Local Health Department Interest in Implementation of a Jail-Based Human Papillomavirus Vaccination Program in Kansas, Iowa, Missouri, and Nebraska.

CONTEXT: Local health departments (LHDs) play a vital role in community vaccination programs for human papillomavirus (HPV) infection, but little research has been done to assess LHD interest in cross-sectoral partnerships to vaccinate high-risk groups, specifically incarcerated persons. OBJECTIVE: To describe factors associated with interest in a novel implementation strategy linking LHDs with jails in 4 Midwestern states to deliver HPV vaccine. DESIGN: Survey based on the Consolidated Framework for Implementation Research (CFIR) model given to LHD administrators. A modified Poisson relative risk regression was used to assess the relationship between independent variables and LHD interest in implementation of a jail-based HPV vaccination program. SETTING: LHDs in Kansas, Missouri, Iowa, and Nebraska. PARTICIPANTS: From September 2017 to April 2018, two-thirds (237/344) of invited LHD administrators from the 4 states responded to the survey. MAIN OUTCOME MEASURE: LHD interest in implementation of a jail-based HPV vaccination program. RESULTS: Forty-five percent of LHDs were interested in learning more about implementing a jail-based HPV vaccination program, and 2% already offered or had plans to offer HPV vaccine in their jails. Barriers to implementation were cost (66%), inmates' short incarcerations (47%), and availability of medical staffing (43%). LHD characteristics associated with interest in implementation of a jail-based HPV vaccination program included "inner setting" CFIR variables, which capture the structural and cultural context for program implementation: 7 or more employees (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.24-3.95), perception of importance to provide HPV vaccine in jails (OR = 3.70; 95% CI, 2.00-6.84), and already providing any vaccines in jails (OR = 2.62; 95% CI, 1.18-5.80). CONCLUSIONS: Nearly half of LHDs in the region expressed interest in partnering with local entities to meet HPV vaccination needs of high-risk groups. Research on cross-sectoral partnerships and what these collaborations look like in practice is needed for public health impact.

Human Papillomavirus Vaccine Knowledge and Intention Among Adult Inmates in Kansas, 2016-2017.

OBJECTIVES: To assess human papillomavirus (HPV) knowledge and vaccine awareness, intention, and uptake among adult inmates in Kansas jails. METHODS: We administered a survey with questions adapted from the US National Cancer Institute's Health Information National Trends Survey to 571 adult inmates in 3 Kansas jails from October 10 to 12, 2016, and January 25 to 27, 2017, to assess HPV knowledge and vaccine awareness, intention, and uptake. RESULTS: Although most adults across demographic groups recognized HPV as causing cervical cancer, knowledge was lower about other HPV-related cancers. Vaccine awareness was higher for women (70%) than men (41%). Only 8% of age-eligible men reported ever receiving the vaccine. Most adults across demographic groups reported "definitely" wanting to get the vaccine if offered in jail at no cost. CONCLUSIONS: Low uptake of HPV vaccine and high interest in receiving the vaccine in jails may indicate that vaccination availability for jail populations needs to be reexamined. Public Health Implications. Expanding HPV vaccine programs or partnerships to facilitate vaccine provision in jails could increase inmates' knowledge of and intention to receive vital health services.

Seatbelt use is associated with lower risk of high-grade hepatic injury in motor vehicle crashes in a national sample.

BACKGROUND: Seatbelt use, alone and in conjunction with an airbag, is associated with lower risk of mortality, blunt abdominal trauma and kidney injury in motor vehicle crashes (MVCs). However, the effect of these protective devices on risk of severe liver injury is not well characterised. METHODS: This retrospective cohort study included patient admissions with liver injuries from MVCs from the National Trauma Data Bank (NTDB), collected from 2010 to 2015 in the USA. We examined associations between injury severity and seatbelt use and airbag presence individually and in the presence of additive interaction. Secondary outcomes were mortality, complications and discharge disposition. RESULTS: We analysed 55 543 records from the National Trauma Data Bank. In adjusted analysis, seatbelt use alone was protective against severe (AAST VI or above) hepatic injury (risk ratio (RR) 0.79, 95% CI 0.75 to 0.84), while airbag presence alone was not (RR 1.05, 95% CI 0.8 to 1.12). The joint association of seatbelt use and airbag presence with injury severity was greater than seatbelts alone (RR 0.74, 95% CI 0.70 to 0.79), with 13% of the joint lower risk attributable to interaction (95% CI 3% to 24%). The adjusted mortality risk of those without protective devices (10.3%, n=2297) was nearly double that of patients who used a seatbelt in conjunction with a present airbag (5.3%, n=699, p<0.001). CONCLUSIONS: Seatbelts are associated with lower liver injury severity and are more protective with airbags present, while airbags without seatbelt use were not protective against severe injury among patients with liver injury.