A Shot of Protection

By Jennifer New

Published on December 14, 2018

A network of cancer researchers are investigating ways to boost adolescent HPV vaccination rates.

portrait of smiling kidsIf a form of cancer could be prevented through a vacci­nation, why wouldn’t that vaccination be as widely given as those for diphtheria or the mumps? The primary cause of cervical cancer is the Human Papillomavirus (HPV), and the HPV vaccine is 90 percent effective at preventing it. Yet less than half of the adolescents in the United States who are eligible to receive the HPV vaccination do so. Why?

This question underlies the work of Natoshia Askelson and her Cancer Prevention and Control Research Network (CPCRN) team at the University of Iowa.

“Currently,” says Askelson, CPH assistant professor of community and behavioral health, “we know that only 49 percent of U.S. teens and 54 percent of Iowa teens are receiving the complete HPV series. How can we increase those numbers?”

Vaccination Rate Disparities

The Centers for Disease Control and Prevention (CDC) recommends three vaccines for adolescents: meningo­coccal (meningitis); tetanus, diphtheria, and pertussis (Tdap); and human papillomavirus (HPV). The HPV vaccine is one of the biggest breakthroughs in cancer prevention in the last decade, providing nearly complete protection from HPV-related cancers—including cancers of the mouth and genitals, as well as the more prevalent cervical cancer. Yet recent studies have shown that while national adolescent vaccination rates are fairly high for Tdap and meningococcal, the rates are substantially lower for HPV.

Figuring out the disparity in these numbers and how to shift them is at the heart of the work of the CPCRN. Initiated in 2002 with funding from the CDC and the National Cancer Institute, the network includes eight funded research institutions. Together, these institutions seek to translate research into practice to prevent and control cancer.

The University of Iowa joined the CPCRN in 2014. Being part of the network allows the UI to access com-munity-based cancer research across geographic boundaries.

“The advantage of being in the network is that we get to use the expertise of people across the country,” Askelson explains. “If we are looking at rural data, for example, we can pool our resources and talents and compare or combine experiences from different states.”

Iowa is not alone in finding that HPV vaccinations are lower in rural and less affluent communities. One issue is that health care providers do not relay the same level of surety regarding the vaccines as they do others. As Askelson notes, a health care provider will say, “‘You’ll get the Tdap and the meningitis; then there’s this other vaccine that you can get if you want.’ That really leaves the door open.”

Reaching Families

To be most effective, the immunization is administered at 11 and 12 years of age, a time when a young person’s immune response is highest. It also needs to be given in a series of two to three vaccinations spread over several months. Unlike infants who don’t have a routine filled with soccer practice and music lessons, adolescents and their working parents are much harder to schedule.

Culture and gender also play a role. Parents may not realize that HPV can infect both males and females, and forego vaccinating their son. Another member of the UI’s CPCRN team, Jason Daniel-Ulloa, clinical assistant professor of community and behavioral health, has focused on rural Latino communities, including developing collaborations between clinics, public health, and community organizations.

Daniel-Ulloa has worked hard to build relationships within the community and to better understand hindrances to the vaccination and find creative ways to overcome them. Noting that Latinos in general, but especially boys, receive the HPV vaccine at a much lower rate than their non-Latino peers, he started a men’s group to develop conversations about health and masculinity. He also helped to bring the UI’s Mobile Clinic to West Liberty, Iowa, a Latino-majority community, to make vaccinations more accessible for busy families.

Amplifying the Message

In addition to collaborating with the other CPCRN institu­tions, Askelson says that the Iowa Department of Public Health Immunization Bureau, the American Cancer Society, and Iowa’s Medicaid managed care organizations have been excellent partners in helping pilot projects that amplify information about the HPV vaccine to health care providers.

Another recent theme of the CPCRN has been increasing the rate of colorectal screenings, especially among people with limited health care insurance. As with the HPV vaccine, Askelson and her colleagues have found that it is effective when providers increase reminders, such as phone messages and texts, as well as establishing flags in people’s charts who are overdue for a colonoscopy, the gold standard for detecting colon cancer.

Askelson hopes that both projects will lead to better information and better health for all Iowans.

“Getting kids vaccinated now against HPV,” she says, “could eliminate HPV-related cancers from ever happening in an entire generation of people.”

This story originally appeared in the fall 2018 issue of InSight magazine