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Description

Nationally, rates for adolescents are 60.4% for one dose of HPV vaccine, and 43.4% for up-to-date HPV vaccination. National rates can mask disparities for specific populations and/or geographic areas; the 2016 CDC National Immunization Survey-Teen documented rural-urban differences in rates for first dose and up-to-date HPV coverage, although there has not been significant research to determine the factors associated with this disparity. In Iowa, rural areas have consistently lower adolescent vaccination coverage than urban areas for both first-dose HPV coverage (55.5% vs 64.1%) and up-to-date HPV coverage (40.5% vs 50.1%). The adoption of evidence-based interventions (EBIs) to encourage HPV vaccine uptake has been limited in rural areas, likely due to challenges identified by our research. Many of the areas with lower vaccination rates are rural and served by small health systems, which have fewer resources and staff dedicated to quality improvement and greater concerns about the financial implications of some EBIs such as standing orders and immunization-only appointments. In the past, these systems have relied on county public health to provide immunization, but local health departments are no longer able to consistently offer those services.

We are partnered with the American Cancer Society in Iowa to test strategies that have been successful in Federally Qualified Health Centers and are currently being implemented in large, urban-based systems.

Additional projects:

• Evaluating Iowa’s Medicaid Managed Care Organizations use of evidence-based interventions: Dr. Natoshia Askelson and Grace Ryan collaborated in evaluating ongoing efforts by the Iowa’s Medicaid Managed Care Organizations to use evidence-based interventions to encourage HPV vaccination uptake and cancer screenings among Medicaid enrollees. Collaborators on this project include the American Cancer Society and the Iowa Department of Public Health.
•  Analyzing Iowa Immunization Registry Data:  Askelson, Kahl, Carrell, and Novak have been analyzing state immunization data to identify geographic areas and characteristics that are associated with lower HPV vaccination uptake. The project is ongoing, and the team receives regular data updates. The analyses have been used to inform the public health departments efforts to encourage HPV vaccine uptake.
• Adolescent vaccination disparities in rural counties: The UI CPCRN leveraged its membership and network to successfully apply for an NCI P30 supplemental grant through the Holden Comprehensive Cancer Center to investigate adolescent vaccination disparities in rural areas. The researchers selected seven counties with low HPV vaccination rates relative to state levels and low HPV vaccination rates relative to the other adolescent vaccines. Based on these results, the team received funds from an internal Holden Comprehensive Cancer Center grant to design formative research data collections to understand the acceptability and feasibility of using the dental hygienists to encourage HPV vaccination uptake.
• Exploring integrated workforce collaborations to promote HPV vaccine uptake: This study aimed to establish the feasibility of using dental hygienists in an intervention to encourage the uptake of the HPV vaccine in adolescents. Findings from the research study have been used to inform the development of a dental clinic-based intervention to train dental hygienist to education, recommend, and refer dental patients for the HPV vaccine. We are now working with ENTs; we conducted and analyzed interviews with community ENTS providers about the acceptability and feasibility of making strong recommendations of HPV vaccination and are preparing a survey to collect data nationally. Dr. Natoshia Askelson is the PI on this project. Drs. Scherer and McKernan are collaborators.
• Collaborative CPCRN HPV Concept Mapping Project: In conjunction with OHSU, , the University of Minnesota, and Sanford Health in South Dakota, we  are conducting a concept mapping study  to understand state-level stakeholders' perceptions of barriers and facilitators to HPV vaccination in their community.

Resources, Media, & Publications 

Publications: 

• Ryan GW, Charlton ME, Scherer AM, Ashida S, Gilbert PA, Daly E, Askelson NM. Understanding Implementation of Evidence-Based Interventions to Address Human Papillomavirus Vaccination: Qualitative Perspectives of Middle Managers. Clin Pediatr (Phila). 2023 Oct;62(10):1193-1200. doi: 10.1177/00099228231154661. Epub 2023 Feb 10. PMID: 36762821.
• Askelson, N.M., Kim, S., Jung, Y.S., Adam, E., Ryan, G., Novak, N., Kintigh, B., Callaghan, D., Carrel, M. (2020). Visualizing immunization registry data to identify places with lower HPV vaccination initiation in a rural state. Preventing Chronic Disease. 17: 190350. doi: 10.5888/pcd17.190350
• Ryan G, Gilbert PA, Ashida S, Charlton ME, Scherer A, Askelson NM. Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: "HPV Is Probably Not at the Top of Our List". Prev Chronic Dis. 2022 Mar 31;19:E15. doi: 10.5888/pcd19.210378. PMID: 35358035; PMCID: PMC8992683.
• Ryan GW, Perry SS, Scherer A, Charlton ME, Ashida S, Gilbert PA, Askelson N. Factors contributing to missed opportunities for human papillomavirus vaccination among adolescents, ages 11 to 13, in Iowa. Vaccine X. 2022 Jul 9;11:100192. doi: 10.1016/j.jvacx.2022.100192. 
• Askelson, N., Ryan, G., McKernan, S., Scherer, A., Daly, E., Avdic, L. A (2021, March). Mixed-Methods Examination of Factors Related to HPV Vaccination Promotion in Private Dental Settings, Iowa, 2019. Preventing Chronic Disease, 18: E26. doi: 10.5888/pcd18.200553.