• The Anti-Vaccination Movement: Past and Present

      Morgosh, Kelsey; The University of Arizona College of Medicine - Phoenix; Kravetz, Robert, MD (The University of Arizona., 2015-02-15)
    • Barriers To HPV Vaccination Among Male Adolescents

      Sheppard, Kate G.; Gora, Kelli; Sheppard, Kate G.; Berg, Judith; Rigney, Ted (The University of Arizona., 2014)
      Purpose: To identify barriers to implementing practice recommendations regarding HPV (human papillomavirus) vaccination for male adolescent patients among Family Nurse Practitioners (FNPs). Rationale/Background: HPV infection is a source of numerous cancers. More than one-quarter of the HPV-associated cancers in the United States occur in males. The quadrivalent vaccine is approved in young males and is effective in the prevention of genital warts and reducing HPV related cancers yet vaccination rates are low and expected to remain low. Barriers to vaccination exist even after the 2011 recommendation for routine use. Method: Quantitative, surveys. A 22-item instrument was administered to FNPs working in primary care settings. Participants were surveyed regarding financial, logistic, provider, and parental barriers to vaccination among adolescent males. Results: Descriptive analysis at both the item and scale level demonstrated that FNPs report financial barriers as the most significant barrier. The barriers of least concern were provider attitudes. Barriers regarding FNPs' perception of parental attitudes were seen as moderately concerning. Independent samples t-tests showed that FNPs who did not administer the HPV vaccine to male adolescent patients reported having significantly more financing barriers as compared to FNPs who did. Conclusion: Results suggested that financial issues may constrain FNPs' implementation of practice recommendations for the HPV vaccine and that FNPs who did not administer the HPV vaccination to adolescent male patients may be unable to do so due to financial reasons. Perceptions of parental attitudes are also seen as playing a role in preventing male adolescent patients from receiving the HPV vaccine. Efforts to reduce barriers to implementing recommended HPV vaccine practices should focus on lessening the expense of the vaccine for both providers and parents and increasing parental knowledge and understanding of the HPV vaccine for their sons. Definitions: HPV4 is used to reference the quadrivalent and Gardasil® vaccinations; permissive refers to the 2009 Advisory Committee on Immunization Practices (ACIP) support of allowing adolescent males aged 9-26 to decide, in collaboration with their health care providers, to vaccinate; recommended is the ACIP's modification from permissive to routine recommendation.
    • The C.A.S.E. Approach (Corroboration, About Me, Science, Explain/Advise): Improving Communication with Vaccine-Hesitant Parents

      Peek, Gloanna; Stevens, Jessica Celeste; Peek, Gloanna; McArthur, Donna B.; Badger, Terry A. (The University of Arizona., 2016)
      OBJECTIVES: The anti-vaccination movement is prevalent in today's media with claims which continue to create feelings of fear and trepidation in the minds of many parents. The C.A.S.E. Approach (Corroboration, About Me, Science, Explain/Advise) is a method ofcommunication to be used in formulating meaningful, rapid responses to parents hesitant to vaccinating their children. This DNP project assessed the effects of a C.A.S.E. Approach learning module on family nurse practitioner (FNP) students' perceived levels of knowledge and self-efficacy regarding vaccination discussion with vaccine hesitant parents (VHPs). METHODS: This DNP project used a pretest-posttest design to measure the effects of the C.A.S.E. Approach training intervention on both knowledge and self-efficacy levels of FNP students. Fourteen students participated in this study. Each took the 20-question pretest C.A.S.E. Approach Questionnaire, then participated in the C.A.S.E. Approach learning module,and finished by repeating the questionnaire as a posttest following the intervention. The questionnaire was designed using four-item Likert questions scored 1 (strongly disagree) to 4(strongly agree), wherein higher scores reflected better understanding and self-efficacy in the C.A.S.E. Approach. Students were recruited via an online classroom format within a nursing course offered at the University of Arizona: Nursing 612, Introduction to Pediatrics. All testing and module information was accessed online and questionnaire responses were stored at Qualtrics.com, also online. RESULTS: Students' posttest scores following the intervention of the C.A.S.E. Approach learning module were significantly higher than pretest scores. Perceived knowledge (p< 0.001)of the C.A.S.E. Approach increased more significantly than did perceived self-efficacy (p =0.001) of the C.A.S.E. Approach following the module. Mean test scores increased on average 14.29 points in perceived knowledge of the C.A.S.E. Approach following the module, and 7.93 points for perceived self-efficacy following the module. CONCLUSION: Key findings included an observed increase in participating students' perceived knowledge regarding the C.A.S.E. Approach as well as an observed increase inparticipating students' perceived self-efficacy in using the C.A.S.E. Approach. There was strong statistical evidence (p≤0.05) to suggest the learning module increased student knowledge andself-efficacy regarding vaccine discussion.
    • The Effect of an Immunization Training Program on the Willingness of Pharmacy Students to Receive, Administer, Recommend, and Counsel About Vaccinations: A retrospective, pre-post study

      Spencer, Jenene; Fazel, Maryam; Ivanov, Marina; Rodriguez, Jessica; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To determine whether pharmacy students were more willing to receive, administer, recommend and counsel patients about vaccinations after completing an immunization training program Methods: Anonymous and voluntary questionnaires administered on paper during a regularly scheduled class collected ratings of confidence on the willingness of first year pharmacy students to receive, administer, recommend and counsel about vaccinations prior to and after the completion of an immunization training program. Data on gender, age range, status of completion and source of the immunization training program completed was also collected. This study was approved by the University of Arizona Institutional Review Board (IRB). Results: Questionnaires were completed by 110 students at the Tucson and Phoenix campus. Students were equally willing (p=0.235) to receive all vaccinations, even if they were not required to by the UA COP, before and after the immunization training program.There was a statistically significant difference in the willingness to administer (p<0.001), to recommend (p=0.024) and to counsel (p<0.001) about vaccinations after completion of an immunization training program. Conclusions: Completing an immunization training program did not have influence on the willingness of pharmacy students to receive vaccinations. However, the results suggest pharmacy students are more willing to administer, recommend and counsel about vaccinations after the completion of an immunization training program.
    • Influenza Acquisition occurring Post-Vaccination Among University of Arizona College of Pharmacy Students

      Tran, Kim; Slack, Marion; Flynn, Shannon; Malott, Megan; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Assess the incidence of influenza despite being vaccinated among pharmacy students in the 2017/2018 influenza season at the University of Arizona. Our working hypothesis is that pharmacy students who received the influenza vaccine in the 2017 year will have a lower rate of acquisition than among people who did not receive the influenza vaccine. Methods: Questionnaires were administered to first, second, and third year pharmacy students during scheduled class times to gather information on influenza acquisition, influenza symptoms, vaccine attainment, and demographic characteristics through self-reported answers. Main Results: The characteristics of pharmacy students were similar between those who acquired the flu or not. However, whether or not the pharmacy students had kids was significantly different between those who had influenza versus not ( p= 0.0146) Pharmacy students who received the vaccine had lower rates of acquiring the flu compared to the national average (p=0.0005). When comparing pharmacy students who received the vaccine and those who did not there was no difference in acquiring influenza (p= 0.854) Conclusions: The findings for this study show that pharmacy students who received the influenza vaccine had lower rates of acquiring the flu when compared to the national average of people who were not vaccinated and acquired the flu. It can be assumed that even with an efficacy as low as 40%, the vaccine still plays a great role in influenza prevention. However, pharmacy students who received the influenza vaccine in the 2017 year did not have significantly different acquisition rates of the flu when compared to the students who did not receive the influenza vaccine that year.
    • Pertussis Cocooning for Alaska: Development of an Educational Brochure

      Peek, Gloanna; Ernest, Lisa Lorene; Peek, Gloanna; Peek, Gloanna; Phipps, Lorri M.; Bencs, Nicole (The University of Arizona., 2016)
      Background and Significance: Pertussis infection rates have significantly increased in the United States even though pertussis is a vaccine preventable illness. Alaska has been significantly impacted by this disease and is ranked 3rd highest in the nation for infection rates per capita. Infants less than three months of age suffer the highest proportion of infections. The effects of pertussis are most severe in this age group, sometimes requiring hospitalization and causing death. One theorized contributing factor to the increased pertussis infection rates is the transition to an acellular pertussis vaccine. The acellular component of the Tdap vaccine may wane up to 42% a year, thus decreasing coverage from 10 years to approximately three to five years. The increased infection rate and decreased vaccine efficacy necessitates improved education regarding preventative measures. The cocooning vaccination strategy immunizes all eligible individuals in contact with the infant, thus creating a cocoon of protection.Purpose and Specific Aims: This Doctor of Nursing Practice (DNP) project addresses the need for improved educational material regarding infantile pertussis prevention for Alaskan families having a baby. Throughout this DNP project an educational brochure is developed, emphasizing the importance of pertussis prevention through cocooning vaccination.Methods: The educational brochure was created using the framework of the Health Belief Model (HBM). The HBM was utilized to structure the information included within the brochure to influence individual health behaviors towards immunization of pertussis through cocooning. Evaluation: Three content experts evaluated the brochure utilizing the Patent Education Materials Assessment Tool (PEMAT) auto-scoring tool. Content experts reviewed the brochure and determined the understandability and actionability of the brochure in the form of a percentage. The content expert evaluations all indicated scores of 100%. Conclusion: The brochure created within this DNP Project addresses the educational needs of Alaskan families regarding pertussis infection and the severity of these infections in the infant population. Future implications include brochure production and distribution. The brochure will have the most impact when distributed to maternity units, obstetrical, and gynecological offices in Alaska.
    • Reducing SARS-CoV-2 Vaccination Hesitancy in a Primary Care Setting

      Allison, Theresa; DeMello, Blythe; Pacheco, Christy; Locke, Sarah (The University of Arizona., 2022)
      Purpose: The purpose of this quality improvement project was to increase SARS-CoV-2 vaccination confidence and knowledge in adults who display reluctance or hesitancy through a brief educational discussion and a written pamphlet. Background: In recent history, the world was faced with an unprecedented challenge as a pandemic quickly encompassed the globe. In early 2020, this became commonly known and referred to as the COVID-19 pandemic. The severe health implications of this respiratory virus quickly overfilled hospitals and placed the health of communities at risk. To get ahead of further spread of COVID-19, it was pertinent to quickly develop an effective vaccine. Following rigorous clinical trials, two mRNA vaccines were approved by the United States (US) Food and Drug Administration (FDA). What seemed like a solution became a challenge within the US. The population of the US showed reluctance to participate in COVID-19 vaccination programs. Vaccine hesitancy related to COVID-19 mRNA vaccines prolonged communities achieving adequate herd immunity. Understanding why individuals were displaying vaccine hesitancy was pertinent for implementing strategies that would lead to increased mRNA COVID-19 vaccine compliance. Methods: Participants were recruited from Peak Family Practice in Colorado Springs, CO. A pre-survey was administered followed by a short one-on-one educational session reviewing a written pamphlet about mRNA vaccines and common misinformation related to COVID-19 vaccines. A post-survey was administered after the educational intervention. Each survey had the same five questions and assessed participant knowledge and confidence related to mRNA COVID-19 vaccines. Results: A total of 20 participants completed the pre- and post-survey responses, along with participating in the short educational session. No statistically significant differences were found, however, participants who changed their answers on post-survey showed an increase in confidence of mRNA vaccines as well as indicating they would be more likely to receive a COVID-19 vaccine. Conclusion: This educational intervention reviewing a written pamphlet of mRNA vaccine information was effective in increasing the confidence of mRNA COVID-19 vaccines in some participants. Participants who changed their post-survey answers indicated an increase in likeliness to receive COVID-19 vaccination and showed improvement in knowledge related to mRNA vaccines. Although there was evidence of clinical significance a larger sample size would be necessary to indicate true statistical significance.
    • The Economics of Ebola Virus Disease

      Abraham, Ivo; Obeng-Kusi, Mavis; Roe, Denise J.; Erstad, Brian (The University of Arizona., 2021)
      Background: Ebola virus disease (EVD) continues to threaten public health globally, disproportionately more so in the low- and middle-income countries (LMICs) of Africa. The enormous burdens of EVD have led to extensive research into prevention and control and triggered significant investments from the global community. There still exists a gap in terms of resource generation and management for addressing this disease, as well as a consequent urgent need for evidence-based economic decision making.Objectives: The work reported in this thesis aimed to synthesize evidence on EVD economic evaluations and to conduct economic evaluations of an EVD vaccine in LMICs. This thesis is built around three studies: (1) a scoping review to identify, characterize, and evaluate published studies involving the economic evaluation of EVD; (2) an economic evaluation using a dynamic transmission model of EVD to assess the cost-effectiveness analysis of an EVD vaccine and vaccination program in a hypothetical population of 1000 using data from an EVD outbreak in selected countries in Africa; and (3) a comparative economic evaluation to examine value-based pricing of an EVD vaccine in Central and West African countries with prior EVD outbreaks. We used a dynamic transmission model to evaluate the cost-effectiveness and a value-based price (VBP) of an EVD vaccine Methods: From eligible studies retrieved using multiple databases, we summarized the impact and economics of EVD, assessed economic studies to date, identified unanswered questions for further exploration, and made recommendations for future EVD economic studies with a special focus on LMICs. Using a modified SEIR (Susceptible, Exposed, Infectious, Recovered, with Death added [SEIR-D]) model that accounted for death and epidemiological data from an EVD outbreak in selected countries (Democratic Republic of Congo, Liberia, Sierra Leone, Uganda), we modeled the transmission of EVD in a hypothetical population of 1000. With our model, we estimated the cost-effectiveness of an EVD vaccine and an EVD vaccination intervention. Based on the cost-effectiveness metrics and using willingness-to-pay thresholds equal to varying percentages of the Gross Domestic Product (GDP) per capita, we demonstrated how a VBP is calculated using an adaptation of the “QALY-capped” approach. Results: Twenty-six studies were retrieved which focused on the cost/burden of EVD, willingness-to-pay for EVD vaccine, cost of preparedness of EVD treatment centers, and funding for EVD. The impact of EVD was estimated to be substantial in terms of human and fiscal loss. Vaccinating the population at risk to the herd immunity threshold was estimated to avert about 99% of infections, deaths, and disability adjusted life years (DALYs). Although vaccination resulted in incremental costs in the countries evaluated, it was found to be cost-effective in all cases given resultant decrements in outcomes that offset the accumulated costs. Cost-effectiveness was determined to be directly proportional to transmission rate – being more cost-effective in settings with higher transmission rates. The VBP for the vaccine is directly proportional to both cost-effectiveness and GDP per capita- with higher cost-effectiveness and higher GDP per capita resulting in higher price ceilings compared to lower cost-effectiveness and lower GDP. Conclusions: The severe impact of EVD puts pressure on governments and the international community for better resource utilization and re-allocation. From the payer perspective, vaccination against EVD is cost-effective. Despite the concerns with the “QALY-cap” approach, we illustrated that it is an easily comprehensible method for determining the VBP of a vaccine using a cost-effectiveness analysis. There is an urgent need for territory-specific evidence-based economic plans and economic evaluation of mitigations to enhance resource allocation for EVD prevention and treatment.