Spring Chenoa Cooper Robbins

“I just signed”: Factors influencing decision-making for school-based HPV vaccination of adolescent girls.

OBJECTIVES Australia was one of the first countries to implement a nationwide program providing HPV vaccination to girls at school. To date, there are no published studies describing decision-making processes and behavior postimplementation of HPV vaccination of adolescents participating in a school-based program. DESIGN A purposive sample of nine schools was selected to reflect a range of vaccination coverage and school types. Semistructured focus groups with girls and interviews with parents, teachers, and immunization nurses (n = 185) were conducted until saturation was reached. Transcripts were analyzed inductively and emergent themes were subject to constant comparison. MAIN OUTCOME MEASURES Explanatory model of decision-making in HPV vaccination. RESULTS An explanatory model of decision-making and behavior was constructed from the data. Five decision-making states emerged across a continuum of vaccination behavior: active decision-vaccinated, passive decision- vaccinated, passive decision- not vaccinated, active decision- not vaccinated, and antivaccination. A range of factors influenced participants in each decision-behavior state. Adolescents were often part of the decision-making process. Where adolescents were not involved, nonagreement sometimes occurred. CONCLUSION We have presented a variety of paths girls and their parents experience regarding decision-making and behavior in HPV vaccination. Attitudes, past experiences, and worldviews contributed to this process.

Implementation of mandatory immunisation of healthcare workers: Observations from New South Wales, Australia

OBJECTIVE To identify factors influencing implementation of a state-wide mandatory immunisation policy for healthcare workers (HCWs) in New South Wales (NSW), Australia, in 2007. Vaccines included were measles, mumps, rubella, varicella, hepatitis B, diphtheria, tetanus and pertussis, but not influenza. METHODS We evaluated the first 2 years of this policy directive in 2009. A qualitative study was conducted among 4 stakeholder groups (the central health department, hospitals, health professional associations, and universities). 58 participants were identified using maximum variation sampling and data were analysed using a hierarchical thematic framework. Quantitative data on policy compliance were reviewed at the regional level. RESULTS Success in policy implementation was associated with effective communication, including support of clinical leaders, provision of free vaccine, access to occupational health services which included immunisation, and appropriate data collection and reporting systems. Achieving high vaccine uptake was more challenging with existing employees and with smaller institutions. CONCLUSION These findings may apply to other jurisdictions in Australia or internationally considering mandatory approaches to HCW vaccination.

Voluntary School-Based Human Papillomavirus Vaccination: An Efficient and Acceptable Model for Achieving High Vaccine Coverage in Adolescents

Recently published data from large efficacy studies suggest that human papillomavirus (HPV) vaccines can substantially reduce anogenital neoplasia and warts overall when administered to young women with no previous exposure to most highand low-risk HPV types [1,2]. These data refer to young women who were naı̈ve to HPVand therefore considered similar to female adolescents before their sexual debut. Most countries have centered HPV vaccination recommendations on this particular age group. Mathematical models predict that vaccination of young adolescent females will dramatically reduce HPV infection and associated disease in the population offered vaccination [3e5], and that this is a cost-effective intervention [6]. These studies have generally assumed vaccination uptake to be in the range consistent with previously published data on uptake for adolescent vaccinations offered through school vaccination programs or programs with mandated vaccination for school entry (70%e80%), and have further assumed that lower levels of uptake predict a lesser effect on infection and disease [7]. As several countries have now implemented HPV vaccination programs, the first data on coverage are beginning to emerge. It is concerning, but also intriguing, that there is such a vast range in HPV vaccine coverage across these countries, from very high to very low [8e13]. In this issue of the Journal of Adolescent Health, four articles report on HPV vaccine uptake in female adolescents and explore issues that potentially affect vaccination consent and completion. Rouzier and Giordanella presented HPV vaccine coverage for female adolescents in Paris, France, 1 year after the French government recommended that adolescents be vaccinated (through medical providers) [11]. The reported uptake of 17% (with less than half of these adolescents receiving all three doses) is similar to the low level of uptake (25% for one dose; 11% for all three) previously reported in the United States [13]. Low vaccination rates were found to have no overall effect on abnormalities detected by the Pap test in a clinic sample from theUnitedStates [14], whereas in Australia, where uptake is much higher,

Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review

PurposeChildhood illness or disability can affect the quality of life (QoL) of the child’s primary caregiver. Our aim was to identify, describe the content and systematically review the psychometric properties of condition-specific QoL questionnaires for caregivers of children.MethodsMedline, PsycInfo, Embase, CINAHL, and the Cochrane library databases were searched from 1 January 1990 to 30 June 2011. Articles related to the development and measurement of caregiver QoL were screened to identify condition-specific questionnaires. The characteristics of the questionnaires were extracted, and their psychometric properties were evaluated using the consensus-based standards for the selection of health measurement instruments checklist with 4-point scale.ResultsWe identified 25 condition-specific caregiver QoL questionnaires covering 16 conditions. Conditions included atopic dermatitis, asthma, diabetes, oro-facial disorders, and two acute illnesses. Questionnaires were developed predominantly in high-income countries. Questionnaires had the highest quality rating for content validity, followed by hypothesis testing. Methodological quality was satisfactory for criterion validity; fair in reliability and responsiveness; and poor in internal consistency and structural validity.ConclusionsThe increasing number of questionnaires developed over time shows improved recognition of the importance of caregiver QoL. There is a paucity of QoL questionnaires for caregivers of otherwise healthy children suffering from physical injuries and acute conditions associated with significant caregiver burden. Cultural validation of existing and new questionnaires in lower-income countries is necessary. Data collected by condition-specific questionnaires can assist clinicians and health economists in estimating caregiver burden and the types of healthcare services caregivers require and may be useful for healthcare administrators to evaluate interventions.

All manner of ills: The features of serious diseases attributed to vaccination.

Anti-vaccination writings have linked vaccines with a wide range of negative outcomes. The majority of evidence negates such connections raising the question of what makes these attributions attractive. This research identified diseases and conditions which are claimed to have been caused by vaccines and identified their shared societal features. They shared an idiopathic origin; apparent rise in incidence; face-value biological plausibility of a link to vaccines; dreaded outcomes; and their onset having close proximity to immunisation. Any attempt to re-frame erroneous claims about vaccination first requires an identification of the deeper anxieties in which they are located.

Australian Newspaper Coverage of Human Papillomavirus Vaccination, October 2006–December 2009

Vaccination against human papillomavirus (HPV) is now routine practice for adolescent females in Australia. Media information about HPV vaccination is likely to affect girls’ and parents’ decisions about vaccination. This article reports a content analysis of 131 Australian print media news stories published between October 2006 and December 2009. Each story was coded for main themes of the article; completeness and accuracy of information presented; potential issues and concerns related to HPV vaccination; phrasing, emphasis, and language used; and representation of experts. Resulting themes were as follows: Australian pride in vaccine development; details and progress of the National Vaccination Program; vaccine safety; HPV vaccinations future; whether or not males could and/or should get the vaccine; issues related to sexual activity and the vaccine; and issues about decision making for acceptance of HPV vaccine. To fill gaps that are created by media representations of HPV vaccination, educational interventions should include information about HPV transmission and male vaccination and should promote adolescent involvement in decision making.

Childhood Behavior Problems and Age at First Sexual Intercourse: A Prospective Birth Cohort Study

BACKGROUND AND OBJECTIVES: Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse social, emotional, and physical health outcomes in adolescence and into adulthood. The aim of this study was to examine relationships between internalizing (eg, anxious/depressed, withdrawn) and externalizing (eg, delinquent, aggressive) behavior problems in childhood and age at FSI. METHODS: We used a large, population-based birth cohort (The Western Australian Pregnancy Cohort [Raine] Study) to address this question. Child behavior was measured by using the Child Behavior Checklist collected from parents at ages 2, 5, 8, 10, and 14 and scores calculated for total, internalizing, and externalizing behavior problems. At age 17, 1200 participants reported sexual behavior. RESULTS: Participants with clinically significant Child Behavior Checklist scores (T ≥60) were at increased risk for earlier first sexual intercourse (FSI) (<16 years). Adjusted odds ratios revealed that total and externalizing behavior problems from age 5 years onward significantly increased the risk of earlier FSI for boys. In girls, externalizing problems from age 10 years increased the risk for earlier FSI. Internalizing problems at ages 8 and 10 were significantly associated with early FSI for boys but not girls. CONCLUSIONS: Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Adolescent sexual health promotion should consider early intervention in children with behavior problems, particularly boys.

Age at menarche and age at first sexual intercourse: A prospective cohort study

OBJECTIVE: Younger age at menarche (AAM) may put girls at risk for earlier first sexual intercourse (FSI). Young age at FSI has far-reaching negative outcomes. We describe the longitudinal relationship between AAM and FSI in a large prospective birth cohort. METHODS: AAM was collected from 554 girls from the Western Australia (Raine) Pregnancy Cohort Study, prospectively from age 10 or retrospectively at age 14. Age at FSI was collected at ages 17 and 20. Cox regression models describe likelihood of FSI by age and years since menarche for younger (<12 years) and older (≥14 years) AAM relative to average AAM (12–13 years). RESULTS: Girls with younger AAM and average AAM were equally likely to have FSI by age 16 (adjusted hazard ratio [aHR]: 0.90 [95% confidence interval (CI): 0.60–1.35]). FSI by age 16 was less likely among girls with older AAM than those with average AAM (aHR: 0.35 [95% CI: 0.17–0.72]). Girls with younger AAM had a longer median interval between menarche and FSI than girls with average AAM (5.0 years [interquartile range: 4.4–8.5 years] vs 3.7 years [interquartile range: 2.4–5.3 years]). Those with younger AAM were less likely to report FSI within 4 years of menarche than those with average AAM (0–2 years aHR: 0.04 [95% CI: 0.01–0.31]; 2–4 years aHR: 0.36 [95% CI: 0.23–0.55]). By age 20, 429 girls (77.4%) reported FSI. CONCLUSIONS: Younger AAM was not a risk factor for younger age at FSI in this cohort.

Making influenza vaccination mandatory for health care workers: the views of NSW Health administrators and clinical leaders

The challenges of maintaining high influenza vaccination rates in health care workers have focused worldwide attention on mandatory measures. In 2007, NSW Health issued a policy directive requiring health care workers to be screened/vaccinated for certain infectious diseases. Annual influenza vaccine continued to be recommended but not required. This paper describes the views of NSW Health administrators and clinical leaders about adding influenza vaccination to the requirements. Of 55 staff interviewed, 45 provided a direct response. Of these, 23 supported inclusion, 14 did not and eight were undecided. Analysis of interviews indicated that successfully adding influenza vaccination to the current policy directive would require four major issues to be addressed: (1) providing and communicating a solid evidence base supporting the policy directive; (2) addressing the concerns of staff about the vaccine; (3) ensuring staff understand the need to protect patients; and (4) addressing the logistical challenges of enforcing an annual vaccination.

Sex after Stroke: A Content Analysis of Printable Educational Materials Available Online:

Background Providing written educational materials to stroke survivors is a key recommendation in many international stroke guidelines. Yet, sexual concerns are generally overlooked in current stroke rehabilitation and the content of educational materials on sexual concerns has not been analyzed nor evaluated in published stroke research. Aim The aim of this study was to identify, describe, and analyze printable educational materials on sexual concerns that are available online and easily shared with stroke survivors. Method Google search engine was used to locate printable educational materials from the Internet using a search term strategy of 35 phrases that were piloted for accuracy. The content of eligible materials was analyzed using NVivo software to produce both enumerative and thematic data. Results Nine educational materials from reputable organizations were included with an average length of seven pages and 1445 words (total 61 pages, 13 000 words). The content of the materials was similar and covered three main content areas: problems experienced after stroke: 30% coverage suggested solutions: 32% coverage, and reassurance: 9% coverage. Content describing potential problems reflected published research, but solutions and reassurance were general, nonspecific, and often not supported by evidence. Conclusions Educational materials on sex after stroke may be helpful for health professionals, stroke survivors, and their partners, yet some messages appear to discourage recovery. Educators, health professionals, and organizations can use this analysis to evaluate their own educational resources and create resources that better address the sexual concerns of stroke survivors and their partners.