Legislative activity related to the human papillomavirus (HPV) vaccine in the United States (2006–2015): a need for evidence-based policy

Abstract Background Since human papillomavirus (HPV) vaccine introduction in the United States in 2006, cervical pre-cancer incidence has declined in young women, but pre-cancer trends have not been reported by race/ethnicity. We evaluated trends in cervical pre-cancers from 2008 to 2016 in non-Hispanic (NH) white, NH black, NH Asian, and Hispanic women identified through active population-based surveillance in the 5-site Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT). Methods We analyzed data on cervical intraepithelial neoplasia (CIN) grades 2–3 and adenocarcinoma in situ (CIN2+) cases aged 20–39 years. Annual CIN2+ rates per 100,000 women were calculated stratified by race/ethnicity in 5-year age groups, using multiple imputation to account for 10% missing race/ethnicity data. Rates were also calculated using estimated numbers screened for cervical cancer to control for known declines in screening. Trends, evaluated using JoinPoint software, are presented as average annual percentage changes (AAPC) with 95% confidence intervals (CI). Results A total of 18,222 CIN2+ cases (62% NH white, 16% NH black, 16% Hispanic, 6% Asian) were reported from 2008 to 2016. CIN2+ rates among 20–24 year-olds declined significantly in all groups: NH white, AAPC: −14.2 (95% CI: −16.3, −12.1); NH black, AAPC: −15.5 (−19.5, −11.4); Asian, AAPC: −14.8 (−20.5, −8.8); Hispanic, AAPC: −14.3 (−17.9, −10.5). In 25–29 year olds, a significant decline was observed for NH whites only (AAPC: −2.4, [−4.0, −0.8]). No declines were seen in 30–34 or 35–39 year olds. Among screened 20–24 year-olds, significant but smaller declines were observed (AAPC: −9.8 to −8.4); no declines were observed in screened 25–29 year olds or older groups. Conclusion In this evaluation of CIN2+ trends by race/ethnicity during the HPV vaccine era, the significant declines in 20–24 year olds across all groups, including among screened women, is consistent with equitable vaccine impact on CIN2+. Disclosures All Authors: No reported Disclosures.

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Defending scientific integrity in conservation policy processes: lessons from Canada, Australia, and the United States

10.7287/peerj.preprints.2946v1 ◽

2017 ◽

Author(s):

Carlos Carroll ◽

Brett Hartl ◽

Gretchen T Goldman ◽

Daniel J Rohlf ◽

Adrain Treves ◽

...

Keyword(s):

United States ◽

At Risk ◽

Conflicts Of Interest ◽

Scientific Information ◽

The United States ◽

Conservation Policy ◽

Scientific Integrity ◽

Evidence Based ◽

Scientific Societies ◽

Evidence Based Policy

Government agencies faced with politically controversial decisions often discount or ignore scientific information, whether from agency staff or non-governmental scientists. Recent developments in scientific integrity (the ability to perform, use, communicate and publish science free from censorship or political interference) in Canada, Australia and the United States demonstrate a similar trajectory: a perceived increase in scientific integrity abuses is followed by concerted pressure by the scientific community, leading to efforts to improve scientific integrity protections under a new administration. However, protections are often inconsistently applied, and are at risk of reversal under administrations that are publicly hostile to evidence-based policy. We compare recent challenges to scientific integrity to determine what aspects of scientific input into conservation policy are most at risk of political distortion and what can be done to strengthen safeguards against such abuses. To ensure the integrity of outbound communication from government scientists to public, we suggest that governments strengthen scientific integrity policies, include scientists’ right to speak freely in collective bargaining agreements, guarantee public access to scientific information, and strengthen agency culture supporting scientific integrity. To ensure the transparency and integrity with which information from non-governmental scientists (e.g., submitted comments or formal policy reviews) informs the policy process, we suggest that governments broaden the scope of independent reviews, ensure greater diversity of expert input with transparency regarding conflicts of interest, require substantive response to input from agencies, and engage proactively with scientific societies. For their part, scientists and scientific societies have a civic responsibility to engage with the wider public to affirm that science is a crucial resource for developing evidence-based policy and regulations that are in the public interest.

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