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Fontenot HB, Quist KM, Glauberman G, Michel A, Zimet G. Impact of the COVID-19 pandemic on social media utilization, influences related to parental vaccine decision making, and opinions on trustworthy social media vaccination campaigns: A qualitative analysis. Hum Vaccin Immunother 2024; 20:2311476. [PMID: 38356267 PMCID: PMC10878019 DOI: 10.1080/21645515.2024.2311476] [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: 06/06/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents' perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic's impact on parent's (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.
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Affiliation(s)
| | - Kevin M. Quist
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indianapolis, IN, USA
| | - Gary Glauberman
- School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alexandra Michel
- School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Wong LP, Lee HY, Alias H, Zimet G, Liu T, Lin Y, Hu Z. Cost-based COVID-19 vaccination and willingness to pay: A post-pandemic review. Hum Vaccin Immunother 2024; 20:2313860. [PMID: 38359815 PMCID: PMC10877984 DOI: 10.1080/21645515.2024.2313860] [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: 10/31/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
The primary objective of this paper is to serve as a valuable resource for policymakers who are confronted with the evolving landscape of the coronavirus disease 2019 (COVID-19), considering both free and cost-based vaccination approaches. The potential consequences of shifting from free to cost-based vaccination are explored, encompassing its impact on global vaccine equity and prioritization, economic well-being, healthcare systems and delivery, public health policies, and vaccine distribution strategies. Examining past studies on willingness to pay for the initial COVID-19 vaccine dose and booster shots provides insights into how individuals value COVID-19 vaccinations and underscores the significance of addressing issues related to affordability. If COVID-19 vaccinations incur expenses, using effective communication strategies that emphasize the importance of vaccination and personal health benefits can increase willingness to pay. Making COVID-19 vaccines accessible through public health programs or health insurance can help alleviate financial barriers and increase vaccination rates.
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Affiliation(s)
- Li Ping Wong
- Department of Epidemiology and Health Statistics, Fujian Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hai Yen Lee
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tongyu Liu
- Department of Gynecology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
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Humphrey J, Wanjama E, Carlucci JG, Naanyu V, Were E, Muli L, Alera M, McGuire A, Nyandiko W, Songok J, Wools-Kaloustian K, Zimet G. Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya. J Acquir Immune Defic Syndr 2023; 94:429-436. [PMID: 37949446 PMCID: PMC10642693 DOI: 10.1097/qai.0000000000003303] [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: 04/25/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Differentiated service delivery models are implemented by HIV care programs globally, but models for pregnant and postpartum women living with HIV (PPWH) are lacking. We conducted a discrete choice experiment to determine women's preferences for differentiated service delivery. SETTING Five public health facilities in western Kenya. METHODS PPWH were enrolled from April to December 2022 and asked to choose between pairs of hypothetical clinics that differed across 5 attributes: clinic visit frequency during pregnancy (monthly vs. every 2 months), postpartum visit frequency (monthly vs. only with routine infant immunizations), seeing a mentor mother (each visit vs. as needed), seeing a clinician (each visit vs. as needed), and basic consultation cost (0, 50, or 100 Kenya Shillings [KSh]). We used multinomial logit modeling to determine the relative effects (β) of each attribute on clinic choice. RESULTS Among 250 PPWH (median age 31 years, 42% pregnant, 58% postpartum, 20% with a gap in care), preferences were for pregnancy visits every 2 months (β = 0.15), postpartum visits with infant immunizations (β = 0.36), seeing a mentor mother and clinician each visit (β = 0.05 and 0.08, respectively), and 0 KSh cost (β = 0.39). Preferences were similar when stratified by age, pregnancy, and retention status. At the same cost, predicted market choice for a clinic model with fewer pregnant/postpartum visits was 75% versus 25% for the standard of care (ie, monthly visits during pregnancy/postpartum). CONCLUSION PPWH prefer fewer clinic visits than currently provided within the standard of care in Kenya, supporting the need for implementation of differentiated service delivery for this population.
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Affiliation(s)
- John Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Esther Wanjama
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - James G. Carlucci
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Violet Naanyu
- Department of Sociology Psychology and Anthropology, Moi University School of Arts and Social Science, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edwin Were
- Department of Reproductive Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Lindah Muli
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Marsha Alera
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alan McGuire
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN
- Health Services Research and Development, Richard L. Roudebush VAMC, Indianapolis, IN; and
| | - Winstone Nyandiko
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - Julia Songok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | | | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Rahim MQ, Jacob SA, Coven SL, Miller M, Meagher CG, Lozano G, Zimet G, Ott MA. Identifying Barriers to HPV Vaccination for Patients With Sickle Cell Disease and Childhood Cancer Survivors. J Pediatr Hematol Oncol 2023; 45:e940-e947. [PMID: 37696002 PMCID: PMC10615738 DOI: 10.1097/mph.0000000000002752] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023]
Abstract
Human papillomavirus (HPV) vaccination prevents the development of HPV-associated malignancies. Adolescent and young adult survivors of childhood cancers and patients with sickle cell disease (SCD) are vulnerable patient populations who would significantly benefit from HPV vaccination. In this multimethod study, a retrospective chart review found a notable difference between the rate of HPV vaccinations and other age-appropriate vaccinations in 177 childhood cancer survivors and in 70 patients with SCD. We then sought to describe patient and caregiver beliefs regarding HPV vaccination, through semistructured interviews with 21 patients and 48 caregivers. Interviews were analyzed with a thematic content approach to understand attitudes regarding the HPV vaccination. Qualitative interviews noted that many caregivers and adolescents had baseline misconceptions regarding the HPV vaccination in general and in context with their chronic illness. It was found that a strong recommendation from a trusted subspecialty provider would create reassurance about vaccination and reduce misconceptions and concerns about side effects in the context of a chronic illness. Counseling from subspecialists could have a strong impact on understanding the HPV vaccine in the context of chronic illness. This would likely help overcome many of the barriers to vaccination that are encountered by patients with SCD or oncology survivors.
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Affiliation(s)
- Mahvish Q. Rahim
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | - Seethal A. Jacob
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W 10 Street, HITS Building, Indianapolis, IN 46202
| | - Scott L. Coven
- Riley Hospital for Children Division of Pediatric Hematology and Oncology at Indiana University Health, Indianapolis, Indiana, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | - Meagan Miller
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Carolyn G. Meagher
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Gabriella Lozano
- Indiana University School of Medicine, 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
| | - Mary A. Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, United States. 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202
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Katzman C, Morgan T, de Roche A, Harris J, Mauro C, Zimet G, Rosenthal S. Longitudinal assessment of COVID-19 vaccine uptake: A two-wave survey of a nationally representative U.S. sample. PLoS One 2023; 18:e0289541. [PMID: 37796981 PMCID: PMC10553259 DOI: 10.1371/journal.pone.0289541] [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] [Received: 03/06/2023] [Accepted: 07/20/2023] [Indexed: 10/07/2023] Open
Abstract
Understanding factors that influence those who are initially COVID-19 vaccine hesitant to accept vaccination is valuable for the development of vaccine promotion strategies. Using Ipsos KnowledgePanel®, we conducted a national survey of adults aged 18 and older in the United States. We created a questionnaire to examine factors associated with COVID-19 vaccine uptake over a longitudinal period ("Wave 1" in April 2021 and "Wave 2" in February 2022), and utilized weighted data provided by Ipsos to make the data nationally representative. Overall, 1189 individuals participated in the Wave 1 survey, and 843 participants completed the Wave 2 survey (71.6% retention rate). Those who intended to be vaccinated as soon as possible ("ASAP") were overwhelmingly vaccinated by Wave 2 (96%, 95% CI: 92% to 100%). Of those who initially wished to delay vaccination until there was more experience with it ("Wait and See"), 57% (95% CI: 47% to 67%) were vaccinated at Wave 2. Within the "Wait and See" cohort, those with income <$50,000 and those who had never received the influenza vaccine were significantly less likely to be vaccinated at Wave 2. Among those who initially indicated that they would not receive a COVID-19 vaccine ("Non-Acceptors"), 28% (95% CI: 21% to 36%) were vaccinated at Wave 2. Those who believed COVID-19 was not a major problem in their community were significantly less likely to be vaccinated, while those with more favorable attitudes toward vaccines in general and public health strategies to decrease the impact of COVID-19 were significantly more likely to be vaccinated. Overall, barriers to vaccine uptake for the "Wait and See" cohort appear to be more practical, whereas barriers for the "Non-Acceptor" cohort seem to be more ideological. These findings will help target interventions to improve uptake of COVID-19 boosters and future novel vaccines.
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Affiliation(s)
- Caroline Katzman
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Tucker Morgan
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ariel de Roche
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Julen Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Christine Mauro
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, United States of America
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Susan Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center, New York, NY, United States of America
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McCormick KM, Sethi S, Haag D, Macedo DM, Hedges J, Quintero A, Smithers L, Roberts R, Zimet G, Jamieson L, Ribeiro Santiago PH. Development and validation of the COVID-19 Impact Scale in Australia. Curr Med Res Opin 2023; 39:1341-1354. [PMID: 37656161 DOI: 10.1080/03007995.2023.2247323] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The COVID-19 pandemic significantly impacted and continues to impact the health and well-being of Australian adults. However, there has been no instrument validated to comprehensively measure how the COVID-19 pandemic impacted adults in Australia across several domains (e.g. fear of COVID-19, attitudes towards vaccination, psychosocial impact of lockdowns).The current study conducted a rigorous psychometric process to develop and validate an instrument to measure the impact of the COVID-19 pandemic in Australia, the COVID-19 Impact Scale (CIS). METHOD Data was obtained from the Australian population. Participants (N = 563) aged between 19 and 91 years (M = 54.50, SD = 16.16) provided online responses between June, 2021 and May, 2022. The majority of participants were female (60.9%), employed either full-time (37.7%) or part-time (22.0%), and had completed an undergraduate degree or higher (70.1%). An initial pool of 30 items was developed based on a review of the literature and input from a panel of experts including psychologists, epidemiologists, and public health experts, among others. The study used network psychometrics to examine the psychometric properties of: (1) item score distributions; (2) item redundancy; (3) dimensionality; (4) model fit; (5) measurement invariance; (6) reliability; and (7) criterion validity. RESULTS Following an evaluation of items for ceiling/floor effects and redundancy, the final CIS network model included eighteen nodes and displayed a three-dimensional structure. The three communities of "Fear" (consisting of three nodes; ω = 0.82), "Attitudes" (consisting of ten nodes; ω = 0.89), and "Ill-being" (consisting of five nodes; ω = 0.79) displayed adequate reliability. The evaluation of model fit indicated a good fit of the network model (RMSEA = 0.047; CFI =0.98). CONCLUSION The instrument is available to be used by Australian researchers and implemented to evaluate public policies, adapted for future pandemics, or used internationally.
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Affiliation(s)
- Kym Michelle McCormick
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - Dandara Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
- School of Public Health, The University of Adelaide, Australia
| | - Davi Manzini Macedo
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - Adrian Quintero
- Icfes - Colombian Institute for Educational Evaluation, Colombia
| | - Lisa Smithers
- School of Health and Society, University of Wollongong, Australia
| | - Rachel Roberts
- School of Psychology, The University of Adelaide, Australia
| | | | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
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Enujioke SC, Shedd-Steele R, Daggy J, Burney HN, Head KJ, Kasting ML, Zimet G. County-level correlates of completed HPV vaccination in Indiana. Vaccine 2023; 41:5752-5757. [PMID: 37599142 DOI: 10.1016/j.vaccine.2023.07.044] [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: 06/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9-14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9-14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.
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Affiliation(s)
- Sharon C Enujioke
- CDR, MC USN, Department of Pediatrics-Division of Adolescent Medicine, Navy Medicine Readiness and Training Command, Portsmouth, VA, United States.
| | | | - Joanne Daggy
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - Heather N Burney
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - Katharine J Head
- Indiana University-Purdue University Indianapolis, Department of Communication Studies, Indianapolis, IN, United States
| | - Monica L Kasting
- Purdue University, Department of Public Health, West Lafayette, IN, United States
| | - Gregory Zimet
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Indianapolis, IN, United States
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Liebermann E, Fontenot HB, Lim E, Matsunaga M, Zimet G, Allen JD. Preferred Location for Human Papillomavirus Self-Sampling for Cervical Cancer Screening. J Obstet Gynecol Neonatal Nurs 2023; 52:364-373. [PMID: 37355248 DOI: 10.1016/j.jogn.2023.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To examine associations among women's preferred locations for human papillomavirus (HPV) self-sampling in relation to their demographic, social, and health characteristics and their perceived benefits and concerns regarding this procedure. DESIGN Cross-sectional, descriptive survey. SETTING Online distribution between March 2022 and April 2022. PARTICIPANTS People who were assigned female sex at birth and were eligible for cervical cancer screening (N = 367: cis-gender women, n = 364; another gender identity, n = 3). METHODS We used quota sampling to obtain a racially and ethnically diverse sample. We conducted bivariate analyses to examine differences in participants' preferred locations for HPV self-sampling by sociodemographic and health characteristics. We used a multinomial logistic regression model to examine the associations between preferred HPV self-sampling location, characteristics of participants, and perceived benefits and concerns regarding this procedure. RESULTS In our sample, 43% (n = 158) of participants preferred HPV self-sampling at the office of a health care provider, 50% (n = 182) preferred HPV self-sampling anywhere (office or home), and 7% (n = 27) did not feel comfortable with HPV self-sampling anywhere. Participants 39 to 45 years of age were more likely to prefer HPV self-sampling anywhere (office or home) than participants 27 to 32 years of age, OR = 2.47, 95% confidence interval (CI) [1.21, 5.06]. Participants who preferred HPV self-sampling anywhere perceived greater benefit related to limited geographic access to a clinic compared to those who preferred office only, OR = 1.82, 95% CI [1.08, 3.07]. Participants who preferred HPV self-sampling anywhere had less concern related to performing the procedure accurately than those who preferred office only, OR = 0.44, 95% CI [0.31, 0.62]. CONCLUSION HPV self-sampling is an alternative strategy to increase cervical cancer screening. As providers consider implementation of HPV self-sampling, our findings suggest that office and home-based collection strategies should be considered to increase access to cervical cancer screening.
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Davies C, Marshall HS, Brotherton JML, McCaffery K, Kang M, Macartney K, Garland S, Kaldor J, Zimet G, Skinner SR. Complex intervention to promote human papillomavirus (HPV) vaccine uptake in school settings: A cluster-randomized trial. Prev Med 2023; 172:107542. [PMID: 37172767 DOI: 10.1016/j.ypmed.2023.107542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Using a cluster-randomized trial design, we aimed to evaluate a complex intervention to increase uptake of human papillomavirus (HPV) vaccination in schools. The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015 with adolescents aged 12-13 years. Interventions included education, shared decision-making, and logistical strategies. The main outcome was school vaccine uptake. Secondary outcomes included consent forms returned and mean time to vaccinate 50 students. We hypothesised that a complex intervention would increase 3-dose HPV vaccine uptake. We recruited 40 schools (21 intervention, 19 control) with 6, 967 adolescents. There was no difference between intervention and control (3-dose mean 75.7% and 78.9%, respectively). Following adjustment for baseline covariates, absolute differences in coverage in favour of the intervention group were: dose 1, 0.8% (95% CI, -1.4,3.0); dose 2, 0.2% (95% CI, -2.7, 3.1); dose 3, 0.5% (95% CI, -2.6, 3.7). The percentage of returned consent forms in intervention schools (91.4%) was higher than in control schools (difference: 6%, 95% CI, 1.4, 10.7). There was a shorter mean time to vaccinate 50 students at dose 3. The difference for dose 3 was 110 min (95% CI, 42, 177); for dose 2, 90 min (95% CI, -15, 196); and dose 1, 28 min (95% CI, -71, 127). Logs revealed the inconsistent implementation of logistical strategies. The intervention had no impact on uptake. Inadequate resourcing for logistical strategies and advisory board reluctance toward strategies with potential financial implications impacted the implementation of logistical components. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014. The study protocol was published in 2015 before data collection was finalised (Skinner et al., 2015). THE HPV.EDU STUDY GROUP: We would like to acknowledge the contributions to this study by members of the HPV.edu Study Group, including: Professor Annette Braunack-Mayer: Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia; Dr. Joanne Collins: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; Associate Professor Spring Cooper: School of Public Health, City University of New York (CUNY), New York, NY, USA; Heidi Hutton: Telethon Kids Institute, University of Western Australia, WA, Australia; Jane Jones: Telethon Kids Institute, University of Western Australia, WA, Australia; Dr. Adriana Parrella: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Associate Professor David G. Regan: The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, NSW, Australia; Professor Peter Richmond: Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, WA, Australia, and School of Medicine, University of Western Australia, Perth, WA, Australia; Dr. Tanya Stoney: Telethon Kids Institute, University of Western Australia, WA, Australia. Contact for the HPV.edu study group: Cristyn.Davies@sydney.edu.au or Rachel.Skinner@sydney.edu.au.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Infectious Diseases Institute, The University of Sydney, NSW, Australia; Wellbeing, Health and Youth National Health and Medical Research Council Centre for Research Excellence in Adolescent Health, Sydney, Australia.
| | - Helen S Marshall
- Women's and Children's Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, SA, Australia
| | - Julia M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; National Centre for Immunisation Research and Surveillance, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Melissa Kang
- General Practice Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kristine Macartney
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, NSW, Australia
| | - Suzanne Garland
- Centre Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia; Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children's Research Institute, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University, Indianapolis, USA
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Wellbeing, Health and Youth National Health and Medical Research Council Centre for Research Excellence in Adolescent Health, Sydney, Australia
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10
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Knopf A, Draucker CB, Fortenberry JD, Ott MA, Arrington-Sanders R, Reirden D, Schneider J, Straub D, Ofner S, Bakoyannis G, Zimet G. Parental Engagement in Consent Processes for Enrollment in Biomedical HIV Prevention Trials: Implications for Minor Adolescents' Willingness to Participate. J Adolesc Health 2023; 72:703-711. [PMID: 36646563 DOI: 10.1016/j.jadohealth.2022.11.241] [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: 05/23/2022] [Revised: 10/10/2022] [Accepted: 11/22/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Minor adolescents are often excluded from HIV prevention clinical trials due to unresolved ethical issues. Their under-representation in research leads to delayed access to new HIV prevention approaches. We examine the relationship between consent procedures, trial features, demographic and social characteristics, and minor adolescents' willingness to participate (WTP) in biomedical HIV prevention research. METHODS We recruited 14-17-year-olds at risk of HIV for this quasi-experimental study. Adolescents were randomly assigned to (1) self-consent, (2) adult permission required, or (3) parental permission required and underwent simulated consent procedures for two types of HIV prevention trials. They rated likelihood of participating in each study if offered the opportunity and completed a survey with demographic, social, and behavioral measures. RESULTS One hundred and twenty nine adolescents with diverse identities and socioeconomic status enrolled. Among the 58% of participants who identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ), 76% were out to at least one parent/guardian (outness). Mean WTP was 3.6 (of 5; 5 = definitely would participate) across all participants and both trial types. We found no evidence of an association between WTP and consent condition, LGBTQ identity, or outness. However, medical mistrust, communication with parents, and concern about HIV were associated with WTP. DISCUSSION Our results suggest adolescents are willing to participate in HIV prevention trials and parental involvement in the consent process may not be the most important deciding factor. However, variation in WTP within consent groups, and variation in other significant variables, underscores the need for individualized approaches to recruitment and consent for these trials.
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Affiliation(s)
- Amelia Knopf
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana.
| | - Claire Burke Draucker
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Reirden
- Section of Adolescent Medicine & Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Diane Straub
- Section of Adolescent Medicine & Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Giorgos Bakoyannis
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Glauberman G, Zimet G, Michel A, Fontenot HB. Emergency preparedness is a healthcare issue: COVID-19 pandemic's influence on attitudes and behaviors among a national sample of parents. J Pediatr Nurs 2023; 71:88-94. [PMID: 37080118 PMCID: PMC10090324 DOI: 10.1016/j.pedn.2023.04.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Improving household emergency preparedness (EP) is a public health priority, yet little is known about what influence the COVID-19 pandemic had on families' EP. This study aimed to explore current EP attitudes and behaviors. METHODS We conducted online focus groups in Winter 2022 with a nationwide sample of parents of adolescents. We held six 90-min focus groups of 9-15 participants using a semi-structured interview script that elicited parental knowledge and attitudes related to household EP. Two researchers conducted qualitative content analysis on focus group transcripts. First-level coding within and across scripts was used to identify broad categories or themes regarding EP. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified the final themes that emerged. RESULTS Participants (N = 64) were mostly female (n = 54, 84.3%), white (n = 46, 71.9%), and college-educated (n = 49, 76.6%). Major themes included: 1) Expanded awareness and behavioral change related to EP due to the COVID-19 pandemic, 2) Reconceptualization of planning for family health as part of EP, 3) Changing perspectives related to vaccination as a component of EP, and 4) Perspectives related to discussing EP with their health care provider. CONCLUSIONS EP was described as a healthcare issue and healthcare providers were identified as trusted sources of EP information. Interventions to support providers' ability to assist with individual EP health action plans, including discussing vaccination as part of preparedness are needed.
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Affiliation(s)
- Gary Glauberman
- University of Hawaii at Manoa, School of Nursing & Dental Hygiene, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA.
| | - Gregory Zimet
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, IN 46202, USA.
| | - Alexandra Michel
- University of Hawaii at Manoa, School of Nursing & Dental Hygiene, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA.
| | - Holly B Fontenot
- University of Hawaii at Manoa, School of Nursing & Dental Hygiene, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA.
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12
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Zhu P, Tatar O, Haward B, Steck V, Griffin-Mathieu G, Perez S, Dubé È, Zimet G, Rosberger Z. Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework. Vaccines (Basel) 2023; 11:vaccines11030628. [PMID: 36992212 DOI: 10.3390/vaccines11030628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional “booster” doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18–39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults’ perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Veronica Steck
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Samara Perez
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Psychosocial Oncology Program, Cedars Cancer Center, McGill University Health Center, Montreal, QC H3A 3J1, Canada
| | - Ève Dubé
- Department of Anthropology, Laval University, Quebec, QC G1V 0A6, Canada
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
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13
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Hartsock JA, Head KJ, Kasting ML, Sturm L, Zimet G. Perceptions of the ethical permissibility of strict travel restrictions to mitigate transmission of SARS-CoV-2. Transp Res Interdiscip Perspect 2022; 14:100577. [PMID: 35252841 PMCID: PMC8885284 DOI: 10.1016/j.trip.2022.100577] [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] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
Although there has been extensive exploration of public opinion surrounding many non-pharmaceutical interventions (NPIs) aimed at mitigating transmission of SARS-CoV-2 (e.g. mask-wearing and social distancing), there has been less discussion of the public's perception of the ethical appropriateness other NPIs. This paper presents the results of a survey of U.S. adults' opinions of the ethical permissibility of both state-to-state and international travel restrictions to mitigate transmission of SARS-CoV-2. Our research revealed overall high agreement with the ethical permissibility of both state-to-state and international travel restrictions, though we saw significant difference across political party affiliation and conservative/liberal ideologies. Other factors associated with agreement with state-to-state travel restrictions included increasing education, increasing income, and both high and low commitment altruism. When considering international travel restrictions, income, education, and low commitment altruism were associated with increased agreement with the ethical permissibility of international travel restrictions. Ethical analysis and implications are explored.
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Affiliation(s)
- Jane A Hartsock
- Clinical and Organizational Ethics - Indiana University Health Adjunct Assistant Professor, Medical Humanities and Health Studies - Indiana University School of Liberal Arts 1800 N. Capital Ave. Suite E644 Indianapolis IN 46202, United States
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis 450 University Blvd. Indianapolis, IN 46202, United States
| | - Monica L Kasting
- Department of Public Health Purdue University 812 W. State Street, Room 216 West Lafayette, IN 47907, United States
| | - Lynne Sturm
- Associate Professor of Clinical Pediatrics Indiana University School of Medicine 1002 Wishard Boulevard, Suite 3120 Indianapolis IN 46202, United States
| | - Gregory Zimet
- Professor of Pediatrics & Psychiatry Indiana University School of Medicine 410 W. 10 Street, Suite 1001 Indianapolis, IN 46202, United States
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14
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Tatar O, Haward B, Zhu P, Griffin-Mathieu G, Perez S, Zimet G, Rosberger Z. Using Best-Worst Scaling to investigate younger adult Canadians' preferences for COVID-19 vaccination and public health measures: An observational study. Prev Med Rep 2022; 26:101755. [PMID: 35284212 PMCID: PMC8902056 DOI: 10.1016/j.pmedr.2022.101755] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/27/2022] [Accepted: 03/06/2022] [Indexed: 11/03/2022] Open
Abstract
Containing the COVID-19 pandemic is dependent on compliance with public health recommendations and mandates which is lower in younger compared to older adults. Furthermore, younger adults have demonstrated lower uptake of COVID-19 vaccines. The aim of this study was to assess preferences for COVID-19 related preventive health measures and vaccination and to explore their association with COVID-19 vaccine acceptability. Canadians aged 18-39 years were invited to participate in a web-based survey in August 2021. We used the Best-Worst-Scaling (BWS) methodology to collect and analyze preference data and multivariable binary logistic regression to estimate associations with vaccine acceptability. Based on 266 complete responses, we found strong preferences for physical distancing and wearing face masks, as compared to general hygiene and respiratory etiquette. High vaccine accessibility independent of the location, receiving successive doses of the same vaccine brand and higher vaccine uptake of people in younger adults' social circle were highly preferred. Higher preferences for mandates requiring proof of vaccination and altruistic motives focused on protecting others by getting vaccinated were associated with vaccine acceptability. As the COVID-19 pandemic waxes and wanes, studies using larger, nationally representative samples are needed to replicate and validate these results to assess preferences for health behaviors corresponding to the latest recommendations. The use of this methodology could provide public health authorities with a unique opportunity to develop targeted, preference-based messaging that aligns with the latest guidelines to effectively encourage compliance and COVID-19 vaccine uptake.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Samara Perez
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada.,McGill University Health Center (MUHC), Montreal, QC, Canada
| | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada.,Departments of Psychology, Psychiatry and Oncology, McGill University, Montreal, QC, Canada
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15
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Zhu P, Tatar O, Griffin-Mathieu G, Perez S, Haward B, Zimet G, Tunis M, Dubé È, Rosberger Z. Efficacy of a brief, altruism-eliciting video intervention in enhancing COVID-19 vaccination intentions amongst a population-based sample of younger adults: Randomized controlled trial (Preprint). JMIR Public Health Surveill 2022; 8:e37328. [PMID: 35544437 PMCID: PMC9153910 DOI: 10.2196/37328] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Samara Perez
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Matthew Tunis
- National Advisory Committee on Immunization Secretariat, Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Ève Dubé
- Faculty of Social Sciences; Anthropology, University of Laval, Québec, QC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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16
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Cary C, Tong Y, Linsell S, Ghani K, Miller DC, Weiner M, Koch MO, Perkins SM, Zimet G. Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC). J Urol 2022; 207:293-301. [PMID: 34551594 PMCID: PMC8741637 DOI: 10.1097/ju.0000000000002233] [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] [Accepted: 08/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy. MATERIALS AND METHODS Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order. RESULTS A total of 58 urologists answered the clinical vignettes which represents >75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility=8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in. CONCLUSIONS This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room.
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Affiliation(s)
- Clint Cary
- Indiana University Department of Urology
- Regenstrief Institute, Inc. Indianapolis, IN
| | - Yan Tong
- Indiana University Department of Biostatistics
| | | | | | | | - Michael Weiner
- Regenstrief Institute, Inc. Indianapolis, IN
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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17
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Fontenot HB, Mattheus DB, Lim E, Michel A, Ryan N, Knopf A, Abuelezam NN, Stamp K, Hekel B, Branson S, Zimet G. Undergraduate nursing students' COVID-19 vaccine intentions: A national survey. PLoS One 2021; 16:e0261669. [PMID: 34936687 PMCID: PMC8694464 DOI: 10.1371/journal.pone.0261669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In December 2020, the first two COVID-19 vaccines were approved in the United States (U.S.) and recommended for distribution to front-line personnel, including nurses. Nursing students are being prepared to fill critical gaps in the health care workforce and have played important supportive roles during the current pandemic. Research has focused on vaccine intentions of current health care providers and less is known about students’ intentions to vaccinate for COVID-19. Methods A national sample of undergraduate nursing students were recruited across five nursing schools in five U.S. regions in December 2020. The survey measured perceived risk/threat of COVID-19, COVID-19 vaccine attitudes, perceived safety and efficacy of COVID-19 vaccines, sources for vaccine information and level of intention to become vaccinated [primary, secondary (i.e., delayed), or no intention to vaccinate]. Results The final sample consisted of 772 students. The majority (83.6%) had intentions to be vaccinated, however of those 31.1% indicated secondary intention, a delay in intention or increased hesitancy). The strongest predictors of primary intention were positive attitudes (OR = 6.86; CI = 4.39–10.72), having lower safety concerns (OR = 0.26; CI = 0.18–0.36), and consulting social media as a source of information (OR = 1.56; CI = 1.23–1.97). Asian (OR = 0.47; CI = 0.23–0.97) and Black (OR 0.26; CI = 0.08–0.80) students were more likely to indicate secondary intention as compared to primary intention. Students in the Midwest were most likely to indicate no intention as compared to secondary intention (OR = 4.6; CI = 1.32–16.11). Conclusions As the first two COVID-19 vaccines were approved/recommended in the U.S. nursing students had overall high intentions to vaccinate. Findings can guide development of educational interventions that reduce concerns of vaccine safety that are delivered in a way that is supportive and affirming to minoritized populations while being respectful of geo-political differences.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Deborah B Mattheus
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Alexandra Michel
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Nicole Ryan
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Amelia Knopf
- Department of Community and Health Services, School of Nursing, Indiana University, Indianapolis, Indiana, United States of America
| | - Nadia N Abuelezam
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Kelly Stamp
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
| | - Barbara Hekel
- Cizik School of Nursing, UTHealth, Houston, Texas, United States of America
| | - Sandra Branson
- Cizik School of Nursing, UTHealth, Houston, Texas, United States of America
| | - Gregory Zimet
- Division of Adolescent Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
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Shah SFA, Ginossar T, Bentley JM, Zimet G, McGrail JP. Using the Theory of Planned behavior to identify correlates of HPV vaccination uptake among college students attending a rural university in Alabama. Vaccine 2021; 39:7421-7428. [PMID: 34772544 DOI: 10.1016/j.vaccine.2021.10.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/05/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Humanpapillomavirus (HPV) has infected nearly 80 million people in the U.S., and is associated with most cervical cancer cases. Alabama ranks first in the country for cervical cancer mortality and third for incidence. Although the HPV vaccine can prevent HPV and reduce cancer rates, Alabama is well-below the national average for HPV vaccination. Using the Theory of Planned Behavior (TPB), this Alabama-based study aimed to examine college students' intentions to get the HPV vaccine; to examine the relationship between the relationship between religious beliefs and HPV vaccination uptake status among college students. METHODS Students (n = 257) from a university in rural Alabama completed the survey. Multiple regression analysis, Mann-Whitney U tests, and moderation analysis were used to examine associations among the variables of interest. FINDINGS Consistent with TPB, results showed that attitudes and subjective norms were significant predictors of intention to get vaccinated. Knowledge that both sexes can experience HPV-related health problems, that HPV can cause genital warts, and that the vaccine protects against HPV were each associated with higher attitude scores. The results indicated that the odds of getting at least one HPV shot were higher for females than for males for non-Caucasians than for Caucasians. Students who were not vaccinated were more likely to report that religion influenced their health beliefs. *Abstract. CONCLUSION TPB was helpful in understanding HPV-related intentions. Communication and education efforts are needed to increase understanding of HPV illnesses and HPV vaccination benefits among peers, parents, and other loved ones of students. in the rural areas of Alabama.
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Affiliation(s)
- Sayyed Fawad Ali Shah
- Department of Communication, Jacksonville State University, 700 Pelham RD N, Jacksonville, Alabama 36265, U.S.
| | - Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, MSC 03 2240, 1 University of New Mexico, Albuquerque, NM 87131, U.S
| | - Joshua M Bentley
- Department of Strategic Communication, Texas Christian University, TCU Box 298040, Fort Worth, TX 76129, U.S
| | - Gregory Zimet
- School of Medicine, Indiana University, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, U.S
| | - J Patrick McGrail
- Department of Communication, Jacksonville State University, 700 Pelham RD N, Jacksonville, Alabama 36265, U.S
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Woodall WG, Zimet G, Kong A, Buller D, Reither J, Chilton L, Myers V, Starling R. Vacteens.org: A Mobile Web app to Improve HPV Vaccine Uptake. Front Digit Health 2021; 3:693688. [PMID: 34713171 PMCID: PMC8521965 DOI: 10.3389/fdgth.2021.693688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
U.S. HPV vaccine uptake remains below the Healthy People 2030 goal of 80% series completion. Parental concerns and misinformation about the efficacy and safety of the Human Papillomavirus (HPV) vaccine remain, and may be addressed by digital interventions tailored to their concerns. Reported here are results from a small scale randomized trial testing a mobile web app for parents and their adolescent daughters (ages 11–14 years) encouraging HPV vaccination in New Mexico, an ethnically-diverse U.S. state. Methods: A clinic-cluster randomized trial where pediatric clinics (n = 9) were recruited and randomized, and parent-adolescent pairs (n = 82) within clinics received either the Vacteens.org/Vacunadolescente.org mobile web app or Usual and Customary (UC) HPV Vaccination information. Parents completed online surveys at baseline and 3-months. Daughters' HPV vaccine data were collected from the New Mexico State Immunization Information System 1 year post baseline. Results: Three month survey results found Vacteens.org/Vacunadolescente.org parents to have higher positive HPV vaccine beliefs, informed decision making, intent to vaccinate and vaccine confidence outcomes than UC parents. HPV vaccine data found higher first dose HPV vaccination (Pearson χ2 = 6.13, p = 0.013, Vacteens.org/Vacunadolescente.org group 59.4%, UC group 40.6%), and higher HPV vaccination series completion (Pearson χ2 = 6.49, p = 0.011, Vacteens.org/Vacunadolescente.org group 68.4%, UC group 31.6%). Conclusions: The small trial results showed the Vacteens.org/Vacunadolescente.org web app prompted positive vaccine-related attitudes and beliefs, and more HPV vaccination initiation and series completion. Mobile web apps can make decision-making tools for HPV vaccination widely available on digital platforms, reducing vaccine hesitancy, and confusion and increase HPV vaccine uptake.
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Affiliation(s)
| | - Gregory Zimet
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University-Purdue University Indianapolis (IUPUI) Center for HPV Research, Indiana University, Indianapolis, IN, United States
| | - Alberta Kong
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | | | - Lance Chilton
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | - Randall Starling
- Center on Alcohol, Substance Use and Addictions (CASAA), The University of New Mexico, Albuquerque, NM, United States
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21
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Fontenot HB, Mattheus D, Lim E, Michel A, Ryan N, Davis KF, Zimet G. Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii. Hum Vaccin Immunother 2021; 17:3933-3940. [PMID: 34254888 DOI: 10.1080/21645515.2021.1947097] [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: 10/20/2022] Open
Abstract
Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Deborah Mattheus
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Eunjung Lim
- John A. Burns School of Medicine, Department of Biostatistics, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alexandra Michel
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nicole Ryan
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Katherine Finn Davis
- School of Nursing & Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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22
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Baker Z, Javanbakht M, Moore J, Brosnan H, Squires K, Bunge K, Zimet G, Mensch B, Soto-Torres L, Kapogiannis B, Levy L, Hoesley C, Reirden D, Gaur A, Mayer K, Futterman D, Gorbach P. Qualitative Study on the Acceptability of and Adherence to a Vaginal Ring for HIV Prophylaxis Among Adolescent Girls. J Acquir Immune Defic Syndr 2021; 87:944-950. [PMID: 33675614 PMCID: PMC8192420 DOI: 10.1097/qai.0000000000002674] [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: 09/14/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to assess the product-related, relationship-related, and sex-related factors that act as facilitators and barriers to the acceptability of a vaginal ring (VR) for HIV prevention among adolescent girls. DESIGN Qualitative study. METHODS Ninety-six girls aged 15-17 years from 6 urban US sites were enrolled in MTN-023/IPM 030, a 24-week randomized controlled trial, for assessing the safety and acceptability of a dapivirine VR for HIV prevention. At week 24, 21 girls were randomly selected to participate in in-depth interviews. Interviews were transcribed verbatim and data analyzed using a thematic analysis approach. Facilitators and barriers to VR acceptability related to participants' relationships, sexual activity, and characteristics of the VR product were identified. RESULTS Factors related to relationships rarely seemed to act as barriers to VR acceptability; most participants disclosed VR use to sexual partners, and positive reactions from sexual partners, which were common, seemed to facilitate VR acceptability. Emotional and/or physical discomfort surrounding VR use during sex was mentioned occasionally as a barrier to VR acceptability. Product characteristics were most frequently mentioned as barriers to VR acceptability. Many participants reported concerns about the large size of the VR on first impression. Although most found the VR comfortable, some reported pain with VR insertion. Several participants were concerned about VR cleanliness, particularly during menstruation. CONCLUSION Product considerations, specifically size and use during menstruation, were the most commonly reported barriers to VR acceptability in this study. Adolescent girls may require additional counseling to assuage product concerns regarding a VR for HIV prevention.
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Affiliation(s)
- Zoë Baker
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Janell Moore
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Hannah Brosnan
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Kathleen Squires
- Division of Infectious Diseases, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
- Global Center of Scientific Affairs, Merck Research Labs, Rahway, NJ
| | - Katherine Bunge
- Department of Obstetrics, Gynecology & Reproductive Services, University of Pittsburgh, Pittsburgh, PA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University, Bloomington, IA
| | | | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD
| | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Craig Hoesley
- Division of Infectious Diseases, University of Alabama, Birmingham, AL
| | - Daniel Reirden
- Department of Adolescent Medicine, Children's Hospital Colorado, Aurora, CO
| | - Aditya Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN
| | - Kenneth Mayer
- Department of Global Health and Population, Harvard School of Public Health, The Fenway Institute, Boston, MA; and
| | - Donna Futterman
- Department of Pediatrics, Albert Einstein College of Medicine, the Bronx, NY
| | - Pamina Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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Coyne-Beasley T, Hill SV, Zimet G, Kanbur N, Kimberlin D, Raymond-Flesch M, Simpson T, Svetaz MV, Trent M, Walker-Harding L. COVID-19 Vaccination of Adolescents and Young Adults of Color: Viewing Acceptance and Uptake With a Health Equity Lens. J Adolesc Health 2021; 68:844-846. [PMID: 33814282 PMCID: PMC8016552 DOI: 10.1016/j.jadohealth.2021.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Tamera Coyne-Beasley
- Division of Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Samantha V. Hill
- Division of Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory Zimet
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara-Turkey, Ihsan Dogramaci Childrens Hospital, Altindag, Ankara-Turkey
| | - David Kimberlin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marissa Raymond-Flesch
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, California
| | - Tina Simpson
- Division of Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Veronica Svetaz
- Department of Family and Community Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
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Biederman E, Donahue K, Sturm L, Champion V, Zimet G. The association between maternal human papillomavirus (HPV) experiences and HPV vaccination of their children. Hum Vaccin Immunother 2021; 17:1000-1005. [PMID: 33026274 DOI: 10.1080/21645515.2020.1817714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/23/2022] Open
Abstract
HPV vaccination prevents most HPV-related cancers yet vaccination rates remain low. In this cross-sectional study, we examined the association between maternal HPV experiences and HPV vaccination uptake among children and whether this association may be explained by perceived benefits of vaccination. We used logistic regression models to estimate the effect of (1) maternal history of abnormal Pap smear, (2), family/friend history of cervical cancer, and (3) maternal history of cervical cancer on HPV vaccination uptake among children. Separate mediation analyses were conducted to determine if perceived benefits mediated the relationship between each maternal HPV experience and HPV vaccination uptake. History of abnormal Pap smear (OR = 1.50, 95% CI = 1.15, 1.97), family history of cervical cancer (OR = 1.72, CI = 1.26, 2.35), and personal history of cervical cancer (OR = 3.00, CI = 1.82, 4.95) predicted HPV vaccination of children. Perceived benefits mediated the relationship between history of abnormal Pap smear (indirect effect =.146, SE =.069, 95% CI =.014, .289), family history of cervical cancer (indirect effect =.228, SE =.079, CI =.080, .387), and personal history of cervical cancer (indirect effect =.298, SE =.116, CI =.082, .533) on HPV vaccination. Our results suggest that personal experiences with HPV-related disease may influence maternal HPV vaccine decision-making.
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Affiliation(s)
- Erika Biederman
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Kelly Donahue
- Department of Pediatrics-Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lynne Sturm
- Ped-Child Development Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victoria Champion
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Gregory Zimet
- Department of Pediatrics-Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Knopf AS, Krombach P, Katz AJ, Baker R, Zimet G. Measuring research mistrust in adolescents and adults: Validity and reliability of an adapted version of the Group-Based Medical Mistrust Scale. PLoS One 2021; 16:e0245783. [PMID: 33481944 PMCID: PMC7822238 DOI: 10.1371/journal.pone.0245783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
Mistrust of health care providers among persons of color is a significant barrier to engaging them in research studies. Underrepresentation of persons of color is particularly problematic when the health problem under study disproportionately affects minoritized communities. The purpose of this study was to test the validity and reliability of an abbreviated and adapted version of the Group Based Medical Mistrust Scale. The GBMMS is a 12-item scale with three subscales that assess suspicion, experiences of discrimination, and lack of support in the health care setting. To adapt for use in the research setting, we shortened the scale to six items, and replaced “health care workers” and “health care” with “medical researchers” and “medical research,” respectively. Using panelists from a market research firm, we recruited and enrolled a racially and ethnically diverse sample of American adults (N = 365) and adolescents aged 14–17 (N = 250). We administered the adapted scale in a web-based survey. We used Cronbach’s alpha to evaluate measure internal reliability of the scale and external factor analysis to evaluate the relationships between the revised scale items. Five of the six items loaded onto a single factor, with (α = 0.917) for adolescents and (α = 0.912) for adults. Mean scores for each item ranged from 2.5–2.9, and the mean summary score (range 6–25) was 13.3 for adults and 13.1 for adolescents. Among adults, Black respondents had significantly higher mean summary scores compared to whites and those in other racia/ethnic groups (p<0.001). There was a trend toward significance for Black adolescents as compared to white respondents and those in other racial/ethnic groups (p = 0.09). This five-item modified version of the GBMMS is reliable and valid for measuring research mistrust with American adults and adolescents of diverse racial and ethnic identities.
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Affiliation(s)
- Amelia S. Knopf
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Peter Krombach
- Office of Evaluation, Indiana University School of Nursing, Indianapolis, Indiana, United States of America
| | - Amy J. Katz
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rebecca Baker
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, United States of America
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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26
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Walker KK, Owens H, Zimet G. "We fear the unknown": Emergence, route and transfer of hesitancy and misinformation among HPV vaccine accepting mothers. Prev Med Rep 2020; 20:101240. [PMID: 33294312 PMCID: PMC7689543 DOI: 10.1016/j.pmedr.2020.101240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
Although licensed since 2006, US HPV vaccination rates remain suboptimal. Since mothers are decision-makers for young adults' vaccination, assessing ongoing knowledge deficits and misunderstanding among parents is important for determining the content and mode of interventions to reach parents. Guided by the social-ecological model and health belief model, 30 interviews with vaccine accepting mothers in the U.S. Midwest were conducted from January through June 2020. Researchers examined ecological determinants of acceptance, perceptions of vaccination barriers, and perceived cues to action for empowering other mothers to vaccinate their children. Data were analyzed using thematic analysis. Results found vaccine accepting mothers exhibited ongoing misconceptions and negative attitudes toward HPV vaccine. Physicians, peers and the media were identified as primary pro-HPV vaccine sources, yet hesitancy and misinformation occurred with each source. Trust in provider recommendation was the primary source for decision-making, yet trust was still lacking. While mothers looked to the media for HPV information, the media were identified as the main source of confusion and distrust. Results show that parents who accept the HPV vaccine can still be hesitant. Thus, mothers who have vaccinated their children for HPV may still need attitudinal and educational training prior to establishing them as role models in interventions for empowering other parents to vaccinate their children. Results showing that the media sow confusion and hesitancy also call for more attention to social media policies to guard against misinformation about the HPV vaccine.
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Affiliation(s)
- Kimberly K Walker
- Zimmerman School of Advertising and Mass Communications, University of South Florida, Tampa, USA
| | - Heather Owens
- College of Public Health, University of South Florida, Tampa, USA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
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Walker KK, Owens H, Zimet G. The role of the media on maternal confidence in provider HPV recommendation. BMC Public Health 2020; 20:1765. [PMID: 33228674 PMCID: PMC7684709 DOI: 10.1186/s12889-020-09877-x] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/11/2020] [Indexed: 12/05/2022] Open
Abstract
Background Despite a growing understanding of the importance of provider HPV recommendation on parental acceptance, U.S. HPV vaccination rates remain suboptimal. Given the prevalence and use of the media for health decisions, this study examined the relationship between the media and provider HPV recommendation on maternal HPV vaccine hesitancy. Methods Thirty individual interviews with HPV vaccine-accepting mothers in the Midwest U.S. were conducted to examine their feelings of hesitancy around the decision to accept HPV vaccination at the time of provider recommendation and their suggestions for improving the recommendation experience by addressing media concerns. Results Media exposure was an antecedent to hesitancy for three main vaccination concerns: safety, protection/efficacy and sexual stigma. Although mothers accepted vaccination, they continued to feel confused and hesitant about HPV vaccination. They had several recommendations for how providers could combat hesitancy to improve confidence in HPV vaccine acceptance. Conclusions Providers’ approach to HPV vaccination recommendation must consider concerns reported in the media with delivery techniques modified to adjust to maternal fears absorbed from adverse media information. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09877-x.
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Affiliation(s)
- Kimberly K Walker
- Zimmerman School of Advertising and Mass Communications, University of South Florida, 4202 E Fowler Avenue, CIS1040, Tampa, FL, 33620, USA.
| | - Heather Owens
- College of Public Health, University of South Florida, Tampa, USA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
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28
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Fontenot HB, White BP, Rosenberger JG, Lacasse H, Rutirasiri C, Mayer KH, Zimet G. Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study. J Med Internet Res 2020; 22:e22878. [PMID: 33146621 PMCID: PMC7673982 DOI: 10.2196/22878] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, United States.,The Fenway Institute, Boston, MA, United States.,Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | | | - Joshua G Rosenberger
- College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Hailee Lacasse
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Chokdee Rutirasiri
- Proper Villains, Boston, MA, United States.,School of Arts and Sciences, Boston College, Chestnut Hill, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,School of Medicine, Harvard University, Boston, MA, United States
| | - Gregory Zimet
- Division of Adolescent Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
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Enujioke SC, Shedd-Steele R, Daggy J, Burney H, Robertson L, Head K, Zimet G. County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan. Vaccine 2020; 38:6730-6734. [PMID: 32891476 DOI: 10.1016/j.vaccine.2020.08.048] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities. METHODS The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11-18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing. RESULTS The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities. CONCLUSIONS We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors. SOURCES OF SUPPORT This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.
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Affiliation(s)
- Sharon C Enujioke
- Indiana University School of Medicine, Department of Pediatrics-Adolescent Medicine, 410 W, 100th Street, Ste 100, Indianapolis, IN 46202, USA.
| | - Rivienne Shedd-Steele
- Indiana University Simon Cancer Center, 535 Barnhill Dr., Indianapolis, IN 46202, USA.
| | - Joanne Daggy
- Indiana University School of Medicine, Department of Biostatistics, 410 W, 10th St., Indianapolis, IN 46202, USA.
| | - Heather Burney
- Indiana University School of Medicine, Department of Biostatistics, 410 W, 10th St., Indianapolis, IN 46202, USA.
| | - Lisa Robertson
- Indiana Immunization Coalition, 6239 S East St., Indianapolis, IN 46227, USA.
| | - Katharine Head
- Indiana University-Purdue University Indianapolis, Department of Communication Studies, 425 University Boulevard, Indianapolis, IN 46202, USA.
| | - Gregory Zimet
- Indiana University School of Medicine, Department of Pediatrics-Adolescent Medicine, 410 W, 100th Street, Ste 100, Indianapolis, IN 46202, USA.
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Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, Vangala S, Dickinson LM, Rand C, Humiston S, Szilagyi PG. Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey. Pediatrics 2020; 146:peds.2019-3852. [PMID: 32540985 PMCID: PMC7329256 DOI: 10.1542/peds.2019-3852] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [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] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization has designated vaccine hesitancy as 1 of the 10 leading threats to global health, yet there is limited current national data on prevalence of hesitancy among US parents. Among a nationally representative sample of US parents, we aimed to (1) assess and compare prevalence of hesitancy and factors driving hesitancy for routine childhood and influenza vaccination and (2) examine associations between sociodemographic characteristics and hesitancy for routine childhood or influenza vaccination. METHODS In February 2019, we surveyed families with children using the largest online panel generating representative US samples. After weighting, we assessed hesitancy using a modified 5-point Vaccine Hesitancy Scale and labeled parents as hesitant if they scored >3. RESULTS A total of 2176 of 4445 parents sampled completed the survey (response rate 49%). Hesitancy prevalence was 6.1% for routine childhood and 25.8% for influenza vaccines; 12% strongly and 27% somewhat agreed they had concerns about serious side effects of both routine childhood and influenza vaccines. A total of 70% strongly agreed that routine childhood vaccines are effective versus 26% for influenza vaccine (P < .001). In multivariable models, an educational level lower than a bachelor's degree and household income <400% of the federal poverty level predicted hesitancy about both routine childhood and influenza vaccines. CONCLUSIONS Almost 1 in 15 US parents are hesitant about routine childhood vaccines, whereas >1 in 4 are hesitant about influenza vaccine. Furthermore, 1 in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines, and only 1 in 4 believe influenza vaccine is effective. Vaccine hesitancy, particularly for influenza vaccine, is prevalent in the United States.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado; .,Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Alison W. Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Christina Albertin
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Gregory Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Abigail Breck
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - L. Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Cindy Rand
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York; and
| | - Sharon Humiston
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Peter G. Szilagyi
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
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Biederman E, Champion V, Zimet G. A conjoint analysis study on self-sampling for human papillomavirus (HPV) testing characteristics among black women in Indiana. BMC Womens Health 2020; 20:55. [PMID: 32192493 PMCID: PMC7082901 DOI: 10.1186/s12905-020-00921-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
Background Self-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing. Methods Survey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics. Results The 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling. Conclusions Self-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.
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Affiliation(s)
- Erika Biederman
- Indiana University School of Nursing, 600 Barnhill Drive, NU317, Indianapolis, IN, 46202, USA.
| | - Victoria Champion
- Indiana University School of Nursing, 600 Barnhill Drive, NU317, Indianapolis, IN, 46202, USA
| | - Gregory Zimet
- Department of Pediatrics-Adolescent Medicine, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN, 46202, USA
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32
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Tatar O, Wade K, McBride E, Thompson E, Head KJ, Perez S, Shapiro GK, Waller J, Zimet G, Rosberger Z. Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening. J Womens Health (Larchmt) 2020; 29:390-405. [DOI: 10.1089/jwh.2019.7678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Emily McBride
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Katharine J. Head
- Department of Communication Studies, IU School of Liberal Arts at IUPUI, Indianapolis, Indiana
| | | | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jo Waller
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, Psychiatry and Oncology, McGill University, Montreal, Canada
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33
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Fontenot HB, Abuelezam NN, Rosenberger JG, Novak D, Mayer KH, Zimet G. The Impact of Advertisement Messaging on Enrollment of Young Men Who Have Sex With Men for Web-Based Research: Observational Study. J Med Internet Res 2020; 22:e16027. [PMID: 31929103 PMCID: PMC6996771 DOI: 10.2196/16027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/27/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/26/2022] Open
Abstract
Background Recruiting young men who have sex with men (YMSM) in community settings is difficult. The use of Web-based social networks and dating apps for recruitment can be successful approaches, although little work has been done on the impact of study advertisement content on recruitment. Objective The aim of this study was to evaluate the effects of advertisement message content on the recruitment of YMSM (aged 18-26 years) for a Web-based focus group study, examining perspectives and preferences for a mobile app that was designed to support sexual health among YMSM. Methods Between March and April 2017, a recruitment campaign to promote human papillomavirus vaccination was launched on a popular social networking and dating app for YMSM, with 3 different text-based advertisement themes (technology, cancer prevention, and sexual innuendo). The campaign recruited YMSM across 3 states (Massachusetts, New York, and Pennsylvania). We examined the click-through rates, conversion rates, and enrollment rates of each of the advertisements and examined differences in views and clicks by age, state, and time of day. Results The sexual innuendo advertisement had the highest click rates when compared with both the technology (click rate ratio [CRR] 2.06, 95% CI 1.74-2.45) and cancer prevention (CRR 1.62, 95% CI 1.38-1.90) advertisements. The sexual innuendo advertisement also had higher study enrollment rates compared with the technology (CRR 1.90, 95% CI 1.23-2.83) and cancer prevention (CRR 2.06, 95% CI 1.37-3.13) advertisements. No differences were observed in clicks or enrollment by age, state, or time of day. Conclusions Our marketing campaign, targeting YMSM, was effective in recruiting participants for a qualitative study, using Web-based focus groups. The sexual innuendo advertisement was the most effective and cost-efficient advertisement of the 3 approaches trialed. Different populations need different targeted strategies for study recruitment. Researchers should work with key representatives to develop and test culturally relevant messaging and approaches that utilize current and popular technologies.
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Affiliation(s)
- Holly B Fontenot
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States.,The Fenway Institute, Boston, MA, United States
| | - Nadia N Abuelezam
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, United States
| | - David Novak
- DSN Consulting, LLC, Quincy, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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34
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Luo X, Zimet G, Shah S. A natural language processing framework to analyse the opinions on HPV vaccination reflected in twitter over 10 years (2008 - 2017). Hum Vaccin Immunother 2019; 15:1496-1504. [PMID: 31194609 DOI: 10.1080/21645515.2019.1627821] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/28/2022] Open
Abstract
In this research, we developed a natural language processing (NLP) framework to investigate the opinions on HPV vaccination reflected on Twitter over a 10-year period - 2008-2017. The NLP framework includes sentiment analysis, entity analysis, and artificial intelligence (AI)-based phrase association mining. The sentiment analysis demonstrates the sentiment fluctuation over the past 10 years. The results show that there are more negative tweets in 2008 to 2011 and 2015 to 2016. The entity extraction and analysis help to identify the organization, geographical location and events entities associated with the negative and positive tweets. The results show that the organization entities such as FDA, CDC and Merck occur in both negative and positive tweets of almost every year, whereas the geographical location entities mentioned in both negative and positive tweets change from year to year. The reason is because of the specific events that happened in those different locations. The objective of the AI-based phrase association mining is to identify the main topics reflected in both negative and positive tweets and detailed tweet content. Through the phrase association mining, we found that the main negative topics on Twitter include "injuries", "deaths", "scandal", "safety concerns", and "adverse/side effects", whereas the main positive topics include "cervical cancers", "cervical screens", "prevents", and "vaccination campaigns". We believe the results of this research can help public health researchers better understand the nature of social media influence on HPV vaccination attitudes and to develop strategies to counter the proliferation of misinformation.
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Affiliation(s)
- Xiao Luo
- a Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis , Indianapolis , IN , USA
| | - Gregory Zimet
- b Pediatric Adolescent Health, Indiana University School of Medicine , Indianapolis , IN , USA
| | - Setu Shah
- a Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis , Indianapolis , IN , USA
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35
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Wilkinson TA, Dixon BE, Xiao S, Tu W, Lindsay B, Sheley M, Dugan T, Church A, Downs SM, Zimet G. Physician clinical decision support system prompts and administration of subsequent doses of HPV vaccine: A randomized clinical trial. Vaccine 2019; 37:4414-4418. [PMID: 31201057 DOI: 10.1016/j.vaccine.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND HPV vaccine is effective in preventing several cancers and anogenital warts, yet rates of HPV vaccination series completion in the United States are low. A primary reason identified by parents for vaccinating children against HPV is a health care provider's recommendation. Although most clinicians embrace vaccine recommendations, they are not always carried out evenly and subsequent HPV vaccines are missed. METHODS Using an electronic health records-based decision support system (CHICA) clinicians were randomized to either usual practice or to receive an automated reminder to recommend the 2nd or 3rd dose of HPV vaccine. The reminder was delivered to clinicians of all intervention group eligible adolescents who had already initiated the vaccine series. Logistic regression models with generalized estimating equations were used for data analysis. RESULTS A total of 1285 clinical encounters were observed across 29 randomized pediatric providers over a 13-month time frame (50.7% control group, 49.3% intervention group). Overall, patients were 44.9% female, 59.4% Black, 22.1% Hispanic, and 48.8% were ages 11-12 yrs. Within the control group, 421 (64.7%) received a subsequent HPV vaccine, compared to 481 (75.9%) (OR: 1.72, (95% CI 1.35-2.19)). Adjusted analysis showed no difference between the groups (aOR 1.52 (95% CI 0.88-2.62)) or when examined by age (11-12yrs aOR 1.66, (95% CI 0.79-3.48)) and 13-17yrs (aOR 1.19, (95% CI 0.76-1.85)) or gender female (aOR 1.39 (95% CI 0.71-2.72)) and males (aOR 1.67 (95% CI 0.95-2.92)). When results were stratified by both age and gender, there was similarly no statistically significant effect between the two groups. CONCLUSIONS Automated physician reminders for subsequent 2nd and 3rd doses of HPV vaccination were used. Despite increased rates of vaccination in the intervention group, the differences did not reach the level of statistical significance. Future studies with multifaceted approaches may be needed to examine the efficacy of computer-based reminders. CLINICAL TRIAL REGISTRATION NCT02558803, "HPV Vaccination: Evaluation of Reminder Prompts for Doses 2 & 3".
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Affiliation(s)
- Tracey A Wilkinson
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Brian E Dixon
- Indiana Univ, Fairbanks School of Public Health, Department of Epidemiology, 1050 Wishard Blvd, RG5, INpolis, IN 46202, United States; Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States.
| | - Shan Xiao
- Indiana University School of Medicine, Department of Biostatistics, 410 W. 10th St., Suite 3000, Indianapolis, IN 46202, United States
| | - Wanzhu Tu
- Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States; Indiana University School of Medicine, Department of Biostatistics, 410 W. 10th St., Suite 3000, Indianapolis, IN 46202, United States.
| | - Brianna Lindsay
- Center for Observational and Real-World Evidence, Merck & Co., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, United States.
| | - Meena Sheley
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Tamara Dugan
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Abby Church
- Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States.
| | - Stephen M Downs
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Gregory Zimet
- Indiana Univ. School of Medicine, Dept. of Pediatrics-Adolescent Medicine, 410 W. 10th St., Suite 1001, Indianapolis, IN 46202, United States.
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36
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Wilkinson TA, Dixon BE, Xiao S, Tu W, Lindsay B, Sheley M, Dugan T, Church A, Downs SM, Zimet G. WITHDRAWN: Physician Clinical Decision Support System Prompts and Administration of Subsequent Doses of HPV Vaccine: A Randomized Clinical Trial. Vaccine X 2019. [DOI: 10.1016/j.jvacx.2019.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hopfer S, Ray AE, Hecht ML, Miller-Day M, Belue R, Zimet G, Evans WD, McKee FX. Taking an HPV vaccine research-tested intervention to scale in a clinical setting. Transl Behav Med 2019; 8:745-752. [PMID: 29425333 DOI: 10.1093/tbm/ibx066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Research tested interventions are seldom ready for wide spread use. Successful intervention adaptation to clinical settings demands an iterative process with target audience feedback. We describe the adaptation process of implementing an NCI research tested HPV vaccine intervention, Women's Stories, to a community clinic context (Planned Parenthood). Five phases are described for the adaptation of content and the development of a health kiosk intervention delivery system: (a) informant interviews with the target audience of young adult, predominantly African-American women, (b) translating HPV vaccine decision narratives into prevention messages, (c) health kiosk interface design, (d) conducting a usability study of the health kiosk intervention product, and (e) conducting a waiting room observational study. Lessons learned and challenges in adapting prevention interventions to clinical settings are discussed.
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Affiliation(s)
- Suellen Hopfer
- Program in Public Health, University of California, Irvine, CA, USA
| | | | | | - Michelle Miller-Day
- REAL Prevention, Clifton, NJ, USA.,Communication Studies and Health and Strategic Communication, Chapman University, Orange, CA, USA
| | - Rhonda Belue
- Health Management and Policy, Saint Louis University, St. Louis, MO, USA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - W Douglas Evans
- The George Washington University, Milken Institute School of Public Health, Washington DC, USA
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38
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Fontenot HB, Rosenberger JG, McNair KT, Mayer KH, Zimet G. Perspectives and preferences for a mobile health tool designed to facilitate HPV vaccination among young men who have sex with men. Hum Vaccin Immunother 2019; 15:1815-1823. [PMID: 30625049 DOI: 10.1080/21645515.2019.1568156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/27/2022] Open
Abstract
We sought to understand young men who have sex with men (YMSM) perspectives and preferred features for a mobile health (mHealth) tool designed to facilitate human papillomavirus (HPV) vaccination. YMSM were recruited on a popular social/sexual networking app to participate in online focus groups. Discussions were designed to elicit what the men would want in a mHealth tool specific for sexual health and HPV. Demographic data were analyzed using descriptive statistics and focus group data were analyzed using conventional content analysis. Forty-eight YMSM participated. Mean age was 23.4 years, and 70.0% reported their race as Black. Qualitative themes included general HPV knowledge and awareness, current patterns in technology use, desired app qualities, and desired app content. Youth described varying levels of HPV knowledge, utilized apps to engage socially, and for travel, banking, gaming, news and entertainment, and few used apps to facilitate personal health or engage with healthcare systems. Participants desired credible, relatable, secure, and easy to use interfaces that provided sexual health and HPV information in a positive context. They described ways to creatively engage and directly connect youth to health providers. We identified a culturally relevant youth driven approach to facilitate HPV vaccination and sexual health among YMSM.
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Affiliation(s)
- Holly B Fontenot
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA.,b Fenway Health/The Fenway Institute , Boston , MA , USA
| | - Joshua G Rosenberger
- c Department of Behavioral Health, Penn State University , University Park , PA , USA
| | - Katelyn T McNair
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA
| | - Kenneth H Mayer
- b Fenway Health/The Fenway Institute , Boston , MA , USA.,d Beth Israel Deaconess Medical Center, Department of Medicine, Boston MA/Harvard Medical School , Boston , MA , USA
| | - Gregory Zimet
- e Section of Adolescent Medicine, Indiana University School of Medicine , Indianapolis , IN , USA
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39
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Affiliation(s)
- Ellen Daley
- Community and Family Health Concentration, College of Public Health, University of South Florida, Tampa
| | - Erika Thompson
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
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40
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Tatar O, Thompson E, Naz A, Perez S, Shapiro GK, Wade K, Zimet G, Gilca V, Janda M, Kahn J, Daley E, Rosberger Z. Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis. Prev Med 2018; 116:40-50. [PMID: 30172799 DOI: 10.1016/j.ypmed.2018.08.034] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023]
Abstract
Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie, Blvd., EAD 709M, Fort Worth, TX 76107-2699, USA.
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Gilla K Shapiro
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 945 Wolfe Avenue, Québec, Quebec G1V 5B3, Canada.
| | - Monika Janda
- Queensland University of Technology, Faculty of Health, Brisbane, Australia.
| | - Jessica Kahn
- University of Cincinnati (Ohio), Division of Adolescent and Transition Medicine, MLC 4000, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
| | - Ellen Daley
- University of South Florida, Department of Community and Family Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
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Wongpakaran T, Wongpakaran N, Sirirak T, Arunpongpaisal S, Zimet G. Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression. Aging Ment Health 2018. [PMID: 28621147 DOI: 10.1080/13607863.2017.1339778] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders. METHODS Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups. RESULTS The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ2 = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models. CONCLUSIONS Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.
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Affiliation(s)
| | | | - Thanitha Sirirak
- c Faculty of Medicine, Prince of Songkla University , Hat Yai , Thailand
| | | | - Gregory Zimet
- e Department of Pediatrics , Indiana University , Indianapolis , IN , USA
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Abstract
Guided by self-determination theory, the present study examines independent and interactive roles of self-efficacy and perceived social support in predicting types of academic motivation. Data were collected from 325 university undergraduates in 18-23 years of age (M=21.09, SD=1.34) from the fifth biggest city of South Asia. Results showed the independent and interactive effects of self-efficacy and social support from friends and from a significant other on intrinsic academic motivation after controlling the potential confounding due to demographics. Social support from friends, but not from family and a significant other, independently predicted extrinsic academic motivation. Neither self-efficacy nor social support significantly predicted amotivation.
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Baker Z, Javanbakht M, Mierzwa S, Pavel C, Lally M, Zimet G, Gorbach P. Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data. AIDS Behav 2018; 22:1174-1183. [PMID: 29079950 DOI: 10.1007/s10461-017-1958-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Young men who have sex with men (YMSM) face a disproportionately high burden of HIV. Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition, but adherence to PrEP among YMSM may be inadequate. Medication adherence may be assessed via biomarkers, which are expensive and invasive, or via self-report through Audio Computer Assisted Self-Interview (ACASI), which may result in over-reporting of adherence. In this paper we assess the potential of a new method of self-report, the Interactive Questionnaire System (iQS), in validly estimating true adherence rates. PrEP adherence among 167 YMSM aged 15-23 was measured via dried blood spot (DBS), ACASI, and iQS twice over a 24-week study period. Both ACASI- and iQS-reported data revealed that over 40% of individuals self-reporting adequate PrEP adherence had DBS-estimated drug levels indicating inadequate adherence. Adjusted logistic repeated measures random intercept regression analyses indicated that younger YMSM had higher odds of over-reporting adherence than older YMSM-each 1 year increase in age was associated with 0.79 times the odds of over-reporting adherence (95% CI 0.63, 0.98; p value = 0.031), and being African American was associated with 3.22 times greater odds of over-reporting than non-African Americans (95% CI 1.51, 6.90; p-value = 0.0003). These results suggest that ACASI and iQS methods of self-report significantly overestimate true PrEP adherence rates among YMSM, and that the odds of over-reporting adherence may be affected by both age and race.
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Donahue K, Hendrix K, Sturm L, Zimet G. Provider Communication and Mothers' Willingness to Vaccinate Against Human Papillomavirus and Influenza: A Randomized Health Messaging Trial. Acad Pediatr 2018; 18:145-153. [PMID: 28754504 PMCID: PMC5785569 DOI: 10.1016/j.acap.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/12/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To understand the effect of a health messaging intervention focused on provider communication about vaccination on mothers' willingness to vaccinate children against human papillomavirus (HPV) and seasonal influenza. METHODS A total of 2476 mothers of 9- to 13-year-olds in the United States completed a Web-based survey in August 2014. Mothers were randomized to 1 of 2 groups targeting HPV or influenza vaccine. Mothers whose child had not received the target vaccine (ie, zero doses of HPV vaccine/no prior-year administration of influenza vaccine) were randomized to the intervention. The study used a 3 × 2 between-subjects design; illustrated vignettes depicted 1 of 3 levels of provider recommendation strength (brief mention of vaccination, strong recommendation of vaccination, or personal disclosure of vaccination of own children), and presence or absence of information comparing safety of vaccination to the safety of a common daily activity. Outcome was mothers' willingness to have their child receive the target vaccine. Perceived benefits of vaccination were assessed before viewing the intervention and were included as a covariate in analyses, along with child gender. RESULTS For HPV vaccine, there was a main effect of safety information (F(1,684) = 7.99, P = .005) and perceived benefits of vaccination (F(1,684) = 221.64, P < .001) on mothers' willingness to vaccinate. For influenza, perceived benefits of vaccination significantly related to willingness to vaccinate (F(1,462) = 105.78, P < .001). Child gender was not associated with willingness. CONCLUSIONS Provider communication about vaccination may need to be tailored to the vaccine in question. A next step to increasing coverage for both HPV and influenza vaccines may be an intervention aimed at increasing mothers' perceived benefits of vaccination.
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Affiliation(s)
- Kelly Donahue
- Department of Pediatrics, Sections of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Ind.
| | - Kristin Hendrix
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind
| | - Lynne Sturm
- Department of Pediatrics, Child Development, Indiana University School of Medicine, Indianapolis, Ind
| | - Gregory Zimet
- Department of Pediatrics, Sections of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Ind
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Nickel B, Dodd RH, Turner RM, Waller J, Marlow L, Zimet G, Ostini R, McCaffery K. Factors associated with the human papillomavirus (HPV) vaccination across three countries following vaccination introduction. Prev Med Rep 2017; 8:169-176. [PMID: 29062681 PMCID: PMC5645176 DOI: 10.1016/j.pmedr.2017.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
Direct international comparisons which aim to understand how factors associated with human papillomavirus (HPV) vaccine initiation and attitudes towards the HPV vaccination in parents differ are scarce. Parents (n = 179) of daughters aged 9-17 years in the US, UK and Australia completed an online survey in 2011 with questions measuring daughters' HPV vaccination status, HPV knowledge, HPV vaccination knowledge, and statements assessing attitude towards the HPV vaccine. The strongest factor associated with vaccination status across all countries was parental HPV knowledge (p < 0.001). Parents with both very low and very high knowledge scores were less likely to have vaccinated their daughters. Parents with higher HPV vaccination knowledge scores intended to vaccinate their daughters (if not already vaccinated) for protective reasons (p < 0.001), while those whose daughters were already vaccinated understood that vaccination protection was not 100% and that their daughters may still be at risk of getting HPV (p < 0.05). Compared to the UK and Australia, a higher proportion of parents with unvaccinated daughters from the US were worried about the side-effects of the HPV vaccination (US: 60.5%, UK: 36.4%, AUS: 15.4%; p < 0.05), believed that getting the vaccination might be a hassle (US: 21.1%, UK: 0%, AUS: 7.7%; p < 0.05), and that the vaccine was too new (US: 44.7%, UK: 22.7%, AUS: 7.7%; p < 0.05). This study adds to the understanding of how parents may influence vaccination uptake by demonstrating the effect of knowledge and the parental attitudes towards HPV vaccination across three countries.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, 2006, Australia
| | - Rachael H. Dodd
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Robin M. Turner
- School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Jo Waller
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Laura Marlow
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Health Information & Translational Sciences, Indianapolis, IN, USA
| | - Remo Ostini
- Rural Clinical School Research Centre, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, 2006, Australia
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Mullins TLK, Zimet G, Lally M, Xu J, Thornton S, Kahn JA. HIV Care Providers' Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults. AIDS Patient Care STDS 2017; 31:504-516. [PMID: 29211514 DOI: 10.1089/apc.2017.0147] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 01/19/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is indicated for use in US adults, and little is known about clinician intentions to prescribe and actual prescription of PrEP to adolescents younger than 18. Fifty-six clinicians who care for HIV-infected and at-risk youth completed an anonymous online survey in 2014. Primary outcomes were (1) intentions to prescribe PrEP to adolescents and adults in four risk categories [men who have sex with men (MSM), transgender women, heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners]; and (2) actual prescription of PrEP to adolescents and adults in these risk groups. Independent variables included clinician characteristics, experience prescribing nonoccupational postexposure prophylaxis, familiarity with and knowledge of PrEP and PrEP guidance, attitudes toward PrEP, and facilitating factors for prescribing PrEP and incorporation of PrEP guidance into practice. Variables associated with intention to prescribe ("very likely to prescribe" vs. other responses) and actual prescription of PrEP stratified by age and risk category were identified in logistic regression models. Mean age was 45.9 years (standard deviation 10.7); 64% were physicians. More clinicians reported high intention to prescribe PrEP to adult versus adolescent MSM (p = 0.02) and transgender women (p = 0.001). Variables associated with intention to prescribe and prescription of PrEP differed by age and risk category. In adolescents, those variables included positive beliefs, higher number of facilitating factors, and fewer barriers to PrEP prescription. Designing strategies based on these findings that address both facilitating factors and barriers to PrEP prescription may improve PrEP uptake by at-risk youth.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University, Indianapolis, Indiana
| | - Michelle Lally
- Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hosek SG, Landovitz RJ, Kapogiannis B, Siberry GK, Rudy B, Rutledge B, Liu N, Harris DR, Mulligan K, Zimet G, Mayer KH, Anderson P, Kiser JJ, Lally M, Brothers J, Bojan K, Rooney J, Wilson CM. Safety and Feasibility of Antiretroviral Preexposure Prophylaxis for Adolescent Men Who Have Sex With Men Aged 15 to 17 Years in the United States. JAMA Pediatr 2017; 171:1063-1071. [PMID: 28873128 PMCID: PMC5710370 DOI: 10.1001/jamapediatrics.2017.2007] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [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] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Adolescents represent a key population for implementing preexposure prophylaxis (PrEP) interventions worldwide, yet tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for PrEP is only licensed for adults. OBJECTIVE To examine the safety of and adherence to PrEP along with changes in sexual risk behavior among adolescent men who have sex with men (MSM). DESIGN, SETTING, AND PARTICIPANTS Adolescent Medicine Trials Network for HIV/AIDS Interventions 113 (Project PrEPare) was a PrEP demonstration project that evaluated the safety, tolerability, and acceptability of TDF/FTC and patterns of use, rates of adherence, and patterns of sexual risk behavior among healthy young MSM aged 15 to 17 years. Participants were recruited from adolescent medicine clinics and their community partners in 6 US cities, had negative test results for human immunodeficiency virus (HIV) but were at high risk for acquiring an infection, and were willing to participate in a behavioral intervention and accept TDF/FTC as PrEP. EXPOSURES All participants completed an individualized evidence-based behavioral intervention and were provided with daily TDF/FTC as PrEP for 48 weeks. MAIN OUTCOMES AND MEASURES The main objectives were to: (1) provide additional safety data regarding TDF/FTC use among young MSM who had negative test results for HIV; (2) examine the acceptability, patterns of use, rates of adherence, and measured levels of tenofovir diphosphate in dried blood spots; and (3) examine patterns of risk behavior when young MSM were provided with a behavioral intervention in conjunction with open-label TDF/FTC. RESULTS Among 2864 individuals screened (from August 2013 to September 2014), 260 were eligible and 78 were enrolled (mean [SD] age, 16.5 [0.73] years), of whom 2 (3%) were Asian/Pacific Islander, 23 (29%) were black/African American, 11 (14%) were white, 16 (21%) were white Hispanic, and 26 (33%) were other/mixed race/ethnicity. Over 48 weeks of PrEP use, 23 sexually transmitted infections were diagnosed in 12 participants. The HIV seroconversion rate was 6.4 (95% CI: 1.3-18.7) per 100 person-years. Tenofovir diphosphate levels consistent with a high degree of anti-HIV protection (>700 fmol/punch) were found in 42 (54%), 37 (47%), 38 (49%), 22 (28%), 13 (17%), and 17 (22%) participants at weeks 4, 8, 12, 24, 36, and 48, respectively. CONCLUSIONS AND RELEVANCE Adolescent Medicine Trials Network for HIV/AIDS Interventions 113 enrolled a diverse sample of adolescent MSM at risk for HIV who consented to study participation. Approximately half achieved protective drug levels during the monthly visits, but adherence decreased with quarterly visits. Youth may need additional contact with clinical staff members to maintain high adherence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01769456.
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Affiliation(s)
| | | | - Bill Kapogiannis
- National Institute of Child Health and Human Development, Bethesda, Maryland
| | - George K. Siberry
- National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Kelly Bojan
- Ruth Rothstein CORE Center, Chicago, Illinois
| | - Jim Rooney
- Gilead Sciences, Foster City, California
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Perez S, Tatar O, Ostini R, Shapiro GK, Waller J, Zimet G, Rosberger Z. Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys. Prev Med 2016; 91:43-49. [PMID: 27471023 DOI: 10.1016/j.ypmed.2016.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 04/15/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/21/2022]
Abstract
As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, The University of Queensland, West Street, Toowoomba, Qld 4350, Australia
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
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49
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Mullins TLK, Zimet G, Lally M, Kahn JA. Adolescent Human Immunodeficiency Virus Care Providers' Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth. AIDS Patient Care STDS 2016; 30:339-48. [PMID: 27410497 DOI: 10.1089/apc.2016.0048] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Oral pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is currently indicated for use in adults in the United States and may soon be indicated for minor adolescents. However, implementation of PrEP use among minors may present unique barriers. We conducted 15 individual, semi-structured interviews among US clinicians caring for HIV-infected and at-risk youth. The theory-driven interview guide assessed demographics, perceived role of oral PrEP in HIV prevention among adolescents, perceived barriers to and facilitating factors for use of PrEP in adolescents, and clinician-reported likelihood of prescribing PrEP. Transcripts were analyzed using framework analysis. Overall, clinicians viewed PrEP as a time-limited intervention that is one part of a comprehensive approach to HIV prevention among adolescents. Perceived barriers to prescribing to minors included concerns about: confidentiality, legality of minors consenting to PrEP without parental involvement, ability of minors to understand the risks/benefits of PrEP, the possible impact of PrEP on bone accrual, off-label use of PrEP medication in minors, and the high costs associated with PrEP use. Clinician-reported facilitating factors for prescribing PrEP to youth included educating communities and other clinicians about PrEP, ensuring adequate financial resources and infrastructure for delivering PrEP, developing formal guidance on effective behavioral interventions that should be delivered with PrEP, and gaining personal experience with prescribing PrEP. Clinicians indicated greater comfort with prescribing PrEP to adults versus minors. For PrEP to become more widely available to youth at risk for HIV infection, barriers that are unique to PrEP use in minors must be addressed.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University, Indianapolis, Indiana
| | - Michelle Lally
- Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University, Providence, Rhode Island
- Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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50
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Skinner SR, Davies C, Cooper S, Stoney T, Marshall H, Jones J, Collins J, Hutton H, Parrella A, Zimet G, Regan DG, Whyte P, Brotherton JML, Richmond P, McCaffrey K, Garland SM, Leask J, Kang M, Braunack-Mayer A, Kaldor J, McGeechan K. HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents. BMC Public Health 2015; 15:896. [PMID: 26373926 PMCID: PMC4572679 DOI: 10.1186/s12889-015-2168-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods/Design HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. Discussion This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2168-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Rachel Skinner
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Cristyn Davies
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Spring Cooper
- CUNY School of Public Health, City University New York, New York City, NY, USA.
| | - Tanya Stoney
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Helen Marshall
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Jane Jones
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Joanne Collins
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Heidi Hutton
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Adriana Parrella
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Gregory Zimet
- Pediatrics & Clinical Psychology, Indiana University, Indianapolis, IN, USA.
| | - David G Regan
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Patti Whyte
- Deakin University, SRC Population Health, Deakin Health Economics, Melbourne, VIC, Australia.
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Peter Richmond
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia. .,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Kirsten McCaffrey
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
| | | | - John Kaldor
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
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