HPPA 516: HPV Vaccination for Adolescents in the Jamaica, New York Residential Area
A. Define the Problem
Sexually transmitted infections (STIs) is a major public health concern affecting the nation. STIs can affect people of all ages, especially adolescents. The CDC estimates that adolescents and young adults between 15 to 24 years may only be just over 25% of the sexually active population, but accounts for half of the 20 million new STIs that occur in the United States every year. Adolescents are usually prone to infection due to a combination of behavioral, biological, and cultural reasons. In fact, the complications that occur from an infection is due to multiple barriers like inability to pay, lack of transportation, conflicts between work and school schedules, and most importantly, embarrassment attached to seeking STI services because of concerns about confidentiality.
According to UpToDate.com, the human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. About 79 million, most in their adolescence and early 20s are infected with HPV. About 14 million people become infected each year. However, since HPV usually does not cause any identifiable symptoms at an early stage, most people will never even know they are infected. Even worse, this leads to unknowingly passing the infection onto others. For some people, HPV can clear up on it’s own. But for others, if the infection is left untreated, it can lead to genital warts, anogenital cancers, and head and neck cancers. The incidence rate is extremely high, which is unfortunate because most could have been easily prevented with the HPV vaccine. The HPV vaccine is a series of 3 shots given over a period of 6 months. It is highly recommended for adolescents (male and female) to protect them from HPV infection.
Compared to the adolescents in New York City (NYC), the adolescents in the Jamaica area are one of the least likely to receive a full series of the HPV vaccine. Out of 59 districts in NYC, Jamaica ranked 41st in 2014. Only 32% of girls between 13 to 17 years old received the 3 doses of the HPV vaccination in Jamaica that same year. With this growing public health concern in Jamaica, Queens it is imperative to implement a program to resolve this situation.
B. Identify Risk and Protective Factors
The risk of HPV can be life threatening. Inability to vaccinate adolescents at an early age leads to that risk. If the adolescents are vaccinated, this will reduce the incidence of HPV infections significantly in Jamaica, Queens. Therefore, the most important question that needs to be answered is why are parents not vaccinating their children during adolescence with the HPV vaccine? This question can be answered through a survey format that can be distributed in public schools (elementary, junior high, and high schools), hospitals, pediatric clinics, churches, and shopping centers. This survey will be able to answer if the community is not aware of the importance of the HPV vaccine or if there are barriers that are making it difficult for them to vaccinate their children.
After much data collection and analysis, studies showed that prior to 2014 (with the implementation of the Affordable Care Act), 24% of adults had no health insurance and 13% of adults went without needed medical care. This lack of quality and poor access to health care has led to negative health outcomes, which resulted in more intensive treatments and serious hospitalizations. Concerning education, 28% of the population is college graduates and 51% graduated from high school or some college. Incomes shows Jamaica to rank 36th in the city with 36% of the population in poverty, 15% unemployed, and 59% with rent burden.
All these statistics have an indirect connection as to why adolescents are not being vaccinated properly. The lack of health insurance in adults would mean adolescents might also not be insured unless they are on Medicaid or Child Health Insurance Program (CHIP). It is possible that before the ACA, many adolescents could have missed the screening process during their early ages and then never have gotten the HPV vaccine by the time the ACA was in affect. Also, majority of the population is has only graduated from high school or some college. This can mean that a large amount of the population might now be aware of the necessity of the HPV vaccine, not that they are intentionally avoiding the vaccine. In addition, Jamaica is suffering from poverty and unemployment in a city where the middle class has a difficult time managing to keep afloat. Due to these circumstances, it would explain why adolescents are not being vaccinated properly. In most cases, the lower the income, the lower the quality of health a person receives or has access to.
C. Develop and Test Prevention Strategies
D. Ensure Widespread Adoption
The key stakeholders in this plan to enforce a higher accessibility of HPV vaccinations to the adolescents of Jamaica, NY are New York State Department of Health, New York State Department of Education, pediatricians, health insurance companies, teachers, parents/guardians, and the adolescents themselves. The implementation of this program will be a community effort. The NYSDOH would need to work with the NYSDOE to implement a requirement of the HPV vaccination just like the MMR, varicella, and polio vaccines that are mandatory to have on record to go to school. Pediatricians should guide parents to vaccinate their children at the appropriate age with the HPV vaccine. Parents can also be well informed during PTA meetings that are provided by schools. If the parents are unable to afford the vaccine for their child, they should check with the adolescent’s health insurance, apply for Medicaid/CHIP, or locate a free vaccine clinic. The state government usually funds free vaccine clinics. Last but not least, teachers should teach adolescents about the importance of safe sex, vaccinations and abstinence in health classes. Although the HPV vaccine is able to protect against most HPV strains, the responsibility of protecting oneself from the exposure of an STI is a responsibility the adolescent should be informed about.
The projected cost of this program should be little to no cost. Pediatricians and teachers from schools would provide majority of the essential information to guide parents and students. Majority of the expense would go to pamphlets and bulletins. The funding for that is usually provided by the National Institute of Health, who provides grants for research and public health programs. A rough estimate of costs would be about $50,000 for a period of at least 3 years. The upcoming year when the New York State Department of Health and Mental Hygiene conducts a research study of the community health profiles of the 59 districts of New York City, we will be able to uncover if the implementation of the program had a strong enough effect in the Jamaica community. If the program is effective in its methods and increases HPV vaccinations over the minimum 10% goal, then we will know the program has been applicable and soon we can branch out to other surrounding districts and eventually the entire New York City population.
RE-AIM FRAMEWORK
| REACH | – In order to reach the desired population of adolescents between the ages 11 to 17 years old (~41,000 adolescents), pamphlets with a brief message were handed out in the local supermarkets, churches, community centers, and PTA meetings to their parents. We first want to spread the word about the availability of an HPV vaccine and how it can protect their children from HPV in the future when they do decide to be sexually active/adults. They are encouraged to visit the adolescent’s pediatrician and be vaccinated as soon as possible for maximum efficacy. (Videos were also provided for visual information when applicable.) | ||||||||||||
| EFFICACY &EFFECTIVENESS | After collection of data and analysis, we were able to calculate a 24% increase in 12 months. We were able to take note that a majority of the parents were not informed about the HPV vaccine and the benefits of vaccination. Once they were well informed, they shared the information with family and friends. | ||||||||||||
| ADOPTION |
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| IMPLEMENTATION | – Reception to information was widely accepted in schools, pediatrician offices, and community centers. The community is very involved and supportive of lending a helping hand to spread the word about the importance of HPV prevention in our youth population. Brief reminders of vaccinations are mentioned in PTA meetings every 2 months. Reminders are also made in churches once a month on the first Sunday. And also in a few super markets and community centers the last Saturday of the month. Reception was not too popular in supermarkets because customers were busy shopping and in a rush but Saturdays are the peak days of the month to reach a high volume of people. Slowly we discontinued visiting supermarkets. | ||||||||||||
| MAINTENANCE | The HPV vaccine is effective for a good 10 years, and may be effective for even longer. Since adolescents are prone to become sexually active in an early age, it is most effective to complete the series when they are 11 to 12 years old. Pamphlets will be continued to be distributed in pediatric offices and PTA/PTC meetings. Should the parents require more information, they can speak to an educator at the school or the pediatrician him/herself at the clinic. The continuation of pamphlets and brief reminders are to inform parents of the following class to also become knowledgeable about the matter at hand to ensure the future health of their children. |
References:
https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm
https://www.cdc.gov/std/stats14/adol.htm
https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-qn12.pdf
https://www.health.ny.gov/diseases/communicable/human_papillomavirus/
https://grants.nih.gov/funding/index.htm
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