Category Archives: Centers for Disease Control and Prevention
The U.S. Centers for Disease Control and Prevention (CDC) has launched three very pink infographics aimed at raising awareness about breast cancer among young women who may not realize they can be at risk for the disease—usually because of a gene mutation inherited from their mother or father.
The campaign, called “Know:BRCA” uses pink for all three of the new infographics because that color is widely identified with breast cancer awareness campaigns. The graphics focus on:
- Knowing about BRCA1 and BRCA2
- Knowing that everyone has BRCA genes
- Knowing your genetic risk factors
According to the CDC, most breast cancers are found in women who are 50 years old or older. However, each year in the United States about 9,000 women younger than 40 are diagnosed with breast cancer. In this younger group the cancer is generally more aggressive, found at a later stage, has lower survival rates and can often be linked to a mutation in one or two genes called BRCA1 and BRCA2.
Usually the BRCA genes protect people from cancer, but mutations to the genes can increase the risk of breast and ovarian cancer in general and especially in younger women. Discussions with physicians and genetics counselors about family history of breast and ovarian cancer can determine the need to test for the gene mutations. And if the tests are positive, health care experts may advise preventive treatment to help avoid breast and ovarian cancer, such as long-term medication or prophylactic mastectomy—the surgery actress Angelina Jolie chose last year because of her family history of breast cancer.
Without treatment, women with a BRCA gene mutation are seven times more likely to get breast cancer and 30 times more likely to get ovarian cancer before age 70 than other women.
The goal of the new infographics is to encourage women to learn their family history of cancer and then talk to their doctor if they have:
- Multiple relatives with breast cancer
- Any relatives with ovarian cancer
- Relatives who were diagnosed with breast or ovarian cancer before age 50
The CDC also recently released a new physician tool to help doctors advise young patients about BRCA testing and prophylactic treatment.
>>Bonus Link: Read a new New York Times story on the evolution of breast cancer treatment
If you’re planning on foreign travel then the U.S. Centers for Disease Control and Prevention (CDC) wants to help you find foods that won’t bite you back. Can I Eat This? is a free app from the agency that lets users search country-by-country for what’s safe to eat and drink. Once you choose the country you’ll be eating in—or where you already are, perhaps standing in line deciding what to order—simply tap the food or drink icon and wait for questions specific to that country.
For example, tapping “eating” in Argentina prompts the app to ask whether you’ll be buying from a street vendor or a store, and your answers prompt even more questions about the food ‘s storage and handling. In Bulgaria, tap “drinking” and you’ll be asked if there’s ice in the drink. Tap “yes” and a scary X will pop up with a warning of “probably not,” because the ice is likely made with tap water, which the CDC has identified as a poor safety choice in that country.
>>Bonus Link: Find more travel health information from the CDC here.
“Of all the forms of inequality, injustice in health care is the most shocking and inhuman,” said the Rev. Dr. Martin Luther King Jr. in 1966 at the Convention of the Medical Committee for Human Rights, which was organized to support civil-rights activists during Mississippi's Freedom Summer. Those words are part of the Health is a Human Right: Race and Place in America exhibit on display at the David J. Sencer Centers for Disease Control and Prevention (CDC) Museum in Atlanta. The museum, located at the CDC’s Visitor Center, mounts several exhibits each year. The timing for the Health as a Human Right exhibit coincides with National Minority Health Month, observed each April to raise awareness of health disparities in the U.S. among ethnic and racial minorities.
The CDC exhibit, curated by museum director Louise Shaw, is organized by social determinants of health such as housing and transportation. Photographs, like those of teeming settlements in urban cities, are a key tool to show museum goers and online viewers the health disparities in U.S. history and present day.
Among the items in the exhibit:
- Mexican men sprayed with DDT on their arrival for a guest worker program in the 1950s.
- A corroded sanitation pipe and bottles of unsafe drinking water from the Community Water Center in the San Joaquin Valley, California.
- An inventive and cheap air sampler from New Orleans that people used to catalogue pollution levels and share with law makers.
- A Chinese version of the "Be Certain: Get Tested for Hepatitis B," campaign.
- A March of Dimes poster depicting an African American child with polio from the late 1950s. (For a long time after the polio epidemic began, many believed African Americans could not contract the virus. As a result, precaution campaigns were rare and late among that population.)
The exhibition is sponsored by CDC's Office of Minority Health and Health Equity, the CDC's Office of the Associate Director for Communication and the California Endowment.
NewPublicHealth spoke with Louise Shaw in Atlanta.
NewPublicHealth: What made you decide to mount and curate this exhibit?
Louise Shaw: Three years ago the CDC Museum was approached by CDC’s Office of Minority Health and Health Equity (OMHHE) to organize an exhibition to commemorate its 25th anniversary. As curator of the Museum, I was excited by the possibilities and conceived of a project that extended beyond just honoring OMHHE accomplishments. Dr. Leandris Liburd, OMHHE director, and her terrific staff, quickly jumped on board, and we all agreed to develop a historic exhibition framed by the social determinants of health.
NPH: What are some of the most striking issues you found in disparities between whites and minorities when it comes to social determinants of health?
Louise Shaw: Although we have made progress in many areas, we are still tackling similar issues in the 21st century that were debated 100 years ago. For instance, how we provide quality education to all children, regardless of race, ethnicity, or income status, was and is one of the greatest challenges facing our country. As the Robert Wood Johnson Foundation has documented, education and the optimum health outcomes are closely linked. Ultimately, education is the pathway to eliminating health disparities. Income equality/inequality is another complex issue that is being hotly debated today. One more specific example: although pre-term birth rates have greatly declined over the past century among all groups, the disparities of those rates between whites and minorities stubbornly remain, and are yet to be eliminated. We need to ask ourselves why that is so. Collectively, we have still not resolved what it means to live in a diverse, multicultural society.
NPH: Do you know of any outcomes that have come from the exhibit?
Louise Shaw: Internally at CDC, the exhibition has been an important touchstone for discussion and debate. I have received incredible feedback about the honesty of the exhibition, thanking me for connecting the dots visually among race, place, and health. By the time it closes on April 25th, over 30,000 people will have seen the show. I don’t think we have ever mounted an exhibition that has been visited by so many college and university students — some even virtually. A consortium of faculty members from the University of Connecticut, Emory University, and Georgia State University, have developed a formal evaluation tool. In addition, there is a local and national movement underfoot to figure out how the show can live on whether online or in another form.
CDC Report Details Support of State, Local Health Responses
The U.S. Centers for Disease Control and Prevention (CDC) has released a new report detailing its support of state and local public health responses from 2012 to 2013, as well as assessments of all state and select local public health preparedness. The 2013-2014 National Snapshot of Public Health Preparedness is the sixth annual report from CDC’s Office of Public Health Preparedness and Response. “The lives protected by the public health response to Hurricane Sandy, the fungal meningitis outbreak, and the tornadoes in Joplin are just a few examples of how communities and CDC can work together to protect the public's health when its needed most,” said CDC Director Tom Frieden, MD, MPH.
Among the report’s highlights:
- During outbreaks and emergencies, response time is essential. In 2012, lead state responders reported for immediate duty within 27 minutes of receiving notification of a potential public health emergency—9 minutes faster than the 2011 national average.
- In 2012, across the 62 Public Health Emergency Preparedness (PHEP) cooperative agreement awardees, Emergence Management Program (EMP) activities included 185 engagements and 204 exercises. Internationally, EMP activities across 35 countries included 15 activations, 19 engagements, and 12 exercises.
- The percentage of E. coli-positive tests analyzed and entered into the PulseNet database within four working days increased from 90 percent to 94 percent and timely testing and reporting of Listeria-positive results increased from 88 percent to 92 percent.
“The ability of our local and state health departments to be innovative and maintain a steady level of preparedness despite extensive budget cuts is reassuring,” said Ali Khan, M.D., M. P. H., director CDC’s Office of Public Health Preparedness and Response. “However, preventing an erosion of our nation’s health security will be difficult in the current fiscal environment.” Read more on preparedness.
Study: Overweight Kindergarteners Four Times as Likely to Be Overweight Teens
Children who are overweight at the age of five are four times as likely to be obese by the age of 14 than are children who start their school years at an average weight, according to a new study in the New England Journal of Medicine. Approximately 27 percent of the five-year-olds in the study were overweight. Using data on almost 8,000 children gathered by the Early Childhood Longitudinal Study conducted by the U.S. National Center for Education Statistics, researchers determined that:
- Approximately 32 percent of kids who were overweight when they entered kindergarten had become obese by age 14, compared to 8 percent of normal-weight kindergarteners.
- The obesity rate rose most rapidly between first and third grades—from 13 percent to almost 19 percent—but not significantly between fifth and eighth grades.
- Between kindergarten and eighth grade, the prevalence of obesity rose by 65 percent among white children, 50 percent among Hispanic children and more than doubled among black children.
"If we're just focused on improving weight when kids are adolescents, it may not have as much of an impact as focusing on the preschool-age years," said lead researcher Solveig Cunningham of Emory University, adding that the study "doesn't tell us what to do about it, but it helps tell us when we need to think creatively about what to do." Read more on obesity.
Study: One-third of Americans, Two-Thirds of University Students Have Used Indoor Tanning
Despite clear and widespread data on their link to skin cancer risk, more than a third of Americans and nearly two-thirds of U.S. university students have used indoor tanning, according to a new study in the journal JAMA Dermatology. Approximately 19 percent of teens had also used the machines. Researchers at the University of California, San Francisco based their conclusions on an analysis of 88 surveys covering more than 406,000 people in the United States, Europe and Australia. "It is appalling how often exposure to indoor tanning takes place in presumably educated populations and particularly worrisome that we allow adolescents to be exposed to this carcinogen," said Mark Lebwohl, MD, chairman of the department of dermatology at Mount Sinai Hospital in New York City. "We must do a much better job at educating people of all ages about the risks of indoor tanning.” Read more on cancer.
FDA Looking to Revise Nutrition Fact Labels
The U.S. Food and Drug Administration (FDA) is looking to revise nutrition fact labels for the first time in more than two decades. The changes should reflect our improved understanding of nutrition, according to nutritionists. "The food environment has changed and our dietary guidance has changed," said Michael Taylor, the FDA's deputy commissioner for foods. "It's important to keep this updated so what is iconic doesn't become a relic." For example, there is now more of a focus on calories and better understanding of the different types of fats. Nutrition experts also have called for more prominent calorie counts, as well as information on added sugar and the percentage of whole wheat in the food. The FDA has sent its proposed guidelines to the White House. Read more on nutrition.
Study: ERs Need to do More to Cut Unnecessary Antibiotic Prescriptions
Despite growing concerns over antibiotic resistance, emergency departments are not decreasing their inappropriate use of antibiotics, according to a new study in the journal Antimicrobial Agents and Chemotherapy. Researchers analyzed data from 2001 to 2010, finding no decrease in emergency department use of antibiotics for adults with respiratory infections caused by viruses, which are not affected by antibiotics. There are approximately 126 million emergency department visits for acute respiratory infections each year in the United States. Halting excessive and unnecessary antibiotic prescriptions in emergency departments is especially critical because many uninsured people also look to them for primary care. "The observed lack of change...is concerning," study co-author Henry Wang, MD, vice chair for research in the department of emergency medicine at the University of Alabama at Birmingham. "This may indicate that efforts to curtail inappropriate antibiotic use have not been effective or have not yet been implemented in all medical settings." Read more on prescription drugs.
CDC: Strategies on Reducing Sodium Levels in Restaurants
A new report from the U.S. Centers for Disease Control and Prevention (CDC) includes strategies on how health departments and restaurants can work together to lower the amount of sodium in foods. The report, “From Menu to Mouth: Opportunities for Sodium Reduction in Restaurants,” appears in the CDC journal Preventing Chronic Disease. While the U. S. Dietary Guidelines recommend the general population limit sodium to under 2,300 mg a day, meals from fast food restaurants contain an average of 1,848 mg of sodium per 1,000 calories and foods from dine-in restaurants contain 2,090 mg of sodium per 1,000 calories. The strategies include:
- Health department dietitians help restaurants analyze the sodium content of their foods and recommend lower-sodium ingredients.
- Restaurants clearly post nutrition information, including sodium content, at the order counter and on menus or offer lower-sodium items at lower cost.
- Health departments and restaurants explain to food service staff why lower sodium foods are healthier and how to prepare them.
“The bottom line is that it’s both possible and life-saving to reduce sodium, and this can be done by reducing, replacing and reformulating,” said CDC Director Tom Frieden, MD, MPH. “When restaurants rethink how they prepare food and the ingredients they choose to use, healthier options become routine for customers.” Read more on the CDC.
Late last year the Grand Rounds program of the U.S. Centers for Disease Control and Prevention (CDC) held a webinar on water fluoridation, a public health intervention that has been a priority in the United States for nearly seventy years.
Fluoridation, which has been shown to significantly reduce cavities in children, has been recognized by the CDC as one of 10 great public health achievements of the 20th century. Despite the benefits such as cost savings, however, CDC says there are ongoing challenges in promoting and expanding fluoridation.
NewPublicHealth recently spoke with Barbara Gooch, DMD, MPH, Associate Director for Science in the Division of Oral Health at CDC’s National Center for Chronic Disease Prevention and Health Promotion, about the challenges and benefits of water fluoridation and other emerging oral health improvement opportunities.
NewPublicHealth: What has been the historical impact of fluoridating water in the United States?
Dr. Barbara Gooch: All water generally contains fluoride, but usually at a level too low to prevent tooth decay, so community water fluoridation is a controlled adjustment of fluoride in a public water supply to an optimum concentration for the prevention of tooth decay.
That optimal concentration has historically been set at about 1 milligram (mg) of fluoride per liter of water, or 1 part per million. Fluoride was first introduced in the United States in Grand Rapids, Mich., in 1945. For cities that implemented community water fluoridation in the 1940s and 1950s, there was a dramatic reduction in tooth decay among children. Sometimes that reduction was greater than 50 percent. It has really been a major factor leading to the improvement in U.S. oral health.
When we compare the National Health and Nutrition Examination Survey done in the early 1970s with one conducted from 1999 to 2004, we found that the percentage of adolescents with one or more decayed teeth decreased from 90 percent in the early 1970s to 60 percent in the ’99-’04 National Survey. And while the number of teeth affected by tooth decay was an average of six in the 1970s survey, the instance was reduced to fewer than three in the later survey.
NPH: There are other sources of fluoride now, such as toothpaste. Is community water fluoridation still important?
Gooch: Current studies indicate that community water fluoridation increases the prevention of tooth decay by an additional 25 percent despite other sources. But the other very important factor about community water fluoridation is in order to receive its benefits, if you live in a fluoridated community. all you have to do is drink the tap water. And we can also show cost savings. One study estimates that for every dollar spent on community water fluoridation, you save about $38 in dental treatment costs.
The pop culture craze of zombie apocalypse films, televisions shows and books penetrated deeper than many might have expected—even the U.S. Center for Disease Control and Prevention (CDC) weighed in on the cultural phenomenon, with a 2011 blog post on preparing for a real zombie apocalypse. The post covers everything from the history of zombie outbreaks to how to assemble an emergency supply kit should one of these possible apocalyptic zombie scenarios play out in your community.
At the time, NewPublicHealth spoke with the CDC’s Dave Daigle, who dreamed up the zombie post. The CDC campaign was crafted to help spread information on emergency preparedness for the upcoming hurricane season, while the zombie cover was designed both to attract a younger demographic and to offer an off-kilter slant that would make people pay attention. The post contains strong recommendations to help people prepare for many types of emergencies, from natural disasters to disease outbreaks—for example, your supply kit should include water, food, medications, important documents, and so on. The CDC was able to reach an even larger audience by packaging this valuable information in a playful nod to the fantastical fears that a zombie outbreak could actually happen.
Among the tips from the CDC’s Preparedness 101: Zombie Apocalypse: "Plan your evacuation route. When zombies are hungry they won’t stop until they get food (i.e., brains), which means you need to get out of town fast!"
Once the post went live, the staff sat back while it was tweeted, retweeted, Facebooked, commented on and reported on by a growing list of mainstream print and online publications. The result was an overwhelming success:
- The initial tweet received 70,426 clicks
- “CDC” and “Zombie Apocalypse” trended worldwide on Twitter
- The CDC Emergency Facebook page gained more than 7,000 fans within the first month of its launch
- There were more than 3,000 articles, broadcasts and other media coverage of the blog
- The messages received an estimated 3.6 billion impressions with a marketing worth of $3.4 million—and all for a campaign that cost $87.00
Youth Smoking Rates Reach Record Lows in 2013
Overall youth smoking declined significantly in 2013, and smoking rates fell to record lows for all three grades surveyed (grades 8, 10 and 12), according to the Monitoring the Future survey released annually by the National Institute on Drug Abuse and conducted by researchers at the University of Michigan’s Institute for Social Research. For all three grades combined, the percentage of students who reported smoking cigarettes in the past month fell from 10.6 percent in 2012 to 9.6 percent in 2013. The data is based on annual surveys of 40,000 to 50,000 students in about 400 different secondary schools. Read more on tobacco.
WHO and UNICEF Vaccinating Millions of Children in the Middle East Against Polio
The World Health Organization (WHO) and UNICEF are mounting the largest-ever immunization response in the Middle East, with a goal of vaccinating more than 23 million children against polio in Syria and neighboring countries over the next few weeks. The campaign is in response to an outbreak of polio in Syria, where 17 cases have so far been confirmed, and to the detection of the virus in sewage in other parts of the Middle East.
The campaign plans to vaccinate all children under age 5 in the targeted areas in the next few months, whether they are living at home or displaced by conflict. The vaccinations will be given at set sites or by workers going house to house, and the campaign will be carried out by national and local health authorities supported by UNICEF, WHO, the Syrian Arab Red Crescent and other partners. The total cost to UNICEF and WHO through April 2014 will be $39 million.
Prior to this outbreak, no polio cases have been recorded in Syria since 1999. The risk of spread to countries in the region and beyond is considered high, and health authorities from 21 countries have declared a public health emergency. Genetically-related polioviruses, which originated in Pakistan, were found in sewage samples in Egypt in December 2012 and in Israel in the West Bank and Gaza earlier in 2013. According to WHO, immunization activities have been significantly constrained in Syria in the past few months by the ongoing conflict, which has led to 500,000 to 700,000 children missing vaccinations.
Editor’s Note: NewPublicHealth also spoke with Sona Bari, WHO's senior communications officer, about the efforts underway to eradicate polio globally. The interview will run later today.
Read more on global health.
CDC Expects TB Test Shortage to Ease
Supplies of tuberculin skin tests are expected to return to normal in January, following shortages that health providers have been experiencing since 2012, according to the U.S. Centers for Disease Control and Prevention (CDC). Two tests are approved by the U.S. Food and Drug Administration to detect tuberculosis and diagnose active illness: Tubersol, made by Sanofi Pasteur Limited; and Aplisol, produced by JHP Pharmaceuticals, LLC. Shortages were first reported for Tubersol, which was out of production from late 2012 through April 2013, increasing the demand for Aplisol. In August, a CDC survey found 29 of 52 U.S. jurisdictions were reporting a shortage of at least one of the tests. Read more on the Centers for Disease Control and Prevention.
Epidemic of E. coli Infections Traced to One Strain of Bacteria
In the past decade, a single strain of E. coli, has become the main cause of bacterial infections in women and the elderly by invading the bladder and kidneys, according to a study published in the American Society for Microbiology's journal mBio. Besides becoming more resistant to antibiotics, the H30-Rx strain gained an unprecedented ability to spread from the urinary tract to the blood, leading to sepsis and posing a threat to the more than 10 million Americans who annually suffer from urinary tract infections. The study authors say the new findings could help trace the history of the “superbug” and possibly lead to the development of a vaccine. Read more on infectious disease.
New reports from the U.S. Centers for Disease Control and Prevention (CDC) show that 39 percent of adults and 41 percent of children six months and older got their flu shots for the 2013-2014 season by early November—a rate similar to flu vaccination coverage last season at the same time.
Other flu shot statistics of note this year include:
- Vaccination among pregnant women (41 percent) and health care providers (63 percent) is about the same as it was this time last year
- High rates were seen again this year among health care providers including pharmacists (90 percent), physicians (84 percent) and nurses (79 percent), but the CDC reported much lower vaccination rates among assistants or aides (49 percent) and health care providers working in long-term care facilities (53 percent)
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” says Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at CDC. “The bottom line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”
Seasonal influenza activity is increasing in parts of the United States. Further increases in influenza activity across the country are expected in the coming weeks. “If you have not gotten your flu vaccine yet this season, you should get one now,” said Schuchat.
The CDC’s report comes just ahead of the observance next week of National Influenza Vaccination Week (NIVW), which is scheduled each year for the second week in December because vaccination rates tend to fall off toward the end of November. It’s hardly too late to get the flu vaccine: flu season usually peaks January through March, and the virus—and the potential to catch it—often lasts as late as May.
People who haven’t had the flu shot should make it a priority to do so as soon as possible for at least two reasons. One, providers tend to return their unused vaccines toward the end of the year, which can make it hard to find a vaccine if you still need the shot (check this flu vaccine finder for providers in your area, and call ahead to be sure they have supplies on hand). Two, it takes two weeks for the flu vaccine to take full effect, so the sooner you get it the more protected you are against people harboring the flu during the upcoming holiday party season.
Still on the sidelines about getting the shot? The CDC has some impressive numbers from last year’s flu season: flu vaccination prevented an estimated 6.6 million influenza-associated illnesses and 79,000 hospitalizations during the 2012-2013 flu season.
>>Bonus Links: Learn more about preventing and treating influenza on NewPublicHealth.
>>Bonus Content: CDC's infographic on the benefits of the flu vaccine (full size PDF).
Chicago Announces Trio of Anti-tobacco Initiatives to Curb Youth Smoking
The city of Chicago and Mayor Rahm Emanuel this morning announced a trio of anti-tobacco initiatives designed to reduce youth access to tobacco. The first would regulate e-cigarettes as tobacco products, while the second would restrict the sale of flavored tobacco products near schools and the third would work to educate the public on the dangers of menthol-flavored cigarettes. Further details:
- By defining “tobacco products” as products that are made of tobacco or include tobacco-derived nicotine, the city would be able to regulate e-cigarettes as they do any other tobacco product. This would mean that under the Chicago Clean Indoor Air Act, e-cigarette use would be restricted everywhere where smoking is restricted, including almost all public places and places of employment.
- Flavored tobacco products, including menthol products, could not be sold within 500 feet of schools, and existing stores would not be grandfathered in. This would be the first regulation of menthol-flavored cigarettes anywhere at the federal, state or local levels.
- Understanding that menthol-cigarettes are often—and wrongly—viewed as less unhealthy than other tobacco products, as well as that fact that the flavoring makes them more appealing to kids, the city is launching a public service advertising campaign on the realities of the products.
“E-cigarettes, as well as flavored products, are gateway tobacco products targeted at our kids,” said Emanuel. “The tobacco industry has spent years developing products that are aimed at hooking our youth on nicotine and getting them smoking for their entire life.” Read more on tobacco.
FDA to Investigate Reports on Weight-related Problems with the Morning-After-Pill
Following yesterday’s report that the European equivalent of the Plan B One-Step “morning after pill,” Norlevo, is less effective for women who weigh 165 pounds or more and ineffective for women who weigh 176 pounds or more, the U.S. Food and Drug Administration (FDA) has announced it will perform its own investigation into the product. The agency is "currently reviewing the available and related scientific information on this issue, including the publication upon which the Norlevo labeling change was based," said FDA spokeswoman Erica Jefferson said in a Monday statement. "The agency will then determine what, if any, labeling changes to approved emergency contraceptives are warranted." By law, the morning-after pill is available to all U.S. women of child-bearing age, over the county and with no point-of-sale restrictions. Read more on sexual health.
Concerns Over Cost, Sexual Activity Keep Many Parents From Having Kids Vaccinated Against HPV
Costs and parental concern over their kids’ sexual activity may be the reason that so view children—both girls and boys—are not being vaccinated against the human papillomavirus (HPV), according to a new review of 55 studies appearing in JAMA Pediatrics. HPV vaccines protect against the strains of genital warts that cause approximately 70 percent of cervical cancers, and they are recommended for girls aged 11 to 12. Boys are recommended to receive the vaccine as young as age 11, as it protects not just against genital warts, but also oral, penis and rectal cancers. However, the review found that many parents put off the vaccination either because they believe their child is not sexually active—so doesn’t “need” the vaccine—or because they fear it will encourage them to become sexually active. Researchers determined that a physician’s recommendation was one of the strongest motivators toward deciding to accept the vaccination, although this did not happen nearly enough. The researchers recommended improving these statistics by educating doctors and parents on the importance of the vaccine. Read more on cancer.