Improving human papilloma virus vaccination rates throughout military treatment facilities.

OBJECTIVES: The four objectives of this study were to (1) educate military healthcare providers on HPV disease and vaccine, (2) assess short term recall of information presented at educational sessions, (3) assess provider comfort level with the vaccine, and (4) assess improvement in HPV vaccination rates. METHODS: Standardized interactive educational sessions were conducted at military primary care clinics with pre- and post-educational quizzes administered before and immediately following the sessions. Provider attitudes were assessed using Likert scale questionnaires. Vaccination rates in children and young adolescents ages 11-18 at one of the participating regions that had a champion and started a Quality Improvement (QI) project were assessed at baseline, at 3-months and at 6-months post sessions. RESULTS: 200 providers were reached at 48 primary care clinics during May 2014 through October 2015 with 200 quizzes and Likert scale questionnaires returned. There was increase in knowledge following the educational sessions as revealed in the pre- and post- test scores [t(57) = -5.04, p < 0.001]. There was a significant overall increase in comfort in answering patients' and parents' questions about HPV vaccine [p = 0.003]. There was a significant increase in the number of vaccines given at all the clinics 3-months after the educational sessions at the region who had a champion dedicated to monitoring vaccine rates and ensuring implementation efforts [p = 0.01] and started a QI project. This increase was not sustained at 6-months [p = 0.324]. CONCLUSIONS: Improvement in provider short term knowledge recall and comfort level in answering parents' questions was seen. We found that educational sessions can improve HPV vaccination rates in military clinics that have a vaccine champion for up to 3-months. Further research into the effects of having clinic vaccine champions is critical.

Military youth and the deployment cycle: emotional health consequences and recommendations for intervention.

The United States military force includes over 2.2 million volunteer service members. Three out of five service members who are deployed or are preparing for deployment have spouses and/or children. Stressors associated with the deployment cycle can lead to depression, anxiety, and behavior problems in children, as well as psychological distress in the military spouse. Further, the emotional and behavioral health of family members can affect the psychological functioning of the military service member during the deployment and reintegration periods. Despite widespread acknowledgment of the need for emotional and behavioral health services for youth from military families, many professionals in a position to serve them struggle with how to best respond and select appropriate interventions. The purpose of this paper is to provide an empirically based and theoretically informed review to guide service provision and the development of evidence based treatments for military youth in particular. This review includes an overview of stressors associated with the deployment cycle, emotional and behavioral health consequences of deployment on youth and their caretaking parent, and existing preventative and treatment services for youth from military families. It concludes with treatment recommendations for older children and adolescents experiencing emotional and behavioral health symptoms associated with the deployment cycle.