Rutgers researchers are seeking the help of pediatric physicians to develop a plan to improve the frighteningly low rate of Newark-area adolescents getting vaccinated against the sexually transmitted human papillomavirus, a known risk factor for several cancers.
“Adolescent patients treated by pediatricians consistently have higher HPV vaccination initiation rates than adolescents treated by other specialists,” said Rula Btoush, associate professor at the School of Nursing, who leads a collaborative team that includes researchers from the School of Public Health.The researchers found that older adolescents who visit gynecologists and other non-pediatric physicians have the lowest vaccination rates of all adolescents, approximately 5 percent, while older adolescents who visited pediatricians had a vaccination rate of 40 percent. Their findings were recently published in the American Journal of Public Health and the Journal of Community Health.
Overall, though the vaccine is free and available at local hospitals and public clinics, only 27.4 percent of females and males ages 10 through 20 in Newark and surrounding communities initiate the recommended three-dose vaccination against the human papillomavirus, or HPV.
“Low-income black and Hispanic adolescents represent the population at highest risk for HPV-related cancers, particularly cervical cancer,” says Btoush. “The vaccination rates in Newark are much lower than in the rest of the country. We need to educate providers and help them develop the skills to inform and assist mothers in the decision-making process regarding the vaccination of their adolescent children.”
The Centers for Disease Control and Prevention said in July 2015 that New Jersey has the nation’s fourth-lowest HPV vaccination rate for girls.
In the Greater Newark area – including Newark, Irvington, Orange and East Orange – the researchers found that vaccination initiation was slightly higher among male adolescents compared to females (31.5 vs. 24.8 percent) and among black adolescents compared to Hispanics (29.6 vs. 25.4 percent). Greater Newark’s morbidity rate for cervical cancer is twice that of New Jersey, which had the 10th highest morbidity rate for cervical cancer nationally from 2006 through 2010.
The alarming statistics have motivated the School of Nursing and School of Public Health team to design an awareness-raising campaign to boost the vaccination rate dramatically. This month, the researchers begin working with local pediatricians on effective ways to communicate HPV’s health risks during office visits.The researchers also will study how best to approach non-pediatric specialists about strengthening their communication concerning HPV to adolescent patients. In their findings, they refer to the 5 percent vaccination rate as a “dire” situation for older adolescents (ages 16-20) who receive health care from non-pediatricians – primarily from obstetricians and gynecologists for females and family medicine and internal medicine physicians for males.
“This indicates the importance not only of pediatric health care providers in improving HPV vaccination but also the critical need to educate and involve non-pediatric providers in efforts to promote HPV vaccination,” the researchers said.
In addition, the researchers will study how to educate adolescents' parents concerning misperceptions about the vaccine. The research found that some parents are unaware that the vaccine is free and that young boys as well as girls are vulnerable to HPV. Btoush, who hopes to have a plan ready to implement by late fall, said that her team also will consider the practicality of telephone calls to remind adolescents of upcoming vaccination appointments.
One reason that HPV remains a major concern in New Jersey is that an HPV vaccine is not mandated as are other vaccines, such as those to protect against pertussis and meningitis. By comparison, the vaccine initiation rate among adolescents is 58.0 percent in nearby New York City and 80.3 percent in Philadelphia, two cities that also do not mandate HPV vaccination but have successfully implemented city-wide programs and campaigns to improve HPV vaccination.
Btoush said the new campaign reflects the researchers’ desire to maintain the momentum their findings have generated, given the vaccine’s effectiveness. Nationally, the CDC estimates that 26,000 new HPV-associated cancers each year – 18,000 among women, 8,000 among men – could be prevented with the vaccine.
“Our research is motivating us to keep going,” said Btoush. “We want to protect the most vulnerable and make sure these kids have a better future.”
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