Understanding Barriers to Human Papillomavirus Vaccination among Parents of 9-10-Year-Old Adolescents: A Qualitative Analysis.

HPV vaccination rates remain low among US adolescents, with only 54% completing the series in 2019. The vaccine is recommended at age 11-12 but can be given as early as age 9. Although it has been found that offering the vaccine earlier improves completion rates by age 13, parents remain reluctant to allow their younger children to initiate this vaccine. The purpose of this study was to better understand parental beliefs regarding receipt of the HPV vaccine among their children at ages 9-10. A 40 min phone interview was completed with 21 participants who were asked about their vaccine viewpoints. Even after receiving one-on-one education from a patient navigator, many caretakers expressed inadequate knowledge of the HPV vaccine and limited exposure to both positive and negative influences. The biggest concern was vaccine side effects, often resulting from a lack of medical understanding. Most parents were reluctant to vaccinate their children at a school-based clinic or pharmacy and believed that the government should not mandate HPV vaccination for public school attendance. Our study provides insight into parental beliefs and attitudes about HPV vaccination at age 9-10 years and barriers that need to be addressed.

Submersion Injuries and the Cost of Injury Associated with Drowning Events in the United States, 2006-2015.

INTRODUCTION: The World Health Organization has reported submersion injuries as the third most common cause of death due to unintentional injury in the world. Greater detail in the rates, risk factors, and healthcare associated costs of submersion injuries could be instrumental in demonstrating the need for further funding and intervention. METHODS: The study was a cross-sectional analysis of a nationally representative dataset of inpatient and emergency department (ED) encounters between 2006 and 2015 in the United States (US). Healthcare utilization costs were provided within the datasets and adjusted to reflect actual charges and provider fees. Lastly, the final cost values were adjusted to the 2020 US dollar (USD) and summarized using a log adjusted mean. RESULTS: On average, there were 11,873 submersion injuries per year that presented to the ED in the US. Resulting in a rate where approximately 9 out of every 100,000 ED visits were associated with a submersion injury. Slightly more than 6% died in the ED, 24.2% were admitted, and 69.3% were discharged from the ED. In total, annual cost of submersion injuries in the US for ED care is approximately $12.5 million, inpatient care is approximately $27.5 million, and total annual healthcare cost exceeds $40 million. DISCUSSION: While these results only represent a fraction of the total cost associated with submersion injuries, it remains substantial and unchanged over the 10-year study period. Certain demographic groups showed higher rates of injury and disease burden, thus bearing a greater amount of the cost.

Outcomes of an integrated practice unit for vulnerable emergency department patients.

BACKGROUND: An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients or multi-visit patients (MVP). However, less is known about differences in the impact of these interventions on insured vs. uninsured SU patients and super high frequency SUs ([Formula: see text]8 ED visits per 6 months) vs. high frequency SUs (4-7 ED visits per 6 months). METHODS: We assessed the percent reduction in ED visits, ED cost, hospitalizations, hospital days, and hospitalization costs following implementation of an IPU for SUs located in an academic tertiary care facility. We compared outcomes for publicly insured with uninsured patients, and super high frequency SUs with high frequency SUs 6 months before vs. 6 months after enrollment in the IPU. RESULTS: There was an overall 25% reduction in hospitalizations (p < 0.001), and 23% reduction in hospital days (p = 0.0045), when comparing 6 months before vs. 6 months after enrollment in the program. There was a 26% reduction in average total direct hospitalization costs per patient (p = 0.002). Further analysis revealed a greater reduction in health care utilization for uninsured SU patients compared with publicly insured patients. The program reduced hospitalizations for super high frequency SUs. However, there was no statistically significant impact on overall health care utilization of super high frequency SUs when compared with high frequency SUs. CONCLUSIONS: Our study supports existing evidence that dedicated IPUs for SUs can achieve significant reductions in acute care utilization, particularly for uninsured and high frequency SU patients. TRIAL REGISTRATION: IRB201500212. Retrospectively registered.

Impact assessment of a provider-targeted national vaccine messaging campaign on human papillomavirus vaccination rates among US adolescent males.

Initial uptake of the cancer-preventative human papillomavirus (HPV) vaccine in the US was slow, especially among adolescent males. To address this, the US Centers for Disease Control and Prevention (CDC) partnered with the Hager Sharp communications development company to launch a national campaign in 2015 to improve physician counseling and rebrand the vaccine as cancer prevention. In this study, we compared HPV vaccination rates among 13-17-year-old males before (2010-2014) and after (2015-2019) the CDC-Hager Sharp campaign using National Immunization Survey-Teen data to determine the potential impact of this campaign on improving vaccine uptake among adolescent males. Employing provider-verified vaccination data available for 49,644 males from 2010 to 2014 and 47,943 males from 2015 to 2019, we found that the adjusted prevalence ratios of 13-17-year-old males who initiated and completed the vaccine series increased approximately 5-fold between the 2010-2014 and 2015-2019 periods. Increases in post-campaign initiation/completion rates were greatest among respondents with mothers who were married or had attended college, respondents who lived in the Northeast or Midwest, and those from households with annual incomes > $75,000. Together, these data suggest that the campaign contributed to the observed increase in HPV vaccine uptake among adolescent males. Although sociodemographic disparities were identified, the greater improvement in vaccination rates observed among individuals with higher socio-demographic status may simply reflect their relatively poorer rates of initial vaccine uptake. Overall, the data suggest that provider-targeted campaigns can be a useful tool to boost vaccinations and should be considered for inclusion in future vaccination campaigns.

Salary Differences Between Schools of Medicine and Schools of Public Health for Nonclinical PhD Faculty: A Case Study of One Large Multicampus University System.

There are no evidence-based findings to assist professionals with advanced public health and social science degrees in choosing the appropriate academic location. A cross-sectional case study in 2019 was conducted using publicly available online data of full-time, nonclinical, doctoral-level academic faculty in schools of public health (SOPHs) and schools of medicine (SOMs), within one large university system. Analyses included descriptive statistics and generalized linear regression models comparing salaries between school types by academic rank, after gender and race/ethnicity adjustment. The study included 181 faculty members, 35.8% assistant, 34.1% associate, and 30.1% full professors. After accounting for race/ethnicity and gender, SOM assistant and associate professors had 9% (P = .03) and 14% (P = .008) higher mean salaries than SOPH counterparts. Findings suggest slight salary advantages for SOM faculty for early- to mid-career PhDs in one university system. Factors such as start-up packages, time to promotion, and grant funding need further exploration.