Estimation of Geographic Variation in Human Papillomavirus Vaccine Uptake in Men and Women: An Online Survey Using Facebook Recruitment

Background

Federally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys.

Objective

Our goal was to use Facebook-based recruitment and online surveys to estimate local variation in HPV vaccine uptake among young men and women in Minnesota.

Methods

From November 2012 to January 2013, men and women were recruited via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. The Facebook advertisements were targeted to recruit men and women by location (25 mile radius of Minneapolis, Minnesota, United States), age (18-30 years), and language (English).

Results

Of the 2079 men and women who responded to the Facebook advertisements and visited the study website, 1003 (48.2%) enrolled in the study and completed the survey. The average advertising cost per completed survey was US $1.36. Among those who reported their postal code, 90.6% (881/972) of the participants lived within the previously defined geographic study area. Receipt of 1 dose or more of HPV vaccine was reported by 65.6% women (351/535), and 13.0% (45/347) of men. These results differ from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men).

Conclusions

This study shows that recruiting a representative sample of young men and women based on county and postal code location to complete a survey on HPV vaccination uptake via the Internet is a cost-effective and feasible strategy. This study also highlights the need for local estimates to assess the variation in HPV vaccine uptake, as these estimates differ considerably from those obtained using survey data that are aggregated to the state or federal level.     

Ground scratching and preferred leg use in domestic chicks: changes in motor control in the first two weeks post-hatching

Lateralisation of a variety of visual functions: food discrimination, fear response, copulation, and performance of topographical and other tasks, such as olfactory and auditory functions, have been described in the domestic chick, Gallus gallus domesticus. A bias to left hemisphere control on day 8 and to the right on day 11 has also been demonstrated in the domestic chick. In this study we show that motor control as to foot preference in initiating a scratching bout and a tape-removing task is lateralised in both adults and chicks. There was a preference for the right leg to initiate a bout of ground scratching in both male and female adult birds. Second, foot preference is also affected by the changes in shifts of bias on day 8 and day 11. The right leg preference in initiating a ground scratching bout observed on day 5 is reversed to a left leg preference on day 8. This then reverts to the right leg preference after day 11. Hence it is postulated that the hemisphere that is not activated due to the bias of age controls the first leg to be used in initiating routine movements such as ground scratching. For the tape-removing task the right leg was used to remove a tape adhered to the beak of the chick for the trained group on day 8; but there was no preference in the naive group. Similarly, on day 11 a left foot bias was observed for the trained group and right foot bias for the naive group. To remove a tape the activated hemisphere on days of bias is used; whereas in a novel situation the foot use is reversed. Thus, footedness is affected by age, type of task, and changing hemispheric dominance.     

Will new human papillomavirus diagnostics improve cervical cancer control efforts?

With the causal link between specific types of human papillomavirus (HPV) and cervical cancer firmly established, efforts have turned to assessing the relative merits of offering HPV testing in screening, triage, and posttreatment management. Many unanswered questions remain, but a growing body of evidence supports a role for HPV testing in cervical cancer prevention programs. Already, clinical centers that serve thousands of women in Europe and the United States have incorporated HPV DNA tests in triage algorithms.     

Will new human papillomavirus diagnostics improve cervical cancer control efforts?

With the causal link between specific types of human papillomavirus (HPV) and cervical cancer firmly established, efforts have turned to assessing the relative merits of offering HPV testing in screening, triage, and posttreatment management. Many unanswered questions remain, but a growing body of evidence supports a role for HPV testing in cervical cancer prevention programs. Already, clinical centers that serve thousands of women in Europe and the United States have incorporated HPV DNA tests in triage algorithms.     

Forgetting as a cause of incomplete reporting of sexual and drug injection partners

BACKGROUND AND OBJECTIVES: Partner notification and social network studies of infectious disease often involve interviewing people to elicit their sexual and/or drug injection partners. Incomplete reporting of partners in these contexts would significantly hamper efforts to understand and control the spread of sexually transmitted diseases, HIV, and other infections. There are many reasons why individuals might not name their partners in interviews. This study provides a comprehensive assessment of forgetting as a cause of incomplete reporting of sexual and injection partners. STUDY DESIGN: One hundred fifty-six persons in Seattle, Washington, at presumed high risk for HIV recalled their sexual and/or injection partners in two interviews separated by 1 week or 3 months. RESULTS: Repeated, nonspecific prompting elicited, on average, 10% of all partners recalled in an interview. Subjects displayed substantial forgetting of partners across partner types, recall periods, and four independent measurement approaches, with up to 72% of partners forgotten. The number of partners recalled and subjective assessment of forgetting are moderate to good predictors of the number of partners forgotten. Recalled and forgotten partners do not differ dramatically on any of several partner variables. CONCLUSIONS: Forgetting is a primary factor in the incomplete reporting of sexual and injection partners. Interviewers should prompt repeatedly to maximize recall of partners. Reinterviewing is currently the best method available for identifying partners as completely as possible and should be focused on individuals who report many partners and/or sense they have other partners they cannot recall.     

Challenges related to human papillomavirus (HPV) vaccine uptake in Minnesota: clinician and stakeholder perspectives

Background

Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders.

Methods

We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews.

Results

14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake.

Conclusion

Emphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.