Availability Of The HPV Vaccine In Appalachia. Mira L. Katz, Ph.D.

Transcription

1 Availability Of The HPV Vaccine In Appalachia Mira L. Katz, Ph.D.

2 Background Cervical cancer incidence and mortality rates have steadily decreased in the U.S. because of the Pap test 11,270 new cases of invasive cervical cancer will occur and 4,070 women will die from cervical cancer in 2009 Elevated cervical cancer rates persist among certain segments of the population

3 HPV 70% of cervical cancers are caused by high-risk HPV types 16 and 18 Low-risk HPV types 6 and 11 cause genital warts and low-grade cervical lesions but do not lead to cervical cancer HPV infection is a common STI in the U.S. with about half of all sexually active adults infected during their lifetime

4 HPV types HPV Prevalence Rates In Ohio Appalachia & U.S. Ohio Appalachia (n=1,118) U.S. (n=1,921) All 43.0% 26.8% High risk 30.0% 15.2% Low risk 28.0% 17.8% 6,11,16, % 3.4% 6 2.0% 1.3% % 0.1% % 1.5% % 0.8% 16 & % 2.0% U.S. rates include females ages years in [Dunne et al; JAMA 2007] Ohio Appalachia rates include females ages years in [Ruffin et al.]

5 HPV types HPV Prevalence Rates In Ohio Appalachia & U.S. Ohio Appalachia (n=1,118) U.S. (n=1,921) All 43.0% 26.8% High risk 30.0% 15.2% Low risk 28.0% 17.8% 6,11,16, % 3.4% 6 2.0% 1.3% % 0.1% % 1.5% % 0.8% 16 & % 2.0% U.S. rates include females ages years in [Dunne et al; JAMA 2007] Ohio Appalachia rates include females ages years in [Ruffin et al.]

6 HPV Vaccine Research Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states

7 Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia Mira L. Katz, Paul L. Reiter, Sarah Heaner, Mack T. Ruffin, Douglas M. Post, and Electra D. Paskett Supported by the National Cancer Institute Grants: P50CA (EDP), K07CA (MLK), CA (ACCN), and P30CA (Behavioral Measurement Shared Resource at OSUCCC

8 Purpose To gain an understanding of the beliefs, attitudes, and acceptability of the HPV vaccine at the individual and community level

9 Methods Developed a focus group guide based on the Social Determinants of Health Framework Sessions were audio recorded, transcribed verbatim, and transcripts reviewed Coding tree developed and coding using NVivo qualitative software

10 Results

11 Summer 2007 COLUMBIANA HOLMES TUSCA RAWAS CARROLL JEFFER SON * OSU COSHOCTON HARRISON MUSK- GUERNSEY BELMONT INGUM Locations of focus groups Focus group participants PERRY MORGAN NOBLE MONROE HOCKING WASHINGTON ROSS VINTON ATHENS CLER MONT BROWN HIGHLAND ADAMS PIKE SCIOTO MEIGS JACKSON GALLIA LAWRENCE Totals = 23 focus groups 9 counties 114 participants from 14 counties HC Providers: 37 Women: 27 Community Leaders: 31 Parents: 19

12 Agency (2.1) Community (2.2) School (2.3) Parent (1.2) Self (1.1) Family (1.3) Friend (1.4) Healthcare provider (1.5) Spouse (1.6) People (1.0) Organizations (2.0) Fatalism (4.1) Fear (4.2) Trust (4.5) Sex (4.4) Attitudes & beliefs (4.0) HPV Vaccine Decision making process (10.0) Health conditions (12.0) Cost (7.1) Time (7.2) Privacy (7.3) Eligibility (7.4) Availability (7.5) Logistics (7.0) Tobacco (14.0) Knowledge (8.0) Appalachian culture (13.0) Facilitators (6.0) TV (3.1) Internet (3.2) Brochures (3.3) Verbal (3.4) Leader (11.1) Audience (11.2) Venue (11.3) Materials (11.4) Church (2.4) Pharm. Company (2.5) Sex (9.4) Interpersonal (9.5) Information sources (3.0) Abstinence (4.3) Barriers (5.0) Educational programs (11.0) Content (11.5) Effectiveness (9.3) Parental rights (9.2) Short-term (9.1.1) Long-term (9.1.2) Side effects (9.1) (7.1) (7.2) (7.3) Concerns (9.0)

13 Quotes I think they perceive it [cervical cancer] as a dirty disease to be honest with you.

14 Community Leaders I think that s billions of dollars in a pharmaceutical pocketbook. Are you raising your daughter not to be involved in multiple sex partners and to try to get married and have one partner? What are you trying to raise? So in my mind, if they have a shot, do they really need it?

15 Community Leaders If this opens a discussion about safe sex, it could have numerous benefits besides just the vaccination for HPV. I mean, it opens up a great door of opportunity to then educate them on, You know, it doesn t protect against pregnancy, it doesn t protect against HIV, or hepatitis or all those other sexually transmitted diseases. So it might be a great way to educate young women on other things associated with being sexually active.

16 Healthcare Providers I think we re operating in a very Appalachian area, a very rural area. So, a lot of these women live in farm communities and they don t have access to that information. There are things that I don t know and I m in the healthcare profession. If I m in it and I don t know, that really tells me the lack of information is obviously there.

17 Healthcare Providers I think that s the key, presenting it as a cancer rather than a sexually transmitted disease. I think that s where we get into a problem with the parents and I think even with the children. The word is out there. They ve all told their friends. They ll come in and they ll say Is this the one that hurts or is it this one that hurts?

18 Women like I would not have no clue if I knew if I had cervical cancer. Like what s the signs of it? No, I really hadn t talked to them about it, because I didn t know whether it was covered under insurance or not, and I was kinda, I didn t want to ask my parents to check on it. I didn t know what they thought about they are kinda of old fashioned and of course, they don t like to talk about sex or anything like that. I didn t know if they thought, OK, you can only get it if you are sexually active.

19 Women I ve heard someone on NPR about Gardasil. Basically, they would talk to parents of younger children, you know, 8 to 9 year old girls. Is it okay to give them or does this give them a free ticket to go out and sexually explore or I think it s so heinous. I think that is the stupidest thing I ve ever heard. No it doesn t ---it s a vaccine. You can end up sleeping with a man, and even if you ve waited forever to be with him, you end up sleeping with him, and he s probably slept with over half the women in this town.

20 Parents Is it going to have effects on her child rearing years if she does this now at this young age? First off, I guess I m going to say, just because my daughter had the vaccine, I don t think it s a ticket for her to be sexually active. I would think that if it is only transmitted sexually that I would not have my daughter do it in 6th grade. Because at that age, they should not be sexually active.

21 Parents My daughter is pretty tough, and she said it was rather painful Why would I care if my son or daughter got it, Why would I care if my son or daughter got it, if they re getting other things, and I don t even realize what they are getting, and if they are getting a small pox vaccine or something. You know, small pox hasn t been around, and why am I so worried about this [HPV vaccine], when it could prevent something.

22 Appalachian Culture They even trust grandma more than they trust the healthcare provider Go educate grandma! That even if they don t prevent it that eventually that medicine will take care of it or medical personnel will make it better.

23 Appalachian Culture Health is not really an issue. Day to day survival like where am I going to get this, where am I going to get that kind of a thing. Well you know if my children do something I know before they get home.

24 Conclusions The issues raised by participants provided valuable information that will be used in the development of educational programs focused on HPV and the HPV vaccine for women, parents of young girls, community leaders, and healthcare providers in Ohio Appalachia

25 Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states Mira L. Katz, Paul L. Reiter, Brenda Kluhsman, Stephanie Kennedy, Sharon Dwyer, Nancy Schoenberg, Andy Johnson, Gretchen Ely, Karen A. Roberto, Eugene J. Lengerich, Pamela Brown, Electra D. Paskett, and Mark Dignan Supported by the National Cancer Institute Grants: K07CA (MLK), CA (ACCN), and P30CA (Behavioral Measurement Shared Resource at OSUCCC

26 Purpose To gain insight into HPV vaccine availability, recommendations, costs, policies, and educational materials being used in public health departments serving Appalachian counties in seven states

27 Methods Cross regional ACCN research 25 item telephone survey developed (conference calls and s) Health Departments contacted and interview was approximately 20 minutes (April June 2008) Pennsylvania: information from state immunization database

28 HPV Availability in Appalachia Health Departments State Level Information Please complete a state-level form for each state on which you are reporting. 1. Identify your state. Kentucky Maryland New York Ohio Pennsylvania West Virginia Virginia 2. How many counties in your state are in Appalachia? Counties 3. Does your state have health department districts / regions? Yes No IF YES, how many districts / regions? Districts / Regions IF YES, how many health department districs / regions are associated with the Appalachian counties? Districts / Regions For the following questions, please mark all that apply: State health department level Health district / region level County health department level 4. Health-related policy issues in your state are made at what level(s)? 5. The HPV vaccine policy in your state was made at what level(s)?

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33 Results

34 Level Of Health Policy In Seven States Level health-related policy issues are determined KY MD NY OH PA VA WV S,R,C S,C S,C S,R,C S S S,R,C Level HPV vaccine policy is determined R,C C S S,R,C S S S,C S: State R: Region/District C: County

35 HPV Vaccine Requests Patients request HPV vaccine? Mean number of requests per month KY MD NY OH PA VA WV 100% 100% 93% 100% 100% 96% 100% n/a n/a: not available

36 HPV Vaccine Availability HPV vaccine available in health department Mean number of HPV vaccine doses provided per month KY (n=51) MD (n=3) NY (n=14) OH (n=37) PA (n=53) VA (n=27) WV (n=49) 100% 100% 93% 97% 100% 100% 100% Current HPV vaccine supply meets demand 94% 67% 77% 94% 100% 48% 98%

37 HPV Vaccine Only Provided Through The VFC Program KY (n=51) MD (n=3) NY (n=14) OH (n=37) PA (n=53) VA (n=27) WV (n=49) HPV vaccine available only through VFC Program 31% 0 39% 50% 100% 63% 69%

38 HPV Vaccine Provided If Not Eligible For The VFC Program Females (< 18 years) who do not qualify for VFC Program may receive vaccine without parental permission KY (n=51) MD (n=3) NY (n=14) OH (n=37) PA (n=53) VA (n=27) WV (n=49) 9% 0 17% 50% 0 50% 67% Financial assistance available for HPV vaccine for females who do not qualify for VFC Program 17% 100% 71% 28% n/a 100% 71% n/a: not available

39 HPV Vaccine Educational Brochures KY (n=51) MD (n=3) NY (n=14) OH (n=37) PA (n=53) VA (n=27) WV (n=49) HPV vaccine educational brochures available 100% 100% 92.9% 97.3% 100% 100% 100% Health Department 19.6% % 100% 0 8.3% Merck & Co., Inc. 72.6% 100% 100% 80.6% 0 100% 91.7% CDC 84.0% 100% 84.6% 58.3% 100% 77.8% 83.3%

40 Conclusions Variation within and among public health departments located within Appalachian states regarding HPV vaccine policy, availability, recommendations, costs, financial assistance, and educational materials

41 Recommendations Future research - Reducing barriers - Providing educational programs Policy Need for more consistent policies that maximize accessibility of the HPV vaccine to women, especially those living in underserved areas