title: Human papillomavirus vaccine policies among american Indian tribes in Washington State.
abstract: OBJECTIVE
  American Indians experience high rates of cervical cancer, which is preventable by vaccination against human papillomavirus (HPV). We sought information on funding, barriers, education, and policies regarding HPV vaccination from clinics that serve tribal members in the Pacific Northwest.
  
  
  METHODS
  We surveyed staff either by telephone or by using a mailed survey at 31 tribal and Indian Health Service clinics serving the 29 federally recognized American Indian tribes in Washington State. The survey included 11 items on policies and use of the HPV vaccine.
  
  
  METHODS
  Primary outcomes were funding options for HPV vaccine administration, barriers to vaccine delivery, potential gaps in education, and determination of tribal or clinic-specific policies.
  
  
  RESULTS
  Thirty-one clinics provided information; 28 administered the vaccine. Vaccination was supported by federal, private, and tribal sources. Barriers were reported by 89% of clinics, most commonly patients' lack of knowledge, distrust of the medical system, and lack of funding. Patient and provider information was widely available. Thirteen clinics had either tribal or internal clinic vaccination policies, or both.
  
  
  CONCLUSIONS
  HPV vaccine is available, but complex policies on administration could result in tribal differences in vaccination rates.
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Jessie
authors.initials: J
authors.lastname: Duvall
authors.affiliation: Partnerships for Native Health, Department of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: dedra@uw.edu.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data; D007198:Indians, North American; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010353:Patient Education as Topic; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*; D014861:Washington; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines