From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Cancer Epidemiology, Biomarkers & Prevention
July 2014, 23 (7)
Physicians’ Human Papillomavirus Vaccine Recommendations in the Context of Permissive Guidelines for Male Patients: A National Study
Teri L. Malo1, Anna R. Giuliano2, Jessica A. Kahn3, Gregory D. Zimet4, Ji-Hyun Lee5, Xiuhua Zhao5, and Susan T. Vadaparampil1
Author Affiliations
1Health Outcomes and Behavior Program, Moffitt Cancer Center
2Department of Cancer Epidemiology, Moffit Cancer Center
3Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center
4Department of Pediatrics, Indiana University School of Medicine
5Biostatistics Department, Moffitt Cancer Center
Abstract
Background:
Little is known about physicians’ human papillomavirus (HPV) vaccine recommendations for males while the Advisory Committee on Immunization Practices’ (ACIP) permissive guidelines for male vaccination were in effect. The purpose of this study was to examine and explore factors associated with U.S. physicians’ HPV vaccine recommendations to early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) males.
Methods:
Nationally representative samples of family physicians and pediatricians were selected in 2011 (n=1,219). Physicians reported the frequency with which they recommended HPV vaccine to male patients (“always” [>75% of the time] vs. other) for each age group. Statistically significant predictors of vaccine recommendation were identified using multivariable logistic regression.
Results:
The prevalence of physicians reporting they “always” recommended HPV vaccination for males was 10.8% for ages 11-12, 12.9% for ages 13-17, and 13.2% for ages 18-26. Pediatrician specialty and self-reported early adoption of new vaccines were significantly associated with recommendation for all patient age groups. Additionally, physician race and patient payment method were associated with physician recommendations to patients ages 11-12, and patient race was associated with recommendations to ages 13-17 and 18-26.
Conclusions:
Less than 15% of physicians surveyed reported “always” recommending HPV vaccine to male patients following national guidelines for permissive vaccination. Vaccine financing may have affected physicians’ vaccine recommendations. Impact: If these recommendation practices continue following the ACIP’s routine recommendation for males in October 2011, then interventions designed to increase recommendations should target family physicians and possibly utilize early adopters to encourage support of HPV vaccination guidelines.

Dissertation: A mixed methods study of health literacy and its role in hpv vaccine uptake among college students
by Williams, Michelle S., Ph.D.
THE UNIVERSITY OF ALABAMA AT BIRMINGHAM, 2014, 216 pages; 3618512
Abstract:
Health literacy includes the ability to understand and process written and spoken health information, and numbers and calculations related to health information. Low health literacy is associated with negative health outcomes, and poor patient-provider communication. In order to advance health literacy research, there is a need to assess health literacy comprehensively and to develop an understanding of how health literacy impacts people at various stages of their lives. A sequential explanatory mixed methods study was conducted to assess college students’ health literacy. During the quantitative phase, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Newest Vital Sign (NVS), the Cancer Message Literacy Test-Listening (CMLT-Listening), and the e-Health Literacy Scale (eHEALS) were used to assess the students’ print literacy, health-related numeracy, aural cancer literacy, and eHealth literacy, respectively. During the qualitative phase, in-depth interviews were conducted with a subset of the original participants to obtain further evidence supporting the results of the literacy assessments and to identify factors in their social cultural environment that influence their health-related decisions including uptake of the Human Papillomavirus (HPV) vaccine. During the quantitative phase, 160 students completed four health literacy assessments. The mean scores on the health literacy assessment were: S-TOFHLA: 35.2; CMLT-Listening: 82%; eHEALS: 80.9%; and NVS: 5.1. The scores of 3 of the 4 health literacy assessments were not correlated with their uptake of the HPV vaccine. Twenty students participated in in-depth interviews during the qualitative phase. The students’ scores on the quantitative health literacy assessments indicated that they had adequate health literacy. However, the qualitative data showed that the students’ cancer literacy, eHealth literacy, and numeracy skills were not as adequate as their health literacy test scores indicated. Furthermore, the qualitative data revealed that the majority of the students who had received the HPV vaccine had done so as the result of a recommendation from a healthcare provider or their parents. Therefore, it did not appear that they made an autonomous decision to get the HPV vaccine. The results of this study indicate that assessing health literacy using a one-dimensional approach may not accurately reflect college students’ level of health literacy. In addition, students tend to rely on their aural literacy and eHealth literacy skills when seeking health information and making healthcare decisions. Therefore, there is a need for the development and implementation of intervention aimed at improving these skills among college students.

2014 STD Prevention Conference
June 9-12, 2014 in Atlanta, GA
A Health Information Technology Intervention Increases HPV Vaccine Series Initiation Among Florida Medicaid and Chip Adolescents
Stephanie A. S. Staras, PhD, MSPH1, Susan Vadaparampil, PhD, MPH2, Melvin Livingston III, PhD1, Lindsay Thompson, MD, MS3, Ashley Sanders, MS1 and Elizabeth Shenkman, PhD, MSN1, 1Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, 2H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 3Department of Pediatrics, University of Florida, Gainesville, FL
Abstract
Background: HPV vaccine series initiation rates have increased modestly compared to other adolescent vaccines and did not increase from 2011 to 2012.
Methods: We evaluated the feasibility and preliminary efficacy of a multi-component intervention to increase HPV vaccine series initiation among adolescents enrolled in Florida Medicaid and Children’s Health Insurance (CHIP) programs. We assigned 11-17 year old boys and girls without HPV vaccine claims, residing in Gainesville or surrounding primary care service areas (PCSA), and having a preventive care visit in the past year to one of four study arms. We assigned all adolescents with records of visits at five participating Gainesville clinics to a health information technology (HIT) system (n=2071) designed to alert providers of interested unvaccinated adolescents during clinic visits. We mailed postcards to a random half (n=1031). For comparison, we selected a random sample of adolescents living in PCSAs surrounding Gainesville (n=4025) and randomly assigned half to receive postcards (n= 2018).
Results: Preliminary efficacy in the two months following the intervention start suggests that the HIT system improved vaccination rates by 1% [HIT arms: 5% vs. non-HIT arms: 4% – Risk Ratio (RR) = 1.3; 95% Confidence Interval (CI) = 1.0, 1.7]. An additional 1% increase may be achieved by supplementing the HIT system with postcards (HIT and postcard arm: 6% vs. standard of care arm: 4% – RR=1.5; 95% CI = 1.1, 2.0). Within HIT system arms, 71 youth who visited the study providers were invited to participate. Most parents consented (82%; n=58) and 63% of adolescents completed the survey. Of the 80% of youth (n=36) verifying they were unvaccinated, only half were interested in the vaccine (n=18).
Conclusions: The intervention was feasible within the Medicaid and CHIP populations. Preliminary evidence suggests increases in HPV vaccine series initiation with the HIT system arms potentially boosted with parent postcards.

2014 STD Prevention Conference
June 9-12, 2014 in Atlanta, GA
Correlates of Human Papillomavirus Vaccine Initiation Among Female Adolescents Attending Sexually Transmitted Disease (STD) Clinics, 2010-2013
Kelly Jamison, MPH, Bureau of STD Control, New York City Department of Health and Mental Hygiene, New York, NY, Preeti Pathela, DrPH, MPH, Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY, Julia Schillinger, MD, MSc, US Centers for Disease Control and Prevention, CDC Division of STD Prevention, NYC DOHMH Bureau of STD,The New York City Department of Health and Mental Hygiene;, Long Island CIty, NY, Vikki Papadouka, PhD, MPH, NYC Department of Health and Mental Hygiene, New York, NY, Rezaul Kabir, MBBS, MPH, Bureau of Immunization, New York City Department of Health and Mental Hygiene, Long Island City, NY, Lauri Markowitz, MD, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA and Eileen Dunne, MD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Abstract
Background: Routine human papillomavirus (HPV) vaccination is recommended for females aged 11 or 12 years. Predictors of vaccine initiation (≥1 dose) have not been examined among STD clinic attendees, who are at high risk for HPV infection.
Methods: Electronic medical records for 11,153 females aged 13-18 years attending New York City (NYC) STD clinics between 2010-2013 were matched against the Citywide Immunization Registry (CIR), which contains immunization records for NYC residents ≤18 years. We assessed correlates of HPV vaccine initiation as of the date of visit to STD clinics among clinic attendees found in the CIR, using bivariable and multivariable logistic regression models. Race/ethnicity, age, census tract poverty, number of sex partners, and self-reported history of: genital warts (GW), STD other than GW, and abnormal pap smear were examined.
Results: Overall, 84% (9,328/11,153) of female STD clinic attendees were found in the CIR; 63% (5,838/9,328) had initiated HPV vaccination. Race/ethnicity, poverty, and history of STD were the only significant independent predictors of vaccine initiation. When adjusted for covariates, history of STD significantly increased odds of vaccine initiation (aOR=1.16, p=0.01); Hispanic females had the highest initiation rates (73%), and females of non-Hispanic (NH) white, NH-black and NH-other race/ethnicity had significantly lower odds of initiation compared with Hispanic females (NH-white: 54%, aOR=0.43, p<0.001; NH-black: 58%, aOR=0.51, p<0.001; NH-other: 62%, aOR=0.59, p<0.001). Additionally, females from medium- and high-poverty census tracts had significantly increased odds of vaccine initiation compared with females from low-poverty when adjusted for covariates (medium-poverty: 62% vs 56%, aOR=1.25, p=0.009; high-poverty: 69% vs 56%, aOR=1.49, p<0.001).
Conclusions: Among STD clinic attendees, HPV vaccine initiation was highest among Hispanic females and those of lower socioeconomic status, populations traditionally associated with poor health outcomes. This is an encouraging finding, but rates remain low and efforts to increase vaccination among all groups should continue.