Deanna Kepka

Economic Burden of Cancer in the United States: Estimates, Projections, and Future Research

The economic burden of cancer in the United States is substantial and expected to increase significantly in the future because of expected growth and aging of the population and improvements in survival as well as trends in treatment patterns and costs of care following cancer diagnosis. In this article, we describe measures of the economic burden of cancer and present current estimates and projections of the national burden of cancer in the United States. We discuss ongoing efforts to characterize the economic burden of cancer in the United States and identify key areas for future work including developing and enhancing research resources, improving estimates and projections of economic burden, evaluating targeted therapies, and assessing the financial burden for patients and their families. This work will inform efforts by health care policy makers, health care systems, providers, and employers to improve the cancer survivorship experience in the United States. Cancer Epidemiol Biomarkers Prev; 20(10); 2006–14. ©2011 AACR.

Factors associated with human papillomavirus vaccination among young adult women in the United States.

BACKGROUND Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases. OBJECTIVE To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18-30 years. METHODS Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18-26 (n=1866) and 27-30 years (n=1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression. RESULTS Overall, 23.2% of women age 18-26 and 6.7% of women age 27-30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18-26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18-26 years (n=490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n=920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine. CONCLUSIONS HPV vaccination coverage among women age 18-26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.

Low Knowledge of the Three-Dose HPV Vaccine Series among Mothers of Rural Hispanic Adolescents

Background. Few previous investigations on correlates of HPV vaccine uptake have included Hispanics, a group known to have a disproportionately high risk of cervical cancer. Methods. Rural Hispanic mothers of daughters aged 9-17 (n=78) were recruited at local community events to participate in a standardized Spanish-language survey that examined factors related to vaccine uptake. Results. Approximately 35% of the mothers reported that their daughter had received at least one dose of the vaccine. Mothers who had heard of the HPV vaccine were more likely to have a vaccinated daughter (p<.01). Mothers who thought their daughters father would approve were more likely to have a vaccinated daughter (p=.004). Contrary to expectation, parents who believed that only one injection is necessary were more likely to have a vaccinated daughter (p=.009). Conclusions. HPV vaccine education programs that target both parents are needed to ensure that Hispanic parents receive the complete HPV vaccine regimen.

Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey.

BACKGROUND In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group. PURPOSE To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years. METHODS Data from the 2010 National Health Interview Survey were analyzed in 2011. RESULTS In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV. CONCLUSIONS HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage.

Cervical Cancer Screening Among Young Adult Women in the United States

Background: Cervical cancer screening guidelines have evolved significantly in the last decade for young adult women, with current recommendations promoting later initiation and longer intervals. Methods: Using self-reported cross-sectional National Health Interview Survey (NHIS) 2000–2010 data, trends in Papanicolaou (Pap) testing among women ages 18–29 years were examined. NHIS 2010 data were used to investigate age at first Pap test (N = 2,198), time since most recent Pap test (n = 1,622), and predictors of Pap testing within the last 12 months (n = 1,622). Results: The percentage of 18-year-olds who reported ever having a Pap test significantly decreased from 49.9% in 2000 to 37.9% in 2010. Mean age at first Pap test in 2010 was significantly younger for non-Hispanic black women (16.9 years), women < high school education (16.9 years), women who received the HPV vaccine (17.1 years), and women who have ever given birth (17.3 years). The majority reported their last Pap test within the previous 12 months (73.1%). Usual source of healthcare (OR, 2.31) and current birth control use (OR, 1.64) significantly increased chances of having a Pap test within the previous 12 months. Conclusions: From 2000 to 2010, there was a gradual decline in Pap test initiation among 18-year-olds; however, in 2010, many women reported ≤12 months since last screening. Evidence-based guidelines should be promoted, as screening young adult women for cervical cancer more frequently than recommended can cause considerable harms. Impact: A baseline of cervical cancer screening among young adult women in the United States to assess adherence to evidence-based screening guidelines. Cancer Epidemiol Biomarkers Prev; 22(4); 580–8. ©2013 AACR.

Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation among Adolescent Girls in the United States

Background: This study is among the first to explore geographic factors that may be associated with human papillomavirus (HPV) vaccine uptake in the United States. Methods: Data from the 2011 and 2012 National Immunization Survey-Teen for 20,565 female adolescents aged 13 to 17 years were analyzed to examine associations of HPV vaccine initiation (receipt of at least one dose) with ZIP code–level geographic factors. Logistic regression including individual and geographic factors was used to estimate the odds of HPV vaccine initiation. Results: Approximately 53% of girls initiated the HPV vaccine in both years. Girls in high poverty communities had higher HPV vaccine initiation compared with those in low poverty communities [61.1% vs. 52.4%; adjusted OR (AOR), 1.18; 95% confidence intervals (CI), 1.04–1.33]. Initiation was higher among girls in communities where the majority of the population was Hispanic (69.0% vs. 49.9%; AOR, 1.64; 95% CI, 1.43–1.87) or non-Hispanic mixed race (60.4% vs. 49.9%; AOR, 1.30; 95% CI, 1.17–1.44) compared with majority non-Hispanic white communities. Interactions between individual-level race/ethnicity and community racial–ethnic composition indicated significantly higher odds of initiation among Hispanic girls living in Hispanic communities compared with Hispanic girls living in predominantly non-Hispanic White (NHW) (AOR, 2.23; 95% CI, 1.87–2.65) or non-Hispanic Black (NHB) (AOR, 1.90; 95% CI, 1.20–3.04) communities, respectively. Conclusion: Initiation rates of HPV vaccination among teen girls were highest in the poorest communities and among Hispanics living in communities where the racial–ethnic composition was predominantly Hispanic or mixed race. Impact: Given low HPV vaccination rates in the United States, these results provide important evidence to inform public health interventions to increase HPV vaccination. Cancer Epidemiol Biomarkers Prev; 25(2); 309–17. ©2016 AACR.

The Implementation Road Engaging Community Partnerships in Evidence-Based Cancer Control Interventions

Southern rural and underserved counties have high proportions of individuals with increased mortality for cervical and breast cancers. To improve the integration of behavioral research into practice, the dissemination and implementation of efficacious interventions to encourage the use of screening have increased in recent years. This study addressed gaps in the dissemination and implementation of evidence-based interventions with a pilot called Team Up. Qualitative interviews with 24 key individuals in six state-level partnerships explored partnership characteristics that influenced selection and use of evidence-based interventions among low-income, rarely or never screened women. Guided by diffusion of innovations theory and the Lasker and Weiss partnership functioning model, interviews about the intervention centered on (a) knowledge surrounding evidence base; (b) identification, selection, and adoption; (c) planning and adaptation; (d) implementation; and (e) partnership reflections and impact. Using grounded theory and content analysis, data revealed that lack of communication and high partner turnover hindered adoption and adaptation, whereas failure of partnership leaders to engage local stakeholders and lack of sufficient funds hampered implementation. Delivery of evidence-based interventions was more effective when partnerships included local partners in early decision making and when coaches were introduced to facilitate strategic thinking about translating evidence-based interventions into practice. A challenge for public health partnerships was the translation of interventions into successful programs, such that underserved communities benefited from early detection intervention research.

Human papillomavirus (HPV) vaccine initiation and HPV and vaccine awareness among men 18–26 years in the United States, 2010

BACKGROUND In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group. PURPOSE To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years. METHODS Data from the 2010 National Health Interview Survey were analyzed in 2011. RESULTS In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV. CONCLUSIONS HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage.

Overuse of Papanicolaou Testing Among Older Women and Among Women Without a Cervix

Leading national organizations are increasingly using evidence-based recommendations for Papanicolaou testing. As of 2003, organizations recommended against Papanicolaou testing for women without a cervix following a hysterectomy who do not have a history of high-grade precancerous lesion or cervical cancer and for women older than 65 years with adequate prior screening and who are not at high risk.1–3 Few studies have investigated overuse of Papanicolaou testing among US women. We aimed to investigate overuse of Papanicolaou testing in relation to cervical cancer screening recommendations.

Student Column: Development of a Radionovela to Promote HPV Vaccine Awareness and Knowledge among Latino Parents

Public Health Reports / January–February 2012 / Volume 127 3. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Aff (Millwood) 2006;25:1053-60. 4. Association of Schools of Public Health. Education Committee master’s degree in public health core competency development project, version 2.3. Washington: ASPH; 2006. Also available from: URL: http://www.uic.edu/sph/prepare/courses/chsc400/syllabus/ mphcorecomp.pdf [cited 2011 Aug 11]. 5. Cotter LE, Chevrier J, El-Nachef WN, Radhakrishna R, Rahangdale L, Weiser SD, et al. Health and human rights education in U.S. schools of medicine and public health: current status and future challenges. PLoS One 2009;4:e4916. 6. Bailey SB. Focusing on solid partnerships across multiple sectors for population health improvement. Prev Chronic Dis 2010;7:A115. 7. Lasker RD, Weiss ES. Creating partnership synergy: the critical role of community stakeholders. J Health Hum Serv Adm 2003;26:119-39. 8. Okubu D, Weidman K. Engaging the community in core public health functions. Natl Civic Rev 2003;89:309-26. 9. Dearing JW, Larson RS, Randall LM, Pope RS. Local reinvention of the CDC HIV prevention community planning initiative. J Community Health 1998;23:113-26. 10. Moyer A, Coristine M, Jamault M, Roberge G, O’Hagan M. Identifying older people in need using action research. J Clin Nurs 1999;8:103-11. 11. Project EXPORT Fellowship Program, Mel & Enid Zuckerman College of Public Health, University of Arizona. Social Justice in Health Symposium 2007: How Social Justice and Human Rights Affect Communities of the Southwest; 2007 Apr 20; Tucson, Arizona. Also available from: URL: http://www.publichealth.arizona.edu/ sites/default/files/coph/students/pdfs/SocialJusticeProceedings _FINAL_0.pdf [cited 2011 Aug 6]. 12. Project EXPORT Fellowship Program, Mel & Enid Zuckerman College of Public Health, University of Arizona. Social Justice in Health Symposium: Local to Global. 2008 Apr 17–18; Tucson, Arizona. Also available from: URL: http://www.publichealth.arizona.edu/ news/2008/sjs-2008 [cited 2011 Aug 16]. 13. Chao SM, Donatoni G, Bemis C, Donovan K, Harding C, Davenport D, et al. Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project. Matern Child Health J 2010;14:827-37. 14. Kim-Ju G, Mark GY, Cohen R, Garcia-Santiago O, Nguyen P. Community mobilization and its application to youth violence. Am J Prev Med 2008;34(3 Suppl):S5-12. 15. O’Neill K, William KJ, Reznik V. Engaging Latino residents to build a healthier community in mid-city San Diego. Am J Prev Med 2008;34(3 Suppl):S36-41. 16. Kegler MC, Norton BL, Aronson RE. Achieving organizational change: findings from case studies of 20 California healthy cities and communities coalitions. Health Promot Int 2009;23:109-18. 17. Rosales CB, Koe MK, Stroupe NR, Hackman A, DeZapien JG. The Culture of Health Survey: a qualitative assessment of a diabetes prevention coalition. J Community Health 2010;35:4-9. 18. Minkler M, Garcia AP, Williams J, LoPresti T, Lilly J. Sí se puede: using participatory research to promote environmental justice in a Latino community in San Diego, California. J Urban Health 2010;87:796-812. 19. Minkler M, Wallerstein N. An introduction to community-based participatory research: new issues and emphases. In: Minkler M, Wallerstein M, editors. Community-based participatory research for health: from process to outcomes. San Francisco: Jossey-Bass; 2003. p. 3-27. 20. Michau L. Approaching old problems in new ways: community mobilisation as a primary prevention strategy to combat violence against women. Gender Dev 2007;15:1355-64. 21. University of Arizona, Mel & Enid Zuckerman College of Public Health. Dean’s report. 2009 [cited 2010 Nov 1]. Available from: URL: http://www.publichealth.arizona.edu/news/deans_report 22. American Public Health Association. Border crossing deaths: a public health crisis along the U.S.-Mexico Border. Washington: APHA; 2009. Also available from: URL: http://www.apha.org/advocacy/ policy/policysearch/default.htm?id=1385 [cited 2010 Oct 7]. 23. Farmer P. Ethnography, social analysis, and the prevention of sexually transmitted HIV infections among poor women in Haiti. In: Inhorn MC, Brown PJ, editors. The anthropology of infectious disease: international health perspectives. Amsterdam: Gordon and Breach; 1997. p. 413-38.