Intervention to increase the percentage of teenagers and adults that receive the HPV Vaccine in Jamaica, Queens

 

Scope of the Problem –

HPV (Human Papilloma Virus) has more than 150 related viruses, some of which could lead to cancer. Some of the cancers that are caused by HPV include mouth/throat, anus/rectum, and for pen, penile HPV cancer. For women, HPV infections could cause cervical, vaginal, and vulvar cancers. HPV is transmitted through sexual contact, including vaginal, anal, and oral sex. HPV infection is very common, infecting 70% of Americans at least once in their life time. In most cases, HPV eliminates itself and does not cause any health concerns, but 10% to 30% of infections stay leading to future health problems. Fortunately, there is a vaccine for HPV, called Gardasil 9, which protects against HPV strain 16 and 18, which are most likely the cause of cancer. This vaccine also protects against 5 more strains that are linked with cancer. Recommendations for the HPV vaccine include all boys and girls ages 11 and 12, all men up till the age 21, and all women, gay or bisexual men, and immunocompromised people though age 26. Receiving the HPV vaccine could save nine out of ten men and women from anal cancer and eight out of ten women from vaginal cancers. These examples were overviews of two of the many benefits that HPV vaccination can lead to. The HPV vaccine is given in a series of two or three shots, depending on the age of the recipient.

 

The underlying issue is that only 30% of girls and 14% of boys who are between the ages of 11-13 are fully vaccinated. Despite the recommendations of the CDC and legislation efforts to require the vaccine, fun, or educate the public or schools about the HPV vaccine, only 60% of the nation’s population chooses to get this vaccine. Only 32% of teenage girls in Jamaica, Queens get the full HPV vaccine series. This percentage is considerably lower than the percentage of teenage girls that get the HPV vaccine in all of Queens (41%) and NYC (43%). There needs to be an emphasis placed on HPV and its vaccine, allowing young teenagers and adults to be aware of the harmful effects of HPV and how they can be prevented. Beneficiaries from this intervention include sexually active teenage girls and boys, sexually active men, women, gays, bisexuals, the general population as they age and more.

 

 

Planning –
The purposed intervention includes more emphasis on educating teenagers, ages 11 through 18, about the benefits of receiving the HPV vaccine, and harms of not getting vaccinated against HPV. This will be done through by school teachers, parents, and providers. Academic educators need to spend more time talking about the HPV vaccine with their students, making sure their students have a general understanding of the harms and benefits of the situation. Parental support is necessary to excel this intervention, teenagers will most likely not go to their PCP on their own, but instead go with a parent. There needs to be more efforts directed towards informing parents about the HPV vaccine and its long-term benefits. Finally, PCP’s and pediatricians need to communicate with their younger patients about the vaccine. According to a study done by Health News, less than 50% of PCP’s and Pediatricians fail to recommend the HPV vaccine, due to their hesitancy to talk about sexual activity among teenagers. This is obviously an issue that needs to be addressed independently, but overall, all three factors: teachers, parents, and providers have a common denominator: awareness. All these suggestions are not life changing, but instead minute interventions that could change statistical outcomes about cancers in the future. None of the suggestions that are made are unrealistic, and with a bit of funding and passion, should be carried out in a simple manner.

 

Stakeholders in this scenario include legislators, academic educators, parents, students, and providers. After showing the benefits of the HPV vaccination and how it could reduce the risk of certain types of cancers, considering the amount of money that is spent on cancer patients, legislators should not have an issue implanting this intervention in Jamaica, Queens. Academic educators, such as teachers, should be provided with minor incentives to talk about HPV with their students, such as paid for lunch once a week, or an extra personal day for the year. For parents and teenagers, all that is needed to encourage them to get vaccinated is providing them with information regarding their future health. If we are able to reach out to them in a way that they are able to understand the benefits of getting the HPV vaccine, there should not be any problems at hand. As for providers, it is our job to inform our patients and recommend the vaccination, even if it is an uncomfortable topic to discuss with parents. As an incentive, the practitioners should be reimbursed if they counsel their patients on the HPV vaccination or administer it. If there is an issue that appears form the insurance companies about reimbursement, the statistics should be sufficient evidence to show that practitioners are preventing expensive complications in the future, which should be a reason why the reimbursement should proceed.

 

Funding should be provided by the state, as this should not be an expensive intervention. Educators do not need to spend anymore time in the class room than they already do, in order to inform their students about HPV vaccination, and practitioners should be spending no more than 10 minutes introducing, discussing, and administering the HPV vaccine. Additional surveys could be taken in school settings, asking students from ages 11 to 18, if they know what HPV is, if they have heard of HPV vaccination, and if they have received the vaccination for it. Because this intervention is not financially based, and because it is dependent on the efforts of academic educators and providers, there should be a high chance of this program obtaining long-term success. Another reason for its long-term feasibility would be because it’s not a dramatic change, but instead pulsations of change taking place over the years. Since stakeholders won’t have to change their normal lives, but instead just keep in mind that HPV needs to be discussed, at some point, also increased the chances of long-term success.

 

 

Development & Dissemination of the Intervention –

The goal of this intervention is to decrease the number of unvaccinated teenagers and adults against HPV. Even if there is a five to ten percent decrease per year, in the number of unvaccinated teenagers, that would be sufficient evidence that the intervention is a success. Achievement would include having at least 95% of teenagers and adults vaccinated against HPV within the next 25 years. Time is the number one input that could influence the success of this intervention. Stakeholders need to be patient and take out time from their normal routine to spread awareness of HPV vaccination in the efforts to prevent future harm. Money is going to be the second largest input in this intervention, providing incentives for academic educators and providers. Even though this should be a fairly inexpensive intervention, time is money, and time needs to be spent for success. The incentives for the providers and academic educators, as well program directors will cost money, but once again, it should not burn a hole in the federal budget.

 

Actual interventions would include the following stakeholders preform these task:

 

• Academic Educators:
• Homeroom teachers would spend at least 15 minutes per week discussing HPV and the vaccination for it. Teachers should be asking certain questions from their students, such as “How many of you know what HPV is?”, “How many of you know what it could lead to?”. “How many know that there are shots to protect yourself from HPV?” and so on.
• Teachers could also bring up the discussion of HPV vaccination during parent-teacher conferences. It should not be something that takes a long time, but instead something very brief, just so the parents are aware that this is an issue that is being taken seriously.
• Schools could hold an HPV awareness event, once in the beginning, where students and parents are both encouraged to come. Providers and teachers could be present and spread awareness to families about HPV. Incentives for parents to come would include food and drinks and incentives for students to come would include games and rewards.

 

• Providers:
• PCP’s and pediatricians, especially, should talk to their patients and parents about HPV and its vaccination. There should be a designated time in which providers abide by to make sure their patients are aware of HPV and its future harms. This time slot should be no more than 10 minutes long, unless the provider feels otherwise.

 

 

 

Evaluation & Maintenance –

 

No intervention is complete without an evaluation, and this HPV vaccination intervention is no different. The first way to see if the intervention is working would be to get statistical analysis if more teenagers and adults are receiving through health records in local clinics. Another way to see if this intervention is working would be to give a survey a year after the initiation of the intervention to grades 6-12, and see if they are anymore aware of HPV than the following years. This survey should include questions like:

• Have you heard of HPV (Human Papilloma Virus)?
• Have you heard that there is a vaccine against HPV?
• Have you received this vaccine?
• Have you ever spoken to your parents about HPV or its vaccine?
• Have your parents ever spoken to you about HPV or its vaccine?
• Has your Pediatrician or Primary Care Provider spoken to you about HPV or its vaccine?

The results of these questions should be compared to previous years results, after two years of the initiation of the intervention and the goal is to get more students that reply yes to more of these questions than no. This way, even if teenagers are not being vaccinated yet, at least they have some board idea of what HPV is and how important it is to get vaccinated.

If this intervention is unsuccessful, more efforts need to be placed on informing parents about this vaccine, because parents are essentially the bridge between children and their doctor visits. Such efforts would include PCP’s and pediatricians reaching out to parents, either by phone call or email, who have not vaccinated their children yet, and just inform parents that it is important for teenagers to receive the HPV vaccine and make sure parents understand what is at risk if they choose not the vaccinate their child. Ultimately, the highest level of success that could be achieved would be making HPV vaccination mandatory for school enrollment by legislation, but that would require a lot more money and time involved. As mentioned before, if there is even a 5% to 10% difference in awareness for HPV from the previous year, this is sufficient evidence that the intervention is making a difference and should be funded by the state. There needs to be an understanding that this will be a slow but progressive movement and patience is required from all directions. Unrealistic goals are a waist of time and as a society that is not open to change, we need to take steps slow. Understanding that a 100% of the population will not be vaccinated within the next year is essential and giving everyone time to digest the intervention and really appreciate it is something that time will bring about.

 

 

 

 

 

 

 

 

Sources:

https://www.acscan.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf

https://www.nwhn.org/10-years-hpv-vaccines-approval-stand/

https://www.npr.org/sections/health-shots/2015/10/22/450827102/doctors-not-parents-are-the-biggest-obstacle-to-the-hpv-vaccine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064497/

https://www.cdc.gov/hpv/infographics/vacc-coverage.html

https://tonic.vice.com/en_us/article/5g9qaa/should-people-over-26-get-the-hpv-vaccine

https://www.cancer.net/sites/cancer.net/files/asco_hpv_infographic.pdf

https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/hpv-and-cancer

https://www.cdc.gov/hpv/parents/whatishpv.html

http://www.sciencedirect.com/science/article/pii/S0264410X14001546