Vaccine Status, Beliefs, Knowledge and Practices among Tunkasenos

1. Vaccine Status, Beliefs, Knowledge and Practices among Tunkasenos MMFRP - CLASS PRESENTATION DECEMBER 1, 2011 INFECTIOUS DISEASE GROUP MATTHEW LEVIN (PRESENTER) ISELA MARTINEZ (PRESENTER) ALICIA RODRIGUEZ REBECA ESPINOZA

2. Brief Overview • Collectively, infectious diseases have been the primary contributors to human morbidity and mortality throughout history 7 • Increasing trend of international migration presents a complex picture for vaccine-preventable disease transmission 2 • Routine immunization is a key components to prevent transmission and improve management 5 • However, multiple gaps in prevention continue to exist among new U.S. immigrants, their families and communities in both sending and receiving societies • Mexican immigrants also have the worst U.S. rates of flu shots and regular source of care compared to non-hispanic whites 5

3. Immunization Coverage in Mexico • Impressive vaccine coverage in Mexico overall at 95% of the population 3, 6 • Primarily due to the “Universal Vaccine Program”, includes strategies such as: • 1) Permanent and systematic vaccination in different health sectors which include housevisits to administer vaccine • 2) National Health Campaigns carried out in February and May • Mexico has taken the lead on mandating the HPV vaccine among girls ages 9-tentatively 28. • There are 8 questions regarding HPV • However, vulnerable and marginalized populations may continue to encounter barriers in receiving IZ’s.

4. Immunization among migrants in the United States (U.S.) • Migrant populations in the U.S. face multiple issues to receiving recommended immunizations 3 • Barriers include • Lack of information/unaware of the availability of services • Mobile and migrant populations often difficult to reach • Lack of insurance, sick leave, medical literacy and language barriers, cultural differences • Fear of ICE officials of which frequently stake out near healthcare services/Political climate

5. Research Focus Immunization (IZ) knowledge, attitudes, practices (KAP) and coverage among Tunkasenos (Mexico & U.S) • KAP regarding IZ’s among Tunakasenos • IZ Status among Children • Recently mandated HPV vaccine among women

6. Research Questions and Hypothesis • Q1) Is childhood immunization (IZ) status lower among Tunkaseño children residing in the United States (U.S) compared to children who have not migrated from Tunkás? • Hypothesis 1 : Children in Tunkás will report higher IZ status compared to Tunkaseño children who reside in the United States

7. Research Questions and Hypothesis • Q2) Do barriers in the access of information and services regarding IZ’s in the U.S. contribute to lower IZ status for Tunkaseño migrants compared to non-migrants in Tunkás? • Hypothesis 2.1: Tunkaseños will report greater knowledge of available IZ services and resources in their community in Tunkás, compared to IZ services offered in the U.S. • Hypothesis 2.2: Tunkaseño migrants in the U.S. will report a greater number of barriers to accessing information regarding immunization services in the U.S, compared to those in in Tunkás, Mexico.

8. Research Questions and Hypothesis • Q3. Are Tunkaseños in Tunkás more likely to receive an HPV vaccination compared to Tunkaseños in the U.S.? • Hypothesis 3: Tunkaseñas in Mexico will report higher HPV vaccine status compared to Tunkaseñas in the U.S.

9. Methods

10. Study Design • Primary analysis of a cross-sectional exploratory study • The “Vacunas” Questionnaireis a component of the larger MMFRP Project • Door to door surveys in the community as well as in depth interviews among selected households and health centers both in Tunkas and in the U.S. • Participants completing the portion of the questionnaire regarding vaccines for children, will be asked for the child's immunization records, from which two vaccines will be used as a proxy for vaccine coverage. • The child will be given a unique identifier in order to identify repeated child questionnaire intakes

11. Methods • Data will be collected through qualitative and quantitative methodologies • Quantitative Methods • 19 items in Questionnaire • Qualitative Methods • In-depth interviews with adults, child primary care-givers, and health professionals • Participant observation (community health centers)

12. Quantitative Measures • Knowledge, Attitudes and Practices “¿Cree usted que las vacunas previenen las enfermedades?” • 1 = Si • 2 = No • 888= N/A • 9999 =NS/NQR • Child IZ Status “¿Usted sabe a dónde puede acudir para recibir una vacuna para su hijo/a?” • 1 = Si • 2 = No • 8888= N/A • 9999= NS/NQR • Human Papillomavirus “¿Ha escuchado usted sobre la vacuna contra el VPH?” • 1 = Si • 2 = No • 8888= N/A • 9999= NS/NQR

13. Interview Questions • Knowledge, Attitudes and Practices “En su opinión, ¿qué tan importante son las vacunas para la salud de uno? ¿Por qué? • Child IZ Status “¿Cree usted que algunas vacunas son ser peligrosas para la salud de los niños? ¿Porque? • Human Papillomavirus (HPV) “¿Ha escuchado usted sobre el VPH o de la vacuna para su prevención? ¿Qué ha escuchado usted del VPH? Prompt: En sus propias palabras, ¿me podría explicar lo que es el VPH?

14. What we hope to Learn and Disseminate • Greater understanding of factors that determine vaccine status in the United States and Mexico • Enablers (health campaigns, binational partnerships, cost free IZ) • Barriers (lack of knowledge/awareness of health services, cost, legal status) • Explore knowledge, beliefs and attitudes regarding vaccines, • Likely to influence related health IZ prevention behaviors for self and for family • Opportunity to learn more about HPV and HPV vaccine among women • Status, knowledge and attitudes • Views on recent government mandate • Compare views regarding HPV in the U.S. and Mexico

15. Strengths of Proposed Study • One of the few study (to our knowledge) to include both qualitative and quantitative methodologies to explore and compare vaccine KAP and status among Tunkasenos in Tunkas and the U.S. • Significance to health systems and community support • Insights into bi-national IZ preventative public health strategies • Entails collaboration with international colegas to carry out research • Findings from this study may provide insights into the development of appropriate and effective health recommendations. • Specific to the population in Yucatan and immigrant groups • Culturally relevant and appropriate to increase effectiveness

16. References 1. Migrant Clinician Networks. (2011). Immunizations. Retrieved from http://www.migrantclinician.org/issues/immunizations.html 2. Migrant Clinicians Network. (2009). What do Migrants from Mexico, Central and South America Think about Immunizations?ImmuNews. Retrieved from http://www.migrantclinician.org/issues/immunizations.html • Schoch-Spana, Bouri, Norwood & Rambhia.(2009). Preliminary Findings: Study of the Impact of the 2009 H1N1 Influenza Pandemic on Latino Migrant Farm Workers in the U.S 4. The United Nations International Children’s Fund [UNICEF]. (2011) Immunization Summary - A statistical reference containing data through 2009. Retrieved from http://www.childinfo.org/files/32775_UNICEF.pdf 5. Wallace, Gutiérrez, & Castañeda. (2005) Health Policy Fact Sheet Health Service Disparities among Mexican immigrants. Retrieved from http://agcenter.ucdavis.edu/AgDoc/healthServicedisparities.pdf 7. World Health Organization (WHO).(2003). Emerging Issues in Water and Infectious Disease. Retrieved from http://www.who.int/water_sanitation_health/emerging/emerging.pdf • World Health Organization (WHO).(2011). Immunization Profile - Mexico. http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=mex

17. Thank you! Questions?