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Influence of yearly cycles in adolescent vaccination on cancer prevention

青少年疫苗接种年度周期对癌症预防的影响

基本信息

批准号：
8781637
负责人：
Jennifer Lindsay Moss
金额：
$ 2.67万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-05 至 2015-05-10
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8781637
关键词：
Address Adolescent Adopted Affect Automobile Driving Centers for Disease Control and Prevention (U.S.)Cervical Country Data Data Analyses Diphtheria District of Columbia Dose Effectiveness Equation Ethics Faculty Fatigue Fellowship Female Adolescents Future Geographic state Goals Health Health Personnel Health behavior Holidays Human Papilloma Virus Vaccination Human Papilloma Virus Vaccine Human Papillomavirus Immunization Incidence Intervention Investigation Lead Malignant Neoplasms Malignant neoplasm of cervix uteri Marketing Masks Mediating Mediator of activation protein Mentorship Methodology Methods Modeling North Carolina Outcome Parents Pertussis Pilot Projects Policies Population Provider Public Health Questionnaires Relative (related person)Research Research Project Grants Research Support Resources Rest Safety Sampling Schools Scientist Seasons Secondary Immunization Series Students Surveys Teenagers Testing Tetanus Time Training Translating Update Vaccination Vaccines Virginia Visit Work base booster vaccine cancer prevention consumer demand disorder prevention girls improved prevent programs public health relevance trend uptake wasting

项目摘要

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) causes thousands of cases of cancer each year, but only about half of adolescent girls in the U.S. receive even one dose of the three-dose HPV vaccine series that can prevent these cancers. Despite its demonstrated safety and effectiveness, coverage with HPV vaccine has improved little in recent years, even as other adolescent vaccines, including tetanus, diphtheria, and pertussis booster (Tdap), continue to achieve steady gains. Public health agencies, including the Centers for Disease Control and Prevention, have sought to address disappointing levels of HPV vaccination by implementing quality improvement programs for vaccine providers and promotional activities for parents and adolescents. These programs are typically implemented on a year-round basis, but much of this work may be ill-timed. Anecdotal evidence suggests that healthcare providers administer many more doses of adolescent vaccines during the summer months than they do during the rest of the year. Our pilot study in North Carolina found that providers delivered 2.02 times as many doses of HPV vaccine and 4.70 times as many doses of Tdap in August compared to December. The reasons driving this summertime peak in vaccination are unclear, but they likely involve states' policies requiring that students receive Tdap vaccine prior to school entry. The specific aims of the proposed research project are to (1) identify summer peaks in HPV and Tdap vaccination, as well as concomitant vaccination with both doses during the same visit, nationally and in U.S. states, and (2) establish the relationships among states' school entry requirements, summer peaks in vaccination, and statewide levels of HPV vaccine initiation among adolescent girls. This project will use data from a nationally-representative sample of ~45,000 adolescent girls, drawn from the National Immunization Survey-Teen from 2008 to 2012. Data analyses will employ Edwards' method (a canonical test of cyclical trends) and longitudinal structural equation modelling. Results of this study have important implications for understanding the mechanism by which state policies influence vaccination and for timing immunization quality improvement efforts to be maximally effective. For instance, campaigns promoting HPV vaccination can concentrate their activities during the summer to capitalize on the increased volume of adolescents seeking vaccines in accordance with Tdap school entry requirements. These implications may ultimately lead to increased levels of HPV vaccination and reductions in the incidence of HPV-attributable cancers, thereby improving future health outcomes in the U.S. This fellowship will build on the applicant's prior research by supporting her training in conceptual underpinnings of cancer prevention in public health, advanced statistical methodologies, and the ethical conduct of research through the mentorship of the faculty sponsor, Dr. Noel T. Brewer. These activities will support the applicant's goal of becoming a tenure-track cancer-prevention scientist specializing in geographic disparities in health behaviors.

描述（由申请人提供）：人乳头瘤病毒（HPV）每年导致数千例癌症，但在美国，只有大约一半的青春期女孩接种了一剂可以预防这些癌症的三剂HPV疫苗系列。尽管已证明其安全性和有效性，但近年来HPV疫苗的覆盖率几乎没有提高，即使其他青少年疫苗，包括破伤风、白喉和百日咳加强疫苗（Tdap）继续稳步增长。公共卫生机构，包括疾病控制和预防中心，通过实施疫苗提供者的质量改进计划和对父母和青少年的推广活动，试图解决令人失望的HPV疫苗接种水平。这些计划通常是全年实施的，但其中大部分工作可能不合时宜。轶事证据表明，卫生保健提供者在夏季接种的青少年疫苗剂量比一年中其他时间要多。我们在北卡罗来纳州的试点研究发现，与12月份相比，8月份提供的HPV疫苗剂量是2.02倍，Tdap剂量是4.70倍。导致今年夏季疫苗接种高峰的原因尚不清楚，但可能与各州要求学生在入学前接种百白破疫苗的政策有关。拟议研究项目的具体目标是：(1)确定HPV和Tdap疫苗接种的夏季高峰，以及在全国和美国各州同一次访问期间同时接种两种剂量的疫苗；(2)建立各州入学要求、疫苗接种的夏季高峰和全州少女中HPV疫苗接种水平之间的关系。该项目将使用从2008年至2012年全国青少年免疫调查中抽取的约45,000名青春期女孩的全国代表性样本的数据。数据分析将采用爱德华兹的方法（周期性趋势的典型检验）和纵向结构方程模型。本研究的结果对于理解国家政策影响疫苗接种的机制以及适时提高免疫质量以最大限度地发挥作用具有重要意义。例如，促进人乳头瘤病毒疫苗接种的运动可以集中在夏季开展活动，以利用越来越多的青少年根据百白破入学要求接种疫苗。这些影响可能最终导致HPV疫苗接种水平的提高和HPV引起的癌症发病率的降低，从而改善美国未来的健康状况。该奖学金将建立在申请人之前的研究基础上，通过支持她在公共卫生中预防癌症的概念基础、先进的统计方法和研究的道德行为方面的培训，通过教师发起人Noel T. Brewer博士的指导。这些活动将支持申请人成为一名终身癌症预防科学家的目标，专门研究健康行为的地理差异。