The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas

Dissertations

Increasing Pediatric HPV Vaccination Rates

Abstract

Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).

Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …

Implementation Of A Human Papillomavirus Vaccination Toolkit Postpartum, Eriola Arapi

Dissertations

Problem: Despite strong recommendations from the Centers for Disease Control and

Prevention (CDC, 2021) for HPV vaccination in individuals aged 9 to 26, postpartum women

are often overlooked as a target population. Every year in the U.S., oncogenic human

papillomavirus (HPV) infection causes approximately 330,000 cases of precancerous cervical

dysplasia and 12,000 cases of cervical cancer, the most common female cancer attributable to

HPV (Wang et al., 2024). Many providers miss the opportunity to offer the vaccine during the

postpartum hospital stay and the six-week visit—when patients are insured, motivated, and

more accessible.

Methods: This quality improvement (QI) project used …

Multilevel Disparities Of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers In The United States, Rhea Verma, David J. Fei-Zhang, Lily B. Fletcher, Sydney A. Fleishman, Daniel C. Chelius, Anthony M. Sheyn, Jeffrey C. Rastatter, Jill N. D’Souza

School of Medicine Faculty Publications

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality–urbanicity measures alongside individual-level race–ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males …

Parental View On Hpv Vaccination, Rebecca Elaine Rhodes

Electronic Theses and Dissertations

The human papillomavirus (HPV) is a sexually transmitted infection widely seen in the United States. Millions of Americans are affected by it each year, especially those in their late teens and early 20s. Although most infections will resolve on their own, 1 in 10 will lead to health problems such as cancer. The HPV vaccine can prevent over 90% of associated precancers and cancers. However, uptake of the HPV vaccine and its completion among adolescents are significantly lower than other recommended adolescent immunizations, falling short of the Healthy People 2030 goal of 80% coverage. Understanding parental attitudes, beliefs, and perceptions …

Increasing Hpv Vaccination Rates In Residents' Primary Care Clinics, Normonique Dyer, Do, Amman Bhasin, Md, Abdul Ekiyoyo, Md, Umma Fatema, Md, Ilana Goldberg, Md, Chukwuemezie Mamanu, Md, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The human papillomavirus (HPV) vaccine was approved in 2014 for the prevention of anogenital, cervical, and oropharyngeal cancers in female and male adolescents up to 26 years of age^1,2
• Data compiled from multiple clinical trials performed between 2006 and 2018 sought to evaluate benefit from extending the vaccination age given the implications on improving quality of life, morbidity/mortality, and reducing overall healthcare costs for preventable diseases³
• Results showed that increasing the vaccination age up to 45 in both males and females could offer additional protections against high-risk oncogenic strains of the HPV virus3
• Current recommendations from the …

Development Of Solitary Keratoacanthoma From A Cutaneous Wart, Joshua M. Ninan, Veronica Salazar

Research Symposium

Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.

Case Presentation: 48-year-old Caucasian female …

Human Papilloma Virus Type 16 Seroprevalence Among Men Living With Hiv, Ashley Duff

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: Individuals living with HIV are at a higher risk for developing human papillomavirus-driven oropharyngeal cancer (HPV-OPC). There are no methods for early detection; however, HPV16 E6 antibodies have been identified as a promising early marker. The objective of this study was to evaluate seroprevalence and predictors of HPV16 E6 seropositivity among men living with HIV.

Methods:2,334 men aged 40+ living with HIV with blood specimens banked within the Tennessee Center for AIDS Research (TN-CFAR) biorepository were evaluated using HPV multiplex serology. Seroprevalence of HPV16 antibodies was calculated for all HPV16 proteins analyzed (L1, E1, E2, E4, E6, E7). …

Hpv Imprints In Western India: The Overlooked Criteria For Cancer Profiling, Ashi R. Thobias, Jayendra B. Patel, Prabhudas P. Patel

Research Symposium

Background: In India, HPV infection detection for cancer-typing has been largely evaded. Especially, data on prevalence of HPV types other than the highly prevalent HPV 16 and 18 are lacking, particularly from the western region. Thus, present study aimed to evaluate prevalence of HPV strains in three most prevailing cancers in India i.e. cervical, oral and oropharyngeal cancer.

Materials & methods: DNA was isolated from tissue samples of 400 cervical cancer cases, 127 oral cancer cases and 75 oropharyngeal cancer cases and endpoint PCR was performed using degenerative primers MY 09/11, GP 5+/6+ and CP I/II. TS-PCR was conducted to …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Men’S Stories: An Account Of Translating Vaccine Decision Narratives From Young Men In The U.S. Into A Targeted Public Health Intervention, Michelle Miller-Day, Erin S. Craw, Diana Harris, Michael L. Hecht

Communication Faculty Articles and Research

Effective interventions to promote human papillomavirus (HPV) vaccination are needed for all young adults across the globe. Yet, most public health efforts focus on HPV-related risks for females. Unfortunately, HPV-related cancers in men are also a concern, as is the potential for men to spread HPV to their partners. The HPV vaccine is highly effective in reducing risks related to these cancers. Yet, vaccination rates among young males are low and their vaccination concerns are not well understood. This project conducted 15 in-depth qualitative interviews with U.S. males aged 18–22 to hear their vaccine decision stories. Themes of HPV vaccination …

The Cost-Effectiveness And Feminization Of The Human Papillomavirus Vaccine, Audrey Jammes

Scripps Senior Theses

Approved in 2006, the Human Papillomavirus (HPV) vaccine provided a medical breakthrough in combating cancer by inoculating first female and then male adolescents in 2010. In 2016, a new HPV vaccine was approved for all adolescents. However, it is the most expensive vaccine created in the United States and its female centered prescription led to debates regarding the vaccine’s necessity and risks. For the STS portion of this paper, analysis of the language in the vaccine’s prescriptions from 2006, 2010, and 2016 demonstrates two implicit assumptions regarding female health built into the vaccine’s rollout. Comparison of the two assumptions to …

Neutrophil Infiltration Into The Cervical Compartment Is Suppressed By Hiv Infection, Madeline Maschka

Honors Program: Senior Projects (Public)

Human Papillomavirus (HPV), is a small circular dsDNA virus with at least 200 different genotypes; each genotype is identified by at least 10% difference at the DNA level in the L1 capsid gene. Each HPV genotype affects the body in different tissues, either mucosal or cutaneous. Mucosal HPVs type 16 and 18 are known as high-risk strains, since HPV infection is the most common cause of cervical cancer and plays a central role in formation of precancerous lesions. Human immunodeficiency virus (HIV) damages the body’s immune system by targeting CD4+ T cells. Once CD4+ T cells are infected, the body …

El Vph Y El Cáncer Cervical En El Perú: Diferencias De Accesibilidad Entre Las Mujeres De Las Zonas Rurales Y Urbanas / Hpv And Cervical Cancer In Peru: The Differences In Accessibility For Rural And Urban Women, Jemma Stratton

James Madison Undergraduate Research Journal (JMURJ)

Este informe examina el estado actual del tratamiento y prevención del VPH en el Perú, y pone énfasis con problemas específicas que han contribuido al riesgo alto de cáncer cervical entre las mujeres rurales. Perú ha tomado grandes pasos en las décadas últimas para establecer programas que se dirigen al VPH y la salud de las mujeres. Sin embargo, las mujeres peruanas tienen una población más probable para contraer cáncer cervical en el mundo. Este informe compara los esfuerzos de prevención del VPH entre las poblaciones rurales y urbanas en el Perú y identificar las barreras que causando esta crisis …

Efficacy Of A Single Dose Hpv Vaccine And Its Potential Outcomes In Low-Income Countries, Brooke Schramm

Theses and Graduate Projects

Cervical cancer is a leading worldwide cause of cancer mortality in women and disproportionately burdens low-income countries. Human papillomavirus (HPV) has been proven as the primary cause of genital warts, some oropharyngeal cancers, and anogenital cancers such as cervical, vulvar, anal, and penile malignancies. HPV vaccination coupled with regular HPV screenings are major strategies for preventing HPV infections, but with high costs and infrastructure complexities associated with current vaccination and screening programs, many world regions are unable to provide protection against HPV infection and its sequalae. If unabated, cervical cancer incidence is expected to increase worldwide over the coming decades …

Regulation Of The Long Non-Coding Rna Fam83h-As1 By Human Papillomavirus In Cervical Cancer, Jamie Ann Barr Ph.D.

Graduate Theses, Dissertations, and Problem Reports (ETD)

Non-coding RNAs (NcRNAs), such as long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), have been found to be involved in a variety of critical biological processes, and dysregulation of ncRNAs have been involved with several human diseases including cancer.

High-risk human papillomavirus (HPV) infection is one of the first events in the process of carcinogenesis in cervical and a subset of head and neck cancers. The expression of the viral oncoproteins E6 and E7 is essential in this process by inactivating the tumor suppressor proteins p53 and Rb, respectively, in addition to their interactions with other host proteins and regulation of …

Human Papillomavirus: The Influence Of Prevention And Vaccination, Lacey N. Russell

Kentucky Journal of Undergraduate Scholarship

Human Papillomavirus infections (HPV) are the most common sexually transmitted diseases in the United States. Of cancers in parts of the body where HPV is often discovered about 80% originated from an HPV infection. Despite this knowledge and the effectiveness of the HPV vaccine, vaccination by both genders in Kentucky and on a national scale remains highly underutilized. As a result, preventable incidence and mortality rates from HPV-related illness are elevated. Health care delivery factors such as increased vaccination and preventative care, insurance coverage, and accessible rural health care are necessary for HPV prevention and promotion of holistic health. The …

Oral Cancer Has A New Risk Factor: Hpv, Tira Hanrahan, Shillpa Naavaal

Dental Public Health and Policy Publications

No abstract provided.

Improving Hpv Immunization By Age 13 In Over 20 Kansas City Pediatric Practices, Luke A. Harris, Douglas Blowey

Posters

No abstract provided.

Molecular Mechanisms Of Dna Replication Initiation In Hpvs With Genetic Variations Leading To Cellular Carcinogenesis, Gulden Yilmaz

Graduate School of Biomedical Sciences Theses and Dissertations

Human papillomaviruses are a vast family of double-stranded DNA viruses containing non-carcinogenic and carcinogenic types, whose crucial differences remain unknown, except for the difference in the frequency of DNA replication. The human papillomavirus (HPV) E2 protein regulates the initiation of viral DNA replication and transcription. Its recognition and binding to four 12 bp palindromic sequences in the viral origin is essential for its function. Little is known about the DNA binding mechanism of the E2 protein found in HPV types that have low risk for oncogenicity (low-risk) as well as the roles of various elements of the individual binding sites. …

Increasing Hpv Vaccination Rates Using Social Marketing Strategies, Sharon Wilson Catledge

Doctoral Projects

The human papillomavirus (HPV) is the most common sexually-transmitted infection (STI). Approximately 20 million Americans between the ages of 15 and 49 years currently have HPV with > 6.2 million new HPV infections estimated to occur each year. Yet, HPV vaccination rates remain relatively low. More than 40 strains of HPV are transmitted through genital contact during vaginal, anal, or oral sex and can infect males and females. In addition to causing genital warts, HPV is associated with cervical, vulvar, vaginal, anus, penile, and oropharyngeal cancers. In women, the most prominent type of cancer is cervical with > 12,000 diagnoses each year …

Molecular Pap Biomarkers For Cervical Cancer Risk Assessment In Thinprep® Clinical Specimens, Jennifer Taylor

Graduate School of Biomedical Sciences Theses and Dissertations

Approximately 500,000 patients are diagnosed with cervical cancer worldwide each year, thus making it the second most common cause of cancer-related deaths in women. Persistent high-risk human papillomavirus (HR-HPV) infections induce cervical dysplasia by increasing the expression of two viral oncogenes, E6 and E7. Utilization of the Papanicolaous smear test (Pap test) has contributed to a decrease in morbidity and mortality of cervical cancer; however, subjective analysis of cell morphology with a limited amount of cells has led to a substantial rate of false positive and false negative diagnoses. A more objective and sensitive diagnostic tool for the detection of …

The Efficacy And Safety Of The Human Papillomavirus Vaccine, Gail Tessler

The Science Journal of the Lander College of Arts and Sciences

The HPV virus is said to be the cause of many infections, warts, and cancers. In addition to the fact that the treatment for HPV is not always successful, not every individual knows that s/he is infected and is very likely to infect his or her partner, too. This is one factor that explains why 14 million people each year in America alone contract HPV and makes cervical cancer so threatening to many people worldwide. In light of this and the known dangers of cervical, anal, vaginal and penile cancers, the HPV vaccine was created to prevent an infection of …

Is 5% Imiquimod Cream More Efficacious At Sustained Clearance Of Genital Warts At 3 Months Compared To 1% Imiquimod, Ablation Therapy, And A Placebo Vehicle Cream?, David A. Smith

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not 5% Imiquimod is more efficacious at sustained treatment of genital warts at 3 months compared to 1% Imiquimod, ablation, and a placebo vehicle cream.