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Khalil L, Russo E, Venkatakrishnan K, Mazul AL, Zevallos JP. Barriers to Human Papillomavirus Vaccination Initiation and Completion among Adults Aged 18-26 Years in a Large Healthcare System. Cancers (Basel) 2023; 15:4243. [PMID: 37686521 PMCID: PMC10487182 DOI: 10.3390/cancers15174243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection, with over 40% prevalence in the US. Oropharyngeal cancers (OPCs) driven by high-risk HPV are increasing (up to 90%), with HPV vaccination being the only prevention available. The aim of this study was to investigate HPV vaccination among patients aged between 18 and 26 years old with at least one encounter at a large healthcare system and identify sociodemographic factors associated with vaccine initiation and completion. A cross-sectional retrospective study was conducted between 2018 and 2021, including 265,554 patients identified from the Clinical Data Warehouse. HPV vaccination status by age, sex, race/ethnicity, insurance type, primary care (PCP) visits in the past year, alcohol, tobacco, illicit drug use, and age at vaccination was examined. Overall, 33.6% of females and 25.4% of males have completed the HPV vaccine. Black Americans were 35% more likely to initiate the vaccine than White Americans but were less likely to complete the entire course. Overall, HPV vaccination prevalence was far below the Health People 2030 goal of 80%, especially in young males. This low rate is troubling, since many patients had a PCP visit and remained unvaccinated, which serves as a missed opportunity for vaccination.
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Affiliation(s)
- Lucien Khalil
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (L.K.); (A.L.M.)
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy;
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Kripa Venkatakrishnan
- Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Angela L. Mazul
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (L.K.); (A.L.M.)
| | - Jose P. Zevallos
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (L.K.); (A.L.M.)
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2
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Wells J, Klosky JL, Liu Y, Gillespie TW. An overview of implementing an evidence based program to increase HPV vaccination in HIV community clinics. BMC Public Health 2022; 22:1696. [PMID: 36071389 PMCID: PMC9450352 DOI: 10.1186/s12889-022-14100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HPV-related anal cancer occurs in excess rates among people living with HIV (PLWH) and has been increasing in incidence. The HPV vaccine is an effective and safe approach to prevent and reduce the risk of HPV-related disease. Yet, HPV vaccine programs tailored and implemented in the HIV population are lagging for this high-risk group. METHODS A pre-post intervention study design will be used to tailor, refine, and implement the 4 Pillars™ Practice Transformation Program to increase HPV vaccination among PLWH. Guided by the RE-AIM framework, the CHAMPS study will provide training and motivation to HIV providers and clinic staff to recommend and administer the HPV vaccination within three HIV clinics in Georgia. We plan to enroll 365 HIV participants to receive HPV education, resources, and reminders for HPV vaccination. Sociodemographic, HPV knowledge, and vaccine hesitancy will be assessed as mediators and moderators for HPV vaccination. The primary outcome will be measured as an increase in uptake rate in initiation of the HPV vaccine and vaccine completion (secondary outcome) compared to historical baseline vaccination rate (control). DISCUSSION The proposed study is a novel approach to address a serious and preventable public health problem by using an efficacious, evidence-based intervention on a new target population. The findings are anticipated to have a significant impact in the field of improving cancer outcomes in a high-risk and aging HIV population. TRIAL REGISTRATION NCT05065840; October 4, 2021.
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Affiliation(s)
- Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, RM. 230, Atlanta, GA, 30324, USA.
| | - James L Klosky
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Theresa Wicklin Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Emory University, Atlanta, GA, USA
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Williams SE, Adams LE, Sommer EC. Improving Vaccination for Young Children (IVY): A Stepped-Wedge Cluster Randomized Trial. Acad Pediatr 2021; 21:1151-1160. [PMID: 34118498 DOI: 10.1016/j.acap.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND High childhood vaccination rates are critical for public health. We hypothesized that implementation of a vaccine education and quality improvement (QI) program, Improving Vaccinations for Young Children (IVY), would improve childhood vaccine rates. METHODS Eight pediatric practices (3 academic-based, 5 community-based) were randomized to implement IVY within a stepped-wedge cluster randomized trial (SWCRT) in middle Tennessee. Two educational modules on vaccines were developed using best practices in instructional design. Modules were provided electronically and were tailored to providers or office staff. Practices completed in-person QI coaching sessions and selected at least 2 vaccination-related QI changes. Data were collected monthly. The primary analysis examined intervention effect on the primary outcome of Combination 10 vaccination status for children who turned 2 in the previous month. Combination 10 status without influenza vaccine was a secondary outcome, and exploratory analyses assessed intervention effects after adjusting for time and practice type. RESULTS Data from 4041 patients (1788 control; 2253 intervention) were collected. The intervention effect was not significant on the primary outcome (OR = 1.01; 95% CI [0.76, 1.34]; P > .9), however there were positive intervention effects in secondary and exploratory models analyzing Combination10 rates without flu, including models adjusting for variation over time (0.20; 95% CI [0.04,0.35]; P = .01) and practice type (higher vaccination rate in academic practices, 0.23; 95% CI [0.03,0.42]; P = .03). CONCLUSIONS Combination 10 rates were not significantly improved with IVY, yet evidence of beneficial effect on rates without flu vaccine was found. Future studies could evaluate effects over a longer time period and within a larger practice sample.
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Affiliation(s)
- S Elizabeth Williams
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn
| | - Evan C Sommer
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn
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5
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Mavundza EJ, Iwu-Jaja CJ, Wiyeh AB, Gausi B, Abdullahi LH, Halle-Ekane G, Wiysonge CS. A Systematic Review of Interventions to Improve HPV Vaccination Coverage. Vaccines (Basel) 2021; 9:vaccines9070687. [PMID: 34201421 PMCID: PMC8310215 DOI: 10.3390/vaccines9070687] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.
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Affiliation(s)
- Edison J. Mavundza
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Correspondence:
| | - Chinwe J. Iwu-Jaja
- Department of Nursing and Midwifery, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
| | - Alison B. Wiyeh
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Blessings Gausi
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Leila H. Abdullahi
- African Institute for Development Policy, Nairobi P.O. Box 14688-00800, Kenya;
| | | | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Rand CM, Humiston SG. Provider Focused Interventions to Improve Child and Adolescent Vaccination Rates. Acad Pediatr 2021; 21:S34-S39. [PMID: 33958090 DOI: 10.1016/j.acap.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry (CM Rand), Rochester, NY.
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City (SG Humiston), Mo
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Egawa N, Shiraz A, Crawford R, Saunders-Wood T, Yarwood J, Rogers M, Sharma A, Eichenbaum G, Doorbar J. Dynamics of papillomavirus in vivo disease formation & susceptibility to high-level disinfection-Implications for transmission in clinical settings. EBioMedicine 2021; 63:103177. [PMID: 33421945 PMCID: PMC7806788 DOI: 10.1016/j.ebiom.2020.103177] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-level disinfection protects tens-of-millions of patients from the transmission of viruses on reusable medical devices. The efficacy of high-level disinfectants for preventing human papillomavirus (HPV) transmission has been called into question by recent publications, which if true, would have significant public health implications. METHODS Evaluation of the clinical relevance of these published findings required the development of novel methods to quantify and compare: (i) Infectious titres of lab-produced, clinically-sourced, and animal-derived papillomaviruses, (ii) The papillomavirus dose responses in the newly developed in vitro and in vivo models, and the kinetics of in vivo disease formation, and (iii) The efficacy of high-level disinfectants in inactivating papillomaviruses in these systems. FINDINGS Clinical virus titres obtained from cervical lesions were comparable to those obtained from tissue (raft-culture) and in vivo models. A mouse tail infection model showed a clear dose-response for disease formation, that papillomaviruses remain stable and infective on fomite surfaces for at least 8 weeks without squames and up to a year with squames, and that there is a 10-fold drop in virus titre with transfer from a fomite surface to a new infection site. Disinfectants such as ortho-phthalaldehyde and hydrogen peroxide, but not ethanol, were highly effective at inactivating multiple HPV types in vitro and in vivo. INTERPRETATION Together with comparable results presented in a companion manuscript from an independent laboratory, this work demonstrates that high-level disinfectants inactivate HPV and highlights the need for standardized and well-controlled methods to assess HPV transmission and disinfection. FUNDING Advanced Sterilization Products, UK-MRC (MR/S024409/1 and MC-PC-13050) and Addenbrookes Charitable Trust.
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Affiliation(s)
- Nagayasu Egawa
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Aslam Shiraz
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Robin Crawford
- Department of Gynae-Oncology, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Taylor Saunders-Wood
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Jeremy Yarwood
- Advanced Sterilization Products, Inc., 33 Technology Drive, Irvine, CA 926184, USA
| | - Marc Rogers
- Advanced Sterilization Products, Inc., 33 Technology Drive, Irvine, CA 926184, USA
| | - Ankur Sharma
- Advanced Sterilization Products, Inc., 33 Technology Drive, Irvine, CA 926184, USA
| | - Gary Eichenbaum
- Johnson & Johnson, Office of the Chief Medical Officer, 410 George Street, New Brunswick, NJ, 08901, USA
| | - John Doorbar
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK.
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Kara Elitok G, Bulbul L, Altuntas SB, Altuntas B, Günindi G, Haltaş M, Yuvarlan A, Toprak D, Bulbul A. Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians. Hum Vaccin Immunother 2020; 16:1132-1138. [PMID: 32040380 DOI: 10.1080/21645515.2020.1715146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.
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Affiliation(s)
- Gizem Kara Elitok
- Department of Family Medicine, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Lida Bulbul
- Department of Pediatrics, University of Health Sciences Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - Bülent Altuntas
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gözde Günindi
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Haltaş
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Yuvarlan
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Dilek Toprak
- Deparment of Family Medicine, University of Namık Kemal, Tekirdağ, Turkey
| | - Ali Bulbul
- Department of Pediatrics, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Sriram S, Ranganathan R. Why human papilloma virus vaccination coverage is low among adolescents in the US? A study of barriers for vaccination uptake. J Family Med Prim Care 2019; 8:866-870. [PMID: 31041215 PMCID: PMC6482788 DOI: 10.4103/jfmpc.jfmpc_107_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Cervical cancer and Human papillomavirus (HPV) affects women, men, and children of all races, ethnicities, and backgrounds. The objective of this study is to examine the association between adolescent (13-17 years) HPV vaccination uptake and the key factors influencing the uptake rates of HPV vaccination. Materials and Methods The 2016 NIS-Teen data, an annual survey conducted by the CDC to monitor vaccination uptake in the United States is used for this study. Multivariable logistic regression model was used to estimate the relationship between various factors and HPV vaccine uptake. Results Male adolescents were 0.26 times less likely to get the HPV vaccines; adolescents covered by private health insurance were 0.18 times less likely to get HPV vaccines; Hispanic adolescents were 1.47 times more likely, adolescents from other races including Asians were 1.75 times more likely to get vaccinated for HPV compared to non-Hispanic white adolescents. Adolescents from the low-income families were 1.21 times more likely to get vaccinated for HPV; adolescents from North-eastern regions of the United States were 1.62 times more likely to get vaccinated; adolescents who were not recommended for vaccination by the family physicians were 0.43 times less likely to get HPV vaccination; adolescents who did not have any safety concerns and concerns about side effects were 3.24 times more likely to get the HPV vaccine; adolescents from households that did have not orthodox religious beliefs were 13.67 times more likely to get vaccinated. Conclusions Vaccination uptake rates are low for adolescents in the US and the results of this study identified important barriers which need to be addressed in order to improve vaccine uptake rates among the target groups which are less likely to get vaccinated. Also, knowing the sociodemographic and community level factors associated with HPV vaccination uptake status, health planners can better plan strategies to improve HPV vaccination in their local settings.
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Affiliation(s)
- Shyamkumar Sriram
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA
| | - Radhika Ranganathan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA
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Bekkat-Berkani R, Romano-Mazzotti L. Understanding the unique characteristics of seasonal influenza illness to improve vaccine uptake in the US. Vaccine 2018; 36:7276-7285. [PMID: 30366802 DOI: 10.1016/j.vaccine.2018.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
Seasonal influenza results in substantial morbidity, mortality and socio-economic burden. The US Advisory Committee on Immunization Practices recommends vaccination of everyone over 6 months of age, but coverage remains substantially below the Healthy People 2020 target of 70% in most age groups. Influenza is different from other vaccine-preventable diseases in several ways that influence vaccine uptake. Although the incidence of most vaccine-preventable diseases is low, there is a perception that these diseases result in significant illness or death. In contrast, seasonal influenza has a relatively high incidence, but there is an incorrect perception of a lower disease severity. The vaccine effectiveness of seasonal influenza vaccines is less than other routine vaccines, varies from season to season between northern and southern hemispheres, and can be low in some seasons. It is also not well recognized that vaccination can attenuate the severity of influenza illness. Finally, the need for annual vaccination is perceived as a burden to busy people. Understanding these differences from the perspective of caregivers and vaccinees might help to improve influenza vaccine uptake. Presenting vaccine effectiveness in terms of clinical outcomes that have the most impact might help to overcome the perceptions that influenza is a non-serious disease and that the vaccine is not effective. The benefits of disease attenuation need to be emphasized in terms of reduced mortality, hospitalization, absenteeism and disruption to daily life. Innovative communication strategies should be adopted, including stronger recommendations from and to healthcare providers, continuous patient education, and social media initiatives employing more emotional and narrative approaches than traditionally used. Finally, access to seasonal influenza vaccination needs to be improved, and barriers such as cost and inconvenience removed. Multiple initiatives have already been successful. The remaining challenge is to translate individual successes into public health policies with corresponding funding and implementation.
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