Natalie Pierre-Joseph

Missed Opportunities for HPV Vaccination in Adolescent Girls: A Qualitative Study

OBJECTIVE: The goal of this study was to identify the rationale by parents/guardians and providers for delaying or administering human papillomavirus (HPV) vaccination to girls. METHODS: Qualitative interviews were conducted with parents/guardians accompanying their vaccine-eligible 11- to 17-year-old daughters to medical visits. Interviews were conducted in 1 public clinic and 3 private practice settings to ascertain why girls did or did not receive HPV vaccination. Questions probed vaccine decision-making from the point of view of parents/guardians and providers. RESULTS: A total of 124 parents/guardians and 37 providers participated. The most common reasons parents reported for not vaccinating their daughters was the lack of a physician recommendation (44%). Both parents and providers believed that HPV vaccination provided important health benefits, but the timing of vaccination with relation to sexual activity was an important theme related to vaccine delay. Providers with lower self-reported vaccination rates delayed vaccine recommendations in girls perceived to be at low risk for sexual activity, and several parents reported that their providers suggested or supported delaying vaccination until their daughters were older. However, parents/guardians and providers agreed that predicting the timing of sexual debut was extremely difficult. In contrast, providers with high vaccination rates presented HPV vaccination as a routine vaccine with proven safety to prevent cancer, and parents responded positively to these messages. CONCLUSIONS: Although most parents and providers believe that HPV vaccination is important, missed opportunities result from assumptions about the timing of vaccination relative to sexual activity. Routinely recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates.

Factors affecting human papillomavirus vaccine use among White, Black and Latino parents of sons.

Background: Although human papillomavirus (HPV) vaccination has been available for males since 2009, its uptake remains low. In light of new recommendations for universal vaccination of males, understanding parental attitudes toward this vaccine is important. This study aimed to describe HPV-related knowledge and intention to accept HPV vaccination among White, Black and Latino parents of sons and to assess vaccination rates among their sons. Methods: We interviewed parents (68 Black, 28 Latino and 24 White; mean age, 43.5) of sons (mean age, 14) attending an urban academic medical center and a community health center. Eligible parents self-identified as White, Black or Latino and spoke English, Spanish or Haitian-Creole. We collected demographic information, knowledge related to HPV vaccination, parents’ intent to vaccinate sons and HPV vaccination rates. Descriptive statistics and multivariable logistic regression were used to describe data. Results: Most parents were mothers, married, expressed a religious affiliation and had completed high school or college. Parents had limited knowledge about HPV; White parents were more knowledgeable than Black parents. Most parents (75%) intended to accept HPV vaccination if recommended by physicians; no racial differences were noted. However, only 30% of sons were vaccinated. Logistic regression indicated that internet use was negatively associated with intention to vaccinate. Intention to vaccinate, clinical site of care and having an older son were associated with vaccine receipt. Conclusions: Although parents in our study had limited understanding of HPV disease in males, most would vaccinate their sons if recommended by their physicians.

Attitudes Toward HPV Vaccination Among Low-Income and Minority Parents of Sons A Qualitative Analysis

Objective. To characterize the attitudes of low-income and minority parents/guardians toward vaccinating sons against human papillomavirus (HPV). Methods. In 2010-2011, we conducted qualitative interviews with 68 black, 24 white, and 28 Latino parents/guardians of sons. We identified attitudes related to HPV vaccination, vaccine mandates for males and females, and adolescent male sexuality using constructs from the Health Belief Model and methods based in grounded theory. Results. Most participants were concerned that their sons could be exposed to HPV through sexual experimentation and believed that the consequences of HPV infection could be severe; thus, 75% would accept HPV vaccine for their sons. Yet the lack of efficacy and safety information specifically pertaining to males posed barriers. More black (73%) and Latino (86%) than white (44%) participants supported school-entry requirements for HPV vaccination. Conclusions. Low-income and minority parents/guardians were generally receptive toward vaccinating their sons against HPV; racial/ethnic differences emerged regarding school-entry mandates.

Could Poor Parental Recall of HPV Vaccination Contribute to Low Vaccination Rates

Introduction. Rates of initiation and completion of the human papillomavirus (HPV) vaccine series remain below national goals. Because parents are responsible for ensuring vaccination of their children, we examined the accuracy of parental recall of the number of shots their daughters received. Methods. Parents/guardians of girls aged 11 to 17 years were asked to recall the number of HPV doses received by their daughters. Dose number was confirmed using provider-verified medical records. Logistic regression assessed variables associated with correct recall. Results. A total of 79 (63%) parents/guardians correctly identified the number of shots their daughters received. Ninety-one (73%) were aware of whether their daughter started the series at all. The only factor significantly associated with accurate recall in logistic regression models was female gender of parent/guardian. Conclusion. Nearly 40% of parents/guardians inaccurately recalled the number of HPV shots their children received, which may contribute to low rates of vaccine initiation and completion.

Drinking Water to Prevent Postvaccination Presyncope in Adolescents: A Randomized Trial

This trial evaluates whether giving water to drink before vaccination decreases the risk of postvaccination presyncope and describes factors associated with postvaccination presyncope. BACKGROUND AND OBJECTIVES: Postvaccination syncope can cause injury. Drinking water prephlebotomy increases peripheral vascular tone, decreasing risk of blood-donation presyncope and syncope. This study evaluated whether drinking water prevaccination reduces postvaccination presyncope, a potential syncope precursor. METHODS: We conducted a randomized trial of subjects aged 11 to 21 years receiving ≥1 intramuscular vaccine in primary care clinics. Intervention subjects were encouraged to drink 500 mL of water, with vaccination recommended 10 to 60 minutes later. Control subjects received usual care. Presyncope symptoms were assessed with a 12-item survey during the 20-minutes postvaccination. Symptoms were classified with a primary cutoff sensitive for presyncope, and a secondary, more restrictive cutoff requiring greater symptoms. Results were adjusted for clustering by recruitment center. RESULTS: There were 906 subjects randomly assigned to the control group and 901 subjects randomly assigned to the intervention group. None had syncope. Presyncope occurred in 36.2% of subjects by using the primary definition, and in 8.0% of subjects by using the restrictive definition. There were no significant differences in presyncope by intervention group for the primary (1-sided test, P = .24) or restrictive outcome (1-sided test, P = .17). Among intervention subjects vaccinated within 10 to 60 minutes after drinking all 500 mL of water (n = 519), no reduction in presyncope was observed for the primary or restrictive outcome (1-sided tests, P = .13, P = .17). In multivariable regression analysis, presyncope was associated with younger age, history of passing out or nearly passing out after a shot or blood draw, prevaccination anxiety, receiving >1 injected vaccine, and greater postvaccination pain. CONCLUSIONS: Drinking water before vaccination did not prevent postvaccination presyncope. Predictors of postvaccination presyncope suggest opportunities for presyncope and syncope prevention interventions.

DREAM: Empowering Preclinical Medical Students With Labor Support

Introduction Delivery Resources, Experiences, and Advocacy for Moms (DREAM) is an interprofessional service-learning program that empowers preclinical medical students by training them to provide labor support. Boston Medical Center is a safety-net hospital featuring an in-house doula service with limited coverage capacity. Consequently, many patients do not receive continuous labor support, although evidence shows that continuous labor support improves outcomes and may help reduce birth-outcome health disparities. We present a pragmatic approach to integrating preclinical students as labor-support staff and outline the methods and content of the training process as well as the evaluations used to assess program effectiveness. Methods Students were trained by doulas (Birth Sisters) and midwives to provide prenatal, labor, and postpartum support. Students completed an orientation and training workshop and then partnered with a Birth Sister for one prenatal visit, labor, and postpartum visit prior to working independently. Student leaders provided structure, mentoring, and support for preclinical students. Pre- and postsurveys assessed student confidence and obstetric knowledge acquisition. Budget, logistics, and program evaluation process are reviewed. Results Students demonstrated increased knowledge, as well as confidence in communication, advocacy, and support. Although balancing DREAM with academics was stressful, students continued to meet academic standards and felt their participation was gratifying and worthwhile. Student reflections and patient statements on their experience show the program was mutually beneficial. Discussion Preclinical students need gratifying clinical opportunities to develop confidence in communication and advocacy skills. Partnering them with underserved women to provide labor support is a pragmatic and clinically valuable intervention.

Factors Affecting Parental Recall of Human Papillomavirus Vaccination

INTRODUCTION: Many surveys estimate vaccine uptake using unverified patient report. We examined factors affecting concordance between recall of human papillomavirus (HPV) vaccination and electronic medical records. METHODS: Parents or guardians of girls aged 11–17 years in an urban safety net hospital and three suburban private practices were interviewed about their recall of the number of HPV shots received by their daughters. The number of HPV shots was confirmed using health care provider-verified medical records. Univariate analyses assessed variables associated with concordance between parent or guardian recall and medical records. RESULTS: Fifty-three white, 40 African American, 21 Hispanic, and 11 parents or guardians of other races participated. Sixty-seven attended the safety net hospital, and 58 attended the private practices. Parents or guardians ranged in age from 25 to 67 years; 16 were male and 109 were female. Seventy-nine (63%) parents correctly identified the number of shots their daughters received. Ninety-one (73%) were correct about whether their daughters had received any injections. We found that concordance between recall and medical record data for the number of shots received was higher for female parents or guardians compared with males (69% compared with 25%; P<.001) and those at private practices compared with safety net hospital (78% compared with 54% P=.002). Those with private insurance were more accurate than those with public insurance (71% compared with 53%; P=.038). CONCLUSION: Nearly 40% of parents or guardians may inaccurately recall the number of HPV shots their children received. Parents or guardians attending safety net clinics are at higher risk for inaccurate recall. Expanding immunization registries to include adolescent vaccines has the potential to both improve the accuracy of national data and reduce disparities through identification of unvaccinated girls.