UT Southwestern Medical Center
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| How can any responsible adult oppose vaccinating children to prevent the spread of cervical cancer? Ask Rep. Flip Filippi. |
A joint study by UT Southwestern Medical Center and Parkland
Health & Hospital System investigators found that a multicomponent outreach
program increased completion of the three-dose human papillomavirus (HPV)
vaccination series that reduces the risk of cervical cancer caused by the
virus.
"Delivery of the HPV vaccine in safety-net settings is
critically important because uninsured African-American and Hispanic women have
higher rates of cervical cancer," said Dr. Jasmin Tiro, Associate
Professor of Clinical Sciences at UT Southwestern, who led the study.
According to the National Cancer Institute (NCI), HPVs are the
most common types of sexually transmitted infections in the United States and
can be spread by vaginal, anal, or oral sex. Completing the HPV vaccine series
before beginning sexual activity reduces risk of infection from the HPV types
targeted by the vaccine. HPV infection can cause cervical, head and neck, and
anal cancers, plus genital warts.
Despite the HPV vaccine being available since 2006, challenges
remain in persuading parents and their teenage children to complete the vaccine
series.
"Teens should receive all three recommended doses to protect against HPV infections that can persist and lead to cervical cancer," added Dr. Tiro, also Co-Leader of the Cancer Control and Population Science Program at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center.
Published in the journal Pediatrics, this study is
the first to compare effectiveness in safety-net populations of HPV-specific
information and follow-up calls to those overdue for later doses of the vaccine
versus more traditional general vaccine information. The work was funded by the
Cancer Prevention and Research Institute of Texas.
The study was conducted at Parkland, the public health system
for Dallas County, the ninth largest county by population and one of the most
ethnically diverse counties in the U.S. From Parkland's system of 10
neighborhood-based pediatric clinics, researchers identified four clinics with
the largest volume of patients aged 11 to 18.
All of the clinics use electronic
health records. At the time of this study (2010-2011), the vaccine was only
recommended for girls. Since then, the Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices has recommended that
boys also receive the vaccine.
The 814 girls in the study were randomly assigned to one of two
groups. Those in one group received a general adolescent vaccine brochure.
Members of the other group received an HPV vaccine-specific brochure, plus
telephone calls to parents who declined, and reminder calls to patients overdue
for the second and third doses of the vaccine.
One year later, HPV one-dose and
three-dose coverage rates were assessed via electronic health records. Study
participants were diverse -- 68 percent Hispanic and 28 percent
African-American.
The HPV vaccine-specific educational brochure, designed to motivate
parents to start the series, had mixed results by race/ethnicity. Developed
with feedback from Parkland parents to explain the value of the cancer-fighting
HPV vaccine in a culturally sensitive manner, the brochure was effective for
Hispanic parents only.
"Our study shows that one brochure does not work for all
parents at Parkland. Parents have different information needs, and different
messages will motivate them to start the series. As a follow-up to this study,
our current grant from the NCI supports testing a tablet-based self-persuasion
intervention to address the needs of different subpopulations at Parkland --
adolescent girls and boys, Hispanics, and African-Americans," said Dr.
Tiro.
The senior author of the study is Dr. Donna Persaud, Parkland's
Chief of Pediatric & Adolescent Medicine, Population Health Division.
"As a result of this research partnership, Parkland has
focused on improving vaccine outreach, education, and parent-provider
discussions with African-American families," said Dr. Persaud.
"We
are implementing a quality improvement program funded by the state's Delivery
System Reform Incentive Payment (DSRIP) Program. Preliminary results show a
small, steady increase in HPV vaccine completion among African-American girls
by their 13th birthday. The rate increased from 14.8 percent to 21.1 percent
during the period October 2014 through September 2015."
"HPV vaccine delivery is challenging because of the dosing
schedule and parental hesitation about vaccines," said contributing author
Dr. Celette Sugg Skinner, Interim Chair of the Department of Clinical Sciences,
Associate Director for Population Research at the Simmons Cancer Center, and
holder of the Parkland Community Medicine Professorship at UT Southwestern.
"Given these challenges, we must offer both education and vaccine
opportunities at all health care visits. UT Southwestern and Parkland are
committed to eliminating health care disparities and improving cancer
prevention services."
The authors recommend that future research test mechanisms that
may mediate intervention effects for different racial/ethnic groups, such as
different informational needs, experiences, norms, or cultural beliefs.
