiation (56% vs 66%, p < 0.05) and completion (39% vs 50%, p < 0.05) rates; yet had similar rates of Tdap (88% vs 89%, p > 0.05) and meningococcal (79% vs 83%, p > 0.05) vaccinations. After adjusting for potential confounders, the regression-adjusted mean rate for HPV vaccine initiation and completion remained significantly lower for “Red” states compared to “Blue” states (57% vs 65%, p < 0.05, and 41% vs 48%, p < 0.05, respectively). ConclusionHPV vaccination rates are associated with statewide-level voting patterns. Future interventions aimed at improving HPV vaccination rates should consider engaging local and national elected leaders to be proactive in disseminating accurate and authoritative immunization information.

Achieving high HPV vaccine completion rates in a pediatric clinic population

ABSTRACT Objective: To evaluate the efficacy of an intervention utilizing patient navigators (PNs) to 1) educate families on human papillomavirus (HPV) vaccination in a clinic setting and 2) provide personalized reminders for follow-up. Method: Families with 9–17 year-old children who had no record of completing the HPV vaccination series receiving primary or specialty care in 3 pediatric clinics were approached by PNs between February 1, 2015 and August 31, 2016. Demographic characteristics, visit type, preferred contact method, rates and correlates of completion, and appointments missed were analyzed. In addition, qualitative interviews of 21 providers and PNs assessed their perceptions of the program. Results: 1,391 adolescents were identified out of 2,162 patients approached as unvaccinated or partially vaccinated prior starters; among the unvaccinated, 930 received the 1st dose after being counseled by the PN (66.9%), either immediately or at a follow-up visit soon thereafter. This included 118 siblings of patients who did not have an appointment that day. Of initiators approached between 2/1/2015 and 8/31/2016, 93% (864/930) completed the series by 8/31/2017. No differences in series completion among initiators were observed by gender or race/ethnicity, but older patients (15–17 years old) were less likely to complete than 11–12 year olds. Of the 688 patients identified as prior starters, 85% completed the series through the program. Qualitative interviews demonstrated that providers felt the program addressed major barriers to HPV vaccination. Conclusion: Employing PNs dramatically increased HPV vaccine series completion among boys and girls with historically low HPV vaccination rates at pediatric clinics in Texas. Clinic providers felt this program addressed many barriers they observed prior to program implementation. This approach could markedly improve HPV vaccine series completion rates in the US.

A collaborative program for educating urban youth about HPV risk and cancer prevention.

169 Background: HPV infection is the most common sexually transmitted disease. Exposure to this infection is associated with cancer later in life. Public data regarding HPV vaccination rates and health disparity (as evidenced by low-income, high teen birth and STI rates) were identified. Methods: Based on the supposition that health disparity is associated with low socioeconomic status, a Wisconsin state map provided by the Center for Urban Population Health identified 29 zip codes in the City of Milwaukee, and are broken by low, medium, and high income brackets. An HPV education program, in partnership with Milwaukee Public Schools (MPS), was developed with a focus on the low income bracket to emphasize infection exposure and the safety and efficacy of the HPV vaccine in cancer prevention. This included education on safe relationships and emphasis on personal health advocacy. Program development was aimed at the health literacy of youth. Collaboration occurred with MPS leadership and their established health curriculum to ensure the HPV program accommodated the academic level of the freshman health classroom. Results: The data is reflective of HPV vaccine series completion rates within the zip codes where the HPV program was presented. Logistic regression was used and a significant rise for HPV completion rates by year (p = 0.0003) and by zip code (p &lt; 0.0001) were observed. Conclusions: As the program evolves, program evaluations and public data continue to be reviewed along with feedback from various stakeholders to maintain the quality and integrity of the program. Additionally, Aurora Health Care has received requests to share this HPV program best practice with other institutions to expand it throughout urban areas of Wisconsin and Illinois.[Table: see text]

Cancer Prevention Education for Providers, Staff, Parents, and Teens Improves Adolescent Human Papillomavirus Immunization Rates

To develop a program to educate providers, office staff, patients, and parents on life-long cancer prevention strategies, including the use of human papillomavirus (HPV) vaccine to improve adolescent HPV vaccination rates. A 2-phase program was implemented at 6 pediatric practices across upstate New York. Phase 1 included provider and staff education regarding practice-specific vaccination challenges and discussion of the contents of a study-specific cancer-prevention booklet, which included HPV vaccine information. Throughout phase 2, the booklets were distributed to all adolescents and their parents during office visits over a 12-month period. Practice-specific, countywide, and statewide HPV vaccination rates were assessed before phase 1, and 6 and 12 months after the launch of phase 2. One year after implementing phase 2 in 6 practices, adolescent HPV vaccine series initiation increased by at least 10% in 3 practices, and at least 5% in 5 practices. Similarly, adolescent vaccine series completion rates increased by more than 10% in 3 practices. The percent change in vaccine series completion rates across all study sites postintervention ranged from 12% to 20% for 11- to 12-year-olds, and from 7% to 23% for 13- to 18-year-olds. Cancer prevention education targeting providers, office staff, patients, and parents was modestly effective for improving adolescent HPV vaccination rates.

An environmental scan to examine stakeholder perspectives on human papillomavirus vaccination: A mixed methods study

PurposeHuman papillomavirus (HPV) vaccine series completion rates among females and males remain low in Florida (46.4% and 34.5%, respectively). Multiple stakeholders influence vaccination uptake, including health care providers (HCPs), public health professionals (PHPs), and members of professional organizations. We examined stakeholder efforts related to increasing vaccine uptake and education among parents/adolescents and HCPs. MethodsWe conducted an environmental scan of stakeholder efforts and identified stakeholders using our professional networks and a snowball sampling approach. Stakeholders (n = 46) completed a survey about involvement in and barriers to vaccination promotion efforts. A subset (n = 12) of stakeholders participated in follow-up interviews further exploring vaccination efforts and barriers. Survey data were analyzed using descriptive statistics. Interview data were analyzed using deductive analysis and coded using constructs from the PRECEDE-PROCEED model. ResultsThe majority of our survey sample was PHPs (50.0%) and HCPs (32.6%). Stakeholder efforts were focused on adolescent/parent/HCP education including providing: educational materials for HCPs (55.8%) and adolescents/parents (59.6%), one-on-one consultations for adolescents/parents (55.3%), and HCP education (54.7%). Lack of knowledge/understanding and education/information were barriers reported across almost all groups/areas. Office staff/HCP education and distribution of patient education materials were efforts described as important during qualitative interviews. Stakeholders also noted HCP discomfort when recommending HPV vaccine, parental perceptions that the vaccine is unnecessary, and a lack of education/understanding among parents and HCPs. ConclusionsResults suggest the need for parent/adolescent education, specifically targeting key areas we identified: importance and benefits of HPV vaccine, and education and skill building in vaccine communication for HCPs.

Impact of an electronic medical record reminder on hepatitis B vaccine initiation and completion rates among insured adults with diabetes mellitus

ObjectiveThe Advisory Committee on Immunization Practices recommends Hepatitis B (HepB) vaccine for previously unvaccinated adults <60 years with diabetes mellitus. This observational retrospective cohort study assessed the impact of implementing electronic provider reminders on HepB vaccine initiation and 3-dose series completion rates among insured adults with diabetes aged 19–59 years old. Research design and methodsDifference-in-difference (DID) analyses compared changes in vaccine initiation and completion rates (ratio of the rate ratio [RRR] and 95% confidence interval [CI]) during 12 months pre- and post-implementation between intervention and control sites. We examined trends in vaccine initiation and completion rates by plotting monthly rates during the study period. We also calculated the overall HepB vaccine coverage rates with 95% CI among all adults with diabetes aged 19–59 years old at the start and end date of the study period. ResultsBaseline HepB vaccine initiation and completion rates were similar at both the intervention and control sites. Gender, age, and race/ethnicity distributions within both sites were similar during the 12 months pre- and post-implementation. DID analyses demonstrated statistically significant differences in the changes of the annual vaccine initiation rates (RRR: 70.7, 95% CI: 62.8–79.6) and the third dose completion rates (RRR = 18.7, 95% CI: 14.2–24.8) between the two sites. The coverage increased significantly at the intervention site while it remained low at the control site. ConclusionsUse of provider reminders is highly effective in increasing both HepB vaccine initiation and series completion rates among adults with diabetes.