County-Level Factors Associated With Influenza and COVID-19 Vaccination in Indiana, 2020‒2022.

Objectives. To assess COVID-19 and influenza vaccination rates across Indiana's 92 counties and identify county-level factors associated with vaccination. Methods. We analyzed county-level data on adult COVID-19 vaccination from the Indiana vaccine registry and 2021 adult influenza vaccination from the Centers for Disease Control and Prevention. We used multiple linear regression (MLR) to determine county-level predictors of vaccinations. Results. COVID-19 vaccination ranged from 31.2% to 87.6% (mean = 58.0%); influenza vaccination ranged from 33.7% to 53.1% (mean = 42.9%). In MLR, COVID-19 vaccination was significantly associated with primary care providers per capita (b = 0.04; 95% confidence interval [CI] = 0.02, 0.05), median household income (b = 0.23; 95% CI = 0.12, 0.34), percentage Medicare enrollees with a mammogram (b = 0.29; 95% CI = 0.08, 0.51), percentage uninsured (b = -1.22; 95% CI = -1.57, -0.87), percentage African American (b = 0.31; 95% CI = 0.19, 0.42), percentage female (b = -0.97; 95% CI = -1.79, ‒0.15), and percentage who smoke (b = -0.75; 95% CI = -1.26, -0.23). Influenza vaccination was significantly associated with percentage uninsured (b = 0.71; 95% CI = 0.22, 1.21), percentage African American (b = -0.07; 95% CI = -0.13, -0.01), percentage Hispanic (b = -0.28; 95% CI = -0.40, -0.17), percentage who smoke (b = -0.85; 95% CI = -1.06, -0.64), and percentage who completed high school (b = 0.54; 95% CI = 0.21, 0.87). The MLR models explained 86.7% (COVID-19) and 70.2% (influenza) of the variance. Conclusions. Factors associated with COVID-19 and influenza vaccinations varied. Variables reflecting access to care (e.g., insurance) and higher risk of severe disease (e.g., smoking) are notable. Programs to improve access and target high-risk populations may improve vaccination rates. (Am J Public Health. 2024;114(4):415-423. https://doi.org/10.2105/AJPH.2023.307553).

Characterizing U.S. mothers with high human papillomavirus vaccine intent yet unvaccinated adolescents.

HPV vaccination rates remain suboptimal in the United States. While the current literature focuses on expressly hesitant parents, few studies have examined parents with "high intent", or those indicating they definitely will vaccinate and have had the opportunity but not yet vaccinated their adolescents. Our objective was to differentiate characteristics of mothers with high intent from those who already vaccinated their adolescents using various socioeconomic, previous vaccine decision-making, and healthcare provider relationship-related variables. English-speaking mothers or female guardians of adolescents ages 11-14 years living in low HPV vaccine uptake states within the U.S. in September 2018 were recruited from a national survey panel as part of a larger study. We assessed HPV vaccine status of their adolescents and categorized respondents into two categories: Already Vaccinated and High Intent. We assessed differences using a multivariable logistic regression model. Among 2406 mothers, 18% reported high intent vs. 82% already having vaccinated. Mothers with high intent were more likely to identify as non-Hispanic White (p = 0.01), to have a younger adolescent (p < 0.001), and to report not receiving a provider HPV vaccination recommendation (p < 0.001). Mothers who estimated that half/more (vs. less) of their child's friends have received/will receive the vaccine had higher odds of already vaccinating (p < 0.001). Our findings suggest that clinicians may be able to improve HPV vaccination uptake within their practices by giving repeated, high-quality recommendations to parents of children who are not yet vaccinated. Additionally, these findings indicate perceived social norms may play a large role in on-time vaccine uptake. Reassuring hesitant parents that most parents accept the vaccine may also improve uptake in clinical practice.

Broad perspectives in understanding vaccine hesitancy and vaccine confidence: an introduction to the special issue.

The World Health Organization has designated vaccine hesitancy and vaccine confidence among the most pressing issues in global health. The COVID-19 pandemic has made vaccine hesitancy and vaccine confidence particularly salient and urgent. The purpose of this special issue is to highlight a broad range of perspectives on these critical issues. We have included a total of 30 papers that address issues related to vaccine hesitancy and vaccine confidence across multiple levels of the Socio-Ecological Model. We have organized the empirical papers into the following sections: individual-level beliefs, minority health and health disparities, social media and conspiracy beliefs, and interventions. In addition to the empirical papers, three commentaries are included in this special issue.

COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample.

Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.

Indiana Parental Perceptions of the Acceptability of General and HPV-Specific State Vaccine Requirements.

State vaccine requirements are a tool for improving child and adolescent vaccination immunization coverage, but to be effective, parental buy-in is needed. The objective of this study was to assess the demographic, healthcare characteristics, and health beliefs associated with parental acceptance of general and HPV-specific state vaccine requirements. Indiana parents (N = 601) with children ages 11-17 years old completed a survey during March 2020.Results showed that 47.2% and 43.1% of parents believed there should always be general and HPV-specific state vaccine requirements, respectively. In multivariable analysis, higher odds of parental support for general state vaccine requirements were associated with being unsure whether HPV-associated cancer is a problem in the participant's county and having higher perceived benefits of HPV vaccines. Lower odds were associated with private insurance, having less than a bachelor's degree, and having less confidence in vaccines. In comparison, parents had higher odds of agreeing with HPV-specific state vaccine requirements if they reported higher interpersonal altruism and higher perceived benefits of HPV vaccines; they had lower odds if they were non-Hispanic White. Findings indicate that while similar percentages of parents agreed with general and HPV-specific state vaccine requirements, there were different characteristics associated with acceptance of each. Results can inform the development of tailored interventions for improving parental support for general and HPV-specific state vaccine requirements.

Perceived Need and Acceptance of a Future Chlamydia Vaccine Among Health Care Providers.

BACKGROUND: Chlamydia vaccination is a potentially important strategy to prevent infections and reduce the global burden of disease. Ideally, chlamydia immunization programs would require vaccinating adolescents before they engage in sexual activity. Communication by health care providers (HCPs) has been shown to have an impact on vaccine acceptance. Therefore, it is imperative to understand their opinions on chlamydia vaccines and factors that would promote strong vaccine recommendations to patients to promote uptake. METHODS: Semi-structured interviews with adolescent HCPs were conducted and focused on perceived need for chlamydia vaccine. Additional topics included vaccine characteristics, such as efficacy, cost, and booster vaccines, and potential vaccine recommendation strategies. RESULTS: From January to July 2021, 22 interviews were completed. Health care providers discussed how chlamydia vaccines are needed, especially in settings with high prevalence rates. Health care providers thought a chlamydia vaccine would need to be very efficacious in preventing infections and related sequalae and cost-effective. However, there were concerns about low completion rates if this vaccine required multiple doses or boosters. In addition, vaccine misinformation was prevalent among HCPs regarding potential benefits of vaccination. CONCLUSIONS: Health care providers' perceptions that an adolescent chlamydia vaccine would be beneficial offers great promise for future promotion. However, there is need for targeted education programs about chlamydia and the benefits of vaccination for HCPs. These programs will be especially important in order for HCPs to effectively communicate about the benefits of vaccination to parents and adolescents provide strong vaccine recommendations.

Chlamydia Vaccination: Parent Opinions and Implications for Future Promotion Programs.

BACKGROUND: Chlamydia vaccines are currently under development and have the potential to lower the incidence of infection and disease, which are highest among adolescents and young adults. Ideally, a chlamydia vaccine would be administered to adolescents before sexual debut, a time when parents are the primary vaccine decision makers. This study explores parent opinions about an adolescent chlamydia vaccine to understand barriers and facilitators to uptake. METHODS: Semistructured interviews were conducted with parents of adolescents. Topics included conversations parents have with their children about chlamydia, opinions on chlamydia vaccine development, and vaccine characteristics, such as efficacy and cost. Interviews were analyzed using a thematic analysis approach. RESULTS: From March to April 2021, 21 interviews were completed. Few parents discuss chlamydia with their children and sex education was seen as limited. Overall, 16 parents indicated that a chlamydia vaccine is needed. However, there were mixed opinions about vaccinating their own children, related to the need to vaccinate at a young age, vaccine efficacy, and confusion about benefits of vaccination. Finally, healthcare provider recommendations were seen as important before deciding to vaccinate a child. CONCLUSIONS: Although parents think that chlamydia vaccines are needed, lack of awareness about infections and potential benefits of vaccination could serve as barriers to uptake. Healthcare provider recommendations can help to improve knowledge and vaccine uptake. However, there is a need for multilevel approaches to improve chlamydia awareness and ensure that vaccination initiation and completion rates remain high.

Factors that differentiate COVID-19 vaccine intentions among Indiana parents: Implications for targeted vaccine promotion.

Given low rates of uptake of the COVID-19 vaccine for children 12-17 and 5-11 years old, research is needed to understand parental behaviors and behavioral intentions related to COVID-19 vaccination for their children. In the state of Indiana, we conducted a non-random, online survey of parents or caregivers (N = 10,266) about their COVID-19 vaccine intentions or behaviors, demographic characteristics, and potential motivating reasons for getting the vaccine. In terms of behaviors/intentions, 44.8% of participants indicated they were vaccine acceptors (i.e., had already had their children vaccinated or would as soon as it was possible), 13.0% indicated they were vaccine hesitators (i.e., wanted to wait and see), and 42.2% indicated they were vaccine rejecters (i.e., would not vaccinate or only would if mandated). Compared to vaccine rejecters, vaccine hesitators were more likely to be motivated by perceptions of vaccine safety and efficacy, normative influences such as close friends/family who had been vaccinated and a recommendation from a provider, as well as if they were vaccinated themselves. These findings have implications for the development of targeted vaccine promotion strategies, such as social norms messaging and a focus on vaccine safety, in order to increase COVID-19 vaccination for eligible children.

Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations.

We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.

Recent changes in cervical cancer screening guidelines: U.S. women's willingness for HPV testing instead of Pap testing.

Cervical cancer screening guidelines in the United States were revised in 2018 to include the option of primary human papillomavirus (HPV) testing. The transition to this screening method may face difficulties as Pap testing has been the primary screening modality in the United States. The objective of this study is to assess information, motivation, and behavioral skills associated with willingness to receive an HPV test instead of a Pap test among women. The sample included U.S. 812 women, ages 30 to 65 years. Participants completed an online survey in 2018. The Information, Motivation, and Behavioral Skills (IMB) model was used to measure predictors of willingness for HPV testing. The outcome variables were willingness to receive the HPV test instead of the Pap test, with and without time interval details. Logistic regression modeling was used with SAS 9.4. Over half of the sample (55%) were willing to receive the HPV test. For the information domain, HPV knowledge was significantly associated with willingness for HPV testing (OR = 1.08, 95%CI 1.04-1.13). Significant motivating factors included: positive attitudes, social norms, perceived benefits, worry about cervical cancer, and worry about abnormal HPV tests. For behavioral skills, women were significantly more willing to get the HPV test if a provider recommended it (OR = 2.43, 95%CI 1.53-3.87) and currently up-to-date on cervical cancer screening guidelines (OR = 1.52, 95%CI 1.52-2.26). Addressing barriers and facilitators to willingness to transition to primary HPV testing over Pap testing is needed as the United States has updated guidelines for cervical cancer screening.

Perceived social support and compliance with stay-at-home orders during the COVID-19 outbreak: evidence from Iran.

BACKGROUND: Strong evidence demonstrates that social support plays a key role in facilitating preventive health behaviors. The aim of the current study was to assess the effects of perceived social support on compliance with stay-at-home orders in response to a COVID-19 outbreak during the Persian New Year (Nowruz) holydays, since Nowruz holidays of 2020 coincided with the peak of the coronavirus epidemic in Iran. METHODS: This cross-sectional survey was carried out based on phone interviews of 1073 adults aged over 18 years from 4 to 12 April 2020 in Mashhad, Khorasan-Razavi Province, as the second largest city of Iran. A systematic random sampling was carried out using fixed phone number lists provided by Telecommunication Company of Khorasan-Razavi Province. Phone interviews were carried out by trained interviewers from the Iranian Students Polling Agency (ISPA) at various times of the day. The survey included sociodemographic questions, perceived social support scale (MSPSS) and questions about self-isolation during the Nowruz holiday. Statistical analysis included Chi-square test, Mann-Whitney test and multivariate logistic regression. RESULTS: 20.5% of participants reported poor compliance with stay at home orders during the first 2 weeks of Nowruz. Clear social gradients were not found in stay-at-home compliance. When controlling socio-demographic factors, perceived social support, interestingly, both fostered and hindered people's compliance with stay at home orders, depending on the source of support from family members (OR = .874, 95% CI = .803, .950, p < .005), friends (OR = 1.147, 95% CI = 1.076, 1.222, p < .001) and a significant other person (OR = .926, 95% CI = .849, 1.010, p = .084). CONCLUSIONS: Public health messaging may need to emphasize the role that friends and families can play in helping to protect those in their friendship/family groups by promoting compliance with social distancing. Further in-depth studies are recommended to evaluate how this kind of messaging can most effectively encourage people to engage in social distancing practices.

Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers.

New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.

A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts.

With SARS-CoV-2 vaccines under development, research is needed to assess intention to vaccinate. We conducted a survey (N = 3,159) with U.S. adults in May 2020 assessing SARS-CoV-2 vaccine intentions, intentions with a provider recommendation, and sociodemographic and psychosocial variables. Participants had high SARS-CoV-2 vaccine intentions (M = 5.23/7-point scale), which increased significantly with a provider recommendation (M = 5.47). Hierarchical linear regression showed that less education and working in health care were associated with lower intent, and liberal political views, altruism, and COVID-19-related health beliefs were associated with higher intent. This work can inform interventions to increase vaccine uptake, ultimately reducing COVID-19-related morbidity and mortality.

The effects of message framing and healthcare provider recommendation on adult hepatitis B vaccination: A randomized controlled trial.

Many adults in the U.S. do not receive recommended vaccines, and the research literature remains inconclusive on the best communication strategies for increasing this behavior. This study examined the association of message framing (gained-framed vs. loss-framed vs. control), and healthcare provider (HCP) recommendation (offered vs. recommended) on uptake of adult hepatitis B virus (HBV) vaccination in a high risk population using a 3 × 2 block design randomized controlled trial. Fear of shots, fear of vaccines, and perceived message framing were examined in secondary analyses. Of the 1747 participants, 47.7% (n = 833) received 0 doses of HBV vaccine, 27.8% (n = 485) received 1 dose, 10.4% received 2 doses, and 14.1% received all 3 recommended doses. There was not a significant interaction between message framing and HCP recommendation (p = .59). Mean number of doses received by the gain-framed group (m = 0.96) was not significantly different from the loss-framed group (m = 0.97, RR = 0.99, 95% CI = 0.88-1.12). However, those receiving any framing message received significantly more doses (m = 0.96) than those in the control condition (m = 0.81, RR = 1.17, 95%CI = 1.06-1.31). Participants who received a HCP recommendation received significantly more vaccine doses (m = 0.95) than those in the vaccine-offered condition (mean = 0.82, RR = 1.16, 95%CI = 1.05-1.28). These results suggest there is no difference in vaccine uptake between gain-frame and loss-frame messages, but both are better than a control message. These results also support advising HCP to provide a strong recommendation for vaccinations beyond merely offering it to patients. This study has implications for vaccine uptake beyond HBV, and can inform future research on effective vaccine communication research. Clinicaltrials.gov Identifier: NCT00739752. Registration date: August 20, 2008.

Human Papillomavirus Vaccine Initiation for Adolescents Following Rhode Island's School-Entry Requirement, 2010-2016.

OBJECTIVES: To assess changes in human papillomavirus (HPV) vaccine initiation for adolescent girls and boys in Rhode Island compared with all other states. METHODS: We estimated the gender-specific effects of Rhode Island's school-entry HPV vaccination policy on self-reported HPV vaccination initiation by using a difference-in-differences design with the National Immunization Survey-Teen from 2010 through 2016. RESULTS: Compared with boys in other states, boys in Rhode Island increased their HPV vaccine initiation rate by 11% (b = 0.11; 95% confidence interval [CI] = 0.05, 0.18) after enactment of the requirement. No difference was seen in the probability of HPV vaccine initiation among girls in Rhode Island compared with girls in the multistate control (b = -0.01; 95% CI = -0.08, 0.05). CONCLUSIONS: Our analysis identified an 11% increase in HPV vaccine initiation rate among boys in Rhode Island after the school-entry requirement was enacted, whereas no significant change was observed for girls. Public Health Implications. Given suboptimal vaccine uptake rates in the United States, continued pursuit of state-level public policy to improve HPV vaccination is needed. School-entry requirements for HPV vaccination may be a strategy for closing the gap in HPV vaccine uptake for boys and girls.

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons.

Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9-16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the 'decided not to vaccinate' stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination.

HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.

Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing.

Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. FINDINGS: therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing. ABBREVIATIONS: HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; CDC: Centers for Disease Control and Prevention; ACASI: audio computer-assisted self-interview; TRA: theory of reasoned action; HBM: Health Belief Model; STI: sexually transmitted infection; STD: Sexually Transmitted Disease; AOR: adjusted odds ratio; CI: confidence interval.

Learning in the zone: toward workforce development of evidence-based public policy communication.

BACKGROUND: Evidence-based policy communication (EBPC) is an important, emerging focus in public health research. However, we have yet to understand public health workforce ability to develop and/or use it. The study objective was to characterize capacity to develop and use EBPC and identify cooperative learning and development opportunities using the case of Human papillomavirus (HPV). METHODS: Vygotsky's Zone of Proximal Development (ZPD) informed guided interviews with 27 advocates in Indiana from government, industry, research, state associations and individuals. Participants focused on HPV, cancer, women's health, school health and minority health. RESULTS: Capacity to develop and use EBPC was reported to develop through cooperative learning opportunities on the job or in advocacy focused coalitions. Coalition learning appeared to translate across health topics. Notably, policy experience did not assure understanding or use of EBPC. CONCLUSIONS: The ZPD framework can inform workforce EBPC interventions by focusing on actual development, potential development and factors for learning and development in the ZPD. Future studies should further clarify and evaluate emerging indicators in additional public health policy areas with a larger sample.

Determinants of Human Papillomavirus Vaccination Intention Among Female Sex Workers in Amsterdam, the Netherlands.

INTRODUCTION: Female sex workers (FSWs) are at risk for human papillomavirus (HPV)-induced diseases but are currently not targeted by the HPV vaccination program in the Netherlands. We explored determinants of their intention to get vaccinated against HPV in case vaccination would be offered to them. METHODS: In 2016, FSWs 18 years and older having a sexually transmitted infection consultation with the Prostitution & Health Center (P&G292) in Amsterdam, either at the clinic or at their working location, were invited to complete a questionnaire assessing sociopsychological determinants of HPV vaccination intention (scale ranging from -3 to +3). Determinants of HPV vaccination intention were assessed with univariable and multivariable linear regression. In addition, we explored the effect of out-of-pocket payment on intention. RESULTS: Between May and September 2016, 294 FSWs participated. The median age was 29 years (interquartile range, 25-37 years). Human papillomavirus vaccination intention was high (mean, 2.0; 95% confidence interval [CI], 1.8-2.2). In multivariable analysis, attitude (ß = 0.6; 95% CI, 0.5-0.7), descriptive norm (ß = 0.2; 95% CI, 0.1-0.3), self-efficacy (ß = 0.2; 95% CI, 0.1-0.3), beliefs (ß = 0.1; 95% CI, 0.0-0.2), and subjective norm (ß = 0.1; 95% CI, 0.0-0.2) seemed to be the strongest predictors of HPV vaccination intention (R = 0.54). Human papillomavirus vaccination intention decreased significantly to a mean of 0.2 when vaccination would require out-of-pocket payment of &OV0556;350. CONCLUSIONS: The HPV vaccination intention among FSWs seems relatively high and is most strongly constituted in attitudinal, normative, and self-efficacy beliefs. Out-of-pocket payment will probably have a negative impact on their HPV vaccination acceptability.