Associations of trust and healthcare provider advice with HPV vaccine acceptance among African American parents

OBJECTIVE: Healthcare providers (HCPs) are advised to give all parents a strong recommendation for HPV vaccination. However, it is possible that strong recommendations could be less effective at promoting vaccination among African Americans who on average have greater mistrust in the healthcare system. This study examines the associations of parental trust in HCPs and strength of HCP vaccination recommendation on HPV vaccine acceptance among African American parents. METHODS: Participants were recruited from an urban, academic medical center between July 2012 and July 2014. We surveyed 400 African American parents of children ages 10-12years who were offered HPV vaccine by their HCPs to assess sociodemographic factors, vaccine beliefs, trust in HCPs, and the HPV vaccine recommendation received. Medical records were reviewed to determine vaccination receipt. RESULTS: In multivariable analysis, children whose parents were "very strongly" recommended the HPV vaccine had over four times higher odds of vaccine receipt compared with those whose parents were "not very strongly" recommended the vaccine. Having a parent with "a lot of" versus "none" or only "some" trust in HCPs was associated with over twice the odds of receiving HPV vaccine. Very strong HCP recommendations were associated with higher odds of vaccination among all subgroups, including those with more negative baseline attitudes toward HPV vaccine and those with lower levels of trust. Adding the variables strength of HCP recommendation and parental trust in HCPs to a multivariable model already adjusted for sociodemographic factors and parental vaccine beliefs improved the pseudo R2 from 0.52 to 0.55. CONCLUSIONS: Among participants, receiving a strong vaccine recommendation and having a higher level of trust in HCPs were associated with higher odds of HPV vaccination, but did not add much to the predictive value of a model that already adjusted for baseline personal beliefs and sociodemographic factors

Adolescent Self-Consent for Biomedical HIV Prevention Research: Implications for Institutional Review Board Approval and Implementation

Purpose The Adolescent Medicine Trials Network Protocol 113 (ATN113) is an open-label, multisite demonstration project and Phase II safety study of human immunodeficiency virus (HIV) preexposure prophylaxis with 15- to 17-year-old young men who have sex with men that requires adolescent consent for participation. The purpose of this study was to examine factors related to the process by which Institutional Review Boards (IRBs) and researchers made decisions regarding whether to approve and implement ATN113 so as to inform future biomedical HIV prevention research with high-risk adolescent populations. Methods Participants included 17 researchers at 13 sites in 12 states considering ATN113 implementation. Qualitative descriptive methods were used. Data sources included interviews and documents generated during the initiation process. Results A common process for initiating ATN113 emerged, and informants described how they identified and addressed practical, ethical, and legal challenges that arose. Informants described the process as responding to the protocol, preparing for IRB submission, abstaining from or proceeding with submission, responding to IRB concerns, and reacting to the outcomes. A complex array of factors impacting approval and implementation were identified, and ATN113 was ultimately implemented in seven of 13 sites. Informants also reflected on lessons learned that may help inform future biomedical HIV prevention research with high-risk adolescent populations. Conclusions The results illustrate factors for consideration in determining whether to implement such trials, demonstrate that such protocols have the potential to be approved, and highlight a need for clearer standards regarding biomedical HIV prevention research with high-risk adolescent populations

Minors' and Young Adults' Experiences of the Research Consent Process in a Phase II Safety Study of Pre-exposure Prophylaxis for HIV

PURPOSE: There is a persistent HIV epidemic among sexual and gender minority adolescents in the U.S. Oral pre-exposure prophylaxis (PrEP) is an efficacious prevention strategy, but not yet approved for minors. Minors' access to biomedical HIV prevention technologies is impeded by the ethical and legal complexities of consent to research participation. We explore autonomous consent and study experiences among minor and adult participants in Project PrEPare, a Phase II safety study of PrEP for HIV prevention. METHODS: Data for this mixed-methods descriptive study were collected via self-administered web-survey and in-depth telephone interviews in early 2016. Eligible participants were previously enrolled in Project PrEPare. We attempted to contact 191 participants; 74 were reached and expressed interest in participating and 58 enrolled. RESULTS: Participants nearly universally felt well informed, understood the study, and freely volunteered with the clear understanding they could withdraw any time. All felt supported by study staff, but a small minority wished for more support during enrollment. Minors were more likely than adults to indicate a wish for more support in decision-making, and adults expressed higher satisfaction with their decision compared to minors. There was no association between elements of consent and Project PrEPare study outcomes. CONCLUSIONS: Participants had an overwhelmingly positive experience in a Phase II safety study of PrEP for HIV prevention. Some minors wished for more support during the decision-making process, but none consulted their parents about the decision. Our results support the inclusion of decisional supports in consent processes for adolescents, while also protecting their privacy

Vaginal microbicide preferences among midwestern urban adolescent women

Abstract: Purpose The purpose of this study was to assess adolescent women's preferences for specific microbicide characteristics including pregnancy prevention, timing of application, potential for side effects, and whether it targeted human immunodeficiency virus (HIV) or other sexually transmitted infections (STI). Potential differences in microbicide preferences by adolescent age group and behavioral patterns including engaging in sexual intercourse and use of hormonal contraception were examined, as it was hypothesized that as adolescents progress into adulthood and gain sexual experience their preferences in microbicide characteristics may shift. Method Adolescent and young women (N = 405, 56.0% African American; 24.0% Euro-American) between the ages of 14 and 20 (mean = 17.0, SD = 1.8) were recruited from urban communitybased clinics. Video-Audio Computer-Assisted Self-Interviews were conducted with the young women, during which they were asked about their preferences regarding the characteristics of hypothetical vaginal microbicides. Conjoint analysis was utilized to determine adolescent women's relative preferences for each microbicide characteristic and intent-to-purchase microbicides based upon a combination of the selected properties. Results Overall, the results suggest adolescent and young women had an ordered preference for a microbicide with (1) no side effects, (2) pregnancy prevention, (3) postcoital application, and (4) protection against HIV. Age and behavioral group conjoint analyses resulted in the same pattern of preferences as those reported for the entire group. However, women having sex and not using hormonal contraception had a stronger preference for postcoital application. Conclusion The findings suggest that young women's ratings of microbicides were sensitive to characteristics such as side effects, pregnancy prevention, and timing of application and should be considered in microbicide development. The conjoint analysis approach is useful in understanding microbicide preferences, and should be utilized with other populations to assess preferences for specific microbicide characteristics. microbicides | adolescent women | sexuality | conjoint analysis | adolescent health | Keywords: sexual health Article: The search for a woman-initiated prevention method has led to focus on topical microbicides for sexually transmitted infection (STI)/ human immunodeficiency virus (HIV) prevention. Microbicides are substances that may substantially reduce transmission of STI when applied in the vagina or rectum [1]. Some microbicides may also prevent pregnancy, although not all microbicides will be contraceptive [2]. Microbicides are not currently commercially available; products are in various phases of clinical trials [1]. Most microbicides under development are coitus dependent, requiring women to recognize and prepare for sexual situations and be willing to use a product that requires some comfort with touching their genitals [3]. The process of inserting a microbicide into the vagina may be challenging, as the dialogue around young women's sexuality and their bodies is often lacking [4]. Acceptability research, therefore, remains crucial to anticipate and prospectively address the kinds of obstacles previously associated with other female-initiated products, such as the female condom [5] and [6]. For instance, although women enjoyed having more control in using the female condom, they often did not like the size and discomfort associated with use or the inability to use it covertly [6]. Extant microbicide acceptability research with young women has suggested that contraceptive and disease prevention properties, timing of use, and associated side effects are important characteristics [7]. The findings suggest that young women generally prefer both pregnancy and disease prevention in a single product and insertion with an applicator up to 8 hours in advance [8]. In addition, there is a preference for lubricating products [9] and [10] with low amounts of messiness [9] and leakage [8]. Previous research also indicated that relevant potential side effects may impact microbicide use, including yeast infections, vaginal itching, and allergic reactions [7] and [11]. Furthermore, access was an important gauge of acceptability in a group of adolescent women. Women indicated that microbicides should be promoted through "adolescentspecific and girl-specific venues," including women's magazines [7]. There was also a reported desire for microbicides that would be small enough to carry in their pocket, bra, or within cell phone or palm pilot cases, and should be distributed through schools and sexuality education classes [7]. Most young women preferred over-the-counter availability of microbicides, yet stated they would be embarrassed if purchasing the product in the presence of others [7] and [8]. Thus far, microbicide acceptability research with adolescents has been conducted primarily with older adolescents, using individual interview and focus group methodologies [7] [16]. These qualitative methodologies allow for an in-depth assessment of individual as well as relational and age-related issues that may influence microbicide use [13] and [17]. However, social desirability is often a concern when studying stigmatized or socially sensitive issues associated with sexuality [18] and [19]. Past research has shown that using a video-audio computer-assisted self-interview (VACASI) format (participants privately responding to questions on a computer) for presenting survey questions alleviates the tendency for individuals to present themselves positively and answer questions in a socially desirable fashion [20]. In addition, women and adolescents report sensitive behaviors more frequently when questions are asked using computer interviewing techniques than when participating in a face-to-face interview [20], [21] and [22]. Existing microbicide acceptability research with adolescents also often lacks detailed attention to the multiple dimensions that must be considered simultaneously in a decision to try a product such as a microbicide. The addition of quantitative biopsychosocial studies addressing these issues thus complements the existing qualitative microbicide acceptability research [8], [23] and [24]. The purpose of this study was to quantitatively assess, using full-profile ratings based conjoint analysis, preferences for specific microbicide characteristics among a young, urban population of women. Building on the existing literature we chose to assess young women's preferences for pregnancy and STI (including HIV) prevention as well as timing of application and side effect potential. It was hypothesized that as women progress through the adolescent years, their relative preferences for specific microbicide characteristics may change as a function of their age and sexual experience. Methods Study participants Participants were 405 adolescent and young women between the ages of 14 and 20 (mean = 17, SD = 1.8) recruited from community-based urban health clinics in the Midwestern United States in an area with relatively low rates of HIV [25]. See Study procedure After informed consent was received, the young women were given a computer and headphones in a private exam room to begin the questionnaire. The VACASI began with participants being asked to choose one of four possible "guides" whose face and voice were used throughout the VACASI. Guides were young women (approximately 18-20 years old) who were professional actors of varied ethnic appearance and voice. The guides were used to increase young women's level of comfort with the interview [27]. Following the choice of a guide, more information was given about the microbicide and a product sample was shown. The participant was then asked multiple demographic and sexual behaviors questions and presented with microbicide vignettes that asked her to rate the likelihood of buying each microbicide. The self-interviews were completed in English and lasted 25-45 minutes. Participants received $20 compensation for the time and effort involved in completing the questionnaire. The protocols for the entire project were approved by the University's institutional review board

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the U.S. are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males

Reliability and Validity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai Version

This study examines the Thai version of the Multidimensional Scale of Perceived Social Support (MSPSS) for its psychometric properties

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination

HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08–1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02–12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20–2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08–8.43), daily patient load (<20 vs. 20–24: aOR = 9.05;95%CI = 2.72–30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11–8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities

Young women's use of a microbicide surrogate: The complex influence of relationship characteristics and perceived male partners' evaluations

This is the post-print version of the article. The official published version can be found at the link below.Currently in clinical trials, vaginal microbicides are proposed as a female-initiated method of sexually transmitted infection prevention. Much of microbicide acceptability research has been conducted outside of the United States and frequently without consideration of the social interaction between sex partners, ignoring the complex gender and power structures often inherent in young women’s (heterosexual) relationships. Accordingly, the purpose of this study was to build on existing microbicide research by exploring the role of male partners and relationship characteristics on young women’s use of a microbicide surrogate, an inert vaginal moisturizer (VM), in a large city in the United States. Individual semi-structured interviews were conducted with 40 young women (18–23 years old; 85% African American; 47.5% mothers) following use of the VM during coital events for a 4 week period. Overall, the results indicated that relationship dynamics and perceptions of male partners influenced VM evaluation. These two factors suggest that relationship context will need to be considered in the promotion of vaginal microbicides. The findings offer insights into how future acceptability and use of microbicides will be influenced by gendered power dynamics. The results also underscore the importance of incorporating men into microbicide promotion efforts while encouraging a dialogue that focuses attention on power inequities that can exist in heterosexual relationships. Detailed understanding of these issues is essential for successful microbicide acceptability, social marketing, education, and use.This study was funded by a grant from National Institutes of Health (NIHU19AI 31494) as well as research awards to the first author: Friends of the Kinsey Institute Research Grant Award, Indiana University’s School of HPER Graduate Student Grant-in-Aid of Research Award, William L. Yarber Sexual Health Fellowship, and the Indiana University Graduate and Professional Student Organization Research Grant

153. AYA Subspecialty Patient and Parent Views on COVID-19 Vaccination

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Purpose: Adolescents/young adults (AYA) with hematologic and oncologic (heme-onc) conditions are important targets for vaccine outreach because they are at increased risk for complications from COVID-19. AYA patients may also need additional support, as they are transitioning from parent to independent vaccine decision-making. AYA with sickle cell disease (SCD) are of particular concern because a high proportion are African American and experience structural racism in addition to their illness. Our objective was to examine AYA and parent attitudes regarding the COVID-19 vaccine among heme-onc populations. Methods: As part of a larger IRB-approved study, we recruited vaccine decision-makers in pediatric SCD and oncology survivor clinics, including parents of adolescents under 18 years (n=35), AYA patients 18-21 years old (n=21), and parents of AYA patients 18-21 years old (n=14). After informed consent, participants completed a demographic survey and a semi-structured interview regarding their vaccine decision-making process. Example questions included “What do you see as the benefits of the COVID-19 vaccine?” and “What are your concerns about the COVID-19 vaccine?”. Saturation was reached. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Codes were developed from the literature and early interviews. Examples included “attitudes against vaccine,” “medical mistrust,” “hesitancy,” “vaccine side effects,” and “vaccine interactions with disease process.” Fisher exact statistical tests were performed to analyze quantitative data. Results: In SCD clinic, we recruited 31 index patients (mean age: 15.1±3.5 years; 30 African American and 1 Other or Mixed), yielding 11 AYA and 26 parent interviews. In survivor clinic, we recruited 26 index patients (mean age: 16.0±3.4 years; 20 White, 2 Hispanic or Latinx; 2 Other or Mixed, 1 African American, and 1 Asian), yielding 10 AYA and 23 parent interviews. Out of the total index patients, 8 had already received the vaccine, 13 were planning to receive it, 27 were considering it, and 9 had declined it. There was no clear relationship between patients’ diagnosis (SCD or cancer) and their vaccine decisions nor between the index patient’s age (under or over 18) and their vaccine decisions. A high proportion of participants saw benefits to vaccination, such as lowering personal risk, community benefits of preventing the spread of COVID-19, and a possible return to “normal.” However, many AYA and parent participants also had concerns toward the vaccine, including concerns about short-term side effects and the potential for unknown, long-term effects. Concerns were also voiced about how rapidly the vaccine was developed and misconceptions about the vaccine were common, namely the vaccine causing infertility or increasing one’s susceptibility to contracting COVID-19. Medical mistrust toward either the vaccine or providers was explicitly stated by several participants, the majority of whom were from minoritized groups. Conclusions: COVID-19 vaccines have the potential to protect medically and socially vulnerable AYA, however patient and parent concerns, misconceptions, and mistrust are still prevalent. These data provide insights into the design and implementation of vaccine counseling interviews for AYA subspecialty patients and families

A comparative analysis of the cultural representation of disability in school textbooks in Iran and England

The paper details the findings of a study which focused on the analysis of the cultural representation of disability in school textbooks in Iran and England. The paper argues that whilst inclusive education could facilitate the incorporating of disabled pupils into mainstream schools, there needs to be deeper examination as to how this transition should take place for children aged 3-13. The paper suggests that in such examinations school textbooks might be of significance in familiarizing non-disabled pupils, teachers and authorities with the issues related to disability and disabled pupils