Browsing by Author "Daley, Ellen M."

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    The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation
    (Elsevier, 2017-06) Daley, Ellen M.; Vamos, Cheryl A.; Thompson, Erika L.; Zimet, Gregory D.; Rosberger, Zeev; Merrell, Laura; Kline, Nolan S.; Pediatrics, School of Medicine
    Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.
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    Human Papillomavirus Vaccine Initiation for Adolescents Following Rhode Island’s School-Entry Requirement, 2010–2016
    (American Public Health Association, 2018-10-01) Thompson, Erika L.; Livingston, Melvin D.; Daley, Ellen M.; Zimet, Gregory D.; Pediatrics, School of Medicine
    Objectives. To assess changes in human papillomavirus (HPV) vaccine initiation for adolescent girls and boys in Rhode Island compared with all other states. Methods. We estimated the gender-specific effects of Rhode Island’s school-entry HPV vaccination policy on self-reported HPV vaccination initiation by using a difference-in-differences design with the National Immunization Survey–Teen from 2010 through 2016. Results. Compared with boys in other states, boys in Rhode Island increased their HPV vaccine initiation rate by 11% (b = 0.11; 95% confidence interval [CI] = 0.05, 0.18) after enactment of the requirement. No difference was seen in the probability of HPV vaccine initiation among girls in Rhode Island compared with girls in the multistate control (b = −0.01; 95% CI = −0.08, 0.05). Conclusions. Our analysis identified an 11% increase in HPV vaccine initiation rate among boys in Rhode Island after the school-entry requirement was enacted, whereas no significant change was observed for girls. Public Health Implications. Given suboptimal vaccine uptake rates in the United States, continued pursuit of state-level public policy to improve HPV vaccination is needed. School-entry requirements for HPV vaccination may be a strategy for closing the gap in HPV vaccine uptake for boys and girls.
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    Recent changes in cervical cancer screening guidelines: U.S. women's willingness for HPV testing instead of Pap testing
    (Elsevier, 2020-01) Thompson, Erika L.; Galvin, Annalynn M.; Daley, Ellen M.; Tatar, Ovidiu; Zimet, Gregory D.; Rosberger, Zeev; Pediatrics, School of Medicine
    Cervical cancer screening guidelines in the United States were revised in 2018 to include the option of primary human papillomavirus (HPV) testing. The transition to this screening method may face difficulties as Pap testing has been the primary screening modality in the United States. The objective of this study is to assess information, motivation, and behavioral skills associated with willingness to receive an HPV test instead of a Pap test among women. The sample included U.S. 812 women, ages 30 to 65 years. Participants completed an online survey in 2018. The Information, Motivation, and Behavioral Skills (IMB) model was used to measure predictors of willingness for HPV testing. The outcome variables were willingness to receive the HPV test instead of the Pap test, with and without time interval details. Logistic regression modeling was used with SAS 9.4. Over half of the sample (55%) were willing to receive the HPV test. For the information domain, HPV knowledge was significantly associated with willingness for HPV testing (OR = 1.08, 95%CI 1.04–1.13). Significant motivating factors included: positive attitudes, social norms, perceived benefits, worry about cervical cancer, and worry about abnormal HPV tests. For behavioral skills, women were significantly more willing to get the HPV test if a provider recommended it (OR = 2.43, 95%CI 1.53–3.87) and currently up-to-date on cervical cancer screening guidelines (OR = 1.52, 95%CI 1.52–2.26). Addressing barriers and facilitators to willingness to transition to primary HPV testing over Pap testing is needed as the United States has updated guidelines for cervical cancer screening.
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    Rhode Island Human Papillomavirus Vaccine School Entry Requirement Using Provider-Verified Report
    (Elsevier, 2020-08) Thompson, Erika L.; Livingston, Melvin D.; Daley, Ellen M.; Saslow, Debbie; Zimet, Gregory D.; Pediatrics, School of Medicine
    Introduction Human papillomavirus vaccine school entry requirements may be an opportunity to improve the low rates of human papillomavirus vaccination among adolescents. This study evaluates changes in provider-verified human papillomavirus vaccine uptake by age 13 years for adolescents in Rhode Island compared with all other states from 2011 to 2017. Methods The National Immunization Survey-Teen 2011–2017, a population-based cross-sectional survey, was analyzed in 2019. The survey included telephone interviews and provider-verified reports of vaccination among U.S. adolescents aged 13–17 years. The sample was subset to participants with provider-verified human papillomavirus vaccination reports (n=145,153). A difference-in-differences approach evaluated the Rhode Island human papillomavirus vaccination school entry requirement enacted in 2015. The main outcome was provider-verified human papillomavirus vaccine uptake by age 13 years. Results Compared with boys in other states, boys in Rhode Island had an increase of 14 percentage points in the probability of uptake of human papillomavirus vaccination by age 13 years (β=0.139, 95% CI=0.073, 0.205). No such differences were observed on comparing girls in Rhode Island with girls in other states (β=0.009, 95% CI= −0.068, 0.086). Conclusions The Rhode Island school entry requirement for human papillomavirus vaccination improved rates of vaccine uptake among boys and may be a useful option for improving human papillomavirus vaccination nationally.
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    School-entry requirements for HPV vaccination: part of the patchwork for HPV-related cancer prevention
    (Taylor & Francis, 2021) Thompson, Erika L.; Daley, Ellen M.; Washburn, Tricia; Salisbury-Keith, Kim; Saslow, Debbie; Fontenot, Holly B.; Zimet, Gregory D.; Pediatrics, School of Medicine
    Human papillomavirus (HPV) vaccination can prevent six types of HPV-related cancers, and approximately, 54.2% of adolescents are up-to-date with the HPV vaccine in the United States. While moderate success has been achieved with provider- and parent-focused interventions, HPV vaccination in the U.S. lags well behind desired goals. In order to maximize HPV vaccination and prevention of HPV-related cancers, it may be prudent to consider state policy approaches, such as school-entry requirements as part of the patchwork of provider, parent, and structural interventions. In this paper, we reviewed the history of efforts to implement school-entry requirements for HPV vaccine, the challenges and benefits associated with implementing these requirements, and the evidence for the effectiveness of school-entry requirements. In addition, we presented new data from Rhode Island's Immunization Information System (IIS) showing how their school-entry requirement, implemented in 2015, has impacted HPV vaccination rates. These registry data indicate that HPV vaccination rates improved significantly after the 2014-2015 school year and policy implementation, and add to the ongoing evidence supporting the value of school-entry requirements for HPV vaccination. School-entry requirements should be considered alongside other initiatives and policies for promoting HPV vaccine uptake. Taking a comprehensive systems approach to HPV vaccination is needed.
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    Understanding the Challenges of HPV-Based Cervical Screening: Development and Validation of HPV Testing and Self-Sampling Attitudes and Beliefs Scales
    (MDPI, 2023-01-15) Tatar, Ovidiu; Haward, Ben; Zhu, Patricia; Griffin-Mathieu, Gabrielle; Perez, Samara; McBride, Emily; Lofters, Aisha K.; Smith, Laurie W.; Mayrand, Marie-Hélène; Daley, Ellen M.; Brotherton, Julia M. L.; Zimet, Gregory D.; Rosberger, Zeev; Pediatrics, School of Medicine
    The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.