2018 winter: HPPA 516 Public Health: Promoting the HPV vaccine uptake in African American community

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Promoting the HPV vaccine uptake in African American communities in Jamaica, NY.
1. Scope of the Problem –
Human papillomavirus (HPV) is a DNA virus to infect humans leading to warts or precancerous lesions to increase the risk of cancers of cervix, vulva, vagina, anus, penis, and oropharynx. USA had a high prevalence (42.5%) of genital HPV infection among persons aged 18 to 59 years during 2013–2014 and the rate of HPV infection among African Americans is 1.5 times higher than that of white Americans. In USA, there are three available HPV vaccines (HPV2, HPV4, and HPV9) to prevent the different types of HPV infection. Vaccination of adolescent girls at ages 11 to 26 years and boys aged 11 to 21 years with HPV vaccine has been recommended. But HPV vaccine uptake remains low. It has been demonstrated by a 2015 national survey that only 42% of girls aged 13–17 years and 28% of boys aged 13–17 years had received all recommended doses. In addition, it has been observed that African American adolescents even have much lower HPV uptake rates while there are much higher HPV infection rate and cervical cancer rate among African Americans.

Multiple interventions have been made to address poor vaccination rates. Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the Society for Adolescent Health and Medicine (SAHM) all recommend the HPV vaccine. Most insurance plans and the Vaccines for Children (VFC) program cover the HPV vaccine at no cost. But obviously, more efforts need to be made. Firstly, more access to HPV vaccine needs to be provided. It has been revealed that HPV vaccine was not offered in nearly half of the children clinics within the Health and Hospitals Corporation. Secondly, there are still many health care providers not recommending HPV vaccination to the eligible. Thirdly, education of adolescents and parents should be strengthened. Studies showed one-third of African American parents even do not have the knowledge of HPV and HPV vaccination. Additionally, many parents believe HPV vaccine only benefits sexually active teens. Another mistaken belief among parents is that HPV vaccine is not safe. Strengthened HPV promotion and education efforts are needed in the African American communities. Since our college is at Jamaica, where nearly half of residents are African Americans, improvements could begin there. African American adolescents in Jamaica, NY would benefit from the intervention. In addition, successful prevention of HPV infection would decrease the possible medical care cost and prevent the spread of infection to benefit all the communities.

2. Planning –
The possible interventions include both environmental and behavioral changes. Firstly, increasing the accessibility and convenience to get the HPV vaccines to change the environment, including providing more HPV vaccines and requiring more facilities such as clinics, community centers, schools and pharmacies to engage in HPV vaccination in Jamaica. Secondly, requiring schools and employers in Jamaica to add information of HPV vaccination in the health exam forms of eligible students and employees. Thirdly, educating health care providers in Jamaica about HPV vaccination and requiring their participation in the education and recommendation of HPV vaccination for the eligible adolescents. Fourthly, providing more programs and handbooks in community centers, schools, libraries, gyms, and shopping centers to educate adolescents and parents about HPV and HPV vaccination. At last, providing rewards to the adolescents in Jamaica who have received the doses of HPV vaccine. All of these factors can be changed.
Identify your key stakeholders and discuss how you would get their buy-in.
Stakeholders should include legislators, vaccine industries, health care providers, school educators, employers, parents, students and employees. Legislators would like to accept the interventions since HPV vaccination can prevent infection, low the cancer risks, and promote the health in addition to the economic benefit that the cost of HPV vaccines and related education will be much less than the possible medical care. Health care providers, school educators, and employers would like to accept the interventions since only minor interventions could prevent disease and promote health. Vaccine industries would like to accept the interventions because they earn money. Parents, students and employees benefit due to disease prevention, health promotion and rewards, and would like to accept the interventions. In addition, the cost of HPV vaccination is inexpensive and usually covered by insurance.
I would like to obtaining information about the HPV uptake, access, recommendations of health care providers, requirements of schools and employers, and the knowledge of HPV and HPV vaccine with surveys within the adolescents (females aged 11-26 and males aged 11-21) and their parents in the African American population and the whole population in Jamaica. To study the effects of interventions, I would like to use cohort studies to determine if there is significant change in HPV uptake after interventions.
It is a local public health program and I will apply for the public health funding from New York City and New York State. (https://www.health.ny.gov/funding/ and http://www.fphnyc.org/)
I believe my program will be feasible in the long run. It is not an expensive program, HPV vaccination is always needed, education is long-term course and changes of attitude will be step by step, suggesting it will be a long-term program.

3. Development & Dissemination of the Intervention –
My goal is all or most eligible adolescents (females aged 11-26 and males aged 11-21) in Jamaica, especially African Americans, receive all the doses of HPV vaccine. I hope 80% of eligible adolescents in Jamaica get HPV vaccination.
The inputs include the cost of studies, HPV vaccines, rewards, handbooks, training, and fee paid to the health care provider and educator, and time spent on education, training, related research and vaccines and handbooks distribution.
HPV vaccines should be ordered and distributed to hospitals, clinics, community centers, schools and pharmacies in Jamaica as required. Education handbooks about HPV and HPV vaccine should be made and distributed to hospitals, clinics, pharmacies, community centers, schools, libraries, gyms, and shopping centers in Jamaica as required. Before working or going to school in Jamaica, HPV vaccination information should be in the health exam form. The training and education of health care providers, teachers, employers, parents and adolescents in Jamaica could be in the form of forum, one hour every three months. The education of adolescents by teachers and employers in Jamaica could be in the form of informal presentation 15 min every month. The health care providers in Jamaica can give the consultation to every eligible adolescent for about 10 min. The education is about the information of HPV, HPV risk and HPV vaccination. $100 should be awarded to adolescents in Jamaica who have received the doses of HPV vaccine by local government.
4. Evaluation & Maintenance –
I will evaluate my program by HPV vaccine uptake rate of eligible adolescents in Jamaica collected by surveys every year.
If my interventions are unsuccessful, I will do more studies to determine what is wrong. I will check if HPV vaccines and education handbooks are available for who need them. I will do a survey to check if health care providers provide the consultation for the eligible, if the eligible are rewarded and if the schools and employers require the HPV vaccination information. I will also do a survey to check if the adolescents and parents have mastered related knowledge. Of course, I will do a survey about the reasons not to accept HPV vaccination and the viewpoints on the interventions among eligible adolescents and parents. I will change the interventions according to analysis of studying results.
I would maintain my program over the next 5-10 years by sources of funding from New York State and/or New York City.

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