HPV Vaccine School Entry Requirement in Puerto Rico: Historical Context, Challenges, and Opportunities

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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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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Content Analysis of Digital Media Coverage of the Human Papillomavirus Vaccine School-Entry Requirement Policy in Puerto Rico

10.21203/rs.3.rs-67660/v1 ◽

2020 ◽

Author(s):

Vivian Colón-López ◽

Vilnery Rivera-Figueroa ◽

Glizette O Arroyo-Morales ◽

Diana T Medina-Laabes ◽

Roxana Soto-Abreu ◽

...

Keyword(s):

Puerto Rico ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Digital Media ◽

Hpv Vaccine ◽

Media Coverage ◽

News Coverage ◽

The United States ◽

School Entry ◽

Theory Approach

Abstract BackgroundIn August 2018, Puerto Rico (PR) became the 4th state or territory in the United States to adopt a human papillomavirus (HPV) vaccine school-entry requirement, for students 11-12 years old. Evidence suggests that the content of media coverage may impact people's perception of HPV vaccine and their willingness to vaccinate. This study aimed to analyze the content of digital news coverage related to the implementation of the policy in PR.MethodsA content review was conducted of digital media published from January 2017 through December 2018. The content reviewed was carried out in two steps: 1) creating a matrix to summarize each article’s content about the policy and 2) qualitative analysis using a grounded theory approach. ResultsThe search resulted in 34 articles in 17 online local and international news outlets that reported on the implementation of the policy. Analyses showed that 61% of the news articles did not mention the number of required doses, and 79% discussed the new policy concerning cancer prevention. In 2017, news coverage focused mostly on describing the policy, while 2018 coverage focused on controversies surrounding the implementation. Negative emergent codes included: 1) infringement to patient and parental autonomy; 2) Hesitancy from the political sector 3) Hesitancy from groups and coalitions. Positive content included: 1) knowledge and acceptance of HPV vaccine for cancer prevention; 2) importance of education and protective sexual behaviors; and 3) new vaccination law proposal. Neutral emergent codes included: 1) Description of the policy; 2) Information about HPV related cancers; and 3) General information about HPV vaccine.ConclusionsMost of the media coverage in PR was neutral and included limited information related to the vaccine, HPV, and HPV-related cancers. Neutral and negative themes could influence public concerns regarding the new policy, as well as HPV vaccination rates in PR.

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Arguments in favor of and against the HPV vaccine school-entry requirement in Puerto Rico: a content analysis of newspaper media

Cancer Causes & Control ◽

10.1007/s10552-021-01431-3 ◽

2021 ◽

Author(s):

Coralia Vázquez-Otero ◽

Dinorah Martinez Tyson ◽

Cheryl A. Vamos ◽

Nancy Romero-Daza ◽

Jason Beckstead ◽

...

Keyword(s):

Puerto Rico ◽

Content Analysis ◽

Hpv Vaccine ◽

School Entry

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Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

10.21203/rs.3.rs-409665/v1 ◽

2021 ◽

Author(s):

Vivian Colón-López ◽

Roxana Soto-Abreu ◽

Diana T. Medina-Laabes ◽

Olga L. Díaz-Miranda ◽

Ana P. Ortiz ◽

...

Keyword(s):

Puerto Rico ◽

Human Papillomavirus ◽

Implementation Research ◽

Hpv Vaccine ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Negative Influence ◽

Barriers And Facilitators ◽

School Entry ◽

Relative Advantage

Abstract Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.

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Content analysis of digital media coverage of the human papillomavirus vaccine school-entry requirement policy in Puerto Rico

BMC Public Health ◽

10.1186/s12889-021-11311-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Vivian Colón-López ◽

Vilnery Rivera-Figueroa ◽

Glizette O. Arroyo-Morales ◽

Diana T. Medina-Laabes ◽

Roxana Soto-Abreu ◽

...

Keyword(s):

Puerto Rico ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Digital Media ◽

Hpv Vaccine ◽

Media Coverage ◽

News Coverage ◽

The United States ◽

School Entry ◽

Theory Approach

Abstract Background In August 2018, Puerto Rico (PR) became the 4th state or territory in the United States to adopt a human papillomavirus (HPV) vaccine school-entry requirement, for students 11–12 years old. Evidence suggests that the content of media coverage may impact people’s perception of HPV vaccine and their willingness to vaccinate. This study aimed to analyze the content of digital news coverage related to the implementation of the policy in PR. Methods A content review was conducted of digital media published from January 2017 through December 2018. The content reviewed was carried out in two steps: 1) creating a matrix to summarize each article’s content about the policy and 2) qualitative analysis using a grounded theory approach. Results The search resulted in 34 articles obtained from 17 online local and international news outlets that reported the policy's implementation. Analyses showed that 61% of the news articles did not mention the number of required doses, and 79% discussed the new policy concerning cancer prevention. In 2017, news coverage focused mostly on describing the policy, while 2018 coverage focused on controversies surrounding the implementation. Neutral emergent codes included: 1) Description of the policy; 2) Information about HPV related cancers; and 3) General information about HPV vaccine. Negative emergent codes included: 1) infringement to patient and parental autonomy; 2) Hesitancy from the political sector, and 3) Hesitancy from groups and coalitions. Positive content included: 1) knowledge and acceptance of HPV vaccine for cancer prevention; 2) importance of education and protective sexual behaviors; and 3) new vaccination law proposal. Conclusions Most of the media coverage in PR was neutral and included limited information related to the vaccine, HPV, and HPV-related cancers. Neutral and negative themes could influence public concerns regarding the new policy, as well as HPV vaccination rates in PR.

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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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Adult Precision Medicine: Learning from the Past to Enhance the Future

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa145 ◽

2020 ◽

Author(s):

Ashley Ghiaseddin ◽

Lan B Hoang Minh ◽

Michalina Janiszewska ◽

David Shin ◽

Wolfgang Wick ◽

...

Keyword(s):

Brain Tumors ◽

Precision Medicine ◽

Historical Context ◽

Pediatric Brain Tumors ◽

Significant Heterogeneity ◽

Future Success ◽

Challenges And Opportunities ◽

Genomic Studies ◽

Patient Advocates ◽

Molecular Therapies

Abstract Despite therapeutic advances for other malignancies, gliomas remain challenging solid tumors to treat. Complete surgical resection is nearly impossible due to gliomas’ diffuse infiltrative nature, and treatment is hampered by restricted access to the tumors due to limited transport across the blood-brain barrier (BBB). Recent advances in genomic studies and next-generation sequencing techniques have led to a better understanding of gliomas and identification of potential aberrant signaling pathways. Targeting the specific genomic abnormalities via novel molecular therapies has opened a new avenue in the management of gliomas, with encouraging results in preclinical studies and early clinical trials. However, molecular characterization of gliomas revealed the significant heterogeneity, which poses a challenge for targeted therapeutic approaches. In this context, leading neuro-oncology researchers and clinicians, industry innovators, and patient advocates convened at the inaugural annual Remission Summit held in Orlando, FL in February 2019 to discuss the latest advances in immunotherapy and precision medicine approaches for the treatment of adult and pediatric brain tumors and outline the unanswered questions, challenges, and opportunities that lay ahead for advancing the duration and quality of life for patients with brain tumors. Here, we provide historical context for precision medicine in other cancers, present emerging approaches for gliomas, discuss their limitations, and outline the steps necessary for future success. We focus on the advances in small molecule targeted therapy, as the use of immunotherapy as an emerging precision medicine modality for glioma treatment has recently been reviewed by our colleagues

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Challenges and opportunities for culturally responsive leadership in schools: Evidence from Four European countries

Policy Futures in Education ◽

10.1177/14782103211040909 ◽

2021 ◽

pp. 147821032110409

Author(s):

Martin Brown ◽

Herbert Altrichter ◽

Igor Shiyan ◽

María José Rodríguez Conde ◽

Gerry McNamara ◽

...

Keyword(s):

Culturally Responsive ◽

School Leaders ◽

Historical Context ◽

Vital Role ◽

Migration Background ◽

European Countries ◽

Significant Extent ◽

Culturally Responsive Leadership ◽

Challenges And Opportunities ◽

Funded Project

Whether voluntary or enforced, increasing patterns of migration have significantly impacted schools by making them linguistically, culturally, religiously and ethnically more diverse than ever before. This increasing diversity requires school leaders to put in place mechanisms to ensure equity of participation for migration background students. Dimmock and Walker (2005) believe that school leaders need to play a vital role in promoting and sustaining an environment that embraces diversity and, by association, contributes to solving the macro problems of society. To accomplish this emerging role, there is a need for ‘new approaches to educational leadership in which leaders exhibit culturally responsive organisational practices, behaviours and competencies’ (Madhlangobe and Gordon, 2012: p. 177). This is all well and good in theory, but the current and historical context in which school leaders operate, together with the training and supports that are provided, influences, to a significant extent, how culturally responsive leadership can operate in practice. This study, which is part of a European Commission Erasmus+ funded project entitled Supporting Culturally Responsive Leadership and Evaluation in Schools (CReLES), examines these assumptions by mapping out the factors and actors that can hinder and facilitate the flourishing of such practices in four European countries, Austria, Ireland, Russia and Spain.

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