Barriers to HPV vaccine series completion among a predominantly hispanic border population: a mixed method evaluation.

BACKGROUND: Human Papillomavirus (HPV) infections are the most common sexually transmitted infections in the United States. The HPV vaccine is a vital tool to prevent against several cancers, namely cervical cancer. Unfortunately, the uptake of the HPV vaccine among Hispanics is relatively low. Some barriers to uptake include language barriers, cultural taboos, and cost. PURPOSE: This study aims to explore barriers to HPV vaccination in a predominantly Hispanic US-Mexico border county between June 2015 and March 2018. METHODS: A mixed-method approach was used to analyze covariates associated with HPV vaccine uptake and to evaluate barriers to HPV vaccination from participant follow-up calls or reminder notes. RESULTS: The total number of participants was 1,787. Young adults were less likely to complete the vaccination series than those aged 9-17, while individuals born in Mexico were more likely to do so. Failure to contact was the most common barrier (n=1,801, 86.42%), followed by scheduling concerns (n=99, 4.5%), being ineligible (74, 3.55%), completing series outside of the program (40, 1.92%), having medical concerns (36, 1.73%), and other reasons (34, 1.63%). CONCLUSION: We predominantly identified structural barriers and various health-related determinants regarding healthcare access and quality.

Effects of Infant Driven Feeding Program on Provision of Breast Milk in Very Low Birth Weight Infants.

Background: The ability to complete nipple feedings is one of the discharge criteria for most premature neonates. The Infant Driven Feeding (IDF) program suggests a system of objective promotion of oral feeds in premature infants. There is a lack of studies systematically studying the effects of IDF on the provision of breast milk. Methods: This was a retrospective study of all premature infants born before 33 weeks and birth weight of <1,500 g admitted to a level IV neonatal intensive care unit. Infants on IDF were compared with those not on IDF. Results: A total of 46 infants in the IDF group and 52 in the non-IDF group met the inclusion criteria. A higher number of infants in the IDF group breastfed at first oral attempt (54% versus 12%). Forty-five percent of IDF mothers completed a full 72 hours of protected breastfeeding at the start of oral feeds, and IDF infants had earlier removal of nasogastric (NG) tube. There was no difference in the provision of breast milk and/or breastfeeding on discharge between the two groups. There was no difference in the length of stay between the two groups. Conclusion: The IDF program attempts to streamline the promotion of oral feeds in very low birth weight infants. Higher incidence of breastfeeding at the start of oral feeds and earlier removal of NG tube did not translate into higher provision of breast milk on discharge in very low birth weight infants in the IDF group. Prospective randomized trials are needed to validate cue-based infant driven feeding programs and their effects on the provision of breast milk.