1. Strategies for Monitoring the Impact of HPV Vaccination Using Population-Based Data Rain Mocello, MPH California DPH STD Control Branch

2. Presentation Overview  Data trends of interest  Sources of aggregate data ●National ●California ●Other  Details of three California surveys ●Methods ●Specific questions

3. Potential Trends of Interest  HPV vaccine coverage  Cervical cancer (Pap) screening ●HPV testing  Knowledge, Attitudes, and Behaviors ●HPV infection, HPV vaccine, cervical cancer (Pap) screening ●Sexual behaviors

4. National Sources of Aggregate Data  National Immunization Survey  National Health Interview Survey 2008  Behavioral Risk Factor Surveillance System (BRFSS) ●Core component ●Optional modules ●State-added questions

5. California Sources of Aggregate Data  BRFS in California ●Sexual behaviors ●STD knowledge, testing, and morbidity  California Women’s Health Survey  California Health Interview Survey  Vaccines for Children Program  California Clinical Laboratory Survey

6. Other Sources of Aggregate Data  Academic surveys  Local immunization registries  Vaccine manufacturers?  HEDIS data?

7. Survey Details  Survey methods and questions ●Behavioral Risk Factor Survey (BRFS) ●California Women’s Health Survey (CWHS) ●California Health Interview Survey (CHIS) ► Adult ► Adolescent ► Child

8. Survey Methods

9. Survey Questions

10. Online Resources  BRFS: http://www.cdc.gov/brfsshttp://www.cdc.gov/brfss  CWHS: http://www.cdph.ca.gov/data/surveys/ Pages/CWHS.aspx http://www.cdph.ca.gov/data/surveys/ Pages/CWHS.aspx  CHIS: http://www.chis.ucla.eduhttp://www.chis.ucla.edu

11. Contact Information Rain Mocello (510) 620-3717 Rain.Mocello@cdph.ca.gov Thank You

12. Appendix: Actual Questions

13. APPENDIX of Actual Questions 2007 CHIS HPV Questions - Adult Have you ever heard of HPV? HPV stands for Human Papillomavirus. Where did you hear about HPV? (Various responses; see detail under “2007 CHIS HPV Questions – Adolescent” Do you think HPV can cause cervical cancer? Do you think you can get HPV through sexual contact? Do you think HPV causes AIDS?

14. 2007 CHIS Vaccine Questions - Adult Have you ever heard of a vaccine or shot to prevent cervical cancer? Have you ever received the HPV vaccine or HPV shots? If not vaccinated → (“HPV is a virus that can cause cervical cancer. A vaccine that protects against HPV has been approved for females ages 9 to 26.”) Would you be interested in getting the vaccine?

15. 2007 CHIS Vaccine Questions - Adult What is the MAIN reason you would NOT want to get the vaccine? 1Does not need vaccine 2Not sexually active 3Too expensive 4Too young/old for vaccine 5Doctor didn’t recommend it 6Worried about safety of vaccine 7Don’t know where to get vaccine 8My spouse/family member is against it 9Don’t know enough about vaccine

16. 2007 CHIS Vaccine Questions - Adult The cost of the vaccine may be about $360. Would you get the HPV vaccine if you had to pay this amount? If you could get the HPV vaccine free or at a much lower cost, would you get it? (Same six vaccine questions asked in reference to a daughter, where applicable.)

17. 2007 CHIS HPV Questions - Adolescent Have you ever heard of HPV? HPV stands for Human Papillomavirus. Where did first you hear about HPV? 1Health care provider/clinic 2Family 3Friends 4TV advertisement 5TV news 6Newspaper or magazine 7Internet 8School 9Other

18. 2007 CHIS Vaccine Questions - Adolescent Have you ever heard of a vaccine or shots to prevent cervical cancer? Did you ever get the HPV vaccine or HPV shots? If not vaccinated → (“HPV is a virus that can cause cervical cancer. A vaccine that protects against HPV has been approved for females ages 9 to 26.”) Would you be interested in getting the vaccine?

19. 2007 CHIS Screening Questions - Adult Have you ever had a Pap test to check for cervical cancer? If needed, say: "Sometimes, when a woman has a routine pelvic exam, she also has a Pap smear to test for cancer of the cervix. A doctor takes a cell sample from the cervix with a small stick or brush and sends it to the lab." How many Pap tests have you had in the last 6 years? _____ PAP SMEARS

20. 2007 CHIS Screening Questions How long ago did you have your most recent Pap test? 1A year ago or less 2More than 1 up to 2 years ago 3More than 2 up to 3 years ago 4More than 3 up to 5 years ago 5More than 5 years ago Have you ever had a Pap tests where the results were NOT normal? In the past 3 years, has a doctor recommended that you have a Pap test?

21. 2007 CHIS Screening Questions What is the ONE most important reason why you have {NEVER had a Pap smear/NOT had a Pap smear in the last 3 years}? 1No reason/never thought about it 2Didn’t know I needed this type of test 3Doctor didn’t tell me I needed it 4Haven’t had any problems 5Put it off/laziness 6Too expensive/no insurance/cost 7Too painful, unpleasant, or embarrassing 8Hysterectomy 9Don’t have a doctor Had HPV vaccine – (Not offered but suggested if this question adopted) Had HPV DNA test – (Not offered but suggested if this question adopted)

22. 2008 BRFS (and CWHS*) Screening Questions A Pap (smear) test is a test for cancer of the cervix. Have you ever had a Pap (smear) test? How long has it been since you had your last Pap (smear) test? 1Within the past year 2Within the past 2 years 3Within the past 3 years 4Within the past 5 years 5More than 5 years ago * Words in parentheses indicate different wording used in CWHS

23. 2008 CWHS Vaccine Questions The human papillomavirus (or HPV) is a common virus; certain types of the virus can cause cervical cancer in women. A vaccine to prevent some of the most common types of HPV infection is now available and is called the cervical cancer vaccine, HPV vaccine, or Gardasil. Before today, have you ever heard of the cervical cancer vaccine or HPV shot? (Prompt: Current vaccine name is Gardasil and Cervarix will be licensed soon). The HPV shot is a new vaccine that is recommended for preteen girls and young women who haven’t yet received this vaccine in the past. Have you received this vaccine?

24. 2008 CWHS Vaccine Questions How many times did you receive the HPV shot? ____ (number) What is the MAIN reason you did not receive HPV shots? 1Doctor didn’t recommend the shot 2Haven’t gone to the doctor or Clinic 3I plan to get the vaccine soon 4Expensive cost 5Other (specify)