Human Papillomavirus Infection and Vaccination Policies in the American South

In the United States, the South has a disproportionate burden of cervical cancer, yet research reporting regional prevalence of human papillomavirus (HPV) infection is scarce. Since 2008, Virginia has passed a HPV vaccine mandate and Louisiana a HPV education bill. This dissertation estimated the prevalence of HPV infection among females and assessed the impact of Virginia’s and Louisiana’s HPV vaccination policy on vaccination among adolescent females. The first manuscript estimated the prevalence of HPV infection using data from 4,250 females collected during the 2007–2010 National Health and Nutrition Examination Survey. Among 14–26 year-olds, the prevalence of high-risk oncogenic HPV was 25.6% (95% CI: 22.4 ̶ 33.3) in the South and 29.1% (95% CI: 24.8 ̶ 33.8) in the rest of the country (p= 0.15). Among 27–59 year-olds, infection rates were 20.9% (95% CI: 17.4 ̶ 24.9) for the South and 14.5% (95% CI: 12.9 ̶ 16.3) for the rest of the country (p=0.0001). The second manuscript assessed the impact of Virginia’s HPV vaccine mandate on vaccination using National Immunization Survey-Teen 2008-2012 data (n=3,203). A difference-in-differences estimation and logistic regression analysis were performed with South Carolina and Tennessee serving as comparison states. Virginia’s mandate was not associated with an increase in vaccination rates. Physician recommendation was strongly associated with vaccination in the Virginia-South Carolina (aOR=10.3; p=0.0001) and Virginia-Tennessee analyses (aOR=9.33; 95%CI: 6.11 ̶ 14.3). The third manuscript assessed the impact of Louisiana’s HPV education policy on vaccination using difference-in-differences estimation and logistic regression analysis, with Alabama and Mississippi as comparison states (n=2,327). There was no evidence that the policy increased vaccination rates. Physician recommendation was associated with vaccination in the Louisiana-Alabama (aOR=7.74; 95% CI: 5.22 ̶ 11.5) and Louisiana-Mississippi comparison (aOR=7.05; 95% CI: 4.6 ̶ 10.5). This study found a higher prevalence of HPV infection among females aged 27 ̶ 59 years in the South compared to the rest of the country. Additionally, physician recommendation was strongly associated with vaccination despite HPV policy implementation. These findings highlight the importance of physician recommendation for HPV vaccination and the need for recommended cervical cancer screening, particularly in the South

Role of Healthcare Providers� Recommendation Style in HPV Vaccine Decision-Making among Haitian Parents and Female Patients

Background and Purpose: The strong influence of physician recommendation on vaccine uptake is well established in the literature. However, its influence on HPV vaccine decision-making among young Haitian women is understudied. This study investigated the role of healthcare providers� recommendation style in Haitian parents� and female patients� HPV vaccine decision-making. Methods: Thirty selfidentified Haitian women aged 17-26 years were recruited from a large university campus in the Southeastern United States (N=30). They completed in-depth face-to-face interviews regarding their HPV vaccine decision-making process. Transcripts were analyzed using thematic analysis. Results: Provider recommendation was cited as a major factor that influenced HPV vaccine uptake. Additionally, the framing of the HPV vaccine message greatly influenced vaccine decisions. Messages that framed the vaccine as a preventive measure for cervical cancer or as a preventive vaccine without an emphasis on the sexual transmission route of the virus were most effective. Messages that framed the vaccine as a preventive measure against a sexually transmitted infection did not positively influence young women to be vaccinated. Conclusions: These findings indicate that providers� recommendation style highly affects HPV vaccine decision. Thus, appropriate HPV vaccine framing is important for encouraging vaccine uptake in this ethnic group

Human Papillomavirus Infections in the Southern and Other United States Regions

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and has been linked to several cancers, including cervical cancer. In the United States, the Southern region has a disproportionate burden of cervical cancer, and research about the epidemiology of HPV in the region is scarce. This study estimates the prevalence and correlates of HPV infection among 14–59 year-old females. Data from 4,250 females aged 14–59 years collected during the 2007–2010 National Health and Nutrition Examination Survey (NHANES) were used. We estimated the prevalence of HPV infection for the South and the rest of the country. We performed weighted chi-square test and logistic regression to examine the association between HPV infection and various demographics. Among 14–26 year-old females, the prevalence of high-risk oncogenic HPV types was 25.6% (95% confidence (CI): 22.4 ̶ 33.3) in the South and 29.1% (95% CI: 24.8 ̶ 33.8) in the rest of the country (p= 0.15). Among 27–59 year-old women, infection from high-risk oncogenic types was 20.9% (95% CI: 17.4 ̶ 24.9) in the South compared to 14.5% (95% CI: 12.9 ̶ 16.3) in the rest of the country (p=0.0001). This study found a higher prevalence of infection from high-risk oncogenic types among 27 ̶ 59 year-old females in the South compared to the rest of the country, but not among the 14 ̶ 26 year-olds. These findings highlight the importance of promoting HPV vaccination as well as cervical cancer screening, particularly in the Southern region

Role of Healthcare Providers\u27 Recommendation Style in HPV Vaccine-Decision-Making among Haitian Parents and Female Patients

Background and Purpose: The strong influence of physician recommendation on vaccine uptake is well established in the literature. However, its influence on HPV vaccine decision-making among young Haitian women is understudied. This study investigated the role of healthcare providers’ recommendation style in Haitian parents’ and female patients’ HPV vaccine decision-making. Methods: Thirty selfidentified Haitian women aged 17-26 years were recruited from a large university campus in the Southeastern United States (N=30). They completed in-depth face-to-face interviews regarding their HPV vaccine decision-making process. Transcripts were analyzed using thematic analysis. Results: Provider recommendation was cited as a major factor that influenced HPV vaccine uptake. Additionally, the framing of the HPV vaccine message greatly influenced vaccine decisions. Messages that framed the vaccine as a preventive measure for cervical cancer or as a preventive vaccine without an emphasis on the sexual transmission route of the virus were most effective. Messages that framed the vaccine as a preventive measure against a sexually transmitted infection did not positively influence young women to be vaccinated. Conclusions: These findings indicate that providers’ recommendation style highly affects HPV vaccine decision. Thus, appropriate HPV vaccine framing is important for encouraging vaccine uptake in this ethnic group

Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake

Objective: Parents play an integral role in young adults’ sexual health including human papillomavirus (HPV) vaccine decision-making. The objective of this study was to explore conversations regarding sexual activity in Haitian households and the influence of such conversations on young Haitian women\u27s HPV vaccine discussion with their parents. Methods: From a large university in the southeastern United States, 30 Haitian-American college women (ages 17–26) were recruited for semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. Interview transcripts were analyzed using thematic analysis. Results: Most participants stated that they either did not have conversations regarding sexual activity or the conversations that they had were described as ‘uncomfortable’ or ‘awkward’. Many participants stated that once parents knew that HPV is sexually transmitted, their discussions about the vaccine would be considered an announcement of their sexual debut or sexual activity. Hence, many decided to not discuss the HPV vaccine with their parents. Conclusion: Findings have important implications for HPV vaccine uptake. Results showed that a lack of conversations about sexual activity within Haitian households led to limited discussions about the HPV vaccine among young Haitian-American college women and their parents. Future HPV vaccine uptake efforts should integrate familial and cultural beliefs about female sexuality, while focusing on cervical cancer prevention