Intersection of HPV and sexual assault: An opportunity for practice change

Thesis advisor: Ann W. BurgessBackground: There is an opportunity for nurses to integrate HPV education and prevention strategies into the routine care for adolescent and young adult sexual assault patients. Study design: An exploratory, cross-sectional, electronic mail survey was conducted to explore forensic nurses' knowledge, beliefs, and attitudes about HPV, the HPV vaccine, and HPV preventative strategies, as well as identify facilitators and barriers that may influence nurses' level of support regarding incorporating HPV preventative strategies into their care. Eligibility criteria for inclusion were: nurse members of the International Association of Forensic Nurses (IAFN) and stakeholders in the care of sexual assault patients. Results: 541 nurses completed the survey; 98% (n= 508) were supportive of at least providing written educational information regarding HPV and the HPV vaccine during post sexual assault care, 86% (n= 446) were supportive of providing written information plus making changes to the written discharge instructions to incorporate HPV vaccination recommendations, and 53% (n= 273) were supportive of providing written information, making changes to the discharge instructions, and initiation of HPV vaccination at point of care. The strongest predictor of level of support was having positive perceived benefits of HPV and vaccination. A one standard deviation increase in perceived benefit was associated with a 50% increased odds of having the highest level of support (support for vaccination initiation) (OR=1.5, CI= 1.1-1.9). Conclusions: Forensic nurses provide care for many adolescents and young adults who are at risk for acquiring HPV and are within the age range for HPV vaccination. There is an opportunity to update current practice guidelines and recommendations. Nurses in this national sample demonstrated a high level of HPV knowledge, as well as positive attitudes and beliefs. The nurses were overwhelmingly supportive of integrating HPV prevention strategies into their care.Thesis (PhD) — Boston College, 2012.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing

Global Delivery of Human Papillomavirus Vaccines

Worldwide, cervical cancer is the fourth most common cancer among women, with over half a million women diagnosed with cervical cancer in 2012. Human papillomavirus (HPV) vaccination, if broadly implemented, has the potential to significantly reduce global rates of morbidity and mortality associated with cervical and other HPV-related cancers. Over 100 countries around the world have licensed HPV vaccines. As of February, 2015, there were an estimated 80 national HPV immunization programs and 37 pilot programs, including many implemented in low- and middle-income countries. In this article, global implementation of HPV vaccination programs is discussed, including successes and ongoing challenges. Issues such as vaccine financing and different approaches to HPV vaccine delivery are presented

Perspectives and preferences for a mobile health tool designed to facilitate HPV vaccination among young men who have sex with men

We sought to understand young men who have sex with men (YMSM) perspectives and preferred features for a mobile health (mHealth) tool designed to facilitate human papillomavirus (HPV) vaccination. YMSM were recruited on a popular social/sexual networking app to participate in online focus groups. Discussions were designed to elicit what the men would want in a mHealth tool specific for sexual health and HPV. Demographic data were analyzed using descriptive statistics and focus group data were analyzed using conventional content analysis. Forty-eight YMSM participated. Mean age was 23.4 years, and 70.0% reported their race as Black. Qualitative themes included general HPV knowledge and awareness, current patterns in technology use, desired app qualities, and desired app content. Youth described varying levels of HPV knowledge, utilized apps to engage socially, and for travel, banking, gaming, news and entertainment, and few used apps to facilitate personal health or engage with healthcare systems. Participants desired credible, relatable, secure, and easy to use interfaces that provided sexual health and HPV information in a positive context. They described ways to creatively engage and directly connect youth to health providers. We identified a culturally relevant youth driven approach to facilitate HPV vaccination and sexual health among YMSM

Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii

Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18–50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination

Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role?

Background: COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents’ intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions. Method: We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (<age 5 years) and confidence in vaccine decision making (decision self-efficacy). A multivariable multinomial logistic regression model was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of parental intention (categorized as intend to vaccinate, unsure, or do not intend to vaccinate). Results: Of the 591 parents in this sample, 49% indicated that they intended to vaccinate their child(ren), 29% reported that they would not, and 21% were undecided. In bivariate analyses, race/ethnicity, health insurance, flu vaccination in the past 12 months, and parental COVID-19 vaccination status were significantly related to parental intention to vaccinate their child(ren). In the multivariable analyses, which controlled for these factors, parents who intended to vaccinate their child(ren) had greater confidence in their ability to make informed decisions about COVID-19 vaccinations compared to those who were unsure about vaccination. Each one standard deviation in the Decision Self-Efficacy score was associated with a 39% increase in intention to vaccinate one’s child versus being unsure about vaccination (AOR 1.39, 95% CI 1.09, 1.77). Conclusions: Parents who are unsure about vaccinating their children against COVID-19 may benefit from interventions designed to increase their ability to obtain, understand, and utilize information to make informed decisions

The Impact of Advertisement Messaging on Enrollment of Young Men Who Have Sex With Men for Web-Based Research: Observational Study

Background: Recruiting young men who have sex with men (YMSM) in community settings is difficult. The use of Web-based social networks and dating apps for recruitment can be successful approaches, although little work has been done on the impact of study advertisement content on recruitment. Objective: The aim of this study was to evaluate the effects of advertisement message content on the recruitment of YMSM (aged 18-26 years) for a Web-based focus group study, examining perspectives and preferences for a mobile app that was designed to support sexual health among YMSM. Methods: Between March and April 2017, a recruitment campaign to promote human papillomavirus vaccination was launched on a popular social networking and dating app for YMSM, with 3 different text-based advertisement themes (technology, cancer prevention, and sexual innuendo). The campaign recruited YMSM across 3 states (Massachusetts, New York, and Pennsylvania). We examined the click-through rates, conversion rates, and enrollment rates of each of the advertisements and examined differences in views and clicks by age, state, and time of day. Results: The sexual innuendo advertisement had the highest click rates when compared with both the technology (click rate ratio [CRR] 2.06, 95% CI 1.74-2.45) and cancer prevention (CRR 1.62, 95% CI 1.38-1.90) advertisements. The sexual innuendo advertisement also had higher study enrollment rates compared with the technology (CRR 1.90, 95% CI 1.23-2.83) and cancer prevention (CRR 2.06, 95% CI 1.37-3.13) advertisements. No differences were observed in clicks or enrollment by age, state, or time of day. Conclusions: Our marketing campaign, targeting YMSM, was effective in recruiting participants for a qualitative study, using Web-based focus groups. The sexual innuendo advertisement was the most effective and cost-efficient advertisement of the 3 approaches trialed. Different populations need different targeted strategies for study recruitment. Researchers should work with key representatives to develop and test culturally relevant messaging and approaches that utilize current and popular technologies

Impact of the COVID-19 pandemic on social media utilization, influences related to parental vaccine decision making, and opinions on trustworthy social media vaccination campaigns: A qualitative analysis

There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents’ perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic’s impact on parent’s (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.</p

Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study

Background: Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective: This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods: The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results: A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions: We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices

School-entry requirements for HPV vaccination: part of the patchwork for HPV-related cancer prevention

Human 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

HPV vaccine recommendations by age: A survey of providers in federally qualified health centers

Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9–10, 11–12, 13–18, 19–26, and 27–45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9–10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30–39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9–10, 94% for ages 11–12, 96% for ages 13–18, 82% for age 19–26, and 26% for ages 27–45 y. Compared to Women’s Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9–10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9–10. Additional research is needed to improve recommendations in younger age groups