An estimated 79 million people in the US are infected with Human Papillomavirus (HPV), and 14 million people are newly infected yearly. High-risk HPV types cause 70% of cervical, 85% of anal, 72% of oropharyngeal, and almost half of vaginal, vulvar, and penile cancers; low-risk HPV types cause genital warts. Cervical cancer incidence and mortality are higher for black than white women and for Hispanic than non-Hispanic women.

Vaccination reduces the likelihood of getting HPV-related cancers or genital warts. Since the vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56% among female youth 14-19 years of age. The Advisory Committee on Immunization Practices (ACIP) r...

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An estimated 79 million people in the US are infected with Human Papillomavirus (HPV), and 14 million people are newly infected yearly. High-risk HPV types cause 70% of cervical, 85% of anal, 72% of oropharyngeal, and almost half of vaginal, vulvar, and penile cancers; low-risk HPV types cause genital warts. Cervical cancer incidence and mortality are higher for black than white women and for Hispanic than non-Hispanic women.

Vaccination reduces the likelihood of getting HPV-related cancers or genital warts. Since the vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56% among female youth 14-19 years of age. The Advisory Committee on Immunization Practices (ACIP) recommends a 3-dose vaccination schedule for 11- to 12-year-old adolescents. But HPV vaccination rates are below the Healthy People 2020 goal of 80% completion. The 2015 National Immunization Survey found that in the US, 62.8% of girls and 49.8% of boys aged 13-17 years had at least one dose of the HPV vaccine, while 41.9% of girls and 28.1% of boys aged 13-17 had completed the vaccination series.

Series completion for girls (40.9%) and boys (24%) in Texas fall below the US rates, while rates of other ACIP-recommended adolescent vaccinations are higher in Texas than for the US. Barriers to HPV vaccination include lost work time for parents, no provider recommendation, vaccine safety or efficacy concerns, and lack of knowledge about the vaccine.

The target populations for this project are 11-13-year-old minority youth attending public middle school in medically underserved areas (MUAs) of Houston and their parents. Participating schools have MUAs within their attendance boundaries and the student population comprises at least half minority youth. 

This project will include a 3-prong strategy to increase vaccine uptake among minority youth in MUAs in Houston, Texas. 1) A parent-focused social marketing campaign to increase knowledge, positive attitudes, and intentions regarding the HPV vaccine, including culturally-appropriate messages delivered through mass, small, and social media, as appropriate for target audiences. 2) Comprehensive adolescent school-based vaccination clinics (SBVCs) held in public middle schools, at which youth will be offered all ACIP-recommended adolescent vaccinations. 3) Continuing nursing education to increase school nurses’ knowledge, positive attitudes, and effective communication with parents regarding HPV vaccine.

Specific Goals: Use a social marketing campaign coupled with SBVCs to increase parents’ acceptance and initiation of the HPV vaccination for their adolescents, and nursing education to improve communication with parents. We will deliver the social marketing campaign to communities that include the parents of 22,500 public middle school youth in participating schools annually. We anticipate the campaign will reach over 50,000 adults, including targeted parents, school staff, and other adults.

SBVCs will be offered in 28 public middle schools, with a specific goal of increasing HPV vaccination initiation by 15 percentage points over baseline and completion by 10 percentage points over baseline. The SBVCs will serve about 21,800 youth in targeted schools annually. We will conduct the CNE annually with nurses in participating schools.

The social marketing approach will provide culturally appropriate messages to parents. Messages will be crafted to appeal to parents at different stages of readiness to adopt the HPV vaccine for their adolescent. Motivational messages will be used to increase motivation to action. Once the campaign is underway, SBVCs will be offered to students to remove vaccination access barriers.

Few projects have paired social marketing, SBVCs and school nurse education to increase uptake of the HPV vaccine. Developing innovative messaging to improve perceptions and increase acceptance and adoption of the vaccine, together with providing adolescent vaccination opportunities in school is a unique approach to increasing HPV vaccine uptake.

This project will increase positive perceptions of and acceptance of the HPV vaccine for parents of adolescents. It can reduce the prevalence of vaccine-type HPVs in Harris County. Providing easy access to vaccines at no cost for the highest risk youth can reduce HPV prevalence even further. As we are targeting minority youth, there is the possibility of future reductions in cervical cancer morbidity and mortality rates for these high risk populations in Harris County. This project can increase access to immunization services for youth in MUAs and establish an ongoing program of SBVCs in public middle schools that can continue once funding has ended.

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