The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico’s HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews ( n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations’ leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza’s case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

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Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

10.21203/rs.3.rs-311697/v1 ◽

2021 ◽

Author(s):

Vivian Colón-López ◽

Diana T. Medina-Laabes ◽

Roxana Soto Abreu ◽

Olga L. Díaz Miranda ◽

Ana P. Ortiz ◽

...

Keyword(s):

Puerto Rico ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Healthcare Providers ◽

School Entry ◽

Human Papillomavirus Vaccine ◽

Structured Interviews ◽

Immunization Policy ◽

Staff Members ◽

The Government

Abstract Background: Human papillomavirus vaccine (HPV) is an important tool for prevention of HPV- related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least 1 dose of HPV vaccination in girls and boys aged 11 and 12 years taking effect in August 2018. Our study aims to examine parents’ views and opinions of the process of implementing the new HPV vaccination school entry policy in Puerto Rico, and understand barriers and facilitators related to this HPV immunization policy. Methods: Three focus group (n=12) and eight in-depth semi-structured interviews were performed, along with a survey. The interviews were recorded and transcript by our staff members. Through a thematic analysis were identified emergent themes. Results: Lack of information in relation to the policy were the theme most mentioned in the interviews. Moreover, participants expressed that previous negative experiences, from friends or family member, adverse effect and the lack of communication from school and healthcare providers deter them from the decision of vaccinated their kids. Barriers in the process of soliciting an exemption was discussed. Conclusion: Most barriers mentioned by participants who express hesitation about vaccinating their kids with the HPV vaccine, are modifiable providing parents information about the mandate’s implementation, and educational materials that address their concerns related to the vaccine’s side effects. Implementation of this efforts, however, need to consider impacting the school (teachers, principal directors, and administrative staff), the government and parents. This multilevel approach will help to improve the dissemination of information about HPV vaccination in order to clarify doubts and misinformation among hesitant parents.

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Impact of Louisiana’s HPV Vaccine Awareness Policy on HPV Vaccination Among 13- to 17-Year-Old Females

Health Education & Behavior ◽

10.1177/1090198116684766 ◽

2017 ◽

Vol 44 (4) ◽

pp. 548-558 ◽

Cited By ~ 3

Author(s):

Dudith Pierre-Victor ◽

Mary Jo Trepka ◽

Timothy F. Page ◽

Tan Li ◽

Dionne P. Stephens ◽

...

Keyword(s):

Hpv Vaccine ◽

Hpv Vaccination ◽

Female Adolescents ◽

Physician Recommendation ◽

Vaccination Rates ◽

National Immunization ◽

Before And After ◽

The Difference ◽

Vaccine Information ◽

The Impact

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana’s policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.

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Abstract PO-040: Understanding views against the HPV vaccine school-entry requirement in Puerto Rico

10.1158/1538-7755.disp21-po-040 ◽

2022 ◽

Author(s):

Gloriany Rivas ◽

Roxana Soto-Abreu ◽

Glizette O. Arroyo-Morales ◽

Diana T. Medina-Laabes ◽

Olga L. Díaz-Miranda ◽

...

Keyword(s):

Puerto Rico ◽

Hpv Vaccine ◽

School Entry

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The Ethical Case for Mandating HPV Vaccination

The Journal of Law Medicine & Ethics ◽

10.1177/1073110518782957 ◽

2018 ◽

Vol 46 (2) ◽

pp. 501-510 ◽

Cited By ~ 5

Author(s):

Michelle J. Bayefsky

Keyword(s):

Cervical Cancer ◽

Health Equity ◽

Hpv Vaccine ◽

Final Section ◽

Hpv Vaccination ◽

School Entry ◽

Best Interests ◽

Moral Imperative

When the HPV vaccine was released over a decade ago, there was intense opposition to mandating the vaccine, including among bioethics and legal scholars. Some of the original concerns are now obsolete, while other objections continue to present an obstacle to mandating the vaccine. This essay responds to earlier critiques of mandatory HPV vaccination and offers a series of arguments in support of a vaccine mandate. The first section briefly addresses initial concerns that are no longer relevant. The second section makes the ethical case for mandating HPV vaccination, based on three principles: 1) the best interests of children, 2) solidarity, and 3) health equity. The final section addresses concerns related to implementation of the vaccine, including the validity of linking vaccination to school entry. The essay concludes that we have a moral imperative to protect children from the leading cause of cervical cancer, and that mandating HPV vaccination is the best way to ensure that children of all backgrounds receive the vaccine before they have been exposed to the virus.

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The Role of the Media on Maternal Confidence in Provider HPV Recommendation

10.21203/rs.3.rs-34379/v3 ◽

2020 ◽

Author(s):

Kimberly Walker ◽

Heather Owens ◽

Gregory Zimet

Keyword(s):

Hpv Vaccine ◽

Hpv Vaccination ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Sexual Stigma ◽

Individual Interviews ◽

Vaccination Recommendation ◽

Protection Efficacy ◽

The Media

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.

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Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study

JMIR Nursing ◽

10.2196/19503 ◽

2020 ◽

Vol 3 (1) ◽

pp. e19503

Author(s):

Anne M Teitelman ◽

Emily F Gregory ◽

Joshua Jayasinghe ◽

Zara Wermers ◽

Ja H Koo ◽

...

Keyword(s):

Human Papillomavirus ◽

Technology Acceptance ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Behavioral Model ◽

The United States ◽

Mobile App ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Vaccination Rates

Background More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI –2.15 to 0.15). Conclusions mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.

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Understanding How Adolescents Think about the HPV Vaccine

Vaccines ◽

10.3390/vaccines8040693 ◽

2020 ◽

Vol 8 (4) ◽

pp. 693

Author(s):

Robyn A. Pennella ◽

Katherine A. Ayers ◽

Heather M. Brandt

Keyword(s):

Decision Making ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

The United States ◽

The Body ◽

Decision Making Process ◽

Vaccination Rates ◽

Qualitative Thematic Analysis ◽

Adolescent Attitudes

Despite educational efforts, Tennessee human papillomavirus (HPV) vaccination rates are 43%, among the lowest in the United States. This study examined how adolescents think about the HPV vaccine to identify patterns and misconceptions to enhance educational efforts. Adolescents (ages 11–12) (N = 168) responded to open-ended questions regarding their thinking about the HPV vaccine. Data were analyzed and interpreted using qualitative thematic analysis. Three domains of themes emerged from responses: (1) characteristics of HPV vaccination, (2) knowledge-related themes, and (3) beliefs-related themes. Prevention of HPV and cancer was the most referenced characteristic of HPV vaccination followed by HPV vaccine rates and HPV vaccine efficacy. Student inquiries were mostly centered on HPV vaccine composition, administration, duration and how the vaccine interacts with the body. Some responses indicated a desire for more information about HPV not specific to the HPV vaccine. Overall, adolescent attitudes were positive towards the HPV vaccine. This study highlights specific questions adolescents have about the vaccine that can be used to tailor future HPV educational efforts, empowering adolescents with the knowledge to be more active students in the decision-making process. In addition, the potential for adolescents to serve as community advocates for the vaccine should be considered for future interventions.

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Long-Term Implications of the Infomedic during the COVID-19 Pandemic to US Adolescents’ HPV Vaccination Rates: Maternal Engagement with Pro- and Anti-vaccine Social Media Posts and Overarching Vaccine Hesitancy (Preprint)

10.2196/preprints.24970 ◽

2020 ◽

Author(s):

Young Argyris ◽

Yongsuk Kim ◽

Won Song

Keyword(s):

Hpv Vaccine ◽

Negative Impact ◽

Hpv Vaccination ◽

Population Based ◽

Vaccine Hesitancy ◽

Healthcare Facilities ◽

Vaccination Rates ◽

Novel Coronavirus ◽

The Impact

BACKGROUND The propagation of vaccine misinformation during the COVID-19 pandemic suggests that the pandemic may pose long-term harm on public health via depressed immunization rates. Between February 2020 and April 2020, the uptake rates of the HPV vaccine have decreased by 73%. Missing the critical age for HPV vaccination (i.e., 11-12 years old) will make adolescents susceptible to HPV-associated cancers in the next 20-30 years. Despite the importance, very few pro-vaccine interventions conducted on SM have succeeded in increasing HPV vaccination rates. OBJECTIVE Our overall objective is to identify the reasons why anti-vaccine messages effectively lower HPV vaccination rates while pro-vaccine messages do not increase such rates. In so doing, we suggest that overarching vaccine hesitancy is a reason for the discrepant outcomes of anti- vs. pro-vaccine SM posts. Our objective is pursued in two specific aims: we compare anti- and pro-vaccine posts in terms of (i) their roles in fostering overarching vaccine hesitancy among mothers (the main HPV vaccine decision-makers), and (ii) accompanying HPV vaccination rates among their adolescent children. METHODS In late December of 2019-mid January of 2020, we conducted a population-based survey among 426 mothers of US adolescents aged 13–18. The outbreak of the novel coronavirus in China occurred in December 2019, and awareness regarding the virus was increasing in the US during this time. Therefore, our data collected during this time allow us to infer the impact of increasing overarching vaccine hesitancy on HPV vaccination rates, while excluding the effects of access restrictions to healthcare facilities imposed since March of 2020. We developed a rigorous scale for engagement with anti- and pro-vaccine SM posts, measured adolescents’ HPV vaccination rates along the series initiation to completion, and conducted path analyses to assess the associations among them. RESULTS Our survey results show that mothers’ engagement with anti-vaccine content is negatively associated with their children’s HPV vaccine vaccination rates via their increased overarching vaccine hesitancy. In contrast, maternal engagement with pro-vaccine SM content is not associated with either overarching vaccine hesitancy or HPV vaccine vaccination rates. These results remained significant after controlling for socioeconomic, demographic, and accessibility factors, suggesting that mothers’ engagement with anti-vaccine messages on SM explains above and beyond what other known factors explain. CONCLUSIONS Our results suggest that increasing overarching vaccine hesitancy, heightened by the infodemic, can substantially reduce HPV vaccination rates, even after accessibility factors are controlled. Our results imply that the negative impact of the COVID-19 pandemic can be extended for many years to come through depressed HPV vaccination rates. As a result, there is an urgent need to develop interventions to increase HPV vaccination rates and to address vaccine hesitancy among mothers who feel emotionally challenged during the pandemic. CLINICALTRIAL N/A

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38. Strategies to Improve HPV Vaccination Rates Among Eligible Undergraduates and Graduate Students at Johns Hopkins University

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.083 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S43-S43

Author(s):

John P Gentile ◽

Roanna Kessler ◽

Paul Auwaerter ◽

Paul Auwaerter

Keyword(s):

Hpv Vaccine ◽

Hpv Vaccination ◽

Control Period ◽

College Campuses ◽

Male Students ◽

Vaccination Rates ◽

Johns Hopkins University ◽

Marketing Materials ◽

The Difference ◽

Research Grant

Abstract Background Completed Poster Presentation Methods Results Study period (8/15/2018 – 5/31/2019) was compared to prior year as a historical control (8/15/2017 – 5/31/2018). During the study, 888 HPV vaccines were administered vs. 504 in the control period (76.1 % increase). The difference between # of vaccines given during these 2 years was statistically significant at p< 0.01. The increase was particularly notable among male students: 383 vaccinations vs. 120 (219.2% increase). About half of the students who completed the EMR form saw the marketing materials on campus: 1,579 out of 3,228 responses. Of the marketing materials, the greatest number of students noticed the yard signs (596). The most frequently cited reason that providers did not give the HPV vaccine during their visit was that the patient already completed the HPV vaccine series (1,603). Conclusion A well-coordinated campaign with extensive awareness efforts and focused clinical interventions can dramatically impact the number of HPV vaccinations on college campuses. Disclosures Paul Auwaerter, Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant)

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Kansan Guardian Perceptions of HPV and the HPV Vaccine and the Role of Social Media

Kansas Journal of Medicine ◽

10.17161/kjm.v13i1.13397 ◽

2020 ◽

Vol 13 (1) ◽

pp. 9-18 ◽

Cited By ~ 1

Author(s):

Monique Luisi

Keyword(s):

Social Media ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Online Survey ◽

Hpv Vaccination ◽

Vaccine Safety ◽

Vaccination Rates ◽

Media Messages ◽

Influence Perceptions

Introduction. Human papillomavirus (HPV) vaccination rates in Kansas historically have been low among children and adolescents. How Kansas parents and guardians perceive the HPV vaccine may influence vaccination rates among Kansas youth. Social media messages also may influence perceptions, suggesting implications for current and future disease and cancer burden. Methods. Eligible Kansas guardians of children aged 9 - 17 years completed an online survey. The survey assessed their perceptions about a) HPV and the HPV vaccine, b) HPV and HPV vaccine representation on social media, and c) the effects that social media has on their perceptions about HPV and the HPV vaccine. Results. Most Kansas guardians (n = 55, 57.9%) indicated seeing information about HPV and the HPV vaccine on social media. Kansas guardians who had reported seeing information on social media about the HPV vaccine were significantly more likely to perceive that the HPV vaccine could kill their child than those who had not seen information (t(79) = 0.019). Additionally, children of wealthier Kansan guardians were vaccinated more than children of less wealthy guardians. Conclusion. Social media messages may be influencing Kansan guardians to think the HPV vaccine is lethal in their children. Future campaigns increasingly should be focused on HPV vaccine safety and effectiveness.

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