2. Immunize Milwaukee! Membership The IM! Coalition is an organization of volunteers consisting of individuals and representatives of agencies, business, and organizations from various community segments. Vision Statement IM! promotes one community fully informed, engaged, and immunized. Mission Statement IM! is an independent, non-for-profit, community coalition focused on innovative education, communication, and collaboration to improve and sustain vaccination rates in Metro-Milwaukee.

3. Immunizations 1994-2013 Prevented 322 million cases of disease Prevented 732,000 early deaths among children http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a1.htm?s_cid=mm6433a1_w

4. What is the estimated net societal cost savings? A.$18.3 million B.$1.38 trillion C. $3.81 billion http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a1.htm?s_cid=mm6433a1_w

5. What is the estimated net societal cost savings? A.$18.3 million B.$1.38 trillion C. $3.81 billion

6. Why do we still have difficulty improving immunization rates?

7. Google Scholar “Vaccine refusal” -30,200 results

8. No one answer and no single solution

10. ?

11. Look for something red

13. ?

14. Look for faces

16. ?

18. What color is the dress?

19. Selective perception Experience and life events Our own unique filters Cultural awareness Blind spots Moods Cues Biases Genetics

20. Source of truth

23. SEX

24. U.S. high school students surveyed in 2013 47% had ever had sexual intercourse. 34% had had sexual intercourse during the previous 3 months, and, of these 41% did not use a condom the last time they had sex http://www.cdc.gov/healthyyouth/sexualbehaviors/

26. Previous life experiences, age, beliefs, family, culture, religion and biases all factor into how others interpret, integrate and accept information that is presented to them.

27. As a provider what am I implying?

28. “bad parent”

29. Parents worry that teens will engage in more risky behavior if they get the vaccine.

30. Risk perceptions following HPV vaccination were not associated with subsequent riskier sexual behaviors in sexually experienced and inexperienced young women. These data contribute to the growing evidence that HPV vaccination does not lead to changes in sexual behaviors among adolescents. Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents Allison Mayhew, BAa, Tanya L. Kowalczyk Mullins, MD, MSa,b, Lili Ding, PhDb, Susan L. Rosenthal, PhDc, Gregory D. Zimet, PhDd, Charlene Morrow, RNb, and Jessica A. Kahn, MD, MPHa,b PEDIATRICS Vol. 133 No. 3 March 1, 2014 pp. 404 -411 (doi: 10.1542/peds.2013-2822)

31. Sexual activity is often not consensual

32. Nearly 1 in 5 women and 1 in 71 men reported experiencing rape at some point in their lives Sexual assault

33. http://www.cdc.gov/vaccines/who/teens/for-hcp/hpv- resources.html

34. Change the conversation and your clinical processes

35. Quantify the risk # of individuals who die from an HPV related cancer each year =15,000- 20,000 # of individuals who die from meningococcal meningitis and pertussis = 125-150

36. Destigmatize the “disease” HPV is ubiquitous - the “common cold” of genital infections

37. Address the myths related to side effects

38. Getting the HPV vaccine does not make it more likely that your child will become sexually active

39. Make the conversation relevant How has cancer already impacted your, a friend or relative’s life?

40. Share your own decisions My children are vaccinated!

41. Be open to questions Simplify your answers

42. Make sure that families and patients here a consistent positive messages about the importance of HPV vaccination from all of your staff

43. Don’t be tentative A strong recommendation from a provider that they trust has been shown to have the most influence

44. Same way and on the same day

45. Make it easy for them to change their mind. Don’t be reluctant to revisit the conversation

46. Check immunization status at all encounters and be willing to administer any recommended vaccine if not contraindicated

47. Implement Reminder & Recall

48. Check your own rates We often are not doing as well as we think Run your WIR reports Share best practices with colleagues

49. Share your support for HPV vaccination broadly We all can make a difference and help prevent HPV related cancer and disease.

51. Resources https://www.facebook.com/ImmunizeMilwaukeeCoali tionhttp://www.cdc.gov/vaccines/who/teens/for- hcp/hpv-resources.html http://www.cdc.gov/vaccines/who/teens/for- hcp/hpv-resources.html https://www.dhs.wisconsin.gov/immunization/hpv.htm https://www.dhfswir.org/PR/portalInfoManager.do https://www.aap.org/sites/Search/Pages/results.aspx? k=HPV%20vaccine

52. Key messages Recognize the impact of selective perception on the interpretation of information we present HPV is ubiquitous HPV is not harmless HPV causes cancer The HPV vaccine is effective The HPV vaccine is safe Reshape your message - Recommend HPV immunization the same way and on the same day as other adolescent vaccinations Revisit the conversation

53. Thank you