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Item Are Boys Ready for Human Papillomavirus Vaccine? A National Study of Boys in Malaysia(Wolters Kluwer, 2019-09) Wong, L. P.; Alias, H.; Yusoff, R. N. A. R. M.; Sam, I. C.; Zimet, G. D.; Pediatrics, School of MedicineBackground The aim of this study was to investigate factors associated with the willingness of boys to accept the human papillomavirus (HPV) vaccine. Methods A nationwide cross-sectional survey among Secondary One male students in Malaysia. Results Among 2823 respondents, knowledge about HPV infection and the HPV vaccine was extremely poor. The mean total knowledge score was only 3.17 (SD ± 2.14), out of a possible score of 10. The majority of respondents were unaware that vaccinating boys can help protect girls against HPV infection (81.6%), and HPV is a sexually transmitted infection (70.1%). Many had the misconception that only females get HPV (78.9%). In multivariable analysis, the factors associated with the intention to receive the HPV vaccination were: agreeing boys need to be vaccinated against HPV infection (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.57–2.68), perceiving their parents might allow them to get the HPV vaccine (OR, 1.66; 95% CI, 1.18–2.34), perceived susceptibility to HPV infection (OR, 1.63; 95% CI, 1.06–2.52), and attending a rural school (OR, 1.49; 95% CI, 1.14–1.95). Conclusions Public health educational programs that are focused and tailored on parents consenting to HPV vaccination for boys at a young age can be useful in improving HPV vaccination rates among boys. There is also a pressing need to educate boys about the benefits of HPV vaccination in males and about HPV disease susceptibility to facilitate adoption of the HPV vaccine by young adults in the future.Item Does Self-Efficacy Mediate the Relationships Between Social-Cognitive Factors and Intentions to Receive HPV Vaccination Among Young Women?(Sage, 2017) Christy, Shannon M.; Winger, Joseph G.; Mosher, Catherine E.; Psychology, School of ScienceDrawing upon health behavior change theories, the current study examined whether self-efficacy mediated relationships between social-cognitive factors (i.e., perceived risk, perceived benefits, perceived barriers, perceived severity, and cue to action) and human papillomavirus (HPV) vaccination intentions among college women. Unvaccinated women (N = 115) aged 18 to 25 years attending a Midwestern university completed an anonymous web-based survey assessing study variables. Correlational analyses and mediation analyses were conducted. Self-efficacy mediated relationships between two social-cognitive factors (i.e., perceived barriers to HPV vaccination—indirect effect = −.16, SE = .06, 95% confidence interval [CI] = [−.31, −.06]—and perceived risk of HPV-related conditions—indirect effect = .16, SE = .09, 95% CI = [.01, .37]) and HPV vaccination intentions but was unrelated to the other three social-cognitive factors. Based on these findings, future research should test whether increasing self-efficacy through education on risk of HPV-related conditions and reducing barriers to HPV vaccination improves vaccine uptake in college women.Item 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 MedicineHuman 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.Item Healthcare providers’ beliefs and attitudes regarding risk compensation following HPV vaccination(Elsevier, 2016-05-28) Kasting, Monica L.; Wilson, Shannon; Dixon, Brian E.; Downs, Stephen M.; Kulkarni, Amit; Zimet, Gregory D.; Epidemiology, School of Public HealthBackground Provider recommendation is a significant predictor of HPV vaccine uptake. Prior research suggests that concerns regarding risk compensation could cause some providers to hesitate recommending the HPV vaccine. Methods During 15–30 min semi-structured interviews in early 2015, 22 U.S. pediatric providers were asked about their beliefs regarding sexual risk compensation and cervical cancer screening following HPV vaccination. Providers were asked if these beliefs result in reservations recommending the vaccine. Interviews were audio-recorded, transcribed, and analyzed using inductive content analysis. Results None of the providers believed the HPV vaccine would result in risky sexual behavior. Half indicated it was better to start vaccination early, before sexual activity was a worry. Others noted that patients’ risky behavior decisions happen independently of vaccination. When providers were asked if they were concerned about decreased cervical cancer screening, half said they did not know and some stated they had never thought about it before. The main themes addressed were the significant time lapse between vaccination and screening and that women tend to get over-screened as opposed to under-screened. Conclusion Providers were generally in favor of HPV vaccination and do not perceive risk compensation as a barrier to HPV recommendation.Item Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study(Elsevier, 2022-11-21) Turner, Kea; Brownstein, Naomi C.; Whiting, Junmin; Arevalo, Mariana; Vadaparampil, Susan; Giuliano, Anna R.; Islam, Jessica Y.; Meade, Cathy D.; Gwede, Clement K.; Kasting, Monica L.; Head, Katharine J.; Christy, Shannon M.; Communication Studies, School of Liberal ArtsTo assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.Item Parents' Acceptance of COVID-19 Compared to Human Papillomavirus Vaccines(Elsevier, 2022-12) Footman, Alison; Kanney, Nita; Niccolai, Linda M.; Zimet, Gregory D.; Overton, Edgar Turner; Davies, Susan L.; Van Der Pol , Barbara; Pediatrics, School of MedicinePurpose: The first vaccine against SARS-CoV-2 (COVID-19) for adolescents 16 years and older in the United States received Emergency Use Authorization in December 2020. Soon after its approval, parents expressed concerns about vaccine safety for adolescents. Similar concerns about vaccine safety partially explain suboptimal human papillomavirus (HPV) vaccine uptake. This qualitative study explores similarities and differences in parents' attitudes about these two vaccines. Methods: Parents were recruited through social media and at health centers in Alabama. Semi-structured interviews with parents of adolescents aged 9-17 years were conducted before and after Alabama expanded age eligibility to those 16 and older. Topics included knowledge about HPV and COVID-19 vaccines, and parents' intentions to have children vaccinated. Interviews were analyzed using thematic analysis. Results: From March 11, 2021 to April 24, 2021, 21 in-depth interviews were conducted. Parents discussed the importance of HPV and COVID-19 vaccines for protecting their children's health but differences between the two related to community protection. Parents were concerned about vaccine safety but media coverage about the COVID-19 vaccine led to more favorable attitudes about the benefits of vaccination, which was not observed for HPV vaccines. Instead for HPV vaccination, parents wanted their healthcare providers' opinions about the vaccine before making a vaccination decision. Discussion: Parents had similar concerns about HPV and COVID-19 vaccines. Although provider recommendations can improve vaccine uptake, local news reports were seen to have a positive impact on COVID-19 vaccine acceptance in lieu of provider recommendation. Disseminating information online could be beneficial to promote HPV and COVID-19 vaccines.Item Pediatrician-Parent Conversations about Human Papillomavirus Vaccination: An Analysis of Audio-Recordings(Elsevier, 2017-08) Sturm, Lynne; Donahue, Kelly; Kasting, Monica; Kulkarni, Amit; Brewer, Noel T.; Zimet, Gregory D.; Pediatrics, School of MedicinePurpose We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits. Methods Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians. Results Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32–34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72–415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children. Conclusions Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.Item Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes.(CDC, 2016-10) Mesher, David; Soldan, Kate; Lehtinen, Matti; Beddows, Simon; Brisson, Marc; Brotherton, Julia M. L.; Chow, Eric P. F.; Cummings, Teresa; Drolet, Mélanie; Fairley, Christopher K.; Garland, Suzanne M.; Kahn, Jessica A.; Kavanagh, Kimberley; Markowitz, Lauri; Pollock, Kevin G.; Söderlund-Strand, Anna; Sonnenberg, Pam; Tabrizi, Sepehr N.; Tanton, Clare; Unger, Elizabeth; Thomas, Sara L.; Department of Pediatrics, IU School of MedicineAfter introduction of vaccination, some prevalences of nonvaccine types changed, without clear evidence for type replacement.Item A Qualitative Analysis of the Vaccine Intention-Behavior Relationship: Parents’ Descriptions of their Intentions, Decision-making Behavior, and Planning Processes toward HPV Vaccination(Taylor & Francis, 2019-03) Auslander, Beth A.; Meers, Jessica M.; Short, Mary B.; Zimet, Gregory D.; Rosenthal, Susan L.; Pediatrics, School of MedicineObjective: Identify factors influencing the vaccine intention-behavior relationship. Design: 445 parents who received a brief intervention to promote HPV vaccination were categorized based on their intentions post-intervention (yes/unsure/eventually/never) and subsequent adolescents’ vaccine status (yes/no). 51 of those parents participated in qualitative interviews. Main Outcome Measures: Parents described their intentions, decision-making, and planning processes toward vaccination. Framework analysis was used to analyze the data. Results: Parents in the “Yes/Yes” category were knowledgeable about HPV/vaccine, described strong, stable intentions, considered themselves the primary decision-makers about vaccination, and said they vaccinated immediately. “Yes/No” parents described strong intentions and thought their adolescent was vaccinated OR described hesitant intentions, seeking advice/agreement from others and noting barriers to vaccination without solutions. “Unsure/Yes” parents described their intentions as strengthening with information from credible sources and identified strategies for overcoming barriers. “Unsure/No” and “Eventually/No” parents had misinformation/negative beliefs regarding vaccination, described being ambivalent or non-supportive of vaccination, and cited barriers to vaccination. “Never/No” parents held negative beliefs about vaccination, described strong, stable intentions to NOT vaccinate, deferring the decision to others, and reported no planning toward vaccination. Conclusions: Intention characteristics and planning processes could moderate the vaccine intention-behavior relationship, potentially serving as targets for future vaccine strategies.Item 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 MedicineHuman 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.