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Item Acceptability of HPV vaccine implementation among parents in India.(Taylor & Francis, 2014) Paul, Proma; Tanner, Amanda E.; Gravitt, Patti E.; Vijayaraghavan, K.; Shah, Keerti V.; Zimet, Gregory D.; Department of Medicine, IU School of MedicineDue to high cervical cancer rates and limited research on human papillomavirus (HPV) vaccine acceptability in India, the research team examined parental attitudes toward HPV vaccines. Thirty-six interviews with parents were conducted to assess sexually transmitted infection (STI)-related knowledge and HPV-specific vaccine awareness and acceptability. Despite limited knowledge, parents had positive views toward HPV vaccines. Common barriers included concerns about side effects, vaccine cost, and missing work to receive the vaccine. Parents were strongly influenced by health care providers' recommendations. Our findings suggest that addressing parental concerns, health worker training and polices, and efforts to minimize cost will be central to successful HPV vaccine implementation.Item Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists(Elsevier, 2022-04-20) Lake, Paige W.; Head, Katharine J.; Christy, Shannon M.; DeMaria, Andrea L.; Thompson, Erika L.; Vadaparampil, Susan T.; Zimet, Gregory D.; Kasting, Monica L.; Communication Studies, School of Liberal ArtsHuman papillomavirus (HPV) vaccination rates in the U.S. are relatively low. Provider recommendation rates for HPV vaccination often vary by patient age and relationship status. Obstetrician/gynecologists (OB/GYNs) represent a key provider group that can recommend the HPV vaccine. This study examined differences in OB/GYN recommendation of HPV vaccination for inpatient postpartum patients by age, parity, and marital status. Data were collected from OB/GYNs nationally via a cross-sectional survey. Participants were randomized to two vignette groups (23-year-old patient or 33-year-old patient). Within each group, participants received 4 vignettes that were identical except for patient marital status (married/not in a committed relationship) and number of children (first/third child), and were asked to indicate HPV vaccination recommendation likelihood on a scale of 0 (definitely would not) to 100 (definitely would). A 2 × 2 × 2 general linear model with repeated measures was used to examine main and interaction effects of patient age, relationship status, and parity. 207 OB/GYNs were included in the final analyses. Recommendation was high for 23-year-old patients (range: 64.5-84.6 out of 100). When marital status and parity were held constant, recommendation likelihood was higher for the younger vs. older patient and was also higher for patients not in a committed relationship, compared to married patients (all p-values < 0.001). Differences in recommendation exist when considering age and relationship status, which provides insight into OB/GYN clinical decision-making. Findings highlight the need to address barriers to HPV vaccination recommendation, including awareness of risk factors to consider when recommending the vaccine.Item Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province(Taylor & Francis, 2021) Lin, Yulan; Su, Zhitai; Chen, Fulian; Zhao, Qinjian; Zimet, Gregory D.; Alias, Haridah; He, Shuqiong; Hu, Zhijian; Wong, Li Ping; Pediatrics, School of MedicineLittle is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.Item Considerations for Child Cancer Survivors and Immunocompromised Children to Prevent Secondary HPV-associated Cancers(Wolters Kluwer, 2020-09) Imburgia, Teresa M.; Shew, Marcia L.; Gravitt, Patti E.; Katzenellenbogen, Rachel A.; Pediatrics, School of MedicineSurvivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary Human Papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives.Item Evaluation methods for vaccination campaigns on college campuses: A scoping review(Elsevier, 2022-12) Carr, Alexcia; Pittman , Eric; Imeri , Hyllore; Nasruddin , Saara; Sparkmon, Wesley; Head, Katharine J.; Vivo, Sarah; Barnard , Marie; Communication Studies, School of Liberal ArtsBackground Vaccinations are successful, cost-effective tools to prevent the spread of certain infectious diseases. Many colleges conduct vaccination campaigns on their campuses for various vaccine-preventable diseases, including measles, mumps, influenza, HPV, and most recently, for SARS-CoV-2, the virus responsible for COVID-19. Implementing these campaigns requires substantial effort and understanding their effectiveness is an important factor in justifying these programs. Aim This scoping review aims to identify, review, and summarize existing evaluation methods for vaccination campaigns on college campuses in order to provide evaluation guidance for institutions planning future vaccination campaigns. Methods Publications that focused on vaccination campaigns on college campuses for students and/or faculty and staff and described their evaluation methods were included in our analysis. A systematic search of the literature identified 2,101 articles. After duplicates were removed, titles and abstracts were screened, and references searched, 43 articles were identified for full-text review. Sixteen articles provided evaluation information and were systematically reviewed. Results Interventions targeted a variety of vaccine-preventable diseases, with the majority either aiming to increase HPV vaccine uptake or vaccinate against meningococcal serogroups. Most studies reported on campaigns that included both educational activities and provided vaccinations. Evaluation methods varied widely. Some studies measured vaccine-related knowledge and attitudes. Vaccine uptake was most commonly measured as a simple count of doses administered. Conclusions College campus vaccination campaigns are evaluated in multiple ways, with little consistency in how the effectiveness of campaigns are measured. There is a need to develop clear evaluation methods for college vaccination programs, especially how to calculate vaccination rates associated with these efforts.Item Human Papillomavirus Oral- and Sero- Positivity in Fanconi Anemia(MDPI, 2021-03-18) Sauter, Sharon L.; Zhang, Xue; Romick-Rosendale, Lindsey; Wells, Susanne I.; Myers, Kasiani C.; Brusadelli, Marion G.; Poff, Charles B.; Brown, Darron R.; Panicker, Gitika; Unger, Elizabeth R.; Mehta, Parinda A.; Bleesing, Jack; Davies, Stella M.; Butsch Kovacic, Melinda; Medicine, School of MedicineHigh-risk human papillomavirus (HPV) is prevalent and known to cause 5% of all cancers worldwide. The rare, cancer prone Fanconi anemia (FA) population is characterized by a predisposition to both head and neck squamous cell carcinomas and gynecological cancers, but the role of HPV in these cancers remains unclear. Prompted by a patient-family advocacy organization, oral HPV and HPV serological studies were simultaneously undertaken. Oral DNA samples from 201 individuals with FA, 303 unaffected family members, and 107 unrelated controls were tested for 37 HPV types. Serum samples from 115 individuals with FA and 55 unrelated controls were tested for antibodies against 9 HPV types. Oral HPV prevalence was higher for individuals with FA (20%) versus their parents (13%; p = 0.07), siblings (8%, p = 0.01), and unrelated controls (6%, p ≤ 0.001). A FA diagnosis increased HPV positivity 4.84-fold (95% CI: 1.96-11.93) in adjusted models compared to unrelated controls. Common risk factors associated with HPV in the general population did not predict oral positivity in FA, unlike unrelated controls. Seropositivity and anti-HPV titers did not significantly differ in FA versus unrelated controls regardless of HPV vaccination status. We conclude that individuals with FA are uniquely susceptible to oral HPV independent of conventional risk factors.Item 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 MedicineObjectives. 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.Item Human Papillomavirus Vaccines: Successes and Future Challenges(Springer, 2018-09) Perez, Samara; Zimet, Gregory D.; Tatar, Ovidiu; Stupiansky, Nathan W.; Fisher, William A.; Rosberger, Zeev; Pediatrics, School of MedicineOver a decade has passed since the first human papillomavirus (HPV) vaccine was introduced. These vaccines have received unequivocal backing from the scientific and medical communities, yet continue to be debated in the media and within the general public. The current review is an updated examination that the authors made five years ago on some of the key sociocultural and behavioral issues associated with HPV vaccine uptake and acceptability, given the changing HPV vaccine policies and beliefs worldwide. We explore current worldwide HPV vaccination rates, outline HPV vaccine policies, and revisit critical issues associated with HPV vaccine uptake including: risk compensation, perceptions of vaccine safety and efficacy, age of vaccination, and healthcare provider (HCP) recommendation and communication. While public scrutiny of the vaccine has not subsided, empirical evidence supporting its safety and efficacy beyond preventing cervical cancer has amassed. There are conclusive findings showing no link that vaccinated individuals engage in riskier sexual behaviors as a result of being immunized (risk compensation) both at the individual and at the policy level. Finally, HCP recommendation continues to be a central factor in HPV vaccine uptake. Studies have illuminated how HCP practices and communication enhance uptake and alleviate misperceptions about HPV vaccination. Strategies such as bundling vaccinations, allowing nurses to vaccinate via “standing orders,” and diversifying vaccination settings (e.g., pharmacies) may be effective steps to increase rates. The successes of HPV vaccination outweigh the controversy, but as the incidence of HPV-related cancers rises, it is imperative that future research on HPV vaccine acceptability continues to identify effective and targeted strategies to inform HPV vaccination programs and improve HPV coverage rates worldwide.Item Knowledge of Cervical Cancer and Acceptability of Prevention Strategies Among Human Papillomavirus-Vaccinated and Human Papillomavirus-Unvaccinated Adolescent Women in Eldoret, Kenya(Mary Ann Liebert, 2019-08-20) Mburu, Anisa; Itsura, Peter; Mabeya, Hillary; Kaaria, Alice; Brown, Daaron R.; Medicine, School of MedicineCervical cancer is a critical public health concern in sub-Saharan Africa. Adolescents are key targets in primary prevention strategies. Following a human papillomavirus (HPV) vaccination initiative (Gardasil) in Eldoret, Kenya, the knowledge and source of information of cervical cancer and acceptance of prevention strategies among vaccinated and unvaccinated adolescents were evaluated. A cross-sectional comparative study enrolled 60 vaccinated and 120 unvaccinated adolescent women. Institutional ethical approval was obtained and signed consent was obtained from the parents. Data collection was performed using interviewer-administered questionnaires derived from factual statements based on information from print material used for community sensitization on cervical cancer. The median age of the participants was 14.0 years (interquartile range [IQR] = 13.0-15.0). Of 60 vaccinated adolescents, 56 (93.3%) had heard of the HPV vaccine compared with 6 (5%) of unvaccinated participants (p < 0.001). Of 60 vaccinated participants, 58 (96.7%) had heard of cervical cancer compared with 61 (50.8%) unvaccinated participants (p < 0.001). Both cohorts identified the school as the main source of information for cervical cancer. The two groups also showed similarity in their selection of cervical cancer prevention strategies acceptable to them such as delaying sexual debut, limiting number of sexual partners, and use of condoms for protection against sexually transmitted infections. Of 120 unvaccinated participants, 63.7% expressed willingness to be vaccinated. Exposure to the HPV vaccine was associated with a higher knowledge of cervical cancer. The adolescents predominantly rely on the school for health information. Both cohorts of adolescents showed remarkable acceptability for cervical cancer prevention strategies.Item A natural language processing framework to analyse the opinions on HPV vaccination reflected in twitter over 10 years (2008 - 2017)(Taylor & Francis, 2019-07-16) Luo, Xiao; Zimet, Gregory; Shah, Setu; Computer Information and Graphics Technology, School of Engineering and TechnologyIn 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.