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Let's discuss: Accelerating HPV Vaccine Uptake: What is Working and Why

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Last year, the President's Cancer Panel referred to accelerating HPV vaccine uptake as one of the "most profound opportunities in cancer prevention today" and called for aggressive implementation of evidence-based recommendations to support widespread HPV vaccination programs throughout the U.S. 

In today's cyber-seminar, we welcome representatives of the President's Cancer Panel, the National Cancer Institute and Cervical Cancer Free South Carolina --- each of which discussed the successes, challenges and lessons learned from their work around this important cancer control issue.

And now we turn the discussion over to you...

  • Do Calls to Action such as the PCP report truly help to build support for implementing evidence-based programs? How have you leveraged to report to implement programs and policies in your state/county/territory?
  • Heather spoke about a number of public policy interventions the CCFSC was able to implement as well as several that met with great oppposition. Do you have any success stories to share?  What works in your state/county/territory? What work still remains?
  • What did you take away from today's session?

 


Posts/Comments

Many thanks to Abby and

Many thanks to Abby and Heather - what a robust presentation!  We had 273 callers on the line and I know a number of you participated with others, so thank you for joining us.  Unfortunately, we had more questions than time, so I would like to re-open the discussion.  Abby, Cindy and Heather will be adding to this discussion and will be delighted to answer your questions.

  • Ellen Ballard Asked: Do you know how many State Cancer Plans have HPV vaccination prioritized as part of their current plan?
  • Claudia Reyes-Garcia Asked: How are you addressing Latinos under your program?
  • Sandy Miller Asked: what is the chief concern of parents who are reluctant to vaccinate children?
  • Marion Banzhaf Asked: I'm curious about the state of the anti-vaccine movement in South Carolina. Have religious objections to vaccines increased in SC?
  • Kelly Nagel  Asked: For Dr. Brandt, what plans does Cervical Cancer Free South Carolina have in term of statewide cervical cancer campaign for 2015?
  • Sharon Bond Asked: what strategies could be developed to vaccinate the catch-up group - the 18-26 yolds?

  • Valerie Vinson Asked: My question is in regards to the idea to use church bulletins to get the word out about the importance of the HPV vaccine. Were you able measure outcome as to how many people actually received the vaccine after reading the information? What a good idea! I just wondered about the measurable outcomes. Thanks!

Ellen Ballard Asked: Do you

  • Ellen Ballard Asked: Do you know how many State Cancer Plans have HPV vaccination prioritized as part of their current plan?

In response, I do not know for sure if there has been a current assessment of HPV vaccination content in State Cancer Plans. HPV testing and HPV vaccination are included as part of the South Carolina State Cancer Plan (2011-2015). I hope that as a result of the President's Cancer Panel report that there will be increased attention to recommendations in the report. Plans may be reviewed and updated, and in South Carolina, we will be writing a new plan next year. We will be including recommendations cited in the report.

One resource that you may want to look into is an article by Steele et al., 2008. In this article, the authors examined HPV-related content in state and tribal cancer plans from October 2006-January 2007. The review included 53 plans. The article describes findings on HPV content in the cancer plans. I would guess, but cannot say for sure, that there has been an increase in HPV-related content in current plans. This would be an ideal assessment to repeat if that has not already been done.

Reference: Steele CB, Thomas CN, Richardson LC. Human papillomavirus-related content in state and tribal comprehensive cancer control plans. J Womens Health (Larchmt). 2008 Jan-Feb; 17(1): 5-10.

Claudia Reyes-Garcia Asked:

  • Claudia Reyes-Garcia Asked: How are you addressing Latinos under your program?

We do not currently have activities for Latinos/as; however, we have had active initiatives in the past. During the presentation, I was unable to include all efforts to address cervical cancer in South Carolina. Iniciativa Latina Contra el Cancer (Latina Initiative) was a model program. Through the Latina Initiative, funded by the American Cancer Society and South Carolina Cancer Alliance, the South Carolina Hispanic/Latino Health Coalition focused on breast and cervical cancer screening and HPV vaccination. Promotoras were trained to deliver a small group program using evidence-based strategies, including facilitating access to screening and vaccination. The small group sessions were supplemented with newspaper ads, PSAs, and flyers. 

In addition, with support from the South Carolina Hispanic/Latino Health Coalition, we offered several printed educational materials in Spanish at the Inaugural Summit of Cervical Cancer-Free South Carolina.

Meeting the needs of the Hispanic community in South Carolina is a priority. We recognize the need for this programming, but funding has been a challenge. We have recently discussed identifying opportunities to fund implementation of Con Amor Aprendemos: Latino/Hispanic Couples Talking about HPV and Cervical Cancer, as one example.

 

 

Sandy Miller Asked: what is

  • Sandy Miller Asked: what is the chief concern of parents who are reluctant to vaccinate children?

According to the NIS-TEEN 2013 results, the top 5 reasons for not receiving the HPV vaccine for parents of girls are:

•15.5 %: Lack of knowledge
•14.7%: Not needed or necessary
•14.2%: Safety concern/Side Effects
•13.0%: Not recommended
•11.3%: Not sexually activeTop 5 Reasons for Not Receiving HPV Vaccine, NIS-Teen,  2013



The top 5 reasons for not receiving the HPV vaccine for parents of boys are:

•22.8%: Not recommended
•17.9%: Not needed or necessary
•15.5%: Lack of knowledge
•  7.7%: Not sexually active
•  6.9 %: Safety concern/Side effects
 
I can provide some insight based on data from South Carolina to supplement these results (see below). 

2012 SOUTH CAROLINA CHILDREN'S HEALTH ASSESSMENT SURVEY (CHAS)

In 2012, CHAS reported that 18% of the respondents have never heard of HPV vaccine; those individuals were mainly males (27%) and non-white (21%). The most effective source of information about HPV vaccine was the news and the internet, regardless of sex, age, or race. Sources like health care providers and drug companies ranked lower. This is inconsistent with national data indicating health care providers are a preferred and trusted source of HPV vaccine information.  In addition, a strong recommendation for HPV vaccination is the main predictor of uptake. The majority (51%) did not specify the reason why the child had not received HPV vaccination, however, about 28% did not know or believe that the child needed and about 21% though the child was too young to receive the vaccine. Moreover, about 56% said that they will not get the child vaccinated against HPV in the next 12 months especially males (58%), whites (64%), and 10-13 year olds (61%).

Marion Banzhaf Asked: I'm

  • Marion Banzhaf Asked: I'm curious about the state of the anti-vaccine movement in South Carolina. Have religious objections to vaccines increased in SC?

There are always some people who object to HPV vaccination for religious reasons. I am reluctant to speculate on whether or not this has increased in South Carolina. South Carolina is a conservative state. HPV has fallen into the domain of sexual health, which has resulted in vast amounts of misinformation to become prevalent. HPV has become a political hot button for conservative decision makers to express opposition, despite the cancer prevention benefits. For example, there are concerns about promoting sexual activity through HPV vaccination. This has been disproven but remains a concern among many decisionmakers. However, there are a few noteworthy achievements in spite of this prevailing norm. Teen births in South Carolina have decreased by 47% in the past 20 years. We also have a Comprehensive Health Education Act (since 1988) that allows for comprehensive sex education inclusive of contraception and abstinence-only sex education. During the 120th legislative session, HPV vaccination was politicized and became fodder for conservatives to demonstrate their opposition for various reasons. It is our hope that we can identify other policy channels through which we can increase uptake. We need to ensure that access to all ACIP recommended vaccines is available to underinsured children through our State Vaccine Program, as one example.

Kelly Nagel  Asked: For Dr.

  • Kelly Nagel  Asked: For Dr. Brandt, what plans does Cervical Cancer Free South Carolina have in term of statewide cervical cancer campaign for 2015?

Cervical Cancer-Free South Carolina is working with the South Carolina Cervical Cancer Prevention Initiative to determine the actual content and format of the campaign. We anticipate the focus will be on comprehensive cervical cancer prevention and control including screening, follow-up care, and HPV vaccination.

Sharon Bond Asked: what

  • Sharon Bond Asked: what strategies could be developed to vaccinate the catch-up group - the 18-26 year old.

 

I should note that Dr. Bond has been an integral part of cervical cancer prevention efforts in South Carolina since before I came to the state in 1997. She was one of the original champions of efforts to address cervical cancer and was part of the efforts I described during the cyber-seminar. We are grateful for her continued involvement in our efforts through Cervical Cancer-Free South Carolina. Thank you, Sharon!



Our efforts to reach the "catch up group" have been targeted to college students. The communication campaign at the College of Charleston is one such example. We are also working on an eight-week intervention to include elements of the It's #MyTime campaign at the College of Charleston for students at the University of South Carolina. One of the main barriers that we have encountered thus far for the catch up group is cost. As one example, in South Carolina, the state health plan is a "grandfathered" plan in terms of the provisions in the Affordable Care Act for providing ACIP recommended vaccinations. Therefore, the largest insurer in our state does not cover adult vaccinations, i.e. for the catch up group. This is a major barrier. We continue to explore options for reaching the catch up group while understanding the importance of vaccinating males and females in the target age group of 11-12.

 

Valerie Vinson Asked: My

  • Valerie Vinson Asked: My question is in regards to the idea to use church bulletins to get the word out about the importance of the HPV vaccine. Were you able measure outcome as to how many people actually received the vaccine after reading the information? What a good idea! I just wondered about the measurable outcomes. Thanks!

 

Due to time constraints, I did not include evaluation information for all initiatives described. I am happy to provide additional details on evaluation results through the discussion thread.



We completed an evaluation of the church bulletin inserts in spring 2014. The evaluation included inserts for the previous year (eight total inserts, including January 2013: Cervical Cancer Awareness Month). Church contacts (n=125) were mailed a paper-and-pen survey to evaluate the usefulness of church bulletin inserts for increasing cancer awareness in the congregations that received them. This information is being used to guide future cancer awareness activities to address cancer disparities.  

As a result of the eight inserts evaluated, church contacts reported that their congregational members have:

Increased their awareness and knowledge of cancer disparities (73.0%)

Continued to get screened for cancer (73.0%)

Encouraged others to get screened for cancer (64.9%)

Talked about cancer in their churches (67.6%)



Using the results of this evaluation, newly developed inserts for September 2014, October 2014, and January 2015 were/are being created. Another evaluation will be conducted in spring 2015, including congregation members in addition to church contacts.



I can provide more information if you are interested. Please email me directly. We widely share the inserts in months for which they are developed. The inserts can be modified to include other logos, etc. We ask only that distribution information is shared with us for tracking purposes.

Regarding messages about

Regarding messages about vaccinating sons, a new article, Parents' Decisions about HPV Vaccine for Sons: The Importance of Protecting Sons' Future Female Partners, in the Journal of Community Health (2014; Volume 39, Issue 5) by Christine L. Schuler et al. may be of interest.

A resource on immunizations

A resource on immunizations for HCPs can be found at
Www.immunize.org. This is the website for the Immunization Action Coalition.