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  1. Implement evidence-based community interventions to increase screening and modify risk behaviors into the Colorado health care system. 
  2. Educate primary care screening providers (generalists, OB/Gyn, Family Practice) on client evidenced-based strategies that increase screenings.
  3. Actively refer eligible women to Women’s Wellness Connection (WWC) who will provide services for low income, uninsured women between 40 and 64 years of age.
  4. Provide cervical cancer education to women that are not routine users of the health care system and may have disparities that prevent access to the health care system. 
  5. Develop partnerships with STD clinics, correctional, domestic abuse, homeless shelters and other community-based organizations that may have contact with women who are rarely or never screened for cervical cancer.  Provide assistance to organizations on where screening services can be obtained in the Colorado health care system.

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The National Immunization Survey (NIS) is sponsored by the National Center for Immunizations and Respiratory Diseases (NCIRD) and conducted jointly by the NCIRD and the National Center for Health Statistics (NCHS).  In 2007, NIS HPV vaccination coverage was reported for the first time and showed that 25.1% of U.S. females 13-17 years of age had received at least one HPV vaccination.  In 2008, the NIS assessed state-level vaccination coverage and reported Colorado’s HPV vaccination (>1 HPV vaccine dose) coverage level for females 13-17 years of age is 34% compared to the national rate of 37%. 

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There are several emerging studies that demonstrate differences in populations that receive the vaccine, those that need and are receptive to education about the vaccine, and persistent myths about HPV vaccine.

  1. Vaccine awareness differs by race, education and income.  Interventions to increase awareness of HPV could benefit from tailoring information to prescreening age, screening age, and postscreening-age women.  (The Impact of Human Papillomavirus Information on Perceived Risk of Cervical Cancer.  Hughes, et al. Cancer Epidemiol Biomarkers Prev. Feb 3, 2009.)
  2. Barriers to vaccination are cost and access to vaccine and concern that immunization with the vaccine may promote adolescent sexual behavior.  HPV vaccine programs should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination. (Predictors of HPV vaccine acceptability: a theory-informed, systematic review.  , .  Preventive Med. 2007 Aug-Sep;45(2-3):107-14. Epub 2007 Jun 2.) 
  3. Given information, mothers of teens in Mexico had high acceptance rates of vaccinating their adolescent children against HPV.  (Parental Attitudes About Sexually Transmitted Infection Vaccination for Their Adolescent Children.  Arch Pediatr Adolesc Med. 2005;159:132-137.)
  • Teenage girls surveyed indicated no increased interest in risky sexual behavior if they were to be vaccinated.  (Attitudes about human papillomavirus vaccine in young women.  (, et al.  Int J STD AIDS. 2003 May;14(5):300-6.)

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According to findings of the CDC Guide to Community Preventive Services (), there are no specific evidence-based interventions for increasing HPV vaccination at this time.  Therefore, the following proven interventions are being recommended for increasing HPV vaccination coverage:

  • Provider Reminder Systems:  Provider reminders let providers or other appropriate staff knows when individual clients are due for vaccinations, through notations, stickers, or other prompts in clients’ charts, or through computer databases or registries.  Reminders can be directed to the primary healthcare provider or clinic staff.
  • Interventions that should be implemented in combination: 
  1. Expanded access in healthcare settings;
  2. Reducing patient out-of-pocket costs;
  3. Patient or family incentives;
  4. Patient reminder/recall systems;
  5. Clinic-based patient education;
  6. Community-wide education;
  7. Vaccination requirements;
  8. Provider assessment and feedback;
  9. Provider education; and
  10. Standing orders.

For detail on individual strategies, please go to The Community Guide, Vaccinations for Preventable Diseases: Targeted Coverage at ().

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  1. Educate healthcare providers about the Advisory Committee on Immunization Practices (ACIP) recommendations for HPV vaccination.
  2. Provide technical assistance to healthcare providers to implement the Standards for Child, Adolescent, and Adult Immunization Practices.
  3. Recruit non-traditional vaccination providers (OB/GYNs, etc.) into the Vaccines for Children (VFC) Program to increase HPV vaccination coverage among uninsured and underinsured females 18 years of age and under.
  4. Support activities that recruit non-traditional vaccination providers into the Colorado Immunization Information System (CIIS) so that HPV vaccination records are accurate, complete, and accessible.
    1. Educate providers about the importance of implementing systems to remind parents/guardians, patients, and staff when vaccinations are due.
    2. Develop targeted, culturally specific media messages about HPV vaccination and disseminate through provider offices, health departments and community organizations.  Messaging should focus on:
      1. Emphasizing the high likelihood of HPV infection if sexually active;
      2. Educating parents of adolescents about high vaccine effectiveness;
      1. Educating parents about the myths related to increase sexual activity in vaccinated adolescents;
      2. Addressing barriers to vaccine access; and
      3. Educate vaccine recipients about the need for continued regular screening with Pap tests.

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