Gloria Manuel, Marlene Marquez, and Jennifer Nguyen University of Colorado Denver Fall 2013

 HPV is the most common and most costly sexually transmitted disease worldwide  Nearly all cervical cancers are caused by the Human papillomavirus (HPV) strains 16 & 18 ◦ About12,000 cervical cancer cases per year ◦ About 4,000 cervical cancer deaths per year (National Cancer Institute, SEER Data, 2013)  Approximately 42.5% of U.S. women are infected with HPV at some point in their lives (American Cancer Society, 2012)

1999-2007

Annual Report to the Nation on the Status of Cancer, 1975-2009. (JNCI, 2012 )

  ◦ ◦ HPV Vaccine Recommendations: ◦ ◦ ◦ ◦ Gardasil and Cervarix Females ages 11-26: 11-17 and 18-26 years old Males ages 11-21 3 doses over 6 months Reducing Behavioral Risks Regular use of condoms Limiting the number of partners (ACS, 2012)

 ◦ ◦ HPV Testing Recommendations Age 30 or older Abnormal Pap smears  ◦ ◦ ◦ Cervical Cancer Screening Recommendations Beginning at age 21 Ages 21 to 29 - Pap test every 3 years Ages 30 to 65 - Pap test and HPV test every 5 years; OR a Pap test alone every 3 years.

(ACS, 2012; CDC, 2013)

      HPV infection Diet Smoking Poverty Oral Contraceptives Family History (ACS, 2012)

 Healthy People 2020’s objective for cervical cancer is to reduce the mortality rate by 10% Baseline: Target: Target-Setting Method: 2.4 uterine cervix cancer deaths per 100,000 females occurred in 2007 (age adjusted to the year 200 standard population 2.2 deaths per 100,000 females 10 percent improvement

     Cost and Access to Care Cultural Beliefs/Language Lack of Knowledge/Literacy Misconceptions Psychological Factors Patient/Parents Factors/ Acceptance

   Parental consent/acceptance Barriers for parents Physicians/pediatricians beliefs and attitudes

      Addressing cost issue Education Engaging health care workers Culturally-tailored interventions Engage friends and family Empowering Latinas

   Discuss cost issue with patients Financial assistance (e.g., cover cost, co-pays) Work with the Vaccines for Children program

 ◦ Culturally tailored educational materials to increase HPV and vaccines knowledge Use different methods to educate     Radionovelas Pamphlets in Spanish Magazines/Newspapers in Spanish Focus groups – both adolescents and parents  Provide pediatricians with resources and trainings on how to approach parents

  ◦ Engaging health care workers Using Promotoras ◦ Culturally tailored interventions Address barriers to community (i.e. transportation problems), use community-based methods, include schools, churches, etc.

  Engaging friends and family ◦ ◦ Educating parents, peers, siblings Having informative sessions for parents-only Empowering women to advocate for themselves and their children

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   HPV in boys and men Life of HPV vaccine Continue building culturally-tailored research and interventions for Latinas