THE DISCOVERY IN THE 1980s linking the human papillomavirus (HPV) to nearly all cases of cervical cancer led to the groundbreaking development of a cancer-prevention vaccine, approved for use in females in 2006 and for males in 2009. The U.S. Centers for Disease Control and Prevention (CDC) now recommends that the HPV vaccine — which can prevent cervical, anal, vulvar, vaginal, penile and certain throat cancers, as well as genital warts — be offered routinely to adolescents and young adults ages 11-26. The vaccines are administered in two (ages 11-14 years) or three (age 15 or older) doses over the course of about 6-12 months.
But 12 years after the HPV vaccine was introduced, usage rates among adolescents remain disappointingly low, says Dr. Roshan Bastani , Fielding School professor, director of the UCLA Kaiser Permanente Center for Health Equity and director for disparities and community engagement in the UCLA Jonsson Comprehensive Cancer Center . Nationally, in 2016, just 60 percent of 13-17 year olds had received the first dose of the vaccine, and only 43 percent had completed the series, according to CDC data.
Bastani attributes this in part to missteps in the way the vaccine was introduced. “The fact that it was initially promoted by the pharmaceutical industry and certain legislators raised suspicions among some people,” she says. “In addition, HPV is a sexually transmitted virus and there were early media reports of concern among parents that receipt of the vaccine would encourage their child to engage in sexual activity. Our own research and that of others around the country has shown that most parents do not hold such beliefs. We do know that many providers do not routinely recommend the vaccine to their patients, and that some providers are not comfortable having a discussion about a sexually transmitted virus with parents of young adolescents.”
To learn how health systems can effectively increase HPV vaccination rates, Bastani heads a $6.6 million, five-year study funded by the Patient-Centered Outcomes Research Institute (PCORI). The study is being done through a partnership with the Northeast Valley Health Corporation (NEVHC), a multisite federally qualified health center (FQHC) serving a low-income population in Los Angeles’ San Fernando and Santa Clarita valleys. Bastani’s team — including Drs. Beth Glenn , Alison Herrmann (PhD ’12) and Catherine Crespi from the Fielding School and Debra Rosen and Dr. Gina Johnson from NEVHC — will compare three strategies:
A system-level strategy targeting physicians, staff and clinic-level policies, procedures and practices;
Text-messaging or mailing reminders to parents of NEVHC adolescent patients who are due for a dose of the HPV vaccine; and
A combination of the system-level and parent-reminder strategies. More than 17,000 HPV vaccine eligible adolescents will receive services at participating NEVHC clinics during the five-year study period. The impact of each strategy will be assessed through a review of NEVHC’s electronic medical records.
The team has been laying the groundwork for the current study for nearly a decade, beginning shortly after the vaccine was introduced. In partnership with the Los Angeles County Department of Public Health, NEVHC and other community clinics, the FSPH researchers have conducted multiple studies to learn about parental knowledge and beliefs about the HPV vaccine and ways to improve vaccine uptake, and to pilot-test parent-reminder and system-level strategies.
This isn’t a vaccine to prevent a sexually transmitted disease; it’s a vaccine to prevent cancer.
Dr. Roshan Bastani
“We didn’t find major opposition to the vaccine; it was more that many parents didn’t know much about it,” says Glenn, an FSPH associate professor of health policy and management and associate director of the UCLA Kaiser Permanente Center for Health Equity . “Knowing that, we began to focus on developing interventions within health systems to make sure that parents were consistently offered the vaccine and were reminded when their adolescent was due.”
NEVHC, the community partner in the study, provides care to a primarily uninsured or publicly insured population in which only about one-third of the teens have received the full HPV vaccine series. “This is a great opportunity to better understand what interventions will work with our safety-net population,” says Rosen, NEVHC’s director of quality and health education. “We are excited to collaborate with the Fielding School and to share what we learn with other organizations.”
Rosen notes that many adolescent patients fail to return to the health center after getting the first dose of the HPV vaccine; to that end, the text and mail reminders will serve both to let parents know that their child is due and to reinforce the importance of completing the series.
But for any organization with limited resources, it is important for strategies to be not just effective, but also efficient. “Convincing individual patients is very inefficient,” Bastani says. “We need to look at systematic changes that will serve patients today, tomorrow and into the future.” Among the system-level changes being emphasized at NEVHC is to view each visit by an adolescent patient, even if it’s for another purpose, as an opportunity to determine whether an HPV vaccine is due, and to offer it when it is. The NEVHC physicians are also being encouraged to make the HPV vaccine a more routine part of practice in the same way that vaccines are routinely ordered for younger-age children, and to de-emphasize that the virus is sexually transmitted. “This isn’t a vaccine to prevent a sexually transmitted disease; it’s a vaccine to prevent cancer,” Bastani says.
The UCLA-NEVHC study is funded through PCORI’s Pragmatic Clinical Studies initiative, which aims to produce results that are broadly applicable to a diverse range of patients and health care settings and can be more quickly adopted in routine clinical practice. “Making an impact on 17,000 patients in this one system is huge,” Bastani says. “But what we learn from this study will also have the potential to improve the prevention of HPV-related cancers in other low-resource clinical settings across the country. This is an extremely safe vaccine that prevents a horrible disease from ever developing. It is important that we learn how to ensure that it’s reaching the population.”
Faculty Referenced by this Article
Roshan Bastani
Health Policy and Management
Beth Glenn
Health Policy and Management
Samuel Sessions
Health Policy and Management
Elizabeth Yzquierdo
Community Health Sciences
Christina Ramirez
Biostatistics
Lori Pelliccioni
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Christie Jeon
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David Gjertson
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Brennan Spiegel
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Jared Diamond
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Jesus Araujo
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Sheena G. Sullivan
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Patricia Ganz
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Ron D. Hays
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Srikanth Kadiyala
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William Comanor
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Jody Heymann
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Shane Que Hee
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Timothy Malloy
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Jian Li
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Steven Teutsch
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Marjorie Kagawa-Singer
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Mark Litwin
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Chandra Ford
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Julie A. Elginer
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James Macinko
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Carol Mangione
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Arturo Vargas Bustamante
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Michael Prelip
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Hamid Arabzadeh
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Emmeline Chuang
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Diana Hilberman
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Barbara Berman
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Roch A. Nianogo
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Jennifer A. Wagman
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Courtney S. Thomas Tobin
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Weng Kee Wong
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Annette Regan
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Dana Hunnes
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Judith M. Siegel
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Robert Brook
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Kirsten Schwarz
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Abdelmonem A. Afifi
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Olivia Jung
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Ilan H. Meyer
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Naomi Greene
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Ralph R. Frerichs
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Liwei Chen
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Dylan Roby
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Avram Kaplan
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Robert Schiestl
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Penelope Fu
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Whitney Pirtle
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Naomi Zewde
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Martin L. Lee
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Alina Dorian
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David Hayes-Bautista
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Anne Coleman
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Anne Pebley
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Paul Chung
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Anthony Hunter Schiff
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Michael Rodriguez
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Thomas D. Gordon
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Robert Weiss
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Kevin Njabo
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Brunilda Balliu
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Hiram Beltrán-Sánchez
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Onyebuchi A. Arah
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Virginia C. Li
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Elizabeth Rose Mayeda
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Jessica Gipson
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Karin B. Michels
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Jose J. Escarce
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Jack Needleman
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Jeanne Miranda
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Richard Ambrose
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Marjan Javanbakht
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Elizabeth D’Amico
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May C. Wang
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Vickie Mays
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Pamela Davidson
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Otoniel Martinez-Maza
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André Nel
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Jonathan Fielding
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Ronald Halbert
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Leeka I. Kheifets
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Feng Gao
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Kristen Choi
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Sheba George
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Thomas R. Belin
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Frank J. Sorvillo
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Donatello Telesca
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Miriam Marlier
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Natalie Muth
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Ron Brookmeyer
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Warren Scott Comulada
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Angelo Bellomo
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Neal Halfon
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Lillian Gelberg
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Dawn Upchurch
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Charlotte G. Neumann
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Curtis Eckhert
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Deborah Anne Freund
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Yoshira Ornelas Van Horne
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Michael Ong
Health Policy and Management
Rebecca Delafield
Community Health Sciences
Felicia Hodge
Health Policy and Management
Vonthanak Saphonn
Epidemiology
Akihiro Nishi
Epidemiology
Wendelin Slusser
Community Health Sciences
Michael Galper
Health Policy and Management
Burt Cowgill
Health Policy and Management
Joseph Zoller
Biostatistics
Alison Herrmann
Health Policy and Management
Catherine M. Crespi
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Health Policy and Management
Whitney Pirtle
Community Health Sciences
Moira Inkelas
Health Policy and Management
Matthew J. Mimiaga
Epidemiology
Eric Malmquist
Assistant Director, Academic and Staff Human Resources
Rachael Jones
Environmental Health Sciences
Annette Regan
Epidemiology
Dana Rose Garfin
Community Health Sciences
Yvonne Flores
Health Policy and Management
Neal Halfon
Health Policy and Management
Diana Hilberman
Health Policy and Management
James Macinko
Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research
Community Health Sciences
Health Policy and Management
Maral DerSarkissian
Epidemiology
Nataly Soberanes
Research Administration Analyst
Epidemiology
Jared Diamond
Environmental Health Sciences
Dorota M. Dabrowska
Biostatistics
Carolina Cormack Orellana
Lisa Stanley
Project Director, Data Informed Futures
Epidemiology
Courtney S. Thomas Tobin
Community Health Sciences
May Sudhinaraset
Community Health Sciences
Nora Sweeney
Director, Office of Public Health Practice
Michael Rodriguez
Community Health Sciences
Rebecca Wolfe
Assistant to the Dean
Arthur Cho
Environmental Health Sciences
Liwei Chen
Professor in Epidemiology
Epidemiology
Donatello Telesca
Biostatistics
Humphrey Duan
Biostatistics
Jonathan Fielding
Health Policy and Management
Otoniel Martinez-Maza
Epidemiology
Sander Greenland
Epidemiology
Ronald Halbert
Community Health Sciences
Joann G. Elmore
Health Policy and Management
Zuo-Feng Zhang
Epidemiology
Roshan Bastani
Health Policy and Management
Charlotte G. Neumann
Community Health Sciences
Timothy Brewer
Epidemiology
Ruzanna Margaryan
Biostatistics
Nick Young
Facilities Coordinator
Nicole Green
Environmental Health Sciences
Deborah Anne Freund
Health Policy and Management
Ron Andersen
Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.
Health Policy and Management
Vonthanak Saphonn
Epidemiology
Nicole Hadjioannou
Staff Research Associate
Epidemiology
Gilbert C. Gee
Community Health Sciences
Jody Heymann
Epidemiology
Health Policy and Management
Elizabeth Rose Mayeda
Epidemiology
Michele Guindani
Biostatistics
Tao Huai
Environmental Health Sciences
Kristen Choi
Health Policy and Management
Janae Hubbard
Program Director
Clifford Ko
Health Policy and Management
Jeanne Miranda
Health Policy and Management
Anne Coleman
Epidemiology
Jenna Mendoza
Health Policy and Management
Xi Zhu
Health Policy and Management
Uyen Ha
Community Health Sciences
Gonzalo Moreno
Senior Policy Analyst
Epidemiology
Andre Nguyen
Clinical Site Interviewer/Staff Research Associate II
Epidemiology
Patricia Ganz
Health Policy and Management
Frank J. Sorvillo
Epidemiology
Emmeline Chuang
Health Policy and Management
Jessica Tuan
Project Coordinator
Jane Valentine
Environmental Health Sciences
Michael Collins
Environmental Health Sciences
Jackie Cisneros
Environmental Health Sciences
Annette Bartlett
Senior Academic Payroll and Human Resources Analyst
Ilan H. Meyer
Community Health Sciences
Eric Wilks
Office Administrator
Yifang Zhu
Environmental Health Sciences
Kenneth Wells
Health Policy and Management
Rey Soto
Data Systems Analyst
Epidemiology
Roch A. Nianogo
Epidemiology
Ramces Jimenez
Senior Fund Manager
Epidemiology
Lillian Gelberg
Health Policy and Management
Natalie Muth
Community Health Sciences
Peter Katona
Epidemiology
Burt Cowgill
Health Policy and Management
Sheba George
Community Health Sciences
Marissa Seamans
Epidemiology
Richard J. Jackson
Environmental Health Sciences
Sean Tan
Senior Public Administration Analyst
Jennifer A. Wagman
Community Health Sciences
Olivia Jung
Health Policy and Management
Joelle Wolstein
Research Scientist
Health Policy and Management
André Nel
Environmental Health Sciences
Alan Tomines
Health Policy and Management
Falco J. Bargagli Stoffi
Biostatistics
Naomi Greene
Epidemiology
Sarah Blenner
Director of Field Studies and Applied Professional Training
Community Health Sciences
Christina Ramirez
Biostatistics
Joselyne Franco
Contract and Grant Analyst
Roxy Naranjo
Biostatistics
William G. Cumberland
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Porchia Toussaint
Assistant Director, MPH for Health Professionals Program
Community Health Sciences
Onyebuchi A. Arah
Epidemiology
Wendelin Slusser
Community Health Sciences
Ondine S. von Ehrenstein
Community Health Sciences
Epidemiology
Robert J. Kim-Farley
Robert J. Kim-Farley, MD, MPH, is a Professor-in-Residence with joint appointments in the Departments of Epidemiology and Community Health Sciences
Community Health Sciences
Epidemiology
Flor Vasquez
Administrator, California Health Interview Survey
Caroline Gallaher
Senior Director of Development
Corrina Moucheraud
Health Policy and Management
Jian Li
Environmental Health Sciences
Epidemiology
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Environmental Health Sciences
Michael Jerrett
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Jason H. Moore
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Biostatistics
Kyle Sullivan
Director, Executive Programs in Health Policy and Management
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Jose J. Escarce
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Lisa V. Smith
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Anna Lim
Health Policy and Management
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Lara Cushing
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Dawn Upchurch
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Leeka I. Kheifets
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Felicia Hodge
Health Policy and Management
Samuel Sessions
Health Policy and Management
Susan Cochran
Epidemiology
Beth Glenn
Health Policy and Management
Kevin Njabo
Environmental Health Sciences
Kamyar Kalantar-Zadeh
Epidemiology
Shirley Watanabe
Management Services Officer
Epidemiology
Kimberly Gregory
Community Health Sciences
Akihiro Nishi
Epidemiology
Angelo Bellomo
Environmental Health Sciences
Deborah Glik
Community Health Sciences
William Comanor
Health Policy and Management
Vilsa Eliana Curto
Health Policy and Management
Brittney Hawkins
Community Health Sciences
Risha Gidwani
Health Policy and Management
Daniel Cheng
Clinic Coordinator
Epidemiology
Joseph Zoller
Biostatistics
Michael Goldstein
Community Health Sciences
David Eisenman
Community Health Sciences
Dylan Roby
Health Policy and Management
Karin B. Michels
Epidemiology
Eun Kwak
Research Coordinator
Epidemiology
Emily Abel
Health Policy and Management
Jingyi Jessica Li
Biostatistics
Robert Schiestl
Environmental Health Sciences
Judith M. Siegel
Community Health Sciences
Kathryn Kietzman
Community Health Sciences
Lawrence Ash
Epidemiology
Lindsay Rice
Director of Undergraduate Experiential Learning
Leah Vriesman
Health Policy and Management
Kristie Allen
Director of Corporate, Foundation & Research Relations
Lori Pelliccioni
Health Policy and Management
Dana Hunnes
Community Health Sciences
Julie A. Elginer
EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program
Health Policy and Management
Randall Kuhn
Community Health Sciences
Linda Rosenstock
Environmental Health Sciences
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Thomas R. Belin
Biostatistics
Andrew Lee
Senior Fund Manager
Susan Ettner
Health Policy and Management
Minette Ozuna
Director, Academic and Staff Human Resources
Dvora Joseph Davey
Dr. Joseph Davey is an infectious disease epidemiologist with over 20 years' experience leading research on HIV/STI services for women and children.
Epidemiology
Andrew Holbrook
Biostatistics
Kimberley Shoaf
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Irwin Suffet
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Carol Mangione
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Teresa Ellen Seeman
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Michael Prelip
Community Health Sciences
David Hayes-Bautista
Health Policy and Management
Daniela Abrahamian
Community Health Sciences
Daniel Uslan
Environmental Health Sciences
Hannah Bateman
Assistant Director
Kristy J. Sherrer
Director of Career Services
Julia Bailey
Epidemiology
Kathy Silva
Program Coordinator, Public Scholars Training Program
Donald E. Morisky
Community Health Sciences
Janet Villanueva
Assistant to the Chair & Academic Personnel Coordinator
Epidemiology
Dena Herman
Community Health Sciences
Anne Pebley
Community Health Sciences
Jennifer Wortham
Health Policy and Management
Jennifer Scott Powers
Assistant Dean for Development and Alumni Affairs
Marjorie Kagawa-Singer
Community Health Sciences
Paul Chung
Health Policy and Management
Jean Balgrosky
Health Policy and Management
Sevan Sherikian
Program Manager, Operation Armenia
Community Health Sciences
Maria Porras
Health Policy and Management
Michael Ong
Health Policy and Management
Sudipto Banerjee
Biostatistics
Roger Detels
Epidemiology
Adelin Lo
Health Policy and Management
William J. McCarthy
Health Policy and Management
Weihao Zhou
Senior Public Administration Analyst
Catherine Ann Sugar
Biostatistics
Jonathan Jacobs
Epidemiology
Michelle Garcia-Navarro
Senior Director of Admissions and Financial Aid
Jesus Araujo
Environmental Health Sciences
Oliver Hankinson
Dr. Hankinson is a Distinguished Professor of Pathology and Laboratory Medicine, and of EHS, and Chair of the Molecular Toxicology IDP
Environmental Health Sciences
Peter Saenz
Staff Human Resources Analyst
Abdelmonem A. Afifi
Biostatistics
Yusuke Tsugawa
Health Policy and Management
Robert Kaplan
Health Policy and Management
Ron D. Hays
Health Policy and Management
Leonel Ibarra
Chief Financial Officer
Naomi Zewde
Health Policy and Management
Valerie Kryger
Health Policy and Management
Brennan Spiegel
Health Policy and Management
Alice Kuo
Health Policy and Management
Sarah Nickerson
Academic Personnel Coordinator/Assistant to the Chair
Community Health Sciences
Penelope Fu
Health Policy and Management
Isomi Miake-Lye
Health Policy and Management
Kelika Konda
Epidemiology
Max Hechter
SRA III
Epidemiology
Stephanie L. Taylor
Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.
Health Policy and Management
Thomas Priselac
Health Policy and Management
Sheena G. Sullivan
Epidemiology
Marjan Javanbakht
Epidemiology
Ty Robbins
Health Policy and Management
Ron Brookmeyer
Biostatistics
Arthur Winer
Environmental Health Sciences
Niklas Krause
Environmental Health Sciences
Epidemiology
Aria Fallah
Health Policy and Management
Shira Shafir
Community Health Sciences
Epidemiology
Parneet Ghuman
Health Policy and Management
Bryan Astrachan
Community Health Sciences
Warren Scott Comulada
Health Policy and Management
Irish del Rosario
Project Manager
Epidemiology
Colleen Habacon
Policy Project Analyst
Epidemiology
Beate Ritz
Environmental Health Sciences
Epidemiology
Martin L. Lee
Biostatistics
Daniel Eisenberg
Health Policy and Management
Jose Ruiz-Rodriguez
Admissions Manager
Alexandra Binder
Epidemiology
Damla Senturk
Biostatistics
Gina Ruiz
Health Policy and Management
Dallas Swendeman
Epidemiology
Samuel Stratton
Community Health Sciences
Elizabeth Yzquierdo
Community Health Sciences
Chandler Eldridge
Biostatistics
Virginia C. Li
Community Health Sciences
Timothy Malloy
Environmental Health Sciences
Angela Rose David
Community Health Sciences
Nicole Werking
Associate Director of Development & Alumni Affairs
May C. Wang
Community Health Sciences
Candace Tsai
Associate Professor for Industrial Hygiene and Environmental Health Sciences
Environmental Health Sciences
Curtis Eckhert
Environmental Health Sciences
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Biostatistics
Joseph Fong
Research Analyst II
Epidemiology
Kirsten Schwarz
Environmental Health Sciences
Pamela Davidson
Health Policy and Management
Jessica Stevermer
Grants Officer
Miriam Marlier
Environmental Health Sciences
Brian Bradbury
Epidemiology
Brian Cole
Environmental Health Sciences
Ninez Ponce
Health Policy and Management
Kathlene Avakian
Assistant Chief Financial Officer
Willetta Waisath
Senior Research Analyst & Research Manager
Janet Park
Senior Fund Manager
Epidemiology
Hiram Beltrán-Sánchez
Community Health Sciences
Hamid Arabzadeh
Environmental Health Sciences
Wendie Robbins
Environmental Health Sciences
Luis Diaz
Project Specialist
Community Health Sciences
Michael Galper
Health Policy and Management
Peter R. Kerndt
Epidemiology
Barbara Berman
Health Policy and Management
Pouran D. Faghri
Environmental Health Sciences
Gilda Noori
Medical Director/Clinical Examiner
Epidemiology
Sangeeta Ahluwalia
Health Policy and Management
Arturo Vargas Bustamante
Health Policy and Management
Christie Jeon
Epidemiology
Cathy Lang
Assistant Dean for Research & Adjunct Associate Professor of Community Health Sciences
Community Health Sciences
Steven Teutsch
Health Policy and Management
Elizabeth D’Amico
Community Health Sciences
Richard Ambrose
Environmental Health Sciences
Hyun J. Grace Kim
Biostatistics
Paula Tavrow
Community Health Sciences
Susan Babey
Health Policy and Management
Michelle S. Keller
Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.
Health Policy and Management
Philip Massey
Community Health Sciences
Alina Dorian
Community Health Sciences
Avram Kaplan
Health Policy and Management
Arlene Fink
Health Policy and Management
Marielle Castaneda
Health Policy and Management
Jacqueline Beltran
Research Coordinator
Epidemiology
Thomas D. Gordon
Health Policy and Management
Thomas Rice
Health Policy and Management
Weng Kee Wong
Biostatistics
Bo-Kyung Elizabeth Kim
Community Health Sciences
Julie Carafelli
Health Policy and Management
Sung-Jae Lee
Epidemiology
Robert Weiss
Biostatistics
Vickie Mays
Health Policy and Management
Laura Erskine
Health Policy and Management
Adrian Aini
Student Affairs Officer
Community Health Sciences
Z. John Lu
Health Policy and Management
Katherine McNamara
Executive Director, Center for Healthy Climate Solutions
Robert Brook
Health Policy and Management
David Gjertson
Biostatistics
Bonnie Taub
Chair/Associate Director - LAI
Community Health Sciences
Rachel Veerman
Bixby Center Administrator
Community Health Sciences
Roberta Malmgren
Epidemiology
Srikanth Kadiyala
Health Policy and Management
Anthony Hunter Schiff
Health Policy and Management
Nadereh Pourat
Health Policy and Management
Sukhwinder Sagoo
Assistant Director of Admissions
Sandra Aronberg
Health Policy and Management
Nathan D. Wong
Epidemiology
Lindsey Lorenzana
Environmental Health Sciences
Gerald Kominski
Health Policy and Management
Rebecca Delafield
Community Health Sciences
David Elashoff
Biostatistics
Marc Suchard
Biostatistics
Paul Dluzniewski
Epidemiology
Shane Que Hee
Industrial Hygiene & Analytical Chemistry
Environmental Health Sciences
Joy Miller
Student Affairs Officer
Epidemiology
Jessica Gipson
Community Health Sciences
Luis España
Environmental Health Sciences
Ximena Vergara
Epidemiology
Jonathan Bates
Community Health Sciences
Jack Needleman
Health Policy and Management
Kirstin Chickering
Associate Director, UCLA-DRC Research Program
Epidemiology
Mark Litwin
Health Policy and Management
Ralph R. Frerichs
Epidemiology
Pamina Gorbach
Epidemiology
Pablo Cicero-Fernandez
Environmental Health Sciences
Annette Maxwell
Health Policy and Management
Chandra Ford
Community Health Sciences
Elizabeth (Becky) Yano
Health Policy and Management