The data source for the HPV Vaccination Rate is the Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). It is estimated that HPV vaccines may prevent 70% of cervical cancer, 80% of anal cancer, 60% of vaginal cancer, 40% of vulvar cancer, and show more than 90% efficacy in preventing HPV-positive oropharyngeal cancers.

Data is from the National Immunization Survey (Teen Vax View) - these are reflective of the child being up to date at that point in time they were surveyed.

When asked how Arkansas adults are doing relative to the trendline data for the indicator, the stakeholders stated the following:

• Things are getting better
• Lower rate in males; however, the gap between females and males is narrowing (getting better but still a gap)

Stakeholders identified the following positive factors helping females and males 13-17 years to get the HPV vaccination:

• Arkansas Chapter, American Academy of Pediatrics did an outreach project on this pre-COVID! 🙂
• Cost is covered by public and private payors
• More common/information is out there
• Not a new vaccine anymore so people are more comfortable with it in general
• School nurses (SN) in schools/districts PreK-12 grades advocate for HPV vaccine with parents. SN are a proven trusted source for parents.
• Vaccines for Children program shares data with practices
• We have been pushing the message of HPV vaccine is cancer prevention
• Word of mouth among parents is creating familiarity with the vaccine among the public

Stakeholders identified the following negative factors preventing females and males 13-17 years from getting the HPV vaccination:

• Lack of provider training on importance of HPV in cancer prevention; motivational interviewing/effective messaging
• Low rates of wellness child checkups for school aged children.
• Religious views surrounding HPV vaccine and sexual activity especially for those under 18
• Multi-dose series requires multiple touchpoints which are not always easy to schedule/remember for adolescents
• Myths and misinformation about the HPV vaccine
• Myths around sexual activity (if you pay to get the HPV done that it leads to sexual activity at an earlier age due to increased desire)
  • belief that it will cause promiscuity/that their child will not have risk factors outside of marriage
  • misunderstanding among parents/kids of what actually "counts" as sexual encounters.
• Not a school required vaccine so providers don't always recommend it
• Overall vaccine fatigue is leading to a decrease in vaccine rates in other areas (flu, vaccine, etc.)
• Perceived safety concerns
• When a physician does not recommend a vaccine it will not be on parents or caretaker's radars

Stakeholders identified the following potential partners to strengthen the positive factors or address the negative factors influencing the HPV vaccination rates amongst females and males ages 13-17 in Arkansas.

• CIP, APIC and ID groups
• American Cancer Society
• Arkansas Chapter, American Academy of Pediatrics
• Arkansas pediatricians, family physicians
• AR School Nurses Association, School-based health Centers, Community Health Nurses (CHNs)
• Childcare advocates
• College athletes/arts drama students promote immunization
• Dept of Education
• Department of Health- sponsor HPV health month and campaigns
• Doctors
• Faith-based community leaders
• Particularly evangelical leaders
• Influencers - broadcast the condition and vaccine efficacy
• MCH advocates - Sponsor HPV health months
• Medicaid - for improved immunization rates 
• Parents
• ADH - vaccines for children program for outreach/data sharing
• School district parent-teacher organizations
• Payors - put quality metrics around HPV vaccines
• Clinics - help incentivize electronic medical records to automate outreach
• Dental community/Arkansas State Dental Association/Hygienists Association
• University health centers (not for age 13-17, but older kids who missed it previously)
   

Stakeholders identified the following solutions to strengthen the positive factors or address the negative factors influencing the HPV vaccination rates amongst females and males ages 13-17 in Arkansas.

• Ask AR School Nurse Association what strategies work best to reach students and families
• Contact faith-based leaders by mail/in person; offer training
• Create an app for developmental milestones (call it something else) for adolescents. Include all needed immunizations that are recommended.
• Education to Dental providers about counseling patients that HPV vaccine is cancer prevention for oropharyngeal cancers
• Engage AR AAP to train pediatricians on motivational interviewing or HPV Roundtable strategies for improving rates
• Enlisting dental providers in effort to counsel patients on getting HPV vaccine
• Get more dentists/hygienists to discuss HPV vaccine with patients/parents
• Grants for outreach (AR Pediatricians - but can’t travel/use time without funding, plus data helps us do that effectively)
• Grants to practices to upgrade EMRs for automated text outreach to patients for HPV reminders (and other vacccines)
• Have college health system broadcast HPV and vaccination on campus platforms and health events throughout the school year
• Identify influencers in low-rate counties who can do grassroots outreach, such as moms groups on Instagram
• Increase outreach through various organizations and partners
• It is not politically likely, but adding HPV vaccine to the required school vaccines
• Joint educational venture with school health, PTA and public health to focus on the issue and make educational resources user friendly and readily available 
• Make a part of sexual health education at family planning and local health unit clinics for all patrons; require for school attendance.
• Start vaccinating kids at age 9 so that they complete the series by age 14
• Utilize social media platforms to make available and more prominent

The following strategies were prioritized by the stakeholders because they ranked highest across four criteria: Impact, Feasibility, Specificity, and Value.

• Deliver education to Dental providers to better counsel patients that HPV vaccine is cancer prevention for oropharyngeal cancers
• Engage providers (school nurses, etc.) and provider support organizations (AR American Academy of Pediatrics) to train pediatricians on motivational interviewing or HPV Roundtable strategies for improving rates
• Increase the capacity for automated text outreach (including grants to upgrade EMR, etc.) to patients for HPV reminders (and other vaccines)
• Start vaccinating kids at age 9 so that they complete the series by age 14

Strategy: Deliver education to Dental providers to better counsel patients that HPV vaccine is cancer prevention for oropharyngeal cancers.

Strategy: Engage providers (school nurses, etc.) and provider support organizations (AR American Academy of Pediatrics) to train pediatricians on motivational interviewing or HPV Roundtable strategies for improving rates.

Strategy: Increase the capacity for automated text outreach (including grants to upgrade EMR, etc.) to patients for HPV reminders (and other vaccines).

Strategy: Start vaccinating kids at age 9 so that they complete the series by age 14.