On the Path to Prevention from the St. Jude HPV Cancer Prevention Program

Have you seen the headlines?

“New data indicates declining confidence in childhood vaccines of up to 44 percentage points in some countries during the COVID-19 pandemic”

“New UNICEF report shows 67 million children missed out on one or more vaccinations over three years due to service disruption caused by strained health systems and diversion of scarce resources, conflict and fragility, and decreased confidence”

“New UNICEF report shows falling vaccine confidence in all but 3 of 51 countries”

According to a new UNICEF report, The State of the World’s Children 2023: For Every Child, Vaccination, the COVID-19 pandemic has led to the loss of more than a decade’s worth of progress in childhood vaccinations worldwide. According to the report, the decline in vaccination confidence occurs during the largest sustained backslide in childhood vaccinations in 30 years. Childhood vaccination levels are at their lowest since 2008.

Threats to vaccination confidence were accelerated during the pandemic due to disruptions in usual health services, pervasive poverty, conflict and displacement, vaccine misinformation and mistrust, and health worker shortages. Many children who are not getting vaccines live in the poorest, most remote, and marginalized communities, according to the report.

Worldwide opinion about the importance of vaccinations has changed. In the United States, there has been a 79 percentage point change in perception of the importance of vaccines for children, from before to after the start of the pandemic (see Figure 4.1 from the UNICEF report).

Our charge is clear: we must build confidence – and in some cases rebuild confidence – in vaccinations, including in HPV vaccination for cancer prevention. At the recent International Papillomavirus Conference in Washington, DC, vaccination hesitancy continued to be a talking point. Our approaches to build confidence in vaccinations must include individuals and communities as well as context and conditions.

As always, we have much information to share with you. We welcome your contributions to our newsletter to further the reach of your own HPV cancer prevention efforts. Reach out to us at PreventHPV@stjude.org.

HPV vaccination is cancer prevention.

May is Asian American and Pacific Islander (AAPI) Heritage Month, a month dedicated to recognizing the history of Asian Americans and Pacific Islanders and the contributions they have made to the United States. While celebrating their rich contributions, we recognize the diversity and unique health care needs within these communities. One size does not fit all.

We spoke with two public health leaders who have dedicated their careers to researching health equity among Asian American and Pacific Islanders. These exceptional women are making efforts to reduce disparities, improve health outcomes and quality of life and increase HPV vaccination uptake among the Asian American and Pacific Islander population.

Grace X. Ma, PhD

Associate Dean for Health Disparities of Laura H. Carnell Professor in Urban Health and Population Science

Founding Director, Center for Asian Health (CAH) ,Lewis Katz School of Medicine

Professor, Fox Chase Cancer Center, Temple University

Ma has dedicated her career to reducing health disparities among ethnic and minority populations, particularly within the Asian American community. Her passion for achieving equity and making this “invisible” population visible inspired her to establish the Center for Asian Health, one of the first organizations in the United States dedicated to reducing health disparities and improving health equity among underserved Asian Pacific Americans and other diverse health disparity populations.

Among the health services Ma and the Center for Asian Health provide is cancer education, prevention and screening with the goal of increasing HPV vaccination among the diverse communities the center serves. To do this, Ma stresses the importance of outreach, engagement and strong partnerships for each specific community within this population.

Over more than two decades, Ma has built a network of trusted partners, including churches, community leaders, healthcare providers, schools and other local organizations that meet members of the community where they are and ensure culturally appropriate education to fit the needs of each community. The Center works with partners to overcome a variety of community barriers – language, accessibility and long-held cultural beliefs – to provide accurate information about HPV vaccination, dispel misinformation about vaccination and stress the importance of HPV vaccination as a cancer prevention tool.

Ha Ngan (Milkie) Vu, PhD, MA

Assistant Professor, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University; 2023 Emerging Leader Fellow, National HPV Roundtable

Vu’s decision to focus on studying HPV vaccination among Asian Americans stemmed from her conversations with community members that revealed low awareness and knowledge of HPV vaccination. Through her community outreach, Vu also recognized the barriers to vaccination among the Asian American community, including access to vaccination, a lack of English language proficiency, and cultural concerns.

Another challenge to increasing HPV vaccination among Asian American and Pacific Islander communities is the myth that these populations do not experience health differences. As Vu explains, these communities are extremely diverse, representing people from more than 30 countries, speaking more than 100 languages and dialects, and facing a variety of health concerns with differing cultural and religious beliefs. Vu notes that historically, cancer prevention efforts among Asian Americans and Pacific Islanders have focused on liver and lung cancers, given the higher rates of these cancers within these populations when compared with other racial and ethnic groups in the United States.

To overcome these barriers to HPV vaccination and move away from adopting a “one-size-fits-all” approach, Vu has collaborated with community organizations to examine determinants of HPV vaccination and explore community-based, culturally relevant strategies to increase the number of people who get the vaccine. She and her partners have examined patterns of health decision-making to determine preferences for health information sources and to address culture-specific beliefs. Still, Vu emphasizes the need to ensure equity in access to and awareness of HPV vaccination and cervical cancer screening programs to protect Asian American and Pacific Islanders against HPV cancers.

Jennifer Tsui, PhD, MPH

Associate Professor, Department of Population and Public Health Science, Keck School of Medicine; Director, Cancer Care Delivery Research and Implementation Science, Norris Comprehensive Cancer Center, University of Southern California

Tsui’s dedication to health equity among Asian Americans and Pacific Islanders began early. The daughter of an immigrant family, she grew up in culturally and linguistically diverse Southern California. She drove her grandparents to medical appointments, where she translated and helped them navigate their health care needs. This opened Tsui’s eyes to “the barriers that you can encounter for Asian American and other immigrant communities with limited English proficiency.” While earning her MPH, Tsui was exposed to programs specifically dedicated to preventing cancer among Asian American and Pacific Islander communities. This, coupled with meeting role models, leaders and mentors, solidified Tsui’s decision to focus on addressing cancer disparities in diverse populations.

Tsui was drawn to HPV cancer, particularly cervical cancer research, because of how preventable it is. To increase HPV vaccination uptake among Asian American and Pacific Islanders, Tsui notes the importance of disaggregating data across the diverse communities to pinpoint the specific linguistic, geographic, and health care needs of each group. She also emphasizes the importance of providing access to information from trusted sources. Given the hundreds of languages spoken among the Asian American and Pacific Islander communities, she affirms the need to relay HPV vaccination information and address misinformation efficiently and accurately in a culturally appropriate way.

She says that addressing health care disparities and increasing HPV vaccination must start with the community. These efforts must be made in partnership with community-based organizations and community clinics whose mission is to serve Asian American and Pacific Islander communities. Partnerships allow for adapting strategies to fit the different communities, ensuring that messaging from providers and leaders is presented in the voice of the community and that trusted messengers and effective communication leaders are delivering the message.

“We can eliminate HPV-associated cancers with this effective and safe vaccine, so the problem is not that we don’t have tools, it’s that we need to make these prevention tools accessible to all communities and in the health care settings that serve diverse communities,” she said.

May is the bridge between spring and summer, but May is also the month of Mother’s Day. Joslyn Paguio is a mother, warrior, and survivor of cervical cancer.

Joslyn was first diagnosed with HPV at age 18 during her freshman year of college. At the time of her diagnosis, she was shocked. She had never heard of HPV before and was scared. Her gynecologist told her it was minor and should go away on its own. Joslyn wanted to know more, so she went to her university library and started learning about HPV. She could not believe some strains of HPV can cause cervical cancer.

After gathering more information, Joslyn immediately requested an additional test, which her gynecologist refused. So, she fought to get a second opinion. During her second exam, doctors determined that her strain was one of the strains linked to cervical cancer. Joslyn learned she had cervical cancer in 2006, only a few weeks before she was supposed to walk down the aisle to get married at age 22.

Joslyn did not let her diagnosis stop her from living her life. Not only does she spread awareness about the importance of the HPV vaccination to prevent cervical and other types of HPV cancers, but she enjoys traveling and experiencing new cultures with her family, cooking, and reading.

As a parent, Joslyn knows the importance of protecting her child. The HPV vaccine will keep children safe, healthy, and protected from cervical cancer and five other HPV-associated cancers. Joslyn would do everything in her power to ensure that her daughter never experiences what she endured.

Efforts to improve HPV vaccination coverage and prevent HPV cancers are urgently needed in the Southeastern U.S. This is a region characterized by low HPV vaccination coverage and a high burden of HPV cancers. As a result, the HPV Vaccination Roundtable of the Southeast brigs together Southeastern state representatives to improve HPV vaccination coverage. These efforts build on previous work facilitated by the National HPV Vaccination Roundtable and the American Cancer Society.

The second of three reconvening meetings with 12 Southeastern states and Puerto Rico occurred last month. About 130 people attended to hear a level-setting data presentation and state updates from Alabama, Arkansas, Georgia, and Virginia.

The presentations discussed success stories in each state including collaboration and engagement key partners, sharing resources, hosting summits, seminars, workshops and developing toolkits and engaging providers and community champions. Furthermore, the state updates included challenges they face such as the ongoing impact of Covid-19 Pandemic, lack of strong provider recommendations, especially not starting at age 9, and data differences and accessing available data. All the states shared opportunities to improve HPV vaccination coverage which include, expanding key partnerships and integrating efforts, provider training & education, address health equity and access, and key metrics & share strategies to measure impact.

At the end of the second meeting, priority action steps were summarized based on the data and state update presentations and virtual engagement throughout the meeting.

Prioritize HPV focused work through Southeastern state comprehensive cancer programs to address disparities in HPV vaccination coverage rates in each state.
Provide more information and services in rural areas.
Change the focus from prevention to elimination of cancers.
Create HPV vaccination social media campaigns.
Identify top examples of HPV vaccination and HPV cancer data sources for replication in other states.

These action steps will be sourced at upcoming meetings and interactions with the HPV Vaccination Roundtable of the Southeast. Register for the last meeting on May 25 with state updates from Florida, Kentucky, Louisiana, North Carolina, and Puerto Rico.

Visit HPV Roundtable Southeast page at stjude.org/southeast-roundtable and join the listserv to stay updated on activities.

Email PreventHPV@stjude.org for more information.

HPV is the most common sexually transmitted infection in the U.S. It is associated with several types of cancer, including cervical, anal, vaginal, oropharyngeal, vulvar, and penile cancer. Despite the availability of the HPV vaccine, vaccination rates remain low, particularly among young adults aged 18–26. Shockingly, only 40% of adult women and 8% of adult men initiate vaccinations nationwide.

The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years of age, while HPV vaccination can be started at age 9. Catch-up vaccination is recommended for adults aged 13–26 years. Despite these recommendations, the uptake of the HPV vaccine remains low, especially in rural areas.

Partnering with colleges and universities presents a promising strategy to increase HPV vaccine uptake among young adults. Vaccination uptake among college students is low, with only 44% receiving at least one dose of the HPV vaccine, and only 16% completing the series, according to a study conducted by Min Jee Lee, PhD, MPH, with colleagues at Southern Illinois University Carbondale.

Vaccinating college students against HPV not only provides personal benefits but also contributes to establishing herd immunity. Young adults are an ideal target audience for HPV vaccination improvement due to their legal ability to consent and the insulated environments of college campuses. By partnering with a local university in a rural community, we can reach this age group and develop interventions that can be implemented nationwide using free or inexpensive strategies.

College students have a higher chance of having access to health insurance, making HPV vaccination more affordable for them. Many universities require their students to have health insurance and provide student health insurance plans. Some students may also be covered by their parents' health insurance until they turn 26. So, cost should not be a significant hurdle for most college students to receive the HPV vaccine.

By collaborating with universities and using existing health care resources, the HPV vaccine can be made available to college students at little to no cost. Moreover, college students can receive the vaccine at their university's health center, which many institutions offer at no cost or reduced cost. This approach not only increases the likelihood of college students getting vaccinated but also minimizes the financial burden of vaccination, particularly for those who lack access to health insurance outside of their university's health center. This is especially important in universities located in rural areas.

Increasing vaccination rates among young adults can significantly reduce the spread of HPV and the associated risk of cancer. It is crucial to prioritize efforts to increase HPV vaccination rates to protect the health and wellbeing of young adults and future generations. By targeting college students with specific interventions, we can make significant strides toward eliminating the spread of HPV and associated cancers.

We invite guest contributors to share information on how they are working to improve HPV vaccination in rural areas. If you are interested in contributing or learning more about our efforts to improve HPV vaccination with rural communities, please email us at PreventHPV@stjude.org.

New research reinforces American Cancer Society’s and American Academy of Pediatrics’ recommendations to start HPV vaccination at age 9 in the U.S.

A new collection of articles expands on research showing that initiating the HPV vaccination series at age 9 improves vaccination use and increases the number of adolescents who complete their series on time compared to starting at ages 11–12.

St. Jude Children's Research Hospital worked with the American Cancer Society and its National HPV Vaccination Roundtable on this special issue.

Check out these resources for the special issue:

The special issue toolkit

Media release

Special issue articles

Video abstracts

National HPV Vaccination Roundtable Age 9 resources

Are you with a community-based organization? You may be invited to share your expertise.

You may be eligible to participate in this study if you work with communities facing health inequities and have used and/or received training about evidence-based health interventions. The web-based survey takes about 30-45 minutes, and as a thank-you, we are offering a $75 gift card. We will also share the findings with you.

This research is being conducted by a team at the Harvard T.H. Chan School of Public Health. For more information, email CommunityLinksProject@gmail.com.

Learn more via the QR code in the image or at bit.ly/CBO_Survey.

Alabama

VAX 2 STOP CANCER Luncheon

VAX 2 STOP CANCER recently hosted its 2nd annual A Shot at Prevention luncheon. The event included keynote speaker Jennifer Pierce, who explained the data behind HPV vaccination rates within the state of Alabama. She helped the audience see the relevance and benefits of the HPV vaccination and the importance of vaccinating adolescent boys and girls to prevent HPV-related cancers in the future.

The second speaker was oropharyngeal cancer survivor Kery McInerny, JD, who shared his powerful story about the second chances that he got in life from surviving cancer. “If there is a risk of developing any of the six HPV-related cancers, why chance It? Help your children stay protected with the HPV vaccination,” he said.

Executive director of VAX 2 STOP CANCER Barbara Schuler concluded the event. Since 2020 the organization has trained 233 providers and staff in 53 practices in 21 Alabama counties. Their aim is to raise HPV vaccination rates and prevent HPV-associated cancers in their patients. Barbara shared the goal of raising 10% of HPV vaccination rates in Alabama and announced that the 12-month data showed an average 10% increase in HPV vaccination completion rates in trained practices.

Arkansas

Immunize Arkansas

The 2023 HPV Summit, HPV Vaccine Is Cancer Prevention, will take place May 5 at the Wyndham Riverfront Hotel, 2 Riverfront Plaza, North Little Rock, Arkansas. The event will highlight the connection between HPV and cancer, give providers tools to talk to patients about the benefits of the HPV vaccine, and share best practices to increase HPV immunization rates. The summit has been approved for 5.75 hours of continuing education for physicians, nurses, pharmacists, dental professionals, and Certified Health Education Specialists. Learn more and register.

Tennessee

Immunization Roadshow

Tennessee's Vaccine-Preventable Diseases and Immunization Program of the Tennessee Department of Health (TDH) recently hosted Immunization Roadshow: Tools & Strategies to Cultivate Vaccine Uptake in Tennessee. During this hybrid event, TDH presented resources on topics ranging from vaccine confidence to motivational interviewing, as well as tools for building strong connections to maximize coverage in clinics and regions. The goal was to empower clinicians and practices with educational tools that emphasize the benefits of improving immunization coverage in their communities.

Knoxville (4/3/2023) - 120 total attendees (35 in person and 85 virtual)
Chattanooga (4/4/2023) - 46 total attendees (15 in person and 15 virtual)
Memphis - (4/11/2023) - 79 total attendees (39 in person and 40 virtual)
Nashville - (4/14/2023) - 99 total attendees (16 in person and 83 virtual)

Memphis and Shelby County, Tennessee

Tigers VAX NOW

The Tigers VAX NOW HPV Student Ambassadors continue to raise awareness on the University of Memphis campus. The ambassadors hosted an event during National Public Health Week to highlight Reproductive and Sexual Health Day. The students shared information about the importance of the HPV vaccination with more than 30 people.

Motivational Interviewing for HPV Cancer Prevention

The Memphis and Shelby County HPV Cancer Prevention Roundtable is hosting Motivational Interviewing for HPV Vaccination Prevention in person May 9 from 9 a.m.–noon at 600 Jefferson Avenue, Memphis, TN.

Sayward Harrison, PhD, the University of South Carolina, and Laura Fish, PhD, Duke University, will serve as trainers. The training has been approved for 3.0 hours of CME credits for physicians, nurses, physician assistants, nurse practitioners and medical residents. Register today.

A strong provider recommendation continues to be the greatest influencer of acceptance and uptake of HPV vaccinations. Motivational Interviewing (MI) is a strategy that heath care providers can use to make strong recommendations and build confidence in HPV vaccination that leads to behavior change. Through this training, providers will:

Understand foundations and key concepts of MI
Learn core skills of MI, including open-ended questions, affirmations, reflective listening and summarizing
Identify ways to implement MI to promote uptake of recommended immunizations
Develop hands-on MI skills through role playing and other interactive training activities
Learn core skills of MI, including open-ended questions, affirmations, reflective listening and summarizing
Identify ways to implement MI to promote uptake of recommended immunizations
Develop hands-on MI skills through role playing and other interactive training activities
Enhance communication skills to address vaccination hesitancy and communicate more effectively with patients

Up to 50 physicians, physician assistants, advanced practice nurses and medical residents can register for this free event. In-person attendance is required, and priority will be given to those working to promote vaccinations in Memphis and Shelby County. For more information, contact Carol Minor at carol.minor@stjude.org.

Become a member of the Memphis and Shelby County HPV Cancer Prevention Roundtable to learn more about this training and other activities aimed at increasing HPV vaccination.

Memphis and Shelby County HPV Cancer Prevention Roundtable Mid-Year Meeting

The Memphis and Shelby County HPV Cancer Prevention Roundtable will host the Mid-Year HPV Roundtable meeting in person May 9 from 12:30–1:30 p.m. at 600 Jefferson Avenue, Memphis, TN. Register today.

The mid-year meeting will focus on how the local HPV Roundtable has progressed since the 2022 annual meeting and will give a review of current HPV vaccination initiatives impacting HPV rates in Memphis and Shelby County. Meeting presenters include:

Joseph Granato: TennIIS overview of the new coverage rate dashboard
Naloni Howard: BlueCare Tennessee Memphis and Shelby County HPV Pilot with Patient Center Medical Home

For more information visit stjude.org/memphis-roundtable.

Catalyzing Your Communication Webinar Series

The National HPV Vaccination Roundtable is offering 3 virtual webinars designed to:

Provide attendees with forecasting trends within various communication channels
Discuss best practices to tailoring communication messages
Empower partners to explore innovative approaches to communication
Evaluate communication plans and campaigns

May 10: Noon–1 p.m. EST Register today

A Deeper Dive into HPV Communications—What Is Working?: Learn best practices to effective HPV communication from highlighted case studies within community, health care and coalition organizations.

June 14: Noon–1 p.m. EST Register today

HPV Communications - Evaluating Your Impact: Learn from HPV evaluation experts on how to frame your evaluation strategy, monitor the process and impact of efforts and use the results for future planning.

If you missed the first webinar of HPV Communications Moving Forward series, you can access the following:

A recording of the April 12 Part 1 webinar
Helpful vaccination messaging resources
A copy of the presentation slides

The National HPV Vaccination Roundtable continues to showcase national work focused on raising HPV vaccination rates and preventing HPV cancers in the U.S.

Access National Roundtable videos, including the Fall 2022 Seminar Series: Keys to Improving HPV Vaccination Coverage:

Access more videos on the National Roundtable YouTube channel.

After the April showers come the May flowers. The St. Jude HPV Cancer Prevention Program Team shared what flower best describes their personality.

“I think orchid, as I like that the most. Purple orchid.” – Pragya Gautam Poudel, postdoctoral fellow

“A sunflower best describes my personality. The sunflower symbolizes happiness and being optimistic.” – Portia Knowlton, program coordinator

“Purple is a symbol of wisdom. The African violet describes me.” – Ursula Leflore, administrative specialist

“According to the Buzzfeed quiz I just took, I am a rose. One of the common traits is being incredibly passionate, and I think that describes me very well. I am very passionate about the things that I love.” – Duha Magzoub, program coordinator

“I love hydrangeas. The color depends on the soil’s pH level where they are planted. A flower full of surprising colors.” – Carol Minor, program coordinator

“I think sunflowers best describe my personality. They are bright and cheerful, but they also grow really tall and strong. They also have many uses, and I am constantly trying to learn new skills.” – Julia Neely, program manager

“I love the gladiolus flower. They come in a variety of colors, sit upright and appear to be friendly and welcoming. These are all ways in which I view myself.” – Andrea Stubbs, administrative director

“My favorite flowers are peonies. They are resilient and reliable—and love the sun. I saw Duha took a Buzzfeed quiz, so I did that too. The quiz results indicated my flower should be a poppy. The poppy, according to the quiz, says I love to learn and try new things and really enjoy helping others. Also true. Maybe I should have two favorite flowers.” – Heather Brandt, director

The St. Jude HPV Cancer Prevention Program’s Path to a Bright Future campaign spotlights the benefits of on-time HPV vaccination to prevent cancer in children ages 9–12. The campaign also raises awareness of the dangers of HPV pre-cancers and cancers.

Join us:

Get your child vaccinated against HPV by their 13th birthday: If you or your child is in the recommended age range (ages 9–26 and possibly until age 45), get vaccinated.
Encourage others to get their children vaccinated: Normalize HPV vaccination as cancer prevention.
Share the facts: HPV vaccination is safe, effective, and durable. It prevents 6 types of cancer.

Learn more and join the campaign.