Parents' perspectives on dental team as advisors to promote HPV vaccination among Spanish adolescents.

PURPOSE: Human papillomavirus (HPV) is a prevalent sexually transmitted infection responsible for many anogenital and oropharyngeal cancers. Dental care providers have the potential to influence vaccine uptake, yet little is known about how patients perceive their role in HPV education and prevention. METHODS: Parents of adolescents aged 9 to 17 years (n = 375) were recruited from Valdeorras District Hospital (Galicia, Spain) to investigate parents' attitudes concerning the involvement of dental care providers in discussions related to HPV. A survey was distributed to the participants, and 343 (91.5%) were included in the analysis. RESULTS: In general, nearly half of the parents reported feeling comfortable regarding discussing HPV with their dentist. Participants described more comfort with dentists than with dental hygienists. Parents' comfort levels were influenced by various social determinants of health, including education level, marital status, geographic origin, and child vaccination status (p > 0.05). CONCLUSION: Parents reported varying comfort levels when discussing HPV and its vaccine with dental professionals, displaying a preference for dentists. Dental settings have the potential to promote vaccination, but the existence of ongoing barriers needs to be addressed.

HPV self-sampling among women in the United States: preferences for implementation.

PURPOSE: With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling. METHODS: We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling. RESULTS: Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail. CONCLUSION: Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers.

BACKGROUND: Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types. METHODS: Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS. RESULTS: Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers. CONCLUSIONS: Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

INTRODUCTION: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

Dental patients' communication preferences for learning about HPV-related topics.

Oropharyngeal cancer (OPC) has the highest incidence of any cancer caused by human papillomavirus (HPV). Oral health providers are urged to support the use of the HPV vaccine, which was approved by the US Food and Drug Administration for the prevention of OPC in 2020. This study evaluated the preferences of dental patients regarding 11 modalities for learning about HPV-related topics from their oral health providers. An online survey was administered to US adults aged 18 to 45 years (n = 285) to assess their communication modality preferences, prior experience discussing HPV with oral health providers, and demographic characteristics. Multiple items were combined to obtain preference scores for each modality. Preference scores were compared using 2 × 3 mixed analysis of variance. Age, sex, income, and HPV vaccination status were assessed as potential confounders. One-on-one discussions were the most preferred modality for learning about HPV-related topics; however, the preference scores differed based on whether the patient had prior HPV-related discussions with oral health providers (partial η2 = 0.054). Patients who had prior discussions showed a weaker preference for one-on-one discussions than did patients who had not had prior discussions. Oral health providers are called on to promote HPV vaccination, which will require increasing communication on this subject with patients. To assure greater acceptance of their recommendations, providers will need to match their communication styles to those desired by their patients. As part of a comprehensive HPV prevention strategy that includes administration of the vaccine, oral health providers should be educated on how to confidently discuss HPV-related issues with their patients.

Characteristics associated with the adoption of consumer-based -self-sampling methods for sexually transmitted infection screening.

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

Understanding the Challenges of HPV-Based Cervical Screening: Development and Validation of HPV Testing and Self-Sampling Attitudes and Beliefs Scales.

The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.

Key Considerations and Recommended Strategies for Conducting a School-Based Longitudinal RE-AIM Evaluation: Insights From a 28-School Cluster Randomized Trial.

RE-AIM is an implementation science framework that provides a structure to promote data collection and analysis in the domains of Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance. The RE-AIM approach promotes more data collection and reporting than typical evaluations so potential adopters can determine the potential program fit for their setting. RE-AIM has been used to evaluate a variety of programs; however, there are few resources that provide strategies for conducting a RE-AIM evaluation in the school setting. The purpose of this article is to inform future studies by elucidating experiences conducting a large, complex, multisite, longitudinal RE-AIM evaluation in schools in partnership with the state's Departments of Education and Health, and to share strategies for overcoming obstacles. With the long-term goal of facilitating the translation of school-based intervention research into practice, we provide key considerations and recommend strategies for school-based RE-AIM evaluation success.

Assessing college students' interest in university-based oral health information and services.

Objective: To assess US college students' (1) oral health behaviors and (2) interest in university-based oral health information and services. Participants: Students at a large public university in the southeast participated in the survey (n = 102). All participants were over the age of 18 and able to speak and read English. Methods:An online quantitative survey was administered to collect information on oral health behaviors, interest in university-based oral health information and services, and sociodemographic factors. Frequencies, descriptive statistics, and bivariate analyses were utilized for this study. Results: Approximately 11% of students rated their oral health as fair/poor and 27% currently had a dental problem. Over half (53%) were interested in receiving oral health information from the university, 87% felt campus-based dental services were important, and 79% were likely to use campus-based dental services. Conclusions: College students may benefit from information and services to promote oral health within the college context.

Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews.

BACKGROUND: Pregnancy presents an opportune time for oral health promotion and intervention; however, implementation of the prenatal oral health guidelines remains a challenge among prenatal and oral health providers. The purpose of this study was twofold: To employ a theory-based approach to identify high-priority Consolidated Framework for Implementation Research (CFIR) constructs with the greatest potential to impact prenatal oral health guideline implementation, and to operationalize and pre-test survey items based on the prioritized CFIR constructs. Identifying barriers and facilitators to guideline implementation will inform the development of targeted interventions that address gaps in adherence which can positively impact oral-systemic health. METHODS: The online survey development process employed three rounds of a modified-Delphi technique with prenatal (i.e., MD/DO, CNM) and oral health (i.e., DMD) Practice Advisory Board Members, cognitive interviews with prenatal and oral health providers, and deliberations among the research team and a Scientific Advisory Board (OBGYN, pediatric dentist, and researchers). High-impact CFIR constructs were identified and translated into survey items that were subsequently piloted and finalized. RESULTS: During three modified-Delphi rounds, a total of 39 CFIR constructs were evaluated with final input and deliberations with the Practice Advisory Board, Scientific Advisory Board, and the research team achieving consensus on 19 constructs. The instrument was pre-tested with four prenatal and two oral health providers. Overall, participants reported that the survey items were feasible to respond to, took an appropriate length of time to complete, and were well-organized. Participants identified specific areas of improvement to clarify CFIR items. The final survey instrument included 21 CFIR items across four domains, with five constructs included from the intervention characteristics domain, two from the process domain, two from the outer setting domain, and 12 from the inner setting domain. CONCLUSIONS: Lessons learned from the survey development process include the importance of soliciting diverse scientific and practice-based input, distinguishing between importance/impact and direction of impact (barrier/facilitator), and the need for additional qualitative methods during interdisciplinary collaborations. Overall, this study illustrated an iterative approach to identifying high-priority CFIR constructs that may influence the implementation of the prenatal oral health guidelines into practice settings.

Ensuring a Successful Transition From Cytology to Human Papillomavirus-Based Primary Cervical Cancer Screening in Canada by Investigating the Psychosocial Correlates of Women's Intentions: Protocol for an Observational Study.

BACKGROUND: The human papillomavirus (HPV) test has emerged as a significant improvement over cytology for primary cervical cancer screening. In Canada, provinces and territories are moving toward implementing HPV testing in cervical cancer screening programs. Although an abundance of research exists on the benefits of HPV-based screening, there is a dearth of research examining women's understanding of HPV testing. In other countries, failure to adequately address women's concerns about changes has disrupted the implementation of HPV-based screening. OBJECTIVE: The aims of the multipart study described in this paper are to develop psychometrically valid measures of cervical cancer screening-related knowledge, attitudes, and beliefs; to examine the feasibility of a questionnaire examining psychosocial factors related to HPV-based screening; and to investigate psychosocial correlates of women's intentions to participate in HPV-based screening. METHODS: We conducted a web-based survey (study 1) of Canadian women to assess the acceptability and feasibility of a questionnaire, including the validation of scales examining cervical cancer knowledge, HPV testing knowledge, HPV testing attitudes and beliefs, and HPV test self-sampling attitudes and beliefs. Preferences for cervical cancer screening were assessed using the best-worst scaling methodology. A second web-based survey (study 2) will be administered to a national sample of Canadian women between June 2022 and July 2022 using the validated scales. Differences in the knowledge, attitudes, beliefs, and preferences of women who are currently either underscreened or adequately screened for cervical cancer will be examined through bivariate analyses. Multinomial logistic regression will be used to estimate the associations between psychosocial and sociodemographic factors and intentions to undergo HPV-based screening. RESULTS: Between October 2021 and November 2021, a total of 1230 participants completed the questionnaire in study 1, and 1027 (83.49%) responses were retained after data cleaning methods were applied. Feasibility was comparable with similar population-based surveys in terms of survey length, participant attrition, and the number of participants excluded after data cleaning. As of May 2022, analysis of study 1 is ongoing, and results are expected to be published in the summer of 2022. Data collection is expected to begin for study 2 in the summer of 2022. Results are expected to be published between late 2022 and early 2023. CONCLUSIONS: Findings will provide direction for Canadian public health authorities to align guidelines to address women's concerns and optimize the acceptability and uptake of HPV-based primary screening. Validated scales can be used by other researchers to improve and standardize the measurement of psychosocial factors affecting HPV test acceptability. Study results will be disseminated through peer-reviewed journal articles; conference presentations; and direct communication with researchers, clinicians, policy makers, media, and specialty organizations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38917.

Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health.

Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students.Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university.Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis.Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students.Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2040517 .

Awareness Levels of the Link Between Oropharyngeal Cancer and HPV Infection Among Spanish Women: a Hospital-Based Cross-sectional Study.

Several observational studies have demonstrated the increased awareness of human papillomavirus (HPV) as an etiological factor of oropharyngeal cancers (OPCs). The incidence of OPCs has increased in recent times, particularly among younger women, and the efficacy of the HPV vaccine in preventing these cancers has gained attention among the medical community. The aim of this study was to explore the health literacy of Spanish adult women regarding factors associated with HPV and its link to OPCs, as well as their awareness of the HPV vaccination. A survey was distributed to 508 women, and 409 (70.5%) were considered as valid participants. The majority of the participants were Caucasian (97.8%) with a mean age of 44.1 ± 11.6. Out of all the participants, only 48.9% women identified HPV as a possible etiology of OPC. The most common sources of information regarding this association were the internet (31.3%), video media (28.9%), and healthcare professionals (28.9%), whereas 16.1% of the participants reported that they had obtained information from three or more sources. The average number of correct answers in the 16-item survey which was used to determine the participants' knowledge of HPV-related diseases was 8.7 ± 4.2, and the average number of correct answers in the 6-item survey regarding the usefulness of the HPV vaccination was 3.3 ± 1.6. According to bivariate models, the variables associated with a poorer level of awareness were related mainly to education (p < 0.001), sexual behavior (p < 0.001), and employment status (p < 0.001). This study contributes toward the discovery of the previously unforeseen psychosocial burden of HPV and its related diseases among Spanish women.

Stakeholders' perspectives on system-level barriers to and facilitators of HPV vaccination among Hispanic migrant farmworkers.

OBJECTIVES: Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities. DESIGN: Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders (n = 13) representative of health, social services, and political sectors. Stakeholders were asked about their perceptions of barriers to and facilitators of HPV vaccination among migrant farmworkers. Interviews were audio-recorded, transcribed, and thematically analyzed. Responses were coded according to components of the SEM. RESULTS: Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy. CONCLUSIONS: Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.

Understanding young Black women's socialisation and perceptions of sexual and reproductive health.

Although sexual and reproductive health inequities acutely and disproportionately affect Black women in the USA, there are few studies that consider the sociocultural context in which Black women transition to adulthood and develop their sexuality. The objective of this study was to describe the lived realities of young Black women to elucidate how the sociocultural context informs their current perceptions of sexual and reproductive health. We conducted phenomenological interviews with 22 Black women aged 18-29 years to elicit their life stories. The main categories identified in the findings include how the sociocultural environment informs the self-concept; how the sociocultural environment informs early learning about sexual health; and how together these experiences inform women's development of a sexual self-concept. Three main groupings of experiences were identified relative to women's sexual self-concept: fear-based disease and pregnancy prevention; a deeper understanding of bodies and sexuality beyond disease and pregnancy prevention; and sexual pleasure and fulfilment as a priority. To address ongoing sexual and reproductive health inequities that particularly disadvantage young Black women, health systems and interventions should address the sociocultural contexts in which young Black women develop and manage their sexual health.

Discussing HPV and oropharyngeal cancer in dental settings: gender and provider-type matter.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and the leading cause of oropharyngeal cancer (OPC), an oral cancer most often identified by dental providers. Given the rise in HPV-associated OPC and recent Food and Drug Administration (FDA) approval of the HPV vaccine to prevent OPC, dental providers have a unique role in HPV prevention. This study assessed US adults' comfort levels discussing HPV and OPC with dental providers. An online survey platform was used to recruit a nationally representative sample of US adults (n = 300). The questionnaire assessed participants' knowledge, acceptability, and comfort discussing HPV-related topics with dental providers. SPSS 24 was utilized for data analyses. In general, participants reported feeling comfortable discussing HPV and OPC with dental providers. Participants reported feeling more comfortable with dentists than dental hygienists when discussing (t = 2.85, p < .01) and receiving recommendations about the HPV vaccine (t = 2.09, p < .05). Participants were less comfortable discussing HPV as a risk factor for OPC compared to non-HPV related risk factors (t = 2.94, p < .01). Female participants preferred female providers, whereas male participants had no preference. Previous research has indicated dental providers recognize their role in HPV prevention, but research is needed to understand patients' perceptions of dental providers' role in HPV prevention. Findings demonstrate that US adults are comfortable discussing HPV and OPC with dental providers, which may be key to OPC-HPV prevention. Future research is needed to facilitate HPV communication between patients and dental providers.

Social Network Influences on Young Women's Choice to Use Long-Acting Reversible Contraception: A Systematic Review.

INTRODUCTION: Long-acting reversible contraception (LARC; including intrauterine devices and implants) is recommended as the first-line contraceptive choice by several professional organizations (eg, American College of Obstetricians and Gynecologists); however, rates of uptake are lower than those of other contraceptive methods. A young woman's social network may influence the decision to use LARC. The purpose of this review was to determine the role of health care providers (HCPs), family, peers, and sexual partner(s) on young women's decisions to initiate LARC. METHODS: Several databases (PubMed, CINAHL, and PsycINFO) were searched for articles published between 2000 and 2020 that studied the social network influences of HCPs, family, peers, and sexual partner(s) on LARC initiation among women in the United States aged 18 to 25. A narrative synthesis of the included articles was conducted. RESULTS: Twenty-nine articles met the inclusion criteria (21 qualitative, 6 quantitative, 2 mixed methods). HCPs are an important influence on a young woman's LARC decision-making. Peers and family also have a role but were often sources of negative or inaccurate information. Gaps in the literature were identified, including a lack of data on implant users and a dearth of studies on the role of sexual partner influence; most studies were not guided by theory. DISCUSSION: HCPs are integral to LARC initiation and may be more influential than other social network members. Future research should focus on understanding how social network members interact to result in LARC initiation. Gaining insight into these influences may improve existing interventions or contribute to the development of new interventions and ultimately promote LARC use among young women.

Arguments in favor of and against the HPV vaccine school-entry requirement in Puerto Rico: a content analysis of newspaper media.

PURPOSE: Vaccine requirements are effective population-based strategies to increase vaccination rates. In 2018, Puerto Rico's DOH announced that the HPV vaccine would be required for school entrance. This study explored arguments in favor of and against the HPV vaccine school-entry requirement in PR. METHODS: We conducted a content analysis of two Puerto Rican newspapers. Articles (n = 286) published between 1/1/2015 and 7/31/2018 containing the Spanish terms for "HPV" and "human papillomavirus" were included. Data were summarized using descriptive statistics. Articles that mentioned the HPV vaccine school-entry requirement (n = 33) were reviewed qualitatively using applied thematic analysis. RESULTS: The top five primary focus areas were education about HPV and the HPV vaccine, advertisements promoting the HPV vaccine, general vaccine information, cervical cancer and screening information, and the HPV vaccine school-entry requirement. Of the 33 articles that mentioned the requirement, 61% presented arguments in favor, 15% presented arguments against, 12% presented both arguments, and 12% only mentioned the existence of the requirement or were the DOH announcement. Arguments in favor centered on cancer prevention, high rates of HPV-associated cancers, and population wellness. Arguments against included worries about sexual transmission of HPV, HPV vaccine's side effects, issues related to the policy (e.g., mandatory), and lack of education. CONCLUSION: Understanding reasons people support or oppose an HPV vaccine school-entry requirement is important for the policy processes to be successful. Education efforts must continue to change the HPV vaccine narrative. Messages should be crafted to educate and gain support among parents and stakeholders towards this population-based cancer prevention strategy.

The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico.

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico's HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews (n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations' leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza's case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

"When Is Health Care Actually Going to Be Care?" The Lived Experience of Family Planning Care Among Young Black Women.

While family planning care (FPC) visits may serve as opportunities to address gaps in knowledge and access to limited resources, young Black women may also face structural barriers (i.e., racism, discrimination, bias) to engaging in care due to the intersections of racial identity, age, and socioeconomic status. Findings from interviews with 22 Black women, ages 18 to 29 years, about the lived experience of FPC highlighted dynamic patient-provider encounters. Women's narratives uncovered the following essences: silence around sex impedes engagement in care, patient-provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience, decision making excludes discussion and deliberation, medical mistrust is pervasive and a part of Black consciousness, and meaningful and empathic patient-provider encounters are elusive. Health systems should prioritize developing and enhancing young Black women's relationship with FPC providers to help mitigate persistent inequities that perpetuate disadvantage among this population.