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PURPOSE: Knowledge, attitudes, and patient preferences about genetic testing and subsequent risk management for cancer prevention among average risk populations are understudied, especially among Hispanics. This study was to assess these items by conducting an in-person survey in this understudied population. METHODS: We conducted in-person surveys using a self-administered, structured questionnaire among young women in 2017. Survey questions were adapted from other validated surveys. This study had 677 participants in the final analyses. Data were collected in 2017 and analyzed in 2018 and 2019. RESULTS: Participants had little knowledge about genes or breast cancer risk, but most felt that genetic testing for cancer prevention is “a good idea” (87.0%), “a reassuring idea” (84.0%), and that “everyone should get the test” (87.7%). Most (64.0%) of these women would pay up to $25 for the test, 29.3% would pay $25-$500, and

Background Genital and oral cancers are often caused by human papillomavirus (HPV) types that can be prevented through HPV vaccination. Since HPV is sexually transmitted, knowledge of penile prevalence of vaccine-type HPV among US males can help predict potential disparities in these cancers. This study examines penile HPV prevalence by age and race/ethnicity among males. Methods This study was a secondary analysis of publicly available data from the National Health and Nutrition Examination Survey (NHANES). Using data from penile swab samples collected from males between 2013 and 2016, the prevalence of 4vHPV and 9vHPV vaccine types was examined across age groups and by race/ethnicity. Logistic regression models adjusting for demographics, sexual behavior, and circumcision were examined to determine whether associations remained after accounting for confounders. Results Among 2548 males evaluated, HPV infection prevalence differed by race/ethnicity, with Black males exhibiting a higher prevalence of HPV. Examination of 4vHPV type prevalence by age group showed that 18–26-year-old males had a lower prevalence than older age groups. After controlling for confounders, 4vHPV prevalence was only significantly elevated among 27–34-year-old males, those who were single, and males with ≥3 lifetime sex partners. In adjusted models, 9vHPV type prevalence remained elevated among Black males compared with White males. Conclusions Variations in 9vHPV type prevalence between Black and White individuals indicate future disparities in HPV-related genital cancers may continue in the United States during the next decade. Revaccinating certain populations with the 9vHPV vaccine may be appropriate to help mitigate this.

Background Human papillomavirus (HPV) vaccination has occurred unequally across the United States, potentially contributing to uneven vaccine‐type HPV prevalence between regions. We examined whether emerging vaccine‐related herd protection exhibits regional differences among unvaccinated girls and women. Methods We evaluated the prevalence of vaginal HPV among women 14‐59 years of age from 2003 to 2014 using repeated cross‐sectional data from the National Health and Nutrition Examination Survey (NHANES). Women who provided an adequate vaginal swab sample were included. Vaginal prevalence of vaccine‐type HPV (types 6, 11, 16, 18) were examined in four regions of the United States between 2003 and 2014. We examined vaccine‐type HPV prevalence in 2007‐2014 in each US census region among younger participants (14‐34 years old) stratified by vaccination status to determine whether one or both groups contributed to uneven HPV prevalence. Results A total of 12 175 participants 14‐59 years of age met inclusion criteria. Vaccine‐type HPV prevalence decreased in all regions. Vaccine‐type HPV varied by region only among unvaccinated 14‐34 year olds, with a higher prevalence in the Midwest (13.8%, 95% confidence interval (CI): 10.7‐17.0) and South (12.5%, 95% CI: 10.2‐14.8) compared to the Northeast (8.9%, 95% CI: 6.5‐11.2). No regional variation in vaccine‐type HPV prevalence was observed among vaccinated participants. Conclusions Higher prevalence of vaccine‐type HPV among unvaccinated women in the South and Midwest may contribute to regional disparities in HPV‐related cancer incidence, as emerging herd immunity may not be as strong in those regions., Uneven HPV vaccination across the US may be contributing to continued geographic disparities in HPV‐related cancers among unvaccinated young women, as emerging herd immunity may not be as strong in regions with lower vaccination rates.

This study examined within group heterogeneity in colorectal cancer screening (CRCS) among foreign-born individuals. Data were from the 2010, 2013 and 2015 National Health Interview Survey data on older adults (N = 5529). In 2018, multivariable logistic regression analysis was conducted to determine whether gender and race/ethnicity were associated with CRCS after controlling for sociodemographic, health access, and acculturation related factors. Overall, Asians were significantly less likely to report CRCS compared with Whites (aOR 0.63, CI 0.52-0.76). Hispanic race/ethnicity was negatively associated with CRCS among men (aOR 0.68, CI 0.50-0.91), but not women compared to white men/women, respectively. Additionally, factors associated with CRCS include having fair/poor health, usual source of care, insurance, ≥ 10 years of US residency and citizenship. Screening disparities experienced by these immigrants may be addressed by improving healthcare access, especially for noncitizens and those with limited healthcare access.

Introduction The consequences of low human papillomavirus (HPV) vaccination in Census regions with higher incidence of cervical cancer may contribute to continued disparities. Our purpose was to evaluate regional variations in HPV prevalence across time. Methods Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2003–2014 were examined. Participants included females 14 to 34 years old who provided adequate vaginal samples for HPV DNA typing (N = 6387). Region of residence and HPV vaccination status associations with HPV prevalence were examined using chi-square and multivariable logistic regression. HPV types were grouped according to vaccine-type HPV (types 6, 11, 16, 18) and risk (high or low-risk). Time and vaccination status were included in subsequent models for post-licensure survey cycles (2007–2014) to assess their effects on observed associations. Results No decreases in vaccine-type HPV prevalence were found between the prevaccine cycles (2003–2006) and early post-licensure cycles (2007–2010, p > 0.05). Vaccine-type HPV prevalence decreased in late post-licensure years (2011–2014) compared to prevaccine years (2003–2006, p = 0.001). The highest prevalence of vaccine-type HPV occurred in the South (8.6%) and Midwest (8.6%), followed by the West (4.8%), and the Northeast (3.5%) in late post-licensure years. Lower odds of vaccine-type HPV across time in post-licensure survey cycles were found to be attributable to time, and more strongly to HPV vaccination. Conclusions There were regional variations in vaccine-type HPV prevalence between prevaccine and post-licensure years. These decreases appeared to be at least partially attributable to HPV vaccination. Programs are needed to address geographical disparities in HPV vaccination.

Objective: Research is limited on how immigrant status affects provider recommendations and adherence to breast cancer screening among women with chronic conditions. This study examined whether chronic comorbidities are associated with breast cancer screening recommendations and adherence, as well as differences between foreign-born and United States-born women. Materials and Methods: The study examined data from the 2013 and 2015 National Health Interview Survey on women 50–74 years of age (N = 12,425). Chi-square analysis was used to assess relationships between chronic comorbidities (hypertension, diabetes, and obesity) and mammography screening recommendation and adherence (screened in the last 3 years). Multivariable binary logistic regression analysis examined the relationship between foreign-born status and mammography screening, adjusting for provider screening recommendation and chronic comorbidities. Results: Obesity and hypertension were positively associated with mammography screening recommendation and adherence (p

Purpose: To examine whether social network characteristics of US-and foreign-born individuals are related to hypertension, diabetes and obesity prevalence. Design: Cross-sectional. Setting: Six San Francisco Bay Area counties. Participants: N = 1153 cohorts of young and older adults (21-30 and 50-70 years). Measures: Network structure and support measures were calculated using name elicitation and interpreter questions common in egocentric surveys. Hypertension and diabetes were self-reported, and overweight/obesity was determined using body mass index calculations. Foreign-birth status was based on country of birth. Analysis: Adjusted and unadjusted logistic regression models were used to examine associations between network characteristics and hypertension, diabetes and overweight/obesity. These relationships were tested for moderation by foreign-birth status, age and gender. Results: Higher percentages of family members (AOR = 4.16, CI: 1.61-10.76) and same-sex individuals (AOR = 3.41, CI: 1.25-9.35) in the composition of respondents’ networks were associated with overweight/obesity. Higher composition of family members (AOR = 3.54, CI: 1.09-11.48) was associated with hypertension. Respondents whose networks composed of higher numbers of advice individuals (AOR = 0.88, CI: 0.77-0.99), female respondents (AOR = 0.52, CI: 0.35-0.77) and foreign-born respondents (AOR = 0.54, CI: 0.32-0.92) were less likely to report overweight/obesity. Diabetes was associated with higher composition of individuals living within 5-minutes to respondents (AOR = 5.13, CI: 1.04-25.21). Conclusion: Family and network support members such as advice individuals could be potential targets for chronic disease prevention, particularly among older adults and immigrants.

Background Prior studies have demonstrated differences in oral human papillomavirus (HPV) prevalence by sex and race/ethnicity. In this study, we examined the impact of vaccination on these disparities. Methods We examined participants aged 18–59 years in the National Health and Nutrition Examination Survey from 2011 to 2016 who reported their HPV vaccination status and submitted an adequate oral sample (N = 9437). Oral prevalence of HPV, grouped by any, low-risk, high-risk, 4 valent (4v) HPV, 9 valent (9v) HPV, and nonvaccine types, was examined by sex, race/ethnicity, and vaccination status. Binary logistic regression was used to estimate prevalence ratios by vaccination status. Multivariable logistic regression models controlled for age, sex, and race/ethnicity. Results The prevalence of any, nonvaccine, low-risk, high-risk, 4vHPV, and 9vHPV types was higher among males than females, even among vaccinated participants. Examination of racial/ethnic differences demonstrated differences in all HPV groups among unvaccinated males and among low-risk types in females. In all but the 2 vaccine-type groups, the prevalence of oral HPV was notably higher among Black males compared with other groups. Significant differences were not observed by race/ethnicity among vaccinated males or females. Conclusions Males tested positive for oral HPV more frequently than females, even among those vaccinated. This may have resulted from a lower frequency of males being vaccinated before initiating oral sex than females. Vaccination of males at the recommended age, therefore, may decrease differences in oral HPV by sex. Racial/ethnic differences were observed only in unvaccinated individuals, suggesting these disparities will decrease as more individuals are vaccinated.

Despite scholars’ early emphasis on the role people play in fostering firms’ absorptive capacity (AC), research has not deeply explored the individual-level antecedents of this important capability. We draw on adaptive-innovative theory to explain how top decision makers’ cognitive styles can influence the degree to which their firms develop AC. Top decision makers who have high adaptive cognitive style prefer to adhere to existing norms, follow established procedures, and rely on current knowledge, and we argue that these attributes will strengthen those dimensions of AC based on firms’ existing knowledge and knowledge-assimilation abilities. Top decision makers who have high innovative cognitive style are more likely to reframe information, experiment with new problem-solving approaches, and take risks by violating norms, and we argue that these attributes may strengthen those dimensions of AC based on firms’ acquisition of new knowledge and the assimilation of knowledge throughout the firm. We also argue that gender differences may moderate these effects. Empirical results support our hypotheses.

Background: Understanding reasons for birth control method choice may inform interventions that help young women choose the best method for them. The purpose of this study was to examine why young women in the general population select their method of contraception. Methods: An online survey was advertised through social media in 2017. After consenting, participants were gated through questions that ensured they were female, within the age range (16-25 years old), lived in the 50 U.S. states, and using intrauterine devices (IUDs), hormonal birth control, or barrier methods specified in the survey. Surveys with incompatible responses were excluded. Satisfaction, plans to discontinue, and primary reason for using current contraceptive method were examined and compared by contraception types using chi-square analyses. Multivariable binary logistic regression was used to examine satisfaction between contraceptive methods and races/ethnicities. Results: A total of 2632 responses were included. A high frequency of women using less effective methods (48.6% of nonhormonal birth control) chose them primarily to prevent pregnancy (20.6% of Copper T IUD, 23.0% of hormonal IUD, and 30.9% of Mirena IUD users), while other more effective birth control methods were often chosen primarily for other reasons. Recommendations from family or friends (14.6%) were used by some to make their contraception decision. Black respondents were less likely and Hispanic respondents were more likely to be satisfied with their birth control compared to white women. Conclusion: Providers should consider that their young patients may want to better understand benefits and side effects of their birth control outside of pregnancy prevention. Furthermore, young women may utilize their friends and family to make their contraceptive choice, which should be taken into consideration when counseling patients.

Highlights • Educating health providers is a strategy to increase vaccination rates in teenagers, A patient navigator (PN) program was implemented in pediatric clinics to increase uptake of the human papillomavirus (HPV) vaccine. The purpose of this study is to examine the impact of this program. All visits between April 1, 2013 and December 31, 2017 for 9–17 year old patients at 3 program and 5 non-program clinics were examined using electronic medical records. These dates included patient visits before and after program initiation (February 1, 2015). Visits including 1 dose of the HPV vaccine were assessed as a proportion of total visits for each month. Multivariable binary logistic regression was used to examine the odds of HPV vaccination across time, between program and non-program clinics, and age group. A total of 128,051 visits by 21,395 patients were examined. HPV vaccines were administered during 12,742 visits (10.0%). Odds of HPV vaccination during visits by 13–17 year olds was greater than during visits by 9–12 year olds in the pre-intervention period (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04–1.19). However, this association changed during the intervention period, with odds of HPV vaccination among visits by 13–17 year olds lower compared to visits by 9–12 year olds (OR: 0.78, 95% CI: 0.75–0.82). The odds of HPV vaccination were elevated among 9–12 year olds in program clinics as compared to 2014, the year before the program was implemented. Having on-site PNs can increase the frequency of HPV vaccination in pediatric clinics, particularly among patients 9–12 years of age.

To assess use, knowledge, and complications of cosmetic contact lenses (CCLs) among women of reproductive age.A cross-sectional, anonymous self-administered survey assessing cosmetic or decorative contact lens knowledge and experiences was completed by 686 women in Texas in 2017. Main outcome measures were use, knowledge, and associated complications.Almost 1 in 4 women (164/686) reported prior use of CCLs and most had worn the lenses3 times. Women born in the United States, who knew someone who wore cosmetic lenses, or had visited an eye doctor in the past year were more likely to have used CCLs. Knowledge scores were low and the majority of cosmetic lens users experienced complications (61%). The most frequently reported complications were eye pain and discomfort (35%); itchy, watery eyes (34%); and red, swollen eyes (28%). Borrowing lenses was significantly associated with medical complications (88% of borrowers reported complications). Among 18 respondents who sought medical attention for a CCL-related problem, only 11% obtained care within 24 hours. Few participants had discussed CCL use with an eye doctor in the past year.Many U.S. women have used CCLs obtained from unauthorized sources. Knowledge of safe practices is very limited and most users develop complications. Interventions are needed to educate the public about the risk of CCL use to reduce adverse outcomes.

Background Cosmetic contact lenses (CCL) are popular among adolescents, but incorrect use can harm the eye. Methods This study assessed CCL hygiene behaviors among adolescents attending a Texas pediatric clinic. Anonymous surveys about CCL hygiene practices were administered to adolescents 13-18 years old. Results We found that 14% (53/392) of respondents had worn CCL, of which 83% were females. Over 70% reported first use at 8 hours/day. Moreover, 15% of CCL users reported borrowing someone else's CCL. Complications resulting from wearing CCL were common. Conclusion This study highlights poor CCL hygiene among adolescents. These data demonstrate the need to develop interventions to educate adolescents on proper care and risks associated with CCLs.

Background Human papillomavirus (HPV) vaccination is expected to reduce HPV-related disease and cancer in the US. However, many parents are hesitant to obtain the vaccine for their children. The purpose of this study is to examine how the reasons for refusing the HPV vaccine vary across regions of the US, across time, and by race/ethnicity. Methods This study used data on 13–17 year old adolescents collected by the National Immunization Survey – Teen (NIS-Teen) annually between 2008 and 2016. We evaluated the frequencies of parents who did not intend to vaccinate their children in the next year among unvaccinated children. Among these non-intenders, we evaluated how reasons for HPV vaccine hesitancy changed across time, by region of the US, and race/ethnicity. Results The proportion of non-intenders among unvaccinated decreased from 72% in 2010 to 58% in 2016. The most frequent reason for vaccine hesitancy was that parents felt HPV vaccination was not necessary (22.4%), followed by lack of provider recommendation (16.2%), and lack of knowledge (15.6%). Lack of provider recommendation increased in frequency as a reason for HPV vaccine hesitancy until 2012, then decreased in frequency through 2016. Cost was one reason that was elevated in all regions compared to the Northeast. Black non-intenders were less likely to report safety, costs, or their children’s fear as reasons for not intending to vaccinate their children compared to white non-intenders. Hispanic non-intenders were more likely to report lack of knowledge and that the vaccine is not a school requirement as reasons not to vaccinate their children compared to white non-intenders. Conclusions National advocacy for improving provider recommendation for HPV vaccination likely contributed to a sharp decline in HPV vaccine hesitancy due to lack of provider recommendation. Results indicate the need for multifaceted interventions to increase HPV vaccination.

BACKGROUND: Low human papillomavirus (HPV) vaccination rates early after introduction, particularly among low income and minority adolescents, may have resulted in disparities in vaccine-type HPV prevalence (types 6, 11, 16, 18). The purpose of this study was to examine racial/ ethnic variations in HPV prevalence, and evaluate how HPV vaccination has affected vaccine-type HPV prevalence across time. METHODS: This study was a retrospective analysis of 6 cycles of the National Health and Nutrition Examination Survey (NHANES) data (2003–2014). Results on HPV status from vaginal samples of 14–26 year old females who responded about HPV vaccination were used to determine HPV prevalence. Prevaccine HPV prevalence was compared to post-licensure prevalence. Racial/ ethnic comparisons were made across time, and models were developed to examine the role of HPV vaccination in observed variations in vaccine-type HPV prevalence. RESULTS: Among 4,080 females, 29.7% were black, 25.6% were Mexican American, 8.9% were Hispanic, and 35.8% were white. Compared to prevaccine years (2003–2006), vaccine-type HPV did not decrease until late post-licensure years (2011–2014; 14.2% vs. 5.2%, p0.05) during the same periods, but the difference was not significant. Interactions between race and time were significant (p

Whereas chronic conditions and foreign-birth have an inverse relationship with cervical cancer screening, the combined effect of these factors on screening is unknown. This study examined the associations between chronic comorbidities and Pap screening recommendations and adherence, and whether these associations vary between foreign- and US-born women. In 2017, data from 2013 and 2015 National Health Interview Survey on women aged 21–65 years (N = 20,080) were analyzed. Bivariate associations between chronic comorbidities (hypertension, diabetes, and obesity) and cervical cancer screening recommendation and adherence (screened in the last 3 years) were examined using Chi-square analysis. Multivariate binary logistic regression was used to examine the association between foreign-born status and participant Pap test adherence, adjusting for physician Pap test recommendation and chronic comorbidities. Obesity, hypertension, and diabetes were positively associated with Pap screening recommendation. Hypertension and diabetes were negatively associated with screening adherence. Pap screening recommendation (60% vs. 57%, p

Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. Several initiatives aimed to encourage HPV vaccination have been adopted. Unfortunately, uptake of the HPV vaccine remains modest, despite evidence that vaccine-type HPV prevalence is decreasing as a result of HPV vaccination. Further, geographic disparities in vaccination uptake across different US regions and by race/ethnicity may contribute to continuing disparities in HPV-related cancers. More data are needed to evaluate impact of HPV vaccination on HPV prevalence in smaller geographic areas. Further, more information is needed on the impact of individual vaccination programs and policy on population level vaccination and HPV prevalence.

Background Overtreatment is a common concern for patients with ductal carcinoma in situ (DCIS), but this entity is difficult to distinguish from invasive breast cancers in administrative claims data sets because DCIS often is coded as invasive breast cancer. Therefore, the authors developed and validated algorithms to select DCIS cases from administrative claims data to enable outcomes research in this type of data. Methods This retrospective cohort using invasive breast cancer and DCIS cases included women aged 66 to 70 years in the 2004 through 2011 Texas Cancer Registry (TCR) data linked to Medicare administrative claims data. TCR records were used as "gold" standards to evaluate the sensitivity, specificity, and positive predictive value (PPV) of 2 algorithms. Women with a biopsy enrolled in Medicare parts A and B at 12 months before and 6 months after their first biopsy without a second incident diagnosis of DCIS or invasive breast cancer within 12 months in the TCR were included. Women in 2010 Medicare data were selected to test the algorithms in a general sample. Results In the TCR data set, a total of 6907 cases met inclusion criteria, with 1244 DCIS cases. The first algorithm had a sensitivity of 79%, a specificity of 89%, and a PPV of 62%. The second algorithm had a sensitivity of 50%, a specificity of 97%. and a PPV of 77%. Among women in the general sample, the specificity was high and the sensitivity was similar for both algorithms. However, the PPV was approximately 6% to 7% lower. Conclusions DCIS frequently is miscoded as invasive breast cancer, and thus the proposed algorithms are useful to examine DCIS outcomes using data sets not linked to cancer registries. Cancer 2018;124:2815-2823. © 2018 American Cancer Society.

Background Previous interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges. Methods We approached students aged 18–26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data. Results During interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends’ opinions, but would want to know about side effects that their vaccinated friends experienced. Conclusions Successful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness.

We administered an anonymous survey to assess knowledge, attitudes, and prevention practices related to the Zika virus among pregnant women residing in Texas. Multivariate logistic regression models controlling for age, race/ethnicity, education, and number of years in the United States assessed differences between women born in outbreak areas (N = 390) versus those born in the United States (N = 249). Results demonstrated that most women wanted more information on the Zika virus and desired to obtain it from their physician. The majority did not know that the Zika virus could be spread through sex with an asymptomatic partner or how often those infected were symptomatic. Few women took precautions to avoid mosquito bites. Only 40% reported frequently using repellent; 21% stated that cost was problematic and almost half were concerned about use during pregnancy. Three-fourths stated they would agree to vaccination, if available. Compared with U.S.-born women, those born in outbreak areas were more likely to have already discussed the Zika virus with their doctor (adjusted odds ratio [aOR] = 1.86, 95% confidence interval [CI] = 1.27, 2.71) and identify microcephaly as the most common birth defect (aOR = 2.59, 95% CI = 1.78, 3.76). Moreover, women born in outbreak areas were less likely to desire to keep it a secret if they became infected (aOR = 0.47, 95% CI = 0.31, 0.71). This study found that, regardless of birthplace, pregnant women need more education on the Zika virus disease and assurance regarding the safety of using repellent during pregnancy. They also need financial assistance for repellent, especially if living in states where transmission by mosquitos has been reported.

Introduction BRCA mutation testing has been used for screening women at high risk of breast and ovarian cancer and for selecting the best treatment for those with breast cancer. To optimize the infrastructure and medical resources allocation for genetic testing, it is important to understand the use of BRCA mutation testing in the U.S. health system. Methods This retrospective cohort study included 53,254 adult women with insurance claims for BRCA mutation testing between 2004 and 2014 from Clinformatics TM Data Mart Database. Data analysis was performed in 2016. This study assessed trends in the use of BRCA mutation testing in women with previously diagnosed breast or ovarian cancer and those without (unaffected women). Results Between 2004 and 2014, of those receiving BRCA testing, the proportion of BRCA tests performed in unaffected women increased significantly ( p BRCA tests used in unaffected women was found in each characteristic subgroup. In 2014, most subgroups had a proportion surpassing 50%, except for those aged 51–65 years and those without a family history of breast cancer. There was a much lower proportion of those aged 20–40 years among tested women with previously diagnosed breast or ovarian cancer than in unaffected women (17.6% vs 41.7%, p Conclusions During the past decade, the role of BRCA testing has gradually shifted from being used primarily in cancer patients to being used in unaffected women in the U.S.

Many medical students are not comfortable recommending the human papillomavirus (HPV) vaccine because they do not feel prepared to discuss it with their patients. A prior study demonstrated that this is particularly a problem among unvaccinated students. Our purpose was to determine if medical student attitudes and comfort with counseling could be improved by attending a single lecture delivered by an expert on the topic. To assess the effects of the educational program, we conducted pre- and posttests on medical students before and after a single lecture on HPV vaccination. Changes in items related to attitude and comfort were examined. Student characteristics associated with changes in scores were also examined and compared. A total of 256 medical students participated in the pre- and posttests. Before the lecture, students demonstrated low knowledge of HPV vaccination and did not feel comfortable counseling parents of younger patients. However, students

Background A postpartum human papillomavirus vaccination program was locally implemented to address low initiation rates among young adults. Within 20 months, the program achieved high vaccine initiation and series completion rates. Based on the program’s success, it was expanded to all 36 counties served by a public hospital. Objective This study aimed to conduct a quantitative and qualitative evaluation to examine the success and limitations of the program when expanded from 1 county to 36 counties, many of which are home to rural and medically underserved communities. Study Design Patient navigators reviewed the electronic medical records and immunization registry records of women aged ≤26 years, who delivered an infant at the public hospital, to determine whether they needed to initiate or complete the human papillomavirus vaccine series. Eligible women were counseled and offered the human papillomavirus vaccine during their hospital stay. Patient navigators scheduled follow-up injections in addition to the mother’s postpartum or her infant’s well-child visits, made reminder phone calls, and rescheduled missed appointments. Descriptive statistics, including frequencies and proportions, were used for patients approached in the initial and expansion programs. Frequencies from the initial and expansion programs were examined separately. Qualitative interviews were conducted with the clinic staff to evaluate the program. The qualitative analyses were conducted using NVivo (QSR International, Melbourne, Australia, version 10). Results Both initial and expanded programs achieved vaccine completion rates above 70%. Of the 2631 eligible postpartum women enrolled in the initial program, 785 (30%) had already been fully vaccinated. Of the remaining 1846 women, 1265 (69%) women received their first dose, and 196 (11%) women received their second or third dose on the postpartum unit. Of the 1461 women who received at least 1 dose through the initial program, 1124 (77%) completed all 3 doses. Of the 4330 eligible postpartum women enrolled in the expanded program, 886 (21%) had already been fully vaccinated. Of the remaining 3444 women, 2284 (66%) received their first dose, and 343 (10%) received their second or third dose on the postpartum unit. Of the 2627 women receiving at least 1 dose through the expanded program, 1932 (74%) completed all 3 doses. Clinic staff interviewed felt the program benefited the postpartum unit and clinics, because it increased patient knowledge of the vaccine, increased patient volume for vaccination, and gave healthcare providers more time to focus on other tasks. Conclusion Human papillomavirus vaccination on the postpartum unit is an effective way to increase catchup rates and is well accepted by healthcare providers. High completion rates can be achieved if adequate support is provided, even among patients residing in rural or underserved areas who need extensive support to access primary healthcare services. Although this particular program may be considered costly, it is overall effective because the vaccine prevents 5 different types of cancer in women. The inclusion of human papillomavirus vaccination in routine postpartum care is a relatively easy way to reach many adults not vaccinated at a younger age and could help address low vaccination rates among young women in the United States, including hard-to-reach populations.

We surveyed third-year medical students to assess whether personal vaccination status was associated with willingness to recommend the human papillomavirus vaccine to patients. A total of 231 students completed an anonymous survey evaluating their knowledge, attitudes, and personal vaccine history. Of 122 female students, 81 (66.4%) reported initiating the vaccine, as did 16 of 109 males (14.7%). Females and students ≤ 25 years old were more likely to be vaccinated. Knowledge did not vary by vaccination status, but anticipated behaviors did. Vaccinated students reported greater willingness to vaccinate adolescents before 15 – 16 years of age (92.1% vs. 78.6%, p=0.008) and discuss vaccination at any type of medical visit (100% vs. 89.7%, p

The objective of this study was to examine correlates of human papillomavirus (HPV) vaccine use according to Advisory Committee on Immunization Practices (ACIP)'s recommendations among US adolescent girls. We used National Immunization Survey of Teens 2013 data. Based on provider-verified (n = 9403) information, 57.3, 39.1 and 19.0 % of adolescent girls, initiated, completed and completed the HPV vaccine according to ACIP's recommendation (by age 12), respectively. Hispanic race/ethnicity, a physician recommendation for HPV vaccine and ≥1 influenza vaccine in the past 3 years were all associated with a higher likelihood of compliance with ACIP's recommendation. Girls from a larger family and those whose immunization provider was a STD/school/teen clinic were less likely to receive the vaccine at the recommended age compared to a girl raised in a smaller sized family and received immunization from a hospital facility, respectively. Only one-fifth of 13-17 yo girls receive the HPV vaccine by age 12 as recommended by ACIP. Physician visits and influenza vaccination settings are opportunities to improve vaccine series completion at the recommended age.

Objectives To examine the accuracy of parental report of HPV vaccination through examination of concordance, with healthcare provider vaccination report as the comparison. Methods The 2008–2013 National Immunization Survey (NIS)-Teen was used to examine accuracy of parent reports of HPV vaccination for their female daughters aged 13–17 years, as compared with provider report of initiation and number of doses. Multivariable logistic regression models were used to examine associations related to concordance of parent and provider report. Results Of 51,746 adolescents, 84% concordance for HPV vaccine initiation and 70% concordance for number of doses was observed. Accuracy varied by race/ethnicity, region, time, and income. The parent report of number of doses was more likely to be accurate among parents of 13 and 14 year old females than 17 year olds. Accuracy of initiation and number of doses were lower among Hispanic and black adolescents compared to white parents. The odds of over-report was higher among minorities compared to whites, but the odds of underreport was also markedly higher in these groups compared to parents of white teens. Accuracy of parental vaccine report decreased across time. Conclusions These findings are important for healthcare providers who need to ascertain the vaccination status of young adults. Strengthening existing immunization registries to improve data sharing capabilities and record completeness could improve vaccination rates, while avoiding costs associated with over-vaccination.

Purpose Little is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior. Methods This retrospective cohort study using administrative insurance claims records included 24,964 19–26 year old women who received at least 1 injection of the HPV vaccine between January 2006 and November 2009. Vaccinated young women continuously enrolled in a nationally-representative private insurance plan for 6 months prior to and 37 months after HPV vaccine administration were included. Logistic regression was used to compare the odds of Papanicolaou (Pap) testing 3 years after vaccine initiation by number of vaccine doses and provider type. Results In this sample, 79.3% had a Pap test 3 years following vaccine initiation. Receiving 1 (aOR: 0.60, 95% CI 0.55–0.65) or 2 (aOR: 0.80, 95% CI 0.74–0.87) doses was associated with decreased odds of Pap testing compared to 3 doses. Many young women in our sample (16.5%) were diagnosed with cervical dysplasia prior to HPV vaccination. Patients vaccinated by non-obstetrician/gynecologists were less likely to get a Pap test following vaccination. Conclusions Women who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3 years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.

Race/ethnicity has been shown to modify the effects between obesity and cancer screening among women. The purpose of this article is to update the literature with recent data to examine how the association between different characteristics, including body mass index (BMI), and cancer screening compliance varies by race/ethnicity in a national sample of women.Three cycles of the Health Information National Trends Survey (HINTS) were combined for this cross-sectional study. Weighted descriptive statistics were evaluated using chi-square tests. Multivariable logistic regression evaluated associations between women with underweight or normal (25), overweight (25-29.9), and obese (30) BMIs and cancer screening concordant with guidelines (Papanicolaou [Pap] testing ≤3 years, ages 21+ years; mammography ≤2 years, ages 40+ years) in analyses stratified by race/ethnicity. We also assessed variance between racial/ethnic groups in how age, income, and insurance status were associated with cancer screening compliance.This study included 4992 women who were evaluated for Pap testing and 3773 for mammography. In analyses stratified by race/ethnicity, whites with a higher household income were more likely to report having a Pap test (adjusted prevalence ratio [aPR] 2.16, 95% confidence interval [95% CI] 1.38-3.40) and a mammogram (aPR 1.63, 95% CI 1.04-2.55) compared to lower income white women. Black women with BMIs between 25 and 30 were less likely to receive a Pap test (aPR 0.38, 95% CI 0.19-0.76) than black women with BMIs25, while no association was observed among the other groups. Insurance was associated with increased likelihood of Pap testing among white and black women. Insurance coverage was positively associated with mammography only among white and Hispanic women.We found variations in adherence to cancer screening guidelines by age, insurance coverage, and income between racial/ethnic groups. Little evidence was observed for variations in screening by BMI.

Dental professionals are encouraged by the American Dental Association (ADA) to recommend the HPV vaccine to eligible patients. To better understand their comfort level in following this recommendation, we conducted a mixed methods study of dentists and dental hygienists. A total of 173 providers were surveyed and 8 interviewed. The majority felt they had an important role in preventing HPV-related OPC and that they should educate their patients and encourage HPV vaccination. However, most providers had low knowledge about HPV and expressed a need to obtain more information on the topic. In particular, they desired information about the HPV vaccine, its connection to cancer and where to refer patients for vaccination. They also wanted access to visual aids to help them bring up the topic. This study demonstrates the need to develop and disseminate educational programs for dental providers so they can assist with efforts to raise HPV vaccination rates.

Objective: To evaluate the efficacy of an intervention utilizing patient navigators (PNs) to 1) educate families on human papillomavirus (HPV) vaccination in a clinic setting and 2) provide personalized reminders for follow-up. Method: Families with 9–17 year-old children who had no record of completing the HPV vaccination series receiving primary or specialty care in 3 pediatric clinics were approached by PNs between February 1, 2015 and August 31, 2016. Demographic characteristics, visit type, preferred contact method, rates and correlates of completion, and appointments missed were analyzed. In addition, qualitative interviews of 21 providers and PNs assessed their perceptions of the program. Results: 1,391 adolescents were identified out of 2,162 patients approached as unvaccinated or partially vaccinated prior starters; among the unvaccinated, 930 received the 1st dose after being counseled by the PN (66.9%), either immediately or at a follow-up visit soon thereafter. This included 118 siblings of patients who did not have an appointment that day. Of initiators approached between 2/1/2015 and 8/31/2016, 93% (864/930) completed the series by 8/31/2017. No differences in series completion among initiators were observed by gender or race/ethnicity, but older patients (15–17 years old) were less likely to complete than 11–12 year olds. Of the 688 patients identified as prior starters, 85% completed the series through the program. Qualitative interviews demonstrated that providers felt the program addressed major barriers to HPV vaccination. Conclusion: Employing PNs dramatically increased HPV vaccine series completion among boys and girls with historically low HPV vaccination rates at pediatric clinics in Texas. Clinic providers felt this program addressed many barriers they observed prior to program implementation. This approach could markedly improve HPV vaccine series completion rates in the US.

To determine if there are any differences in the patient populations that choose subdermal implants versus intrauterine devices (IUDs) for contraceptive purposes.Retrospective chart review. Electronic medical records of women who presented to the University of Texas Medical Branch in Galveston's Regional Maternal Child Health Program Clinics in southeast Texas from March 2011 to March 2013 and received a subdermal implant or IUD were reviewed. Differences in characteristics of women who chose either form of contraception were determined.A total of 356 charts were reviewed. Of those, 188 (53%) women chose the subdermal implant and 168 (47%) chose an IUD. Patients who chose subdermal implants were more likely to have had a long-acting reversible contraceptive (LARC) method previously (p0.01), previous vaginal deliveries (p0.001), and an interval from delivery to LARC placement of1 year (p0.001). LARC choice was race-specific in that, when compared to Caucasian women, African-American women were significantly more likely to choose an IUD, while Hispanic women were significantly more likely to choose subdermal implants (p=0.002).Different populations choose subdermal implants versus IUDs for contraception. Further research is needed to determine etiologies for these differences.

Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is recommended for all women during each pregnancy to prevent pertussis in young infants. However, data on the safety of this protective measure are limited and conflicting. To assess maternal and infant outcomes associated with administration of this vaccine during pregnancy, we reviewed medical records of 1,759 women who delivered a singleton infant at a southeast Texas public hospital between November 1, 2012 and June 30, 2014. After excluding women who had inadequate prenatal care or who delivered at

Objective Clinical guidelines recommend that women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age. However, screening remains common among US women over 65 years old. This study was conducted to examine whether overutilization was attributable to provider’s recommendation or patient choice. Method This cross-sectional study used data from 1752 female participants (70 + years) from the 2013 National Health Interview Survey (NHIS). We quantitatively assessed the proportions of provider-recommended and patient self-initiated Pap smears. Results Among female respondents, 40.8% had a Pap smear within the past 3 years, 19.4% had a Pap smear in the last year, and 39.7% reported receiving a recommendation for a Pap smear from their provider in the past year. Among women who received a recommendation to obtain a Pap smear, 39.8% did so within the past 12 months compared to 5.9% of women who did not receive a recommendation (adjusted odds ratio 10.5, 95% confidence interval 7.39–15.0). About 70% of women who visited an obstetrician/gynecologist and reported receiving a recommendation to have a Pap smear did so in the past year, while 32.3% of women who visited an obstetrician/gynecologist but did not receive a recommendation obtained one. Conclusion Pap smears were common among women ≥ 70 years of age. Health care providers may need additional education on current guidelines regarding indications for Pap smears in this age group to help reduce screening of patients who may not benefit.