Dale S. Mantey

Introduction: HPV vaccination rates for adolescents in the United States are below recommended levels. The Adolescent Vaccination Program (AVP) guides pediatric clinics on how to implement evidence-based strategies to increase HPV vaccination rates. These strategies comprise the adoption of (1) immunization champions, (2) provider assessment and feedback, (3) continuing education, and (4) prompts, (5) parent reminders, and (6) parent education. The AVP systems-based intervention has demonstrated increased HPV vaccination rates in large urban pediatric clinic networks. The purpose of this study was to assess the feasibility of using an online decision support tool, the AVP Implementation Tool (AVP-IT), to implement AVP strategies in safety-net clinics to improve healthcare for the medically underserved in Texas. Methods: AVP immunization clinic staff champions in four urban safety-net clinics completed tailored Action Plans within the AVP-IT to guide strategy implementation, received webinar training from the research team commensurate to each AVP strategy, and participated in monthly monitoring calls with AVP-IT project staff over a 33-month period from 2022 to 2024. Results: All clinics made progress toward full implementation of AVP strategies. Interrupted time series (ITS) trend analysis demonstrated that AVP-IT implementation was associated with an immediate boost in HPV vaccine initiation rates (p < 0.001) and that long-term trends (ITS slopes) were significant for HPV, MCV4, and Tdap vaccines despite low post-COVID-19 pandemic rates (p < 0.001). Vaccination rates using raw data (mean differences) were not longitudinally significant except for older youth aged 13–17 years. Conclusions: The AVP-IT promises accessible and practical decision support to implement strategies to increase HPV vaccination rates in safety-net clinics. Scale-up in these clinics will require leadership support, technical assistance, and EHR optimization.

Experiencing sexual violence is an adverse childhood experience. Emerging data suggest transgender youth disproportionately experience sexual violence. We investigate differences in sexual violence victimization by gender identity in a nationally representative sample of U.S. high school students. We analyzed 2023 Youth Risk Behavior Surveillance Survey data of n = 15,073 U.S. high school students. Multivariable logistic regressions compared three measures of sexual victimization (lifetime forced sexual intercourse [FSI]; past 12-month any sexual violence; and past 12-month dating sexual violence) by gender identity. We also conducted sex-stratified models. Analyses controlled for grade, race, ethnicity, and alcohol use. Transgender youth had significantly greater odds of lifetime FSI (adjusted odds ratio [aOR]: 3.29), past 12-month sexual violence (aOR: 2.47), and past 12-month dating violence (aOR: 2.01), relative to cisgender youth. Interactions were significant for all three outcomes ( p < .001). Among those who identified their sex as male, transgender identity corresponded with greater odds of reporting lifetime FSI (aOR:13.17), past 12-month sexual violence (aOR: 9.24), and past 12-month dating violence (aOR: 9.56). Among those who identified their sex as female, odds of all outcomes were equivalent by gender identity. Transgender youth had higher odds of experiencing sexual violence in their lifetime and within the past year. Prevention measures, as well as trauma-informed treatment, are needed to reduce the incidence and impact of sexual violence among youth.

Nicotine vaping is common among Canadian youth. However, there is a lack of evidence for effective school-based prevention approaches targeting nicotine vaping, particularly for high school students. This study explored Canadian student and presenter perceptions of the CATCH My Breath (CMB) curriculum’s appeal, appropriateness, and comprehensiveness. A convenience sample of 10 high schools across Ontario, Canada, implemented the CMB curriculum between October 2022 and April 2023. A group of 40 students between 13 and 15 years old participated in six focus groups and 12 curriculum presenters [i.e. teachers and public health unit staff (PHU)] completed interviews to provide feedback about the appeal, appropriateness, and comprehensiveness of the curriculum for Canadian high school students. Qualitative thematic analysis identified major themes from both groups. Presenters and students highlighted key aspects of the curriculum, including the negative health risks of vaping, refusal skills development, and use of engaging activities. Presenters and students offered suggestions for improvement, including extending the session length, using up-to-date relevant statistics, and adding content (e.g. personal testimonies). Presenters and students generally thought that the curriculum was comprehensive, appealing, and appropriate for Canadian high school students. Future studies should evaluate the impacts of the curriculum on student vaping behaviours.

Background/objectives: Pediatrician recommendations are highly influential in parents’ decisions to vaccinate their children against HPV. Unqualified, presumptive, and bundled recommendations (UPBRs) are associated with increased HPV vaccine uptake and are considered best practice. This study analyzes pediatricians’ self-reported data to assess changes in UPBR use and the psychosocial determinants of UPBR use as a result of the implementation of a multi-level intervention, the Adolescent Vaccination Program (AVP). Methods: We surveyed pediatricians across 51 clinics in the Houston area. Baseline surveys (n = 137) were distributed in 2015, and follow-ups (n = 120) in 2019. Results: Pediatrician UPBR use significantly increased as a result of AVP implementation. Change in the provider belief that it is necessary to tell parents that HPV vaccination is not required for public school attendance significantly predicted UPBR use at follow up. This belief was also a significant mediator of increased use of UPBRs at follow-up. Conclusions: AVP was successful in increasing pediatricians’ use of UPBRs. Change in UPBR use is related to one critical psychosocial determinant: beliefs about communication regarding the non-mandatory nature of HPV vaccination for school enrollment. HPV vaccine promotion efforts should devote focus to changing pediatricians’ beliefs about the necessity of disclosing the non-mandatory nature of HPV vaccination for school attendance.

National estimates of tobacco use are reported by racial category after excluding all individuals who identify as Hispanic (e.g., non-Hispanic [NH], Black; NH-White). In this study, we assess the impact of excluding Hispanics from racial categories on national estimates of youth tobacco use in the US. We pooled four years of Youth Risk Behavioral Surveillance Survey (YRBSS) data (2015-2021). Participants were n=60,327 high school students (9-12^th grade). We report prevalence of past 30-day (current) use of cigarettes, cigars, smokeless tobacco and electronic cigarettes, stratified by racial category: (1) American Indian/Alaskan Native [AI/AN]; (2) Asian; (3) Black; (4) Native Hawaiian/Other Pacific Islander [NHOPI]; (5) White; (6) multiracial; and (7) unspecific. Within racial category, we compared prevalence for each product between non-Hispanic and Hispanic youth; comparisons controlled for sex, grade, and year. Descriptively, the majority of AI/ANs (75.6%) and Pacific Islanders (58.9%) identified as Hispanics, as did a minority of multiracial (20.6%), White (14.6%), Black (8.2%), and Asian (7.9%) youth. Prevalence estimates were significantly greater for all four tobacco products among Hispanic-Asian and Hispanic-Black youth, relative to their NH counterparts. Conversely, tobacco use was lower among Hispanic-White youth relative to non-Hispanic Whites. Systematically removing Hispanics from classification within each racial category results in underestimation of tobacco use among Asian and Black youth, overestimation of tobacco use among White youth, and unstable estimates among AI/AN and NHOPI youth. These findings challenge the utility of the “race/ethnicity” variable in study of youth in the US. Findings highlight the need to reconsider the operationalization of “race/ethnicity” which currently exclude Hispanics from each racial category. Hispanic ethnicity appears to function as a “within-group” difference; study of these within-group differences may provide unique insights into tobacco use disparities.