Issues Surrounding HPV Vaccine Delivery in a Multi-Ethnic Country in Asia: the Physician’s Perspective

The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine delivery in a multi-ethnic, multi-religious and multi-cultural society. A qualitative in-depth interview study was conducted with a sample of 20 physicians. Physicians described the success of HPV vaccines recommendation as very poor. Many expressed reluctance to offer the vaccine to preadolescents. The most notable barrier to vaccination was the vaccine’s high cost. Parents of eligible vaccinees were concerned about the efficacy and side effects of the new vaccine, while adult women have low risk perception for HPV infection. Promoters and inhibitors of HPV vaccination in our multi-ethnic, multi-religious and multi-cultural community were identified. This study suggests the need to strengthen the infrastructure necessary for HPV vaccine delivery and to specifically target poor underserved women.     

Inadequate and Incomplete: Chinese Newspapers’ Coverage of the First Licensed Human Papillomavirus (HPV) Vaccine in China

Glaxo Smith Kline’s Cervarix was the first human papillomavirus (HPV) vaccine licensed for use in China and officially launched there on 31 July 2017. Since news media content can influence people’s vaccine-related knowledge, understanding, and intentions, a content analysis was used to examine Chinese newspapers’ coverage of the HPV vaccine. A total of 253 articles published from 2000 to 2016 met the inclusion criteria and were coded. The results show that HPV and the HPV vaccine received very little newspaper coverage in China both before and after vaccine licensure. Most of the coverage came from China Party press newspapers, with the stories predominantly using thematic rather than episodic framing. Application of the Health Belief Model to the content analysis revealed that benefits, self-efficacy, and cues to action were found in most news stories. Overall, given the relative lack of Chinese newspaper coverage, public health officials and health-care providers in China should assume most people, including those for whom HPV vaccination is recommended, have little or no knowledge about HPV, HPV vaccine, and the reasons for the vaccination recommendation. If news media are to be a source of HPV information for the Chinese public, significant efforts will be needed to increase attention.     

Parents’ Decisions About HPV Vaccine for Sons: The Importance of Protecting Sons’ Future Female Partners

Parents’ decisions about human papillomavirus (HPV) vaccine for sons may be influenced by potentially protecting sons’ future female partners from HPV. We sought to identify characteristics of parents likely to consider future partner protection in vaccine decisions, and to determine if parents likely to consider future partners in vaccine decisions had greater intention to vaccinate. We performed a cross-sectional survey of parents with sons in a pediatric clinic in 2010. We used Fisher’s exact tests to identify demographics associated with consideration of future female partners in vaccine decisions. We used adjusted logistic regression to determine if parents likely to consider future partner protection in vaccine decisions had greater intention to vaccinate sons. Most parents (76 %, 187/246) reported vaccine decisions for sons were likely to be influenced by preventing HPV transmission from sons to their female partners. Parents 40 years and older, White and Black parents (vs other race), non-Hispanic, and college-educated parents were significantly more likely to indicate female partner protection may influence vaccine decisions (p < 0.05). Parents likely to be influenced by female partner protection in vaccine decisions had greater intention to vaccinate sons than their counterparts (adjusted odds ratio 2.54, 95 % CI 1.22, 5.28). Overall, many parents were likely to consider sons' female partners in vaccine decisions. Because parents likely to consider female partners had increased intention to vaccinate sons, future efforts to improve vaccine uptake in boys should explore the benefits of highlighting potential female partner protection, as this concept may resonate with many parents.     

Looking for Mr. PG: Masculinities and men’s depression in a northern resource-based Canadian community

Research has attributed the ‘silent suffering’ of men with depression to the influences of dominant masculine ideals such as strength and stoicism. Similarly, rural ideals – romanticized notions about rural places – have been shown to mute mental health issues and create barriers to help-seeking. This article examines the experiences of men with depression in Prince George, a northern resource-based community in British Columbia, Canada. Findings reveal how depressed men and their female partners enacted strategies to positively reinforce men’s gendered sense of self, in a context that otherwise may render them ‘out of place’. While favouring men’s wellbeing, these strategies can also perpetuate an invisible geography of men’s depression.     

Adolescent Participation in HPV Vaccine Clinical Trials: Are Parents Willing?

Approximately one-quarter of human papillomavirus (HPV) infections are acquired by adolescents, with a higher burden among racial/ethnic minorities. However, racial/ethnic minorities have been underrepresented in previous HPV vaccine trials. Ongoing and future HPV vaccine optimization trials would benefit from racially- and ethnically-diverse sample of adolescent trial participants. This study examined factors influencing parental willingness to consent to their adolescents’ participation in HPV vaccine clinical trials and tested for possible racial differences. A convenience sample of parents of adolescents (N?=?256) completed a cross-sectional survey. Chi square analyses were used to assess racial differences in parental HPV vaccine awareness and intentions and willingness to consent to their child participating in an HPV vaccine clinical trial. Ordinal logistic regression was used to identify factors associated with willingness. Approximately 47% of parents were willing to allow their adolescent to participate in HPV vaccine clinical trials (30.7% African American and 48.3% Caucasian, p?=?.081). African Americans had lower HPV vaccine awareness (p?=?.006) but not lower intentions to vaccinate (p?=?.086). Parental willingness was positively associated with the following variables: Child’s age (p?<?.039), Perceived Advantages of HPV Vaccination for Adolescents (p?=?.002), Parental Trust in Medical Researchers (p?<?.001), and Level of Ease in Understanding Clinical Trial Information (p?=?.010). Educating parents about the advantages of HPV vaccines for younger adolescents using low-literacy educational materials and building trust between parents and researchers may increase parental willingness to consent to adolescent participation in HPV vaccine clinical trials.     

Systems Epidemiology: What’s in a Name?

Systems biology is an interdisciplinary effort to integrate molecular, cellular,tissue, organ, and organism levels of function into computational models thatfacilitate the identification of general principles. Systems medicine adds adisease focus. Systems epidemiology adds yet another level consisting ofantecedents that might contribute to the disease process in populations. Inetiologic and prevention research, systems-type thinking about multiple levelsof causation will allow epidemiologists to identify contributors to disease atmultiple levels as well as their interactions. In public health, systemsepidemiology will contribute to the improvement of syndromic surveillancemethods. We encourage the creation of computational simulation models thatintegrate information about disease etiology, pathogenetic data, and theexpertise of investigators from different disciplines.     

Tanzanian Adolescent Boys’ Transitions Through Puberty: The Importance of Context

We explored the masculinity norms shaping transitions through puberty in rural and urban Tanzania and how these norms and their social-ecological context contribute to high-risk health behaviors. We conducted a qualitative case study of adolescent boys in and out of school in 2011 and 2012. Tanzania’s social and economic development is reshaping the transition into young manhood. Adolescent boys are losing traditional mechanisms of pubertal guidance, and new meanings of manhood are arising from globalization. Traditional masculinity norms, including pressures to demonstrate virility and fertility, remain strong. Adolescent boys in modernizing Tanzania receive inadequate guidance on their burgeoning sexuality. Contradictory masculinity norms from family and society are shaping their sexual expectations, with implications for their engagement in unsafe sexual behaviors.Inadequate attention has been paid to adolescent boys’ transitions through puberty in the context of the rapidly changing social norms and contexts of many sub-Saharan African countries, including Tanzania.1,2 Significant attention and resources have focused on adolescent girls aged 15 years and older because of their increased vulnerability to HIV and other sexually transmitted infections, unplanned pregnancy, and gender-based violence. Adolescent boys have their own unique health needs and challenges,3 such as increased risks of injury; engagement in violence; abuse of alcohol, tobacco, and other drugs; and risky sexual behaviors.1,4 Adolescent boys’ and young men’s behaviors may also significantly affect the sexual and reproductive health of adolescent girls and young women.Tanzania, like other sub-Saharan African countries, has undergone significant social upheaval in recent decades. Participation in traditional practices, such as puberty rites and ceremonies, has declined; extended-family structures have changed because of migration to cities and the devastatingly high mortality toll of HIV/AIDS5; and globalization and modernization have brought an influx of new ideas and images. These factors are reshaping the contexts in which adolescent Tanzanian boys transition into young adulthood.6,7 It is important to understand how such changes influence boys’ growing-up experiences, including the masculinity norms shaping their perceptions of manhood and sexuality, to develop effective interventions that promote healthy transitions into adulthood and reduce unsafe sexual behaviors.In many sub-Saharan African countries, girls reaching puberty experience new controls imposed on their burgeoning sexuality.8,9 One reason is their perceived vulnerability to pregnancy and its implications for their marriageability and for family honor.10 By contrast, postpubescent boys are likely to be encouraged, or even expected, to demonstrate their virility (not necessarily through safe sex practices).11 The expression of any qualities that can be interpreted as feminine may be verbally if not physically suppressed.12 Heteronormativity, at least in public, is often the strongly reinforced and desired sign of manhood, and it frequently encompasses engagement in sexual relations and dominance over girls and women.13Growing evidence suggests that early adolescence may be an important window of opportunity for health interventions affecting the transition into young manhood.14,15 This is partially because of the increased intensity of gendered norms focused on young people during puberty (as compared with younger children) and the perceived possibility of reshaping norms that may play a role in high-risk health behaviors.16 Little is known about the masculinity norms and other contextual influences shaping adolescent boys’ perceptions of becoming a man in a modernizing society such as Tanzania, but these may contribute to risky behaviors that endanger health. We have even less evidence on the perspectives of adolescent boys themselves about the influences shaping their participation in and decision-making about safe or unsafe sexual behaviors.Tanzania is a large East African country with an estimated population of 48 million, of whom almost 65% are younger than 24 years.17 More than 120 ethnic groups reside in the country, and Christianity and Islam are the predominant religions. Overall, 2.0% of adolescents and young men and women (aged 15–24 years) are HIV positive, with the likelihood of infection with HIV increasing with age: among persons aged 23 to 24 years, young women are more than twice as likely as young men to be infected (6.6% vs 2.8%).18,19 The increasing prevalence rates with age emphasize the importance of improving prevention efforts with adolescents. The few prevention initiatives that have included adolescent boys have also relied on limited evidence about young people''s sexual maturation experiences in a changing society.We conducted an in-depth study with adolescent boys in rural and urban Tanzania. We sought to explore, from the perspectives of adolescent boys themselves, their experiences of puberty and their interpretations of manhood in their changing social context. We (1) compared an urban to a rural context, which was important because of expected differences in traditional practices regarding puberty; (2) examined the predominant and alternative local masculinity norms being shaped simultaneously by tradition and modernization; and (3) assessed the globalizing influences shaping adolescent boys’ perceptions of manhood and sexuality, such as mass media, the Internet, and global marketing (e.g., alcohol companies). We hypothesized that influences from globalization and modernization create experiences of adolescence that conflict with traditional expectations of young manhood, particularly in urban contexts.We used an ecological framework of adolescent health20 to assess the multiple levels of influence shaping Tanzanian adolescent boys’ transitions through puberty today, particularly those that affect high-risk behaviors.21 We examined historical and cultural norms related to manhood at the societal level, along with adolescent boys'' interpersonal interactions and individual-level experiences. The conceptual framework guided an exploration of adolescent boys'' emotional and physical experiences among their families and peers, in school and in the larger community, along with the norms shaping their perceptions of manhood. We applied the theory of the social construction of gender to better understand the ways adolescent boys’ gendered experiences within their own identities, and among their peers, families, and communities, shaped their perceptions and experiences of young manhood.22,23     

Vaccine acceptance: Science,policy, and practice in a ‘post-fact’ world

Suboptimal vaccination uptake may be associated with outbreaks of vaccine-preventable diseases in many parts of the world. Researchers and practitioners working on improving vaccine acceptance and uptake gathered together for the fifth annual meeting on vaccine acceptance, organized by the Fondation Mérieux at its conference centre in Veyrier-du-Lac, France, to share their experiences in building, improving and sustaining vaccine confidence and uptake. The importance and value of truly listening to people and seeking to understand the perspectives of vaccine hesitant people was emphasized throughout the meeting. The benefits of social marketing, which can be used to influence behavior that benefit individuals and communities for the greater social good, and its integration into strategies aimed at improving vaccine acceptance and uptake, were discussed. Healthcare professionals (HCPs) need tools and training to help them engage effectively in vaccination acceptance conversations with parents and other patients. Two potential tools, motivational interviewing (MI) and AIMS (Announce, Inquire, Mirror, Secure), were presented. Examples of MI approaches that have successfully improved vaccination acceptance and uptake included a project in Canada aimed at parents just after the birth of their baby. The role of mandates to increase vaccination uptake in the short-term was discussed, but to achieve sustainable vaccination uptake this must be complemented with other strategies. These annual meetings have led to the creation of an informal community of practice that facilitates cross-pollination between the various disciplines and different settings of those involved in this area of research and implementation. It was agreed that we must continue our efforts to promote vaccine acceptance and thus increase vaccination uptake, by fostering more effective vaccination communication, monitoring of the media conversation on vaccination, designing and rigorously evaluating targeted interventions, and surveillance of vaccine acceptance and uptake with pertinent, reliable measures.     

The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries

ObjectiveTo examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.MethodsBetween 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.FindingsCompared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15–1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17–5.67 and IRR: 2.52; CI: 1.23–5.17, respectively). Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24–76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.ConclusionDespite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.     

“He Enjoys Giving Her Pleasure”: Diversity and Complexity in Young Men’s Sexual Scripts

Archives of Sexual Behavior - Research on heterosexual men’s sexual expectations has focused on self-described personal traits and culturally dominant models of masculinity. In a pair of...     

“What’s in a Name”

Pulmonary parameters including tidal volume, respiratory rate, minute volume, pulmonary flow resistance, dynamic compliance of the lung, and the work of breathing were measured in unanesthetized cynomolgus monkeys. A small group of animals was tested frequently during a period of 78 weeks and regression analysis of the data, including calculations of confidence limits, provided an estimate of the variation and trends in the above parameters. A digital computer technique, which was used for real-time data analysis of the recorded analog signals, was developed to elucidate the effects of long-term exposure to low levels of pulmonary irritants and urban atmospheric pollutants, such as sulfur dioxide and nitrogen dioxide.