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Kasting ML, Laily A, Burney HN, Head KJ, Daggy JK, Zimet GD, Schwab-Reese LM. County-Level Factors Associated With Influenza and COVID-19 Vaccination in Indiana, 2020‒2022. Am J Public Health 2024; 114:415-423. [PMID: 38386970 PMCID: PMC10937598 DOI: 10.2105/ajph.2023.307553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Abstract
Objectives. To assess COVID-19 and influenza vaccination rates across Indiana's 92 counties and identify county-level factors associated with vaccination. Methods. We analyzed county-level data on adult COVID-19 vaccination from the Indiana vaccine registry and 2021 adult influenza vaccination from the Centers for Disease Control and Prevention. We used multiple linear regression (MLR) to determine county-level predictors of vaccinations. Results. COVID-19 vaccination ranged from 31.2% to 87.6% (mean = 58.0%); influenza vaccination ranged from 33.7% to 53.1% (mean = 42.9%). In MLR, COVID-19 vaccination was significantly associated with primary care providers per capita (b = 0.04; 95% confidence interval [CI] = 0.02, 0.05), median household income (b = 0.23; 95% CI = 0.12, 0.34), percentage Medicare enrollees with a mammogram (b = 0.29; 95% CI = 0.08, 0.51), percentage uninsured (b = -1.22; 95% CI = -1.57, -0.87), percentage African American (b = 0.31; 95% CI = 0.19, 0.42), percentage female (b = -0.97; 95% CI = -1.79, ‒0.15), and percentage who smoke (b = -0.75; 95% CI = -1.26, -0.23). Influenza vaccination was significantly associated with percentage uninsured (b = 0.71; 95% CI = 0.22, 1.21), percentage African American (b = -0.07; 95% CI = -0.13, -0.01), percentage Hispanic (b = -0.28; 95% CI = -0.40, -0.17), percentage who smoke (b = -0.85; 95% CI = -1.06, -0.64), and percentage who completed high school (b = 0.54; 95% CI = 0.21, 0.87). The MLR models explained 86.7% (COVID-19) and 70.2% (influenza) of the variance. Conclusions. Factors associated with COVID-19 and influenza vaccinations varied. Variables reflecting access to care (e.g., insurance) and higher risk of severe disease (e.g., smoking) are notable. Programs to improve access and target high-risk populations may improve vaccination rates. (Am J Public Health. 2024;114(4):415-423. https://doi.org/10.2105/AJPH.2023.307553).
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Affiliation(s)
- Monica L Kasting
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Alfu Laily
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Heather N Burney
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Katharine J Head
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Joanne K Daggy
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Gregory D Zimet
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Laura M Schwab-Reese
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
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Xiong S, Humble S, Barnette A, Brandt H, Thompson V, Klesges LM, Silver MI. Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states. BMC Public Health 2024; 24:702. [PMID: 38443823 PMCID: PMC10916280 DOI: 10.1186/s12889-024-18206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND We assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child. METHODS An online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9-17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level. RESULTS Analyses were conducted using responses from 926 parents about their oldest child in the target age range (9-17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children. CONCLUSIONS The results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.
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Affiliation(s)
- Serena Xiong
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 166, 55414, Minneapolis, MN, USA.
| | - Sarah Humble
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Alan Barnette
- Saint Francis Medical Center, 211 St. Francis Drive, 63703, Cape Girardeau, MO, USA
| | - Heather Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, 38105-3678, Memphis, TN, USA
| | - Vetta Thompson
- Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University School of Medicine, 63110, St. Louis, MO, USA
- Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 63110, St. Louis, MO, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Michelle I Silver
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
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Moore R, Purvis RS, Willis DE, Li J, Langner J, Gurel-Headley M, Kraleti S, Curran GM, Macechko MD, McElfish PA. "Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine. Vaccines (Basel) 2024; 12:171. [PMID: 38400154 PMCID: PMC10892107 DOI: 10.3390/vaccines12020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Jonathan Langner
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA;
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Shashank Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
| | - Geoffrey M. Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA;
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 4300 W. 7th St., North Little Rock, AR 72114, USA
| | - Michael D. Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA;
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
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Falk GE, Okut H, Lightner JS, Farrokhian N, LaCrete F, Chiu A, Shnayder Y, Bond J, Sykes KJ. Forecasting Rural and Urban Otolaryngologists, Radiation Oncologists, and Oropharyngeal Carcinoma. Laryngoscope 2024; 134:136-142. [PMID: 37395265 DOI: 10.1002/lary.30809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/04/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. METHODS Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. RESULTS Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96). CONCLUSIONS Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. LEVEL OF EVIDENCE NA Laryngoscope, 134:136-142, 2024.
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Affiliation(s)
- Grace E Falk
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Hayrettin Okut
- Office of Research and Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Nathan Farrokhian
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Frantzlee LaCrete
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Alexander Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Justin Bond
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
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Skuras A, Iseler J. Increasing COVID-19 Immunization Awareness in Rural Communities Through a Multimedia Campaign. CLIN NURSE SPEC 2023; 37:291-298. [PMID: 37870515 DOI: 10.1097/nur.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/OBJECTIVES The purpose of this project was to implement a multimedia campaign to increase COVID-19 vaccine awareness and acceptance in rural communities. DESCRIPTION OF PROJECT This project was created and implemented in partnership with a public university in Michigan and targeted to rural Michigan communities. The campaign consisted of digital advertisements and video interviews with nurses from rural areas. Interview questions were developed using knowledge of the health belief model and allowed the nurses to share their COVID-19 stories. Video interviews were published to social media, and digital advertisements were targeted to rural areas via geofencing. A viewer response survey was provided to measure likelihood of behavior change after viewing. OUTCOME The campaign advertisements and videos reached 602 980 people during the implementation period, and 239 surveys were completed. Of the 53 unvaccinated respondents, 87% stated an increased likelihood to vaccinate. CONCLUSION This project supports the ability of the clinical nurse specialist to lead a multimedia campaign partnership that can reach thousands of people and increase the likelihood of vaccination. As the popularity of digital media continues to rise, clinical nurse specialists can embrace these channels to disseminate critical health information.
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Affiliation(s)
- Alexis Skuras
- Author Affiliations: Assistant Professor (Dr Skuras), University of Michigan-Flint; and Program Director and Clinical Nurse Specialist (Dr Iseler), Michigan State University, Grand Rapids
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Owens C, Hubach RD. Rural-urban differences in monkeypox behaviors and attitudes among men who have sex with men in the United States. J Rural Health 2023; 39:508-515. [PMID: 36394371 DOI: 10.1111/jrh.12726] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM. METHODS A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test. FINDINGS Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox. CONCLUSIONS As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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Kaddas HK, Ramsay JM, Ou JY, Fair D, Kepka D, Kirchhoff AC. HPV Vaccination Initiation and Completion Among Pediatric, Adolescent, and Young Adult Cancer Survivors and a Comparison Population Sample Receiving Primary Care. J Pediatr Hematol Oncol 2023; 45:e236-e243. [PMID: 36219685 PMCID: PMC9974526 DOI: 10.1097/mph.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) vaccinations can reduce pediatric, adolescent, and young adult (PAYA) cancer survivors' susceptibility to HPV-related subsequent cancers. We examined differences in HPV vaccination initiation and completion among a Utah-based cohort of PAYA cancer survivors and a cancer-free population sample. Participants received primary care at 1 of 2 health care systems during study follow-up: 2006-2016. Vaccination records were identified from these health care systems, statewide vaccination records, and an all-payer claims database. HPV vaccination initiation (1 dose) and completion (3 doses) were compared between cancer survivors (N=1579) and age-matched and sex-matched cancer-free population sample (N=4513). Individuals were 9 to 21 years old at cohort entry. Mixed-effects Poisson regression estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Relative to the population sample, cancer survivors were less likely to initiate vaccination (IRR=0.8, 95% CI: 0.73-0.98). The most severe disparity compared with the population sample for vaccine initiation (IRR=0.5, 95% CI: 0.31-0.74) or completion (IRR=0.5, 95% CI: 0.28-0.89) was observed for Hispanic survivors. PAYA cancer survivors are less likely to initiate HPV vaccination series than noncancer counterparts. Targeted interventions should be directed at PAYA survivors to raise HPV vaccination with emphasis on high-risk groups such as Hispanic survivors.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | - Douglas Fair
- Department of Pediatrics, University of Utah
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah
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Owens C, Hubach RD. An Exploratory Study of the Mpox Media Consumption, Attitudes, and Preferences of Sexual and Gender Minority People Assigned Male at Birth in the United States. LGBT Health 2023. [PMID: 36735618 DOI: 10.1089/lgbt.2022.0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: This study examined the consumption of, attitudes toward, and preferences for mpox media among U.S. sexual and gender minority (SGM) people assigned male at birth (AMAB). Methods: A total of 496 SGM people AMAB completed an online cross-sectional survey between August 6 and 15, 2022. Data were analyzed with descriptive statistics and logistic regressions. Results: Approximately two-thirds of participants overall agreed that media-related content about mpox targeted (66.3%) and stigmatized gay, bisexual, and other men who have sex with men (69.2%). The three most preferred mpox content were the destigmatization of SGM people (44.2%), mpox vaccine accessibility (25.2%), and mpox transmission and prevention (19.2%). Rural participants had a lower likelihood of consuming mpox-related media than urban participants. Conclusion: SGM people AMAB prefer mpox messaging campaigns to be grounded in stigma-reduction to ensure that messages do not perpetrate stigma against them. Stigmatizing content might foster SGM people AMAB to distrust mpox interventions.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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Tubaş F, Dulkadir R, Taplak AŞ, Ünlü E. Knowledge and Attitudes of Physicians and Nurses in Turkey Regarding Human Papillomavirus Vaccination of Their Children. J Community Health 2023; 48:99-103. [PMID: 36305983 DOI: 10.1007/s10900-022-01141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/31/2022]
Abstract
AIM This study aimed to determine the knowledge and attitudes of physicians and nurses as parents about human papillomavirus (HPV) vaccination and their views on vaccination in children. MATERIALS AND METHODS This cross-sectional study included 72 physicians and 128 nurses who had children. Data were collected using questionnaires prepared by researchers. Descriptive statistical analysis and chi-square tests were used for data analysis. RESULTS In this study, 84.7% of physicians and 70.3% of the nurses knew that HPV is a cancer factor, and two-thirds of the healthcare professionals believed that the HPV vaccine is protective. Moreover, 62.5% of physicians and 74.2% of nurses reported that they did not intend to vaccinate their children. The reasons for vaccination hesitancy of healthcare professionals was believing it was unnecessary, thinking it was expensive, having insufficient knowledge about vaccine, thinking it may have side effects, and not trusting the vaccine. In this sample, 70.8% of physicians and 53.9% of nurses stated that they could have their children vaccinated only if the HPV vaccines were in the national vaccination schedule. DISCUSSION Further studies should be conducted to include the HPV vaccine in the childhood national vaccination program to reduce vaccine hesitancy.
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Affiliation(s)
- Filiz Tubaş
- Department Of Pediatrics, Erciyes University Faculty Of Medicine, Kayseri, Turkey.
| | - Ramazan Dulkadir
- Department of Pediatrics, K?rşehir, K?rşehir Ahi Evran Un?versity Faculty of Medicine, Kayseri, Turkey
| | | | - Erdal Ünlü
- Department of Pediatrics, K?rşehir, K?rşehir Ahi Evran Un?versity Faculty of Medicine, Kayseri, Turkey
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Rodriguez AM, Do TQN, Eyada MF, Chen L, Schmeler KM, Montealegre JR. Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion. Vaccines (Basel) 2023; 11. [PMID: 36851207 DOI: 10.3390/vaccines11020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey-Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016-August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9-21) and 12 years (9-20). The overall median interval between HPV vaccine doses (range) was 291 days (146-2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion.
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Dang JHT, McClure S, Gori ACT, Martens T, Mojadedi A, Smith U, Austin CJ, Chen MS. Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents. J Rural Health 2023; 39:136-141. [PMID: 35798683 PMCID: PMC9771865 DOI: 10.1111/jrh.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic. METHODS This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up. FINDINGS The proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. CONCLUSIONS The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.
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Affiliation(s)
- Julie H. T. Dang
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, California, USA
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | - Alexandra C. T. Gori
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | | | - Ulissa Smith
- Neighborhood Wellness Foundation, Sacramento, California, USA
| | | | - Moon S. Chen
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California, USA
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Harry ML, Asche SE, Freitag LA, Sperl-Hillen JM, Saman DM, Ekstrom HL, Chrenka EA, Truitt AR, Allen CI, O'Connor PJ, Dehmer SP, Bianco JA, Elliott TE. Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial. Hum Vaccin Immunother 2022; 18:2040933. [PMID: 35302909 PMCID: PMC9009937 DOI: 10.1080/21645515.2022.2040933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates are low in young adults. Clinical decision support (CDS) in primary care may increase HPV vaccination. We tested the treatment effect of algorithm-driven, web-based, and electronic health record-linked CDS with or without shared decision-making tools (SDMT) on HPV vaccination rates compared to usual care (UC). METHODS In a clinic cluster-randomized control trial conducted in a healthcare system serving a largely rural population, we randomized 34 primary care clinic clusters (with three clinics sharing clinicians randomized together) to: CDS; CDS+SDMT; UC. The sample included young adults aged 18-26 due for HPV vaccination with a study index visit from 08/01/2018-03/15/2019 in a study clinic. Generalized linear mixed models tested differences in HPV vaccination status 12 months after index visits by study arm. RESULTS Among 10,253 patients, 6,876 (65.2%) were due for HPV vaccination, and 5,054 met study eligibility criteria. In adjusted analyses, the HPV vaccination series was completed by 12 months in 2.3% (95% CI: 1.6%-3.2%) of CDS, 1.6% (95% CI: 1.1%-2.3%) of CDS+SDMT, and 2.2% (95% CI: 1.6%-3.0%) of UC patients, and at least one HPV vaccine was received by 12 months in 13.1% (95% CI: 10.6%-16.1%) of CDS, 9.2% (95% CI: 7.3%-11.6%) of CDS+SDMT, and 11.2% (95% CI: 9.1%-13.7%) of UC patients. Differences were not significant between arms. Females, those with prior HPV vaccinations, and those seen at urban clinics had significantly higher odds of HPV vaccination in adjusted models. DISCUSSION CDS may require optimization for young adults to significantly impact HPV vaccination. TRIAL REGISTRATION clinicaltrials.gov NCT02986230, 12/6/2016.
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Adjei Boakye E, McKinney SL, Whittington KD, Boyer VE, Franca MC, Lee M, McKinnies RC, Collins SK, Gerend MA. Association between Sexual Activity and Human Papillomavirus (HPV) Vaccine Initiation and Completion among College Students. Vaccines (Basel) 2022; 10:2079. [PMID: 36560489 PMCID: PMC9784235 DOI: 10.3390/vaccines10122079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
HPV vaccination is most effective if received before initiation of sexual activity. Previous studies suggested that young adult women who were not sexually active were not interested in receiving the vaccine because they did not think it was necessary. Whether this misperception is still prevalent today-and also shared by men-is unknown. This study examined whether sexual activity was associated with HPV vaccine uptake (initiation and completion) among university students. A cross-sectional study was conducted between February and May 2021 among students (n = 951) at a public Midwestern University. Sexual activity was categorized as "never" or "ever" had oral and/or vaginal sex. Outcome variables were HPV vaccine initiation, defined as receipt of ≥1 dose, and completion, defined as receipt of ≥3 doses. Multivariable logistic regression models estimated the association between sexual activity and HPV vaccine uptake, adjusting for sociodemographic factors. Approximately 18% of students reported never engaging in sexual activity. Overall, 45.5% initiated the HPV vaccine, and 16.5% completed the vaccine series. After adjusting for covariates, compared to students that reported never engaging in sexual activity, those that had ever engaged in sexual activity were more likely to have initiated the vaccine series (aOR = 2.06, 95% CI: 1.34-3.17); however, no difference was observed for completion. HPV vaccination was low; sexually naïve students were less likely to initiate the HPV vaccine. Since sexually naïve students may benefit from receiving the HPV vaccination, targeted interventions should be implemented towards this population to help increase vaccination rates and prevent HPV-associated diseases.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Otolaryngology—Head and Neck Surgery, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Stacey L. McKinney
- Department of Dental Hygiene, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Kelli D. Whittington
- Department of Nursing, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Valerie E. Boyer
- Department of Communication Disorders and Sciences, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Maria C. Franca
- Department of Communication Disorders and Sciences, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, Springfield, IL 62794, USA
| | - Richard C. McKinnies
- Department of Radiologic Sciences, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Sandra K. Collins
- Department of Health Care Management, School of Health Sciences, Southern Illinois University, 1263 Lincoln Dr, Carbondale, IL 62901, USA
| | - Mary A. Gerend
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA
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Rodriguez AM, Do TQN, Chen L, Schmeler KM, Montealegre JR, Kuo YF. Human papillomavirus vaccinations at recommended ages: How a middle school-based educational and vaccination program increased uptake in the Rio Grande Valley. Hum Vaccin Immunother 2022; 18:2133315. [PMID: 36252275 DOI: 10.1080/21645515.2022.2133315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human papillomavirus (HPV) vaccination is recommended for U.S. adolescents at ages 11-12 requiring two or three doses depending on if the vaccine series started before age 15. The objective was to compare HPV vaccination rates among medically underserved, economically disadvantaged, students in rural middle school districts (Rio Grande Valley [RGV], Texas) by age of initiation (≤ age 11 years vs. age 12 years and older). This quasi-experimental study included 1,766 students (884 females; 882 males) who received at least one HPV vaccine dose through our school-based vaccination program between 08/2016-06/2022. Summary statistics were stratified by age at initiation and gender. The overall HPV up-to-date (UTD) rate was 59.7% (95% Confidence Interval: 57.4-62.0%). The median age at HPV UTD (range) was 12 years (9-19) and median interval between HPV vaccine doses (range) was 316 days (150-2,855). Most students received the HPV vaccine bundled with other vaccinations (72.4%, 1,279/1,766). There was a higher HPV UTD rate among students who initiated the HPV vaccine on or before age 11 than those who initiated on or after age 12 (73.6% versus 45.1%, respectively). The median age of HPV UTD was age 12 for those initiating on or before 11 years versus age 13 for those initiating on or after 12 years of age. Initiating the HPV vaccine at age ≤11 years increased completion of the HPV vaccine series. Improving HPV vaccine coverage and introduction of pan-gender vaccination programs will significantly decrease HPV-related diseases in the RGV.
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Affiliation(s)
- Ana M Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Thuy Quynh N Do
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Lu Chen
- Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jane R Montealegre
- School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Pilcher F, Carney JK, Stein GS. Overcoming barriers to HPV vaccination in rural Vermont through a multicomponent peer-based approach. Hum Vaccin Immunother 2022; 18:2122494. [PMID: 36130214 PMCID: PMC9746368 DOI: 10.1080/21645515.2022.2122494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Human Papillomavirus (HPV) causes almost all cervical cancers and many cancers of the anus, vagina, vulva, penis, and oropharynx. The HPV vaccine provides protection to all adolescents from a broad spectrum of cancers, yet HPV vaccination rates remain lower than those of other routine vaccines. Developing effective HPV vaccine interventions is particularly important in rural areas, whose residents have lower rates of HPV vaccination and higher cervical cancer incidence and mortality; however, interventional research in these populations is relatively limited. Furthermore, though rural areas are heterogeneous in many regards, few interventions engage stakeholders to develop community-specific solutions to overcome obstacles associated with HPV vaccination. Based on a review of existing literature, we recommend a multicomponent peer-based approach that includes school-based vaccination and awareness, parental involvement, and stakeholder engagement to increase HPV vaccination in rural areas, and we provide an example of such an intervention in rural Vermont.
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Affiliation(s)
- Finlay Pilcher
- Larner College of Medicine, University of Vermont, Burlington, VT, USA,CONTACT Finlay Pilcher Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Given C401, Burlington, Vermont05405, USA
| | - Jan Kirk Carney
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Gary S. Stein
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Rodriguez AM, Do TQN, Jibaja-Weiss ML, Chen L, Schmeler KM, Montealegre JR, Kuo YF. Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas. Am J Public Health 2022; 112:1269-1272. [PMID: 35862887 PMCID: PMC9382169 DOI: 10.2105/ajph.2022.306970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).
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Affiliation(s)
- Ana M Rodriguez
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Thuy Quynh N Do
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Maria L Jibaja-Weiss
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Lu Chen
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Kathleen M Schmeler
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Jane R Montealegre
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Yong-Fang Kuo
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
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Pruitt SL, Tiro JA, Kepka D, Henry K. Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics. Am J Prev Med 2022; 62:538-547. [PMID: 35125272 DOI: 10.1016/j.amepre.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described. METHODS In 2020-2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015-2017 National Immunization Survey-Teen for male and female adolescents aged 13-17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression. RESULTS Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1-2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas. CONCLUSIONS A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deanna Kepka
- College of Nursing, The University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kevin Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: a systematic review of the literature. Prev Med Rep 2022; 27:101804. [PMID: 35656229 PMCID: PMC9152779 DOI: 10.1016/j.pmedr.2022.101804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 12/22/2022] Open
Abstract
Early childhood vaccination coverage is low in rural areas of the United States. Reminder-recall & positive family-provider relationships facilitate vaccine uptake. Parental hesitancy is a barrier to early childhood vaccination in the rural U.S. Vaccine referrals & distance to providers are also rural-specific barriers. To increase vaccine coverage, interventions across rural populations are needed.
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies’ methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents’ relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural–urban immunization disparities.
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Cheng J, Zhou X, Xu H, Dan H, Li J, Chen Q. Incidence and Survival of Oral Cavity and Oropharyngeal Cancer in the USA from 1975 to 2018. J Oral Maxillofac Surg 2022; 80:1294-1305. [DOI: 10.1016/j.joms.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
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Schrote K, Hersh A, Bruegl A, Rodriguez MI. Women's perspectives on receiving and expanding access to essential health services in pharmacies in the United States. J Am Pharm Assoc (2003) 2021; 62:711-716.e3. [PMID: 34930682 DOI: 10.1016/j.japh.2021.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Expanding reproductive health services in community pharmacies is a promising strategy for reaching underserved communities. Limited information exists on women's attitudes to receive these services and if interest may differ in urban and rural locations. OBJECTIVE We sought to determine whether there were differences by rural location in women's perspectives and willingness to receive essential preventative and diagnostic reproductive health services in community pharmacies. METHODS We conducted a cross-sectional national survey of women in November 2020. The survey consisted of demographic data, women's experiences receiving essential preventative health services, and questions regarding perspectives on and interest in receiving these services in community pharmacies. Descriptive statistics assessed differences in survey responses between rural and urban communities. RESULTS Our sample size consisted of 867 women. We received 544 responses for a response rate of 62.7%. Rural women were as likely as their urban counterparts to delay receiving preventative care owing to concerns about insurance or how they would pay for services (P = 0.45). Rural women were less likely than urban women to have received the human papillomavirus vaccine (P = 0.02) or have had regular cervical cancer screenings (P = 0.04). Overall, both rural and urban women want to receive preventative reproductive health services in community pharmacies. CONCLUSION Expanded access to reproductive health services in community pharmacies has the potential to improve access and health screening, particularly in underserved rural areas.
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