Environmental Protection Agency. Washington, DC. Under the High Production Volume HPV Challenge Program, companies were "challenged" to make health and environmental effects data publicly available on chemicals produced or imported in the United States in the greatest quantities.
HPV chemicals are classified as those chemicals produced or imported in the United States in quantities of 1 million pounds or more per year.
However, the completion rate rose to Table 1 reports the initiation and completion rates for the intervention and comparison schools by sex. At baseline, vaccination rates were lower at the intervention school than at the comparison schools, for both males initiation: By April 25, , initiation rates for males Similar results were observed for the completion rates.
Appendix Table 3 reports the percentage of newly vaccinated students at the intervention school during our onsite vaccination events. Our data support the findings of a previous US study that documented that educating parents, school staff, and health care professionals greatly increased HPV and HPV vaccine knowledge [ 27 ].
Our study provides further evidence on the feasibility and effectiveness of a school-based HPV vaccination and education program and suggests that HPV vaccinations outside traditional healthcare settings ie, school-based mass vaccination programs can boost vaccine uptake in medically underserved areas [ 28 , 29 ].
Our study addresses many of research gaps highlighted by Reiter et al. While school-based HPV programs have been evaluated in the US [ 31 ], this study is the first to implement this program in an economically disadvantaged, medically underserved area with a high proportion of minority children.
In our study, HPV vaccine uptake was higher among middle school students who received both community-based education and onsite vaccinations than those who received education only. Initiation and completion rates at the intervention school almost doubled to The increase in HPV vaccine initiation and completion rates was lower at the comparison schools that received education only The majority of the HPV vaccines delivered at our vaccination events at the intervention school were covered by the VFC program.
Nationwide, boys are at a higher risk for not completing HPV vaccines [ 26 ], and our program demonstrates success in improving vaccine rates among middle school boys.
Notably, the completion rates for boys at our intervention school reached Our study focuses on improving accessibility and addressing system-level barriers. As we learned, schools are champions for improving HPV vaccine uptake. With the appropriate resources and partnerships, schools can carry out vaccination-related activities from educating students, parents, and communities to developing policies supporting vaccination, providing vaccines, or serving as the site where vendors administer vaccines [ 35 ].
Despite the successes, we faced some challenges. A key challenge in offering HPV vaccines in schools is creating the demand for the vaccination services among parents, school staff, and the community [ 28 ]. Voluntary mass vaccination programs in schools require partnerships between providers and community members. To overcome this, we repeated the initial educational presentations during a teacher in-service training day before the start of the academic year and repeated presentations for new nursing staff.
Moreover, we did not include student education in our program because of the lack of evidence of whether it alters vaccination behaviors. Further, there could be other factors eg, insurance coverage of students that could have impacted vaccination rates at our comparison schools which were not addressed. Our study has its limitations. Limited information was collected on students and parents, ie, students' race, ethnicity, and other socioeconomic status; and parents' education, income levels, country of birth, or knowledge and confidence in the HPV vaccines.
Therefore, examination of rates by these important characteristics cannot be undertaken. Bundling of the HPV vaccine with other ACIP recommended vaccines could have accentuated the impact of our program [ 37 , 38 ]; however, we do not have complete data on these other vaccines, but this could be an important future extension of our study.
Some students may change schools during our study time; however, for simplification, we followed our baseline cohort through the study.
Some students may have received the HPV vaccine outside the school settings through their local providers. If parents failed to report the HPV vaccine status to the schools, we would be unable to account for those in our study. The vendor and schools shared updated information, but it may not capture all vaccines received. We suspect that the increased HPV vaccine uptake at the intervention school may be due to more motivation to share updated records because of the onsite vaccination events, more exposure to study personnel, and better access to vaccinations.
Future studies should explore issues, such as inadequate school-based health centers and vaccine billing, as barriers for school-based HPV programs [ 29 ]. School-based onsite vaccinations and community-based education increased adolescent HPV vaccination rates more than education alone.
Per our experience, environmental interventions, such as school-based vaccination programs, have 2 major advantages over informational and behavioral interventions. First, it increases access to the HPV vaccine. Second, it could reach a large, diverse population regardless of individual access to healthcare. In summary, it is important to bundle HPV vaccines with other required vaccines, and educating parents, local providers, school board members, and school staff can result in sustained HPV vaccine uptake.
Neither NIH nor CPRIT have roles in the development of this article, including the study design; collection, analysis, and interpretation of data; writing of the manuscript; or in the decision to submit the manuscript for publication. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
We also thank Iris L. Tijerina and Iris I. Rivera from the University of Texas Medical Branch for their work and involvement in this project. National Center for Biotechnology Information , U. Journal List Papillomavirus Res v. Papillomavirus Res. Published online Oct Sapna Kaul , a Thuy Quynh N. Do , a Enshuo Hsu , b Kathleen M. Schmeler , c Jane R.
Montealegre , d and Ana M. Thuy Quynh N. Kathleen M. Jane R. Ana M. Author information Article notes Copyright and License information Disclaimer. Rodriguez: ude. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1. Abstract Objective Compare the effectiveness of community-based HPV-related education and onsite school-based vaccination versus community-based education only for increasing HPV vaccine uptake in a rural, medically underserved area.
Results At baseline, the intervention school had lower HPV vaccine initiation and completion rates than the comparison schools Conclusion The school with on-site vaccination events and community-based education had a higher adolescent HPV vaccination rate compared to schools that received community-based education only. Introduction The human papillomavirus HPV vaccine is safe and effective and prevents morbidity and mortality associated with HPV-related diseases, including cervical, oropharyngeal, vaginal, vulvar, penile, and anal cancers [ 1 , 2 ].
Material and methods 2. Statistical analyses Summary statistics for sex and age were computed. Results 3. HPV vaccination rates Fig. HPV vaccination is cancer prevention.
The problem: Not enough people get the HPV vaccine. WHO identified three main ways to get the job done:. HPV vaccination Cervical cancer screening Cervical cancer treatment The world already has these tools. The WHO plan includes three targets:. People may get the vaccine as early as age 9 and up to age In the U.
Here is what you can do in support of the WHO goal:. Get vaccinated against HPV if you are in the age range. Encourage others to get vaccinated.
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