Public Health Program: Increase uptake of HPV vaccination in the youth of Jamaica, Queens
Define the problem:
Human papillomavirus (HPV) infection is a common virus, with 80 million people, or one in four, currently infected with the virus in the United States. It is estimated that 14 million people become infected each year, including teens. HPV can go without notice in the infected person, but it can also have serious health consequences. It can cause cervical, vaginal, or vulvar cancer in women, cancers of the penis in men, and anal and throat cancers in both men and women. According to the CDC, each year HPV causes 30,700 cases of cancer in men and women. The HPV vaccine has the ability to prevent about 28,000 of these cancers from ever occurring, which is why it is so important to educate and advocate for the vaccine in young men and women.
Boys and girls should get the HPV vaccination at age 11 or 12, which is when the vaccine is the most effective and ideally before possibly exposure to HPV. These children need two shots on the vaccine 6-12 months apart, and if they are received less than 5 months apart, a third dose is required. If adolescents don’t receive the vaccinations at age 11 or 12, it is still recommended for women up to 26 years old, and men up to 21 years old.
In Jamaica and Hollis, only 32% of girls ages 13-17 are reported to have received all 3 doses of the HPV vaccination, ranked 41st compared to other teens citywide. For comparison, NYC has a rate of 43%, and Queens has a rate of 41%.
Rates of teen births (ages 15-19) in Jamaica ranks well above Queens and NYC at 27.2 per 1,000 girls. This could be indicative of the teen population in Jamaica either being more sexually active, or not using proper protection during sex, which may lead to a higher risk of exposure to HPV and is another reason why increasing the uptake of the HPV vaccination is important in this community. Public health measures need to be taken to raise awareness and educate on the importance of the HPV vaccine.
Identify Risk and Protective Factors:
As we are aware, health disparities are more likely to occur amongst minority populations, which can potentially lead to barriers to receiving necessary care. In Jamaica, the population is 67% black, 17% Hispanic, 11% Asian, 3% other and 2% white. 15% have limited English proficiency, another factor that can lead to poor health outcomes. Dr. Mary Bassett from the New York City Department of Health and Mental Hygiene points out that, “poor health outcomes tend to cluster in places that people of color call home and where many residents live in poverty.” Jamaica and Hollis have a 17% poverty rate.
Lack of access to care because of financial struggles can also be a barrier to receiving health care for parents and their children. In Jamaica and Hollis, close to one in seven adults (15%) ages 16 and above are unemployed. Additionally, 24% of adults in Jamaica and Hollis do not have health insurance, making their access to health care limited, which could mean also limiting their children’s access to care.
Lack of education on an issue such as thing one could also be a barrier. Residents of Jamaica may not know how dangerous HPV can be or that it can be prevented with the vaccination if they do not see their PCP regularly. Misinformation and prejudgement could also come into play, causing residents to avoid necessary vaccinations such as this one.
Preliminary data was gathered and shown above for the percentage of girls having received the vaccination, however we will need additional data for boys as well. We will also distribute surveys either by mail, phone, or on foot to residents in the area to assess why more children are not getting the vaccinations. This data will then give us a better idea of what the most important barrier is, and therefore guide us on what to focus on when creating educational messages for our campaign.
Timeline:
The focus of this public health program will be to increase HPV vaccination in children ages 11-18 in Jamaica, Queens by 20% over the course of about 2 years. The purpose for the age range: 1) 11 is the recommended starting age for boys and girls to receive the vaccine and 2) At these ages they are still in grade school, therefore the message can be constantly reemphasized in their educational setting. We will seek to educate students and their parents of the dangers of HPV and how important receiving the vaccine is through an ongoing social media campaign within schools. By creating numerous accounts on various social media sites and promoting these accounts on posters throughout the school, we have the opportunity to gain attention and reach our goal. The first year will be dedicated to building our social media accounts and follower base, securing a few different local sources for positive promotion (such as local news or local businesses), and gaining the approval and support of the community towards our message. The second year will be dedicated to ensuring that the program is lasting and sustainable in schools in Jamaica, and maybe even spreading to other areas in Queens.
Funding and Key Stakeholders:
We will need about $100,000 for the two years to fund the project. This will cover print supplies to display in schools, campaign “swag” such as promotional pens/pencils and T-shirts to hand out in schools, free-lance marketing services for the social media designs, and other staffing for oversight of the program in general. The Fund for Public Health in New York City would be a good partnership, as they connect the NYC Health Department with public and private sector parters to build and fund public health programs.
Key stakeholders in this campaign would be the children of Jamaica, NY Health Department, local hospitals and clinics, and primary care clinicians in the area.
Sustainability and Ensuring Widespread Adoption:
I believe this program could be sustainable for the next 5-10 years because the benefits of receiving the HPV vaccine are not a trend or a fad that will likely lose the interest of people in the community. HPV is one of the most important public health concerns in our society and will continue to be for many, many years to come. With success, this program could hopefully gain permanent funding from the state. Ideally the campaign would turn into a small non-profit organization with a full time staff. In this way, new and innovative techniques will be used to constantly provide information regarding HPV and updated statistics. Also, social media accounts are all free, so as long as the campaign has a strong marketing team and dedicated staff, the information will exist and continue to be promoted.
Another way to keep the program sustainable within schools is to create around 3-4 student and faculty ambassador positions. The faculty ambassadors could be beneficial members of the campaign by influencing the support and participation from fellow faculty members and parents, and making sure things are running smoothly from the inside. The position would not be too time consuming, so the compensation could be relatively reasonable pertaining to program budget. Student ambassadors could do the same with fellow students. Adolescents and teens are very impressionable and tend to gain interest in what their peers are interested in, so a student ambassador is likely to effectively gain the support of the student body. The take away from this position could be that it would be an impressive part of their college applications, and give them valuable experience for the future work force.
RE-AIM program evaluation:
| Purpose | Indicator | Data Level | Method/Data Source | Phase (Time) |
| Reach | % Vaccinated/ Not vaccinated
% Insured/ Not insured |
Participant | Current online data
Surveys |
Recruitment |
| Effectiveness | % Newly vaccinated
Followers on social media accounts |
Participant | Surveys
Numbers on social media |
Implementation |
| Adoption | Widespread knowledge about the program
HPV series correctly received
Continuation of advertisement
|
Participant
Participant
Staff |
Community opinions (surveys)
Individual vaccination reports
School faculty/staff involvement |
Post-intervention |
| Implementation | Staff and school ambassadors constantly updating information and engaging participants | Staff | Periodic review
Exit surveys (12th graders graduating) |
Post-Intervention |
| Maintenance | Frequent but relevant postings on social media accounts to keep followers engaged
Outreach activities and charity events throughout the year |
Staff | Approval ratings
Attendance |
Post-intervention |
Sources:
https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-qn12.pdf
https://www.cdc.gov/hpv/parents/vaccine.html
http://www.fphnyc.org/innovators/who-we-are/
