Newsletter 2019 – May/June

Registration is open for several of our 2019 trainings!

DIMENSIONS: Tobacco Free Advanced Techniques: June 26 – 27, 2019

Motivational Interviewing for Behavior Change – Level II: August 6 – 7, 2019

Whether you get your news from the internet, TV, radio, or newspaper, you’ve likely heard that the HPV vaccine is the best option available today to prevent cervical, penile, and throat cancers associated with the HPV virus. In fact, the HPV vaccine is one of only two cancer prevention vaccines, the other being Hepatitis B, and it is also one of the most underutilized when compared to other age appropriate adolescent vaccinations. The vaccine series (two or three shots, depending on age) is recommended to begin between ages 11 and 26.¹ However, as of 2016, only 60% of children aged 13 to 17 years had started the HPV vaccination series, and only approximately two-thirds of those starting the series completed it.²

This topic is particularly relevant to me as my niece was diagnosed with stage 3 cervical cancer several years ago. Thankfully, she is cancer free today. Unfortunately, that is not the case for the 35,000 people who were diagnosed with HPV-related cancers in the United States last year.³ So why aren’t more adolescents receiving the HPV vaccine?

If your first thought in response to that question is “Oh, the anti-vaxxer movement is the biggest obstacle,” you would be only partly correct. Some parents do refuse or delay the HPV vaccine, but primary care providers also play a role in lower HPV vaccine rates.⁴ In part because HPV is sexually transmitted, and conversations about HPV prevention between providers and parents of young adolescents can be awkward, many providers have approached their conversations about the HPV vaccine differently than those about other scheduled vaccines. Often, it has been the provider, and not the parent, who is hesitant, and, as it turns out, provider hesitancy is contagious. Parents pick up on the provider’s tentativeness and that can weaken their resolve to vaccinate.

The good news is that things are changing. Increasingly, providers are reframing the HPV vaccine conversation away from prevention of a sexually transmitted virus and toward cancer prevention.⁴ They are learning how to bundle the HPV recommendation between other vaccines recommendations, so that all vaccines are given equal weight.⁵ And providers are learning Motivational Interviewing techniques to meet their patients where they are—to help them to embrace their ambivalence and find their own internal motivation to vaccinate their child.⁶

Here at the BHWP, we are delighted to witness this movement in provider knowledge and skill in delivering HPV vaccine recommendations through our MI for vaccine hesitant parents training and research activities. We invite you see what we are up to by viewing our provider-facing video, which was co-developed with our partners at the Unity Consortium and Indiana University.

References:

1. Centers for Disease Control and Prevention (2019). Recommended Child and Adolescent Immunization Schedule for 18 Years or Younger, United States 2019.
2. Walker, T. Y., Elam-Evans, L. D., Singleton, J. A., et al. (2017). National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2016. Morbidity and Mortality Weekly Report, 66(33);874-882.
3. Viens, L. J. (2016). Human papillomavirus–associated cancers—United States, 2008–2012. Morbidity and Mortality Weekly Report, 65(26);661-666.
4. Dempsey, A. F., Pyrznawoski, J., Lockhart, S., et al. (2018). Impact of a provider communication training intervention on adolescent human papillomavirus vaccination: A cluster randomized, clinical trial. JAMA Pediatrics, 172(5):e180016.
5. Garrett, K. & Zimet, G. (2018). UNITY Consortium’s three Cs approach to improve adolescent immunization coverage: Implementing confident, concise, and consistent vaccination recommendations and overcoming communication challenges. Presented at the Society of Adolescent Health and Medicine (SAHM) Annual Conference, Seattle, WA.
6. Reno, J. E., O’Leary, S., Garrett, K., et al. (2018). Improving provider communication about HPV vaccines for vaccine-hesitant parents through the use of motivational interviewing. Journal of Health Communication, 23(4):313-320.

During a recent visit with a friend, she apologized after our conversation took a turn she described as “going deep.” Surprised by her apology, I brushed it off, telling her that deep conversations are the kind that nourish me. And I wasn’t just saying it for her benefit. I have been aware for some time that conversations that skim across the surface of a person just aren’t fulfilling to me. When I consider all of the experiences I have on any given day and how few people with whom I share my deepest thoughts and feelings, the opportunity to do so is a gift to me. Being able to share with another person aspects of oneself previously unknown, deepens relationships and our emotional connections.

While I understand there is a time and place for all kinds of interactions, I believe that taking the risk to share deeply meaningful thoughts and experiences is one of the most satisfying parts of life. Moments when I felt disconnected and alone were times when I have been isolated and withdrawn, or remained silent when I had something to say. Of course, I can justify my avoidance of taking this risk by saying, “It just wasn’t the right time,” or, “The other person isn’t someone I trust,” or, “They’re just not interested.”

And I know this is not the truth. It takes courage and mindfulness to show up in the moment with another person. While we may not always feel like we have the time or energy for the conversation, we are better for it. To see and be seen, makes life feel worthwhile. Even with differences in opinion and diverse perspectives, there is some common ground upon which we can walk together. These opportunities often appear in unexpected places. I, for one, want to pay attention when the moment occurs and practice taking a deep dive. Do you want to join me?

Of course, I found my groove eventually, but my initial struggles to relate to these interesting, kind, and easy-going people was telling. I have come to realize that the quality and ease of my social connections at any given time (or lack thereof) represents a kind of barometer – an indicator of how balanced my life is. When the prospect of socializing seems draining, when I find it difficult to actively listen, or when I am challenged to think of things to share with others, it usually means I have been overly preoccupied with my own life – often one particular aspect of it. It could be my work, but it could just as easily be parenting struggles, a big project, or anything else I tend to become all-consumed by.

The weather is warming, children will be out of school in a few short weeks, and the season of socializing will soon be in full swing. I am fortunate to have been given a gentle wake-up call from my social barometer – a reminder to turn off my laser vision and see the world around me on a wider screen.

Achieving and maintaining social wellness is an unending process that requires an active, ongoing commitment, as well as a conscientious approach. Social ties—whether to individuals, a group of people, or a community—are constantly evolving and necessitate effort. Perhaps due to this dynamic we too often consider these relationships through the prism of our own experiences and expectations, focusing on what we receive from them and what might be missing. Yet if we’re able to concentrate on the support and strength we can give to others, alongside what we receive, we stand to achieve a greater sense of social wellness. One can even argue that humans and human society have evolved to behave in this way, with the sum of our efforts being greater than the parts.

This concept of collective social uplifting is far from novel, but it’s worth taking a moment to consider. Recently, I had a unique experience in which I benefited from a personally unprecedented amount of social support—from complete strangers no less—and I want to share my own testament to its power. In April, I ran the Boston Marathon, and in addition to all the help and love from my family, thousands of strangers helped carry me to the finish line. Going beyond a general cheer, dozens of spectators directly addressed me with personal encouragement, yelling out various “Colorado” cheers, in recognizing the shirt I was wearing from a previous race that featured our state flag. The unending surge of energy and enthusiasm they provided remains hard to comprehend, let alone describe, but it may be best summed up by the reality that even after having already run over twenty miles, it was actually more difficult to take a break and walk amid such relentless support.

With this story in mind, think about a time in your life when you’ve received an abundance of social support from someone, a group of people, or even a community of strangers. I would imagine the additional energy and encouragement you received helped you to achieve more than you thought possible. Recognizing and valuing such a gift is a huge step toward taking the next step—paying that positive energy forward to others. In truth these concepts are not mutually exclusive, but even so, it’s all too easy to lose sight of this bigger picture. I plan to proactively take my recent experience to heart and spread that positive energy onward, and I encourage you to join me. Through a collective, bidirectional approach, we’ll be able to create a greater sense of social wellness—both for ourselves, and those we empower.