Background: The impact of cancer therapy on chronic health condition (CHC) burden in childhood cancer survivors is well-established; however, the role of neighborhood-level social determinants of health (SDOH) remains underexplored. Methods: We analyzed 2,508 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study with ≥2 clinical assessments (2007-2020). SDOH encompassed social vulnerability (the Social Vulnerability Index) and environmental vulnerabilities (e.g., primary care physician [PCP] availability, food inaccessibility), each categorized into quartiles. 177 CHCs were severity-graded (CTCAE v4.03), aggregated into 48 CHC groups, and summarized into global burden. Multivariable logistic regressions examined associations between baseline SDOH and CHC severity progression at global and group levels, adjusting for clinical and personal sociodemographic factors. Interactions of SDOH with personal insurance and educational attainment were examined for effect modification. Findings: Survivors residing in the most SDOH-vulnerable neighborhoods, characterized by low income (OR: 1.83, 95%CI: 1.36-2.46), low education (OR: 1.53, 95%CI: 1.15-2.04), limited PCP availability (OR: 1.30, 95%CI: 1.03-1.64), and food inaccessibility (OR: 1.49, 95%CI: 1.08-2.07), had higher risks of global CHC burden progression than those in the least vulnerable neighborhoods. Living in the most SDOH-vulnerable neighborhoods was associated with higher risks of new-onset/worsening of multiple CHC groups, including low education for peripheral nervous system disorders (OR: 2.69, 95%CI: 1.63-4.43), food inaccessibility for arrhythmias (OR: 4.36, 95%CI: 1.32-14.35), and poor walkability for abnormal glucose metabolism (OR: 4.60, 95%CI: 1.41-15.04), than those in the least vulnerable neighborhoods. Among survivors with public insurance, living in neighborhoods with limited PCP availability and poor walkability amplified peripheral musculoskeletal disorder risk up to 7-fold (OR: 6.11, 95%CI: 2.33-16.04 and OR: 7.37, 95%CI: 2.82-19.27, respectively). Interpretation: SDOH are associated with CHC severity progression among childhood cancer survivors, suggesting the need to integrate multilevel social risk assessment into survivorship care alongside standard clinical management.

10010 Background: Childhood cancer survivors face elevated risks for chronic health conditions and premature mortality. Engaging in healthy behaviors may mitigate these risks, yet neighborhood-level vulnerability may constrain survivors’ ability to adopt or sustain them. Methods: Among survivors (n=3,303) and community controls (n=652) in SJLIFE, neighborhood-level vulnerability was measured using census tract level overall and domain-specific (i.e. socioeconomic status, household composition, minority status, housing type and transportation) Social Vulnerability Index (SVI) scores, with higher values indicating higher vulnerability, and the U.S. Department of Agriculture’s persistent poverty measure. Health behaviors, including sedentary time/physical activity, smoking, alcohol, and illicit drug/marijuana use, were categorized as healthy, moderately unhealthy (1-2 unhealthy behaviors), and unhealthy (≥3 unhealthy behaviors). Multinomial logistic regression evaluated associations between neighborhood-level vulnerability at enrollment and health behavior patterns at most recent evaluation among survivors, adjusted for sociodemographic and cancer treatment factors as determined by backward selection. Interaction models compared associations between survivors and controls. Results: Survivors were 53.1% male, 82.5% non-Hispanic White, with a median age of 31.0 years (interquartile range: 23.5 – 38.5) at health behavior assessment. The most common childhood cancer diagnosis was acute lymphoblastic leukemia (28.8%). Survivors in the highest vs. lowest SVI tertile had higher odds of reporting moderately unhealthy (Odds Ratio [OR]: 1.46, 95% Confidence Interval [95% CI]: 1.08 – 1.98) or unhealthy (OR: 1.70, 95% CI: 1.13 – 2.56) behavior patterns, compared to a healthy behavior pattern. Socioeconomic and housing type SVI domains drove these associations, with survivors in the highest tertiles more likely than those in the lowest to have an unhealthy rather than healthy behavior pattern (Socioeconomic OR: 1.55, 95% CI: 1.02 – 2.35; Housing type OR: 1.53, 95% CI: 1.03 – 2.27). Persistent poverty was associated with greater odds of a moderately unhealthy behavior pattern (OR: 1.70, 95% CI: 1.09 – 2.66) in survivors. Housing type vulnerability was associated with disproportionately higher odds of an unhealthy behavior pattern among survivors compared to controls (ratio of ORs: 2.80, 95% CI: 1.19 – 6.60). Conclusions: Neighborhood-level vulnerability was associated with higher likelihood of unhealthy behavior patterns in childhood cancer survivors with housing type vulnerability having a greater impact on health behaviors in survivors compared to controls. Effective interventions to improve survivors’ health behaviors should incorporate neighborhood-level factors.

Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of HPV-related cancers, yet HPV vaccination remains lower than in the general population. The purpose of this study was to examine HPV vaccination initiation and completion among CAYA survivors and to assess the influence of sociodemographic and cancer-specific factors on vaccination. We used data from the St. Jude Lifetime Cohort, 5 + year cancer survivors, treated at St. Jude Children’s Research Hospital, eligible for HPV vaccination since 2006 (year of FDA licensure in the USA). Primary outcomes were HPV vaccination initiation and completion. HPV vaccination was assessed between 2011 and 2020. We performed descriptive statistics and evaluated associations using univariate and multivariable logistic regression analysis using SAS version 9.4. We included 2907 CAYA survivors. HPV vaccination initiation was reported by 27.31

Background: The impact of cancer therapy on chronic health condition (CHC) burden in childhood cancer survivors is well-established; however, the role of neighborhood-level social determinants of health (SDOH) remains underexplored. Methods: We analyzed 2,508 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study with ≥2 clinical assessments (2007-2020). SDOH encompassed social vulnerability (the Social Vulnerability Index) and environmental vulnerabilities (government-sourced indicators, e.g., primary care physicians [PCP] availability, food inaccessibility), categorized into quartiles. A total of 177 CHCs were severity-graded (CTCAE v4.03), aggregated into 48 CHC groups, and summarized into global burden. Multivariable logistic regressions examined associations between baseline SDOH and CHC severity progression at global and group levels, adjusting for clinical and personal sociodemographic factors. Interactions of SDOH with personal insurance and educational attainment were examined for effect modification. Findings: Survivors residing in the most SDOH-vulnerable neighborhoods, characterized by low income (OR: 1.83, 95%CI: 1.36-2.46), low education (OR: 1.53, 95%CI: 1.15-2.04), limited PCP availability (OR: 1.30, 95%CI: 1.03-1.64), and food inaccessibility (OR: 1.49, 95%CI: 1.08-2.07), had higher risks of progressive global CHC burden than those in the least vulnerable neighborhoods. Living in the most SDOH-vulnerable neighborhoods, including low education (OR: 2.69, 95%CI: 1.63-4.43 for peripheral nervous system disorders), food inaccessibility (OR: 4.36, 95%CI: 1.32-14.35 for arrhythmias), and poor walkability (OR: 4.60, 95%CI: 1.41-15.04 for abnormal glucose metabolism), was associated with higher risks of new-onset/worsening of multiple CHC groups than in the least vulnerable neighborhoods. SDOH interacted with survivors’ public insurance coverage to amplify CHC burden risk, including limited PCP availability (OR: 6.11, 95%CI: 2.33-16.04) and poor walkability (OR: 7.37, 95%CI: 2.82-19.27) for new-onset/worsening of peripheral musculoskeletal disorders. Interpretation: SDOH are upstream determinants of CHC progression among childhood cancer survivors, necessitating survivorship care that integrates clinical management with community- and policy-level interventions.

Childhood cancer survivors are at increased risk for human papillomavirus (HPV) cancers yet are less likely to be vaccinated against HPV than the general population. This scoping review identified studies describing barriers, facilitators, and strategies to improve HPV vaccination in this vulnerable population. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify full-length studies, published in English, from July 2006 to June 2024. We excluded survivorship studies unrelated to HPV vaccination and non-empirical studies (e.g. commentaries). Twenty studies were identified. Multi-level barriers reported occurred in patients- (e.g. vaccine safety-concerns), provider- (e.g. inconsistent guidelines), and system-levels (e.g. lack of vaccine availability). The primary facilitator was the health care provider’s recommendation. Potential strategies for increased vaccination included clear recommendations and digital reminders. This review provides valuable insights for developing strategies to improve HPV vaccination coverage and reduce the risk of HPV-related cancers among childhood cancer survivors.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and has a significant healthcare burden and cost due to HPV-related cancers and diseases. Despite the proven safety and effectiveness of the HPV vaccine, its uptake in the U.S remains suboptimal. Furthermore, the combined influence of individual, social, and policy factors on HPV vaccination rates remains unclear. This study investigated how individual, social, and policy factors affect HPV vaccination rates, focusing on initiation and completion rates in the U.S. It also aimed to assess the potential cost savings from implementing certain recommended policy changes, aiming to boost HPV vaccination rates and subsequently lower HPV-related cancer cases. We analyzed publicly available data on population demographics (e.g., children’s public insurance coverage status, parental education, and rurality), policy, and access (e.g., Medicaid income eligibility criteria for children, state-level vaccine requirement, vaccine exemption status, access to pediatricians, access to Vaccine for Children (VFC) providers, and meningococcal conjugate vaccine uptake among adolescents) to quantify the impact of these factors on HPV vaccination coverage using a multilevel regression analysis. Using the regression results, we conducted a cost-savings analysis of higher HPV vaccine uptake and reduced HPV-related cancer incidence resulting from policy changes. The results revealed that meningococcal vaccination uptake, Medicaid income eligibility among children, parental education, and public insurance coverage increased HPV vaccination initiation by 0.028–0.53

PURPOSE:For children with ALL in low- and middle-income countries (LMICs), treatment regimen adaptation based on local contexts is often necessary. However, the clinical impact of such modifications is poorly understood. The purpose of this study is to examine pediatric ALL treatment regimens used in LMICs, assess for patterns in adaptation to identify common barriers affecting global delivery of ALL care, and describe the breadth of outcomes. METHODS:Using the PRISMA guidelines, a systematic review was conducted, across seven databases, of ALL regimens use in LMICs in 2000-2021, documenting the geographic distribution of treatment backbone adoption, regimen modifications, and outcomes. Article characteristics were summarized using descriptive statistics. RESULTS:Of 13,900 articles, 125 met abstraction criteria. Data spanned 36 countries (6.4% low-income, 43.2% lower-middle-income, 50.4% upper-middle-income) and 163 regimens, of which 138 (84.6%) referenced a high-income ALL collaborative group regimen as a backbone. Sixty-four percent of regimens (n = 104) were adapted. Individual modifications (n = 390) were consolidated into 73 distinct regimen changes; reduction/omission of high-dose methotrexate, observed in 30 modified regimens (28.8%), was the most common. Implementation challenges, such as drug access and cost, were cited more frequently than toxicity as the rationale for modification; however, implementation outcomes (eg, feasibility, cost) were only measured in 6.4% of articles. Across all outcomes, 5-year overall survival was higher with modified versus unmodified regimens (P = .030). CONCLUSION:Although implementation barriers are primary drivers of ALL regimen adaptations globally, the paucity of reported implementation outcomes represents a methodological gap in the literature. Incorporating implementation science methods and frameworks is critical for the timely and effective delivery of innovative treatment regimens across resource settings.

ImportanceResearch indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear.ObjectiveTo investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings.Design, Setting, and ParticipantsThis cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC. Analyses for each specific cancer screening subsample were limited to screening-eligible participants according to the latest US Preventive Services Task Force (USPSTF) guidelines. Data were analyzed from February 22 to June 5, 2024.ExposuresTen social risk items, including life satisfaction, social and emotional support, social isolation, employment stability, food security (2 questions), housing security, utility security, transportation access, and mental well-being.Main Outcomes and MeasuresUp-to-date status (adherence) was assessed using USPSTF definitions. Adjusted risk ratios (ARRs) and 95% CIs were estimated using modified Poisson regression with robust variance estimator.ResultsA total of 147 922 individuals, representing a weighted sample of 78 784 149 US adults, were included in the analysis (65.8% women; mean [SD] age, 56.1 [13.3] years). The subsamples included 119 113 individuals eligible for colorectal cancer screening (CRCS), 7398 eligible for lung cancer screening (LCS), 56 585 eligible for cervical cancer screening (CCS), and 54 506 eligible for breast cancer screening (BCS). Findings revealed slight differences in effect size magnitude and in some cases direction; therefore results were stratified by sex, although precision was reduced for LCS. For the social contextual variables, life dissatisfaction was associated with nonadherence for CCS (ARR, 1.08; 95% CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). Lack of support was associated with nonadherence in CRCS in men and women and BCS, as was feeling isolated in CRCS in women and BCS. An association with feeling mentally distressed was seen in BCS. Under economic stability, food insecurity was associated with increased risk of nonadherence in CRCS in both men and women, CCS, and BCS; the direction of effect sizes for LCS were the same, but were not statistically significant. Under built environment, transportation insecurity was associated with nonadherence in CRCS in women and BCS, and cost barriers to health care access were associated with increased risk of nonadherence in CRCS for both men and women, LCS in women, and BCS, with the greatest risk and with reduced precision seen in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33).Conclusions and RelevanceIn this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations is essential before effective interventions can be implemented.

10059 Background: Children’s Oncology Group’s (COG) LTFU Guideline adherence is poor. We evaluated the impact of universal payer coverage on patient costs associated with adherence to COG-directed cardiomyopathy (CM), breast (BC), and colorectal cancer (CRC) screening. Methods: We reviewed coverage guidelines for Medicare, Medicaid, and commercial plans for COG screening for exposure-based CM (echocardiogram [echo] every 2-5 yrs based on cumulative chest radiation (RT) and anthracyclines), BC (yearly mammography [MAM] and magnetic resonance imaging [MRI] beginning at age 25 or 8 yrs from chest RT), and CRC (colonoscopy [COL] every 5 yrs or multitarget stool DNA [MTSD] every 3 yrs, starting 5 yrs from abdominopelvic RT or age 30). The eligible US population was estimated from SEER and American Cancer Society cancer survival rates. Cost of screening was derived from the Center for Medicare & Medicaid Services (CMS) and of lifetime treatment from published data. Net costs vs. benefits (in US $) were calculated, assuming 100% adherence, as the sum of cost-savings (i.e., treatment costs averted) and monetary value of quality-adjusted life-yrs (QALYs) gained minus costs (e.g., screening, false positives). Results: Screening coverage varied by payer (Table). BC screening for all US survivors with prior chest RT (n = 42,847) yielded a net benefit ranging from $0.5 to $3.4 billion, with patients paying 19.3% of costs. Among 138,702 survivors at-risk of CRC, net benefit from COL and MTSD was $5.7 and 5.0 billion. Patients nationally bore 0% of MTSD but 60% of COL costs. Among 218,322 at-risk of CM, costs exceeded cost-savings by $1.7 billion when using the median echo cost by payer but yielded a $400 million benefit when using the average cost of CMS and the lowest commercial plan. Patients bore 90% of CM costs. Conclusions: Screening for CM, BC, and CRC per the COG guidelines results in substantial cost savings and benefits. However, as adherence is < 100% due to copay, inadequate coverage, and low provider awareness, interventions and policies focused on boosting adherence could yield cost savings to the health system and reduce disease burden in this population. COG Screening By Payer (Subset) Cost Bearer, % (Aggregated across Payers) Value of Cases Averted Value of QALYs Gained Total Cost Net Costs (-) or Benefit (+) Medicare Medicaid Commercial Patient (Pt) Payer Billion US $, Range BCMAM & MRI Coverage Full, at physician’s discretion MAM: Full MRI: None Full 19.3 80.7 NA* 2.6 - 5.9 2.1 - 2.5 0.5 - 3.4 Pt Cost 20% copay after Part B deductible 20% copay MAM: 0% MRI: 15-30% copay after deductible CRCCOL or MTSD Coverage COL: None MTSD: Full NoneFull NoneFull COL: 60 40 3.7 4.4 2.4 5.7 Pt Cost COL: 100% MTSD: 0% 100% 0% 100% 0% MTSD: 0 100 2.9 4.0 1.9 5.0 CMEcho Coverage None None ≤2 covered after age 18 90.3 9.7 0.01 0.74 0.36 - 2.5 -1.7 - 0.4 Pt Cost 100% 100% 15%-30% copay after deductible *Not available in published models.

As many as 14 million people contract a new case of HPV each year in the United States, with over 37,000 HPV cancers diagnosed each year. However, HPV vaccination coverage varies greatly with disparities by population and region. In rural areas, HPV vaccination rates for adolescents are significantly lower (12

For decades, incidence of human papillomavirus (HPV)-associated cancers has been increasing in rural communities across the United States. Although emerging evidence shows a widening rural-urban disparity, rural intersectionality has been understudied. Our study examined the incidence of HPV-associated cancers within rural communities to identify differences by race/ethnicity for males and females, and explore how these differences varied by cancer type, socioeconomic, and geographic factors. We accessed age-adjusted cancer incidence rates (2010–2019) from the North American Association of Central Cancer Registries (NAACCR) for HPV-associated cancers (cervical, vaginal, vulvar, penile, anal, oropharyngeal) in rural counties. Stratifying by sex, we calculated incidence rate ratios by race/ethnicity. Subgroup analyses included age, site, census-tract poverty, census tract socioeconomics, and region. Between 2010 and 2019, rural HPV-associated cancer was 11.8 cases per 100,000 population. We found significant heterogeneity within male (10.5) and female (13.2) rates. For males, the lowest rate was found in non-Hispanic Asian-American/Pacific-Islander populations (3.7) and Hispanic populations (4.8), and the highest rate was found in non-Hispanic White populations (11.2). For females, the lowest rate was also found in Hispanic Asian-American/Pacific-Islander populations (8.8) and the highest rates were found in non-Hispanic Black (13.8) and non-Hispanic American Indian/Alaska Native populations (14.5). However, these racial/ethnic differences varied across rural subpopulations, geography, and poverty. Appreciating the diversity of the rural cancer burden can be used to effectively develop and implement public health interventions to address HPV-related cancer disparities in rural communities. Actions are needed to prioritize reducing the burden of HPV-associated cancer in AIAN populations in high-poverty rural communities.

Geographical disparities exist in human papillomavirus (HPV) vaccination rates with Southern states having the lowest rates. Parental attitudes remain understudied in different Southern locations. We assessed factors related to HPV vaccination receipt among children aged 9-17 years in Tennessee, and if those factors differed by child's age and gender. A cross-sectional survey of 506 parents was performed via random digit dial from May to August 2022. A multivariable logistic regression model was used to estimate adjusted odds ratios and 95 % confidence intervals to predict sociodemographic and overall vaccine-related factors associated with HPV vaccine receipt or non-receipt (referent) for their child, and exploratory analyses to determine if those factors differed by child's age and gender. In adjusted logistic regression models, HPV vaccine receipt was significantly positively associated with the child's age (13-17 years) and the parent and child having had the influenza vaccine this season and the COVID-19 vaccine, and negatively associated with children who were male and had a parent employed parttime/unemployed/retired/student/disabled. Significant associations for HPV vaccine receipt were with increased levels of agreement of the parent having enough information for decision-making, belief the vaccine was beneficial, and increased levels of trust and perceived effectiveness of the vaccine. Increased levels of hesitancy and increased levels of agreement that the vaccine might cause infertility issues in the child, was unsafe, and natural immunity is better than vaccine immunity had negative associations with HPV vaccine receipt. All associations were more pronounced among older than younger children, and all but one association (overall vaccine trust) was more pronounced among males compared with females. Strategies to improve HPV vaccine uptake should be targeted to and/or include males and parents with children aged 9-12 years, and include education on the importance and process of protecting the body through HPV vaccination and vaccines in general.

PURPOSE:Human papillomavirus (HPV) can cause cancers of the genital system, anus/rectum, and oropharynx. Prior research showed that HPV-associated cancer incidence was rising faster in nonmetro than in metro populations. Our study identified which cancers contributed to the widening disparity. METHODS:Representing ∼93% of all cancers in the United States, we analyzed data from the North American Association of Central Cancer Registries (2000-2019). Restricting the analysis to HPV-associated cancers, we compared 5-year average age-adjusted incidence rates (per 100,000 population) for nonmetropolitan (Rural-Urban Continuum Codes 4-9) and metropolitan populations, by sex and cancer site. To quantify the rural-urban gap, we calculated rate ratios and absolute differences of incidence trends. RESULTS:Although incidence was similar in 2000-2004 (nonmetropolitan = 9.9; metropolitan = 9.9), incidence in 2015-2019 was significantly higher in nonmetropolitan (12.3) than metropolitan (11.1) populations. The gap was widest for cervical cancers (females) in 2015-2019 (1.0 case per 100,000) but grew the most since 2000-2004 in oropharyngeal cancers among males (+1.1 cases per 100,000). The nonmetropolitan rate ratios for females (RR = 1.15, 95% C.I. = 1.13, 1.17) and males (RR = 1.07, 95% C.I. = 1.05, 1.09) in 2015-2019 were higher than the respective RRs for all other years. Since 2000, the nonmetropolitan disparity has significantly grown for anal and cervical cancers in females, and oropharyngeal cancers in both sexes. DISCUSSION:Although preventable, nonmetropolitan Americans have shouldered a growing burden of HPV-associated cancers. To address these cervical, anal, and oropharyngeal cancer disparities, it is imperative that HPV vaccination programs are effectively implemented at scale.

To guide researchers and funders, we sought to identify top priorities for research on increasing HPV vaccine coverage among US children ages 9-12 years. In Survey 1, 60 participants (researchers, health care professionals, and other stakeholders engaged in HPV vaccination research) viewed 57 research topics about increasing HPV vaccination coverage and provided additional topics. We integrated their suggestions into the list and condensed similar items to reach a list of 38 topics. In Survey 2, 230 participants identified their top ten research priorities. The top HPV vaccination research priorities and their corresponding themes were misinformation (chosen by 50% of respondents, from the theme of vaccine confidence), starting at age 9 years (48%, primary care), and single dose (48%, other). The top ten research priorities also included vaccine communication (40%, primary care), system-wide approach (39%, health system and payers), community settings (39%, alternative settings), immunization registries (38%, policy), geography and rurality (37%, populations), school mandates (37%, policy), and near elimination of HPV cancers (37%, other). The proportion of participants selecting topics within each theme varied between 15% for health system and payers to 32% for alternative settings. These research priorities highlight research areas likely to yield impactful strategies for increasing HPV vaccination. Focusing US HPV vaccine research on these topics can optimize resource allocation, inform evidence-based interventions, and support policymaking to enhance vaccine uptake.

This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9-17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers' attitudes, information sources, and trust in those sources were associated with their adolescent's HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

BackgroundThe COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee.MethodsA cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines.ResultsApproximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50–65) (aOR = 1.9; 95% CI: 1.2–3.2), Black (aOR = 2.0; 95% CI:1.3–2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5–3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3–0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3–2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4–4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5–0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust (p < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy (p < 0.0001).ConclusionStrategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines.

Background Over 60 % of U.S. adults report adverse childhood experience (ACE), which correlate with risky health behaviors and lower utilization of healthcare preventive measures, potentially leading to chronic diseases in later life. Objective This study investigates the relationship between ACEs and human papillomavirus (HPV) vaccination in a national U.S. adult sample. Participants and setting We used data from selected states from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System collected in years 2019 (Mississippi, South Carolina, and Tennessee), 2020 (Georgia, Mississippi, North Dakota, South Carolina), 2021 (Mississippi), and 2022 (Arkansas) (N = 3578, 4392, 904, and 810, respectively). Methods We conducted descriptive, univariate, and multivariable regression analysis using SAS 9.4. Independent and dependent variables were ACEs and HPV vaccination, respectively. Results Individuals with ≥4 ACEs, versus no ACEs, were significantly more likely to report HPV vaccination in 2019, 2020, and 2021 (OR = 1.40, 1.77, 2.80, all p < 0.05 respectively), except in 2022 (OR = 1.54, p = 0.165). In 2019, specific ACE types, emotional abuse, and household mental illness were associated with HPV vaccination, whereas in 2021, emotional abuse, household mental illness, incarcerated household member, and substance abuse in household, and in 2022, emotional abuse was associated with HPV vaccination. Conclusions We found mostly positive association between ACEs and HPV vaccination, particularly in initial three years. However, findings in 2022 were not significant, except for emotional abuse. Diverse patterns in relationship between ACEs and HPV vaccination was observed overtime, highlighting the need for consistency in ACEs and HPV vaccination data collection, including vaccination timing, to better understand the underlying mechanisms and plan for interventions to prevent HPV-related cancers among these populations.