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

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\u27s 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\u27s 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\u27s 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

Understanding the adoption process of an HPV vaccine school-entry requirement in Puerto Rico

Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US. Infection with low-risk HPV (i.e., 6 and 11) can cause genital warts, and persistent infection with high-risk HPV types (i.e., HPV 16 and 18) can progress to cancer. Currently, there is an HPV vaccine that is recommended for boys and girls, aged 11 to 12. Healthy People 2020 established a national objective of 80% completion of HPV vaccination among children aged 13 to 15 years old. Although the HPV vaccine is proven to be a safe and effective primary prevention strategy, uptake and completion rates remain low in the US. Vaccination mandates for school entrance are an effective strategy to improve vaccination coverage. In the US, HPV vaccine policies vary; some legislate in favor of educational campaigns, while others require health insurance to cover the HPV vaccine or require it for middle-school entry. Currently, only Virginia, Rhode Island, and Washington DC require the HPV vaccine for school entrance. In Puerto Rico (PR) the Department of Health recently approved the HPV vaccine school-entry requirement for children 11 to 12 years old, starting in fall 2018. Despite HPV vaccination’s cancer-preventive properties and vaccine mandates’ effectiveness, HPV vaccine school-entry requirements have not been widely adopted in the US. Guided by the Multiple Streams Approach, the purpose of this study was to understand the adoption process of PR’s HPV vaccine school-entry requirement. Phase 1 consisted of an HPV vaccine school-entry approval process (in favor/against). Purposive sampling was used to recruit stakeholders identified from online sources, by consulting local experts, and utilizing snowball sampling. Interviews were audio-recorded and transcribed. Data were analyzed using applied thematic analysis. Phase 2 consisted of a content analysis of PR’s newspapers from January 1st, 2015 to July 31st, 2018. Data were described quantitatively and qualitatively. From 21 stakeholders that were interviewed, only one person expressed views against the HPV vaccine school-entry requirement. The stakeholders highlighted problems such as, the high incidence of HPV and HPV-related cancers in PR (e.g., cervical/oropharyngeal) that needed to be resolved. Social factors such as the case of Rhaiza López Plumey, a young mother, who died of cervical cancer in 2015, and the VOCES HPV Advisory Panel Report served as focusing events that motivated the adoption process. Stakeholders also discussed other policy initiatives, such as changes to the current immunization law. The political turn-over in key government positions facilitated the adoption process. During the summer of 2017, a policy window opened, and the HPV vaccine school-entry requirement was adopted in the summer of 2018. The policy entrepreneurs worked on what was needed for the HPV vaccine school-entry requirement to be adopted through collaborations among different sectors. A total of 286 news articles included the key terms “HPV” or “human papillomavirus” in Spanish. Thirty-four articles mentioned the HPV vaccine school-entry requirement. The highest number of publications that mentioned the HPV vaccine school-entry requirement in PR occurred in 2017, and during the first seven months of 2018. The arguments listed in the articles included concerns related to the side effects of the HPV vaccine, the sexual nature of the transmission of the virus, and that it should be the parents’ right to choose to vaccinate their children. Other areas such as the HPV clears by itself and that there is no consensus regarding the HPV vaccine, were mentioned less frequently. Findings from this study can inform other states and public health practitioners interested in adopting HPV vaccine policy initiatives to improve HPV vaccination rates across the US and target the prevention of HPV-related cancers

Child nutrition and physical activity in the Monteverde Zone: An exploratory study

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1093/thumbnail.jp

Nutrición y actividad fisica en los niños de Monteverde: Un estudio exploratorio [powerpoint]

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1095/thumbnail.jp

Child nutrition and physical activity in the Monteverde Zone: An exploratory study [powerpoint]

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1094/thumbnail.jp

Child nutrition and physical activity in the Monteverde Zone: An exploratory study [powerpoint]

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1094/thumbnail.jp

Nutrición y actividad fisica en los niños de Monteverde: Un estudio exploratorio [powerpoint]

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1095/thumbnail.jp

Child nutrition and physical activity in the Monteverde Zone: An exploratory study

Abstract This study assesses objective levels of children\u27s physical activity as well as children\u27s subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. Abstract Spanish Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.https://digitalcommons.usf.edu/community_health/1093/thumbnail.jp

Tobacco-control policy support among people from low socioeconomic positions in Massachusetts

People from low socioeconomic positions (SEP) are at a higher risk of smoking, face greater barriers to smoking cessation, and have lower access to health information. To improve tobacco-related health outcomes, policies requiring altering labeling on cigarette packs could be implemented. However, public support is needed to influence the policymaking process. We assessed factors associated with supporting tobacco-control communication policies. We analyzed data from Project CLEAR, a study conducted in Massachusetts. The analytic sample included participants who answered questions on their support for three policies: 1) graphic health warnings (GHWs), 2) Quitline number, and 3) smoking cessation information on cigarette packs (n = 357). Binomial logistic regression modeling was conducted by policy. Independent variables included demographic characteristics and smoking status. We found that younger vs. older individuals (aOR = 0.41, 95 %CI:0.23–0.72), males vs. females (aOR = 0.58, 95 %CI:0.35–0.96), and people who smoke vs. those who don’t smoke (aOR = 0.41, 95 %CI:0.24–0.70) were less likely to support a law requiring GHWs. Participants with a low vs. higher level of education (aOR = 0.55, 95 %CI:0.32–0.95) were less likely to support a law requiring a Quitline number. Younger (18–39) vs. older individuals (aOR = 0.53, 95 %CI:0.29–0.94), males vs. females (aOR = 0.57, 95 %CI:0.34–0.96), and participants with a low vs. higher level of education (aOR = 0.56, 95 %CI:0.32–0.98) were less likely to support a law requiring cessation information on cigarette packs. Findings suggest that targeted theory-based public health and communication strategies should be developed to increase awareness and support towards policies that would help reduce cigarette smoking among people from low SEP to eliminate tobacco-related health inequities in the US

Cultural Adaptation of a Supportive Care Needs Measure for Hispanic Men Cancer Survivors

Objective. Research with ethnic minority populations requires instrumentation that is cultural and linguistically relevant. The aim of this study was to translate and culturally adapt the Cancer Survivor Unmet Needs measure into Spanish. Methods. We describe the iterative, community-engaged consensus-building approaches used to adapt the instrument for Hispanic male cancer survivors. We used an exploratory sequential mixed method study design. Methods included translation and back-translation, focus groups with cancer survivors (n = 18) and providers (n = 5), use of cognitive interview techniques to evaluate the comprehension and acceptability of the adapted instrument with survivors (n = 12), ongoing input from the project\u27s community advisory board, and preliminary psychometric analysis (n = 84). Results. The process emphasized conceptual, content, semantic, and technical equivalence. Combining qualitative and quantitative approaches offered a rigorous, systematic, and contextual approach to translation alone and supports the cultural adaptation of this measure in a purposeful and relevant manner. Conclusion. Our findings highlight the importance of going beyond translation when adapting measures for cross-cultural populations and illustrate the importance of taking culture, literacy, and language into consideration