Publications by authors named "Cristyn Davies"

9 Publications

  • Page 1 of 1

School-based HPV vaccination positively impacts parents' attitudes toward adolescent vaccination.

Vaccine 2021 Jul 12;39(30):4190-4198. Epub 2021 Jun 12.

Speciality of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Introduction: This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP).

Methods: Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013-2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent's knowledge about HPV vaccination; and their adolescent's understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis.

Results: Parents' of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents' responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents' knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males.

Conclusions: Parents' positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents' knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.
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http://dx.doi.org/10.1016/j.vaccine.2021.05.051DOI Listing
July 2021

Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices.

BMJ Open 2021 05 19;11(5):e043237. Epub 2021 May 19.

The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia

Objective: Fertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for-and qualities of-fertility counselling for TGD adolescents based on clinicians' experiences.

Design: We conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person's experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis.

Setting: This qualitative study examined experiences of clinicians at the Royal Children's Hospital-a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia.

Participants: We interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents.

Results: Based on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice.

Conclusions: Identification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents' experiences of fertility counselling are also required.
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http://dx.doi.org/10.1136/bmjopen-2020-043237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137211PMC
May 2021

Waiting to be seen: social perspectives on trans health.

Health Sociol Rev 2021 03;30(1):1-8

Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.

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http://dx.doi.org/10.1080/14461242.2020.1868900DOI Listing
March 2021

IPVS policy statement. Equity in cervical cancer prevention: for all and not just for some.

Papillomavirus Res 2020 06 4;9:100192. Epub 2019 Dec 4.

Justice of the Peace for NSW, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.pvr.2019.100192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217985PMC
June 2020

Safety, tolerability, acceptability and immunogenicity of an influenza vaccine delivered to human skin by a novel high-density microprojection array patch (Nanopatch™).

Vaccine 2018 06 17;36(26):3779-3788. Epub 2018 May 17.

Vaxxas Pty Ltd, Translational Research Institute, 37 Kent Street, Brisbane, QLD 4102, Australia. Electronic address:

Background: Injection using needle and syringe (N&S) is the most widely used method for vaccination, but requires trained healthcare workers. Fear of needles, risk of needle-stick injury, and the need to reconstitute lyophilised vaccines, are also drawbacks. The Nanopatch (NP) is a microarray skin patch comprised of a high-density array of microprojections dry-coated with vaccine that is being developed to address these shortcomings. Here we report a randomised, partly-blinded, placebo-controlled trial that represents the first use in humans of the NP to deliver a vaccine.

Methods: Healthy volunteers were vaccinated once with one of the following: (1) NPs coated with split inactivated influenza virus (A/California/07/2009 [H1N1], 15 µg haemagglutinin (HA) per dose), applied to the volar forearm (NP-HA/FA), n = 15; (2) NPs coated with split inactivated influenza virus (A/California/07/2009 [H1N1], 15 µg HA per dose), applied to the upper arm (NP-HA/UA), n = 15; (3) Fluvax® 2016 containing 15 µg of the same H1N1 HA antigen injected intramuscularly (IM) into the deltoid (IM-HA/D), n = 15; (4) NPs coated with excipients only, applied to the volar forearm (NP-placebo/FA), n = 5; (5) NPs coated with excipients only applied to the upper arm (NP-placebo/UA), n = 5; or (6) Saline injected IM into the deltoid (IM-placebo/D), n = 5. Antibody responses at days 0, 7, and 21 were measured by haemagglutination inhibition (HAI) and microneutralisation (MN) assays.

Findings: NP vaccination was safe and acceptable; all adverse events were mild or moderate. Most subjects (55%) receiving patch vaccinations (HA or placebo) preferred the NP compared with their past experience of IM injection with N&S (preferred by 24%). The antigen-vaccinated groups had statistically higher HAI titres at day 7 and 21 compared with baseline (p < 0.0001), with no statistical differences between the treatment groups (p > 0.05), although the group sizes were small. The geometric mean HAI titres at day 21 for the NP-HA/FA, NP-HA/UA and IM-HA/D groups were: 335 (189-593 95% CI), 160 (74-345 95% CI), and 221 (129-380 95% CI) respectively. A similar pattern of responses was seen with the MN assays. Application site reactions were mild or moderate, and more marked with the influenza vaccine NPs than with the placebo or IM injection.

Interpretation: Influenza vaccination using the NP appeared to be safe, and acceptable in this first time in humans study, and induced similar immune responses to vaccination by IM injection.
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http://dx.doi.org/10.1016/j.vaccine.2018.05.053DOI Listing
June 2018

Fit4YAMs: Structuring a Lifestyle Intervention for Rural Overweight and Obese Young Adult Males Using Participatory Design.

J Adolesc Health 2018 03;62(3S):S65-S71

Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, New South Wales, Australia.

Purpose: Young adult males (YAMs) are understudied with respect to lifestyle interventions to address overweight and obesity in this group. This study reports on the participatory design of the structure and delivery of the Fit4YAMs text message-based lifestyle intervention for 18- to 25-year-old rural YAMs in Australia.

Methods: Two semi-structured focus group discussions were held with six overweight or obese YAMs. Sessions explored their preferences for the structure and delivery of a weight loss intervention. Focus groups were recorded, and the contents transcribed verbatim for thematic analysis.

Results: The YAMs were unanimous in their preference for a highly personalized intervention program, complete with personalized goal setting, personalized motivation and engagement strategies, and personalized text message content. A text message frequency of three-four messages per week was deemed optimal for this group. Minimal direct contact by the intervention team was requested, but with clear guidelines and reminders of key contacts whom they could contact should they require help and guidance. The YAMs also agreed that a comprehensive goal setting session and personalization session prior to commencement of the intervention would be best.

Conclusions: To engage rural YAMs in lifestyle interventions, a high degree of personalization of the program appears important. Although initially more time and resource intensive than a less personalized approach, it is essential to identify strategies to prevent and reverse weight gain in this hard to engage group. Maximizing their engagement using a more personalized approach could be the key to promoting long-term health outcomes in this group.
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http://dx.doi.org/10.1016/j.jadohealth.2017.06.019DOI Listing
March 2018

Safety, acceptability and tolerability of uncoated and excipient-coated high density silicon micro-projection array patches in human subjects.

Vaccine 2017 12 23;35(48 Pt B):6676-6684. Epub 2017 Oct 23.

Vaxxas Pty Ltd, Translational Research Institute, 37 Kent Street, Woolloongabba, Queensland 4102, Australia. Electronic address:

Most vaccinations are performed by intramuscular injection with a needle and syringe. However, this method is not ideal due to limitations, such as the risk of needle-stick injury, the requirement for trained personnel to give injections and the need to reconstitute lyophilized vaccines. Therefore, we tested an alternative delivery technology that overcomes the problems with needle and syringe. The Nanopatch™ is an array of 10,000 silicon micro-projections per cm that can be dry-coated with vaccine for skin delivery. The high number and density of micro-projections means that high velocity application is required to achieve consistent skin penetration. Before clinically testing a vaccine Nanopatch, this study tests the safety, tolerability and acceptability/utility of uncoated and excipient-coated Nanopatches in healthy adults. Nanopatches were applied to skin of the upper arm and volar forearm and left in contact with the skin for two minutes before removal. The application sites were assessed for local skin response over 28 days. Acceptability interviews were also performed. No unexpected adverse events directly related to the Nanopatch application were reported. All applications of the Nanopatch resulted in an expected erythema response which faded between days 3 and 7. In some subjects, some skin discolouration was visible for several days or up to 3 weeks after application. The majority (83%) of subjects reported a preference for the Nanopatch compared to the needle and syringe and found the application process to be simple and acceptable. On a pain scale from 0 to 10, 78% of applications were scored "0" (no pain) with the average scores for less than 1. The results from this study demonstrate the feasibility of the Nanopatch to improve vaccination by showing that application of the product without vaccine to human skin is safe, tolerable and preferred to needle and syringe administration. Clinical trial registry ID: ACTRN1261500083549.
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http://dx.doi.org/10.1016/j.vaccine.2017.10.021DOI Listing
December 2017

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.

BMC Public Health 2015 Sep 15;15:896. Epub 2015 Sep 15.

School of Public Health, University of Sydney, Sydney, NSW, Australia.

Background: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

Methods/design: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

Discussion: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.

Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628 , 14.04.2014.
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http://dx.doi.org/10.1186/s12889-015-2168-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572679PMC
September 2015

Producing cosmopolitan sexual citizens on The L Word.

J Lesbian Stud 2009 ;13(2):174-88

Faculty of Education and Social Work, The University of Sydney, NSW 2006, Australia.

Using Showtime's The L Word as a case study, we argue that lesbian sexuality and lesbian lifestyles are produced alongside broader discourses of cosmopolitan consumer citizenship. The lesbian characters in this program are first and foremost constructed through their investments in certain neo-liberal consumer and lifestyle practices that limit the possibility of what lesbian subjectivities and/or lesbian politics can or cannot become. We offer an alternative strategy of reading lesbians in image-based media and popular culture that attends to the ways in which lesbian subjectivities are produced in a climate of neo-liberal consumer and lifestyle practices that have shifted the ways in which sexual citizens are produced. Our aim is to provide a critical framework that can be applied to other lesbian-themed television texts and to a range of other image-based visual media including film, commercial advertising, and new media.
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http://dx.doi.org/10.1080/10894160802695353DOI Listing
March 2010