Need. The Centers for Disease Control reported that between 2014and 2018, approximately 24,886 females and 19,113 males were diagnosed with HPV-associated cancers. The HPV-associated cancer incidence rate for Texas between 2013 and 2017 was 11.7/100,000. Oropharyngeal cancers and cervical cancer are the most commonly diagnosed HPV-associated cancer among males and females, respectively. Brazoria and Galveston County (PHR 6) have been designated as Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs). The incidence of cervical cancer is in these counties is 8.3/100,000. This is the same as the overall HPV-associated cervical cancer incidence rate in Texas (i.e., 8...

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Need. The Centers for Disease Control reported that between 2014and 2018, approximately 24,886 females and 19,113 males were diagnosed with HPV-associated cancers. The HPV-associated cancer incidence rate for Texas between 2013 and 2017 was 11.7/100,000. Oropharyngeal cancers and cervical cancer are the most commonly diagnosed HPV-associated cancer among males and females, respectively. Brazoria and Galveston County (PHR 6) have been designated as Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs). The incidence of cervical cancer is in these counties is 8.3/100,000. This is the same as the overall HPV-associated cervical cancer incidence rate in Texas (i.e., 8.3/100,000), which is higher than the US rate of 7.2/100,000. Bastrop and Caldwell Counties (PHR 7) are designated MUAs and HPSAs. Bastrop is also classified as rural. In PHR 7, the incidence rate of all HPV-associated cancers is 11.6/100,000 and the cervical cancer incidence rate is 7/100,000. Gonzales, Guadalupe, and Victoria County (PHR 8) have an incidence rate of all HPV-associated cancers is 11.8/100,000 and cervical cancer incidence rate is 9.6/100,000. The cervical cancer incidence rate in PHR 8 is higher than the rate for Texas as a whole (i.e., 8.3/100,000). These Counties are classified as MUAs and HPSAs and Victoria County is designated as partially rural. The HPV-associated cancer incidence rates in these counties are unacceptable given the availability of the HPV vaccine, which is an effective primary cancer prevention tool at our disposal. The latest available data from the National Health Interview Survey indicates that HPV vaccination rates among young adults aged 18-26 was 39.9% for vaccine initiation and 21.5% for vaccine series completion. Our partner clinics for this project, in Brazoria and Galveston Counties report a baseline HPV vaccination rate of 7.7% among young adults aged 18-26. The baseline HPV vaccination rate among 18-26 year olds in our partner clinics in Bastrop, Caldwell, Gonzales, Guadalupe and Victoria Counties is 4%. These rates highlight the need to continue efforts to increase HPV vaccination among young adults aged 18-26, in these Counties. Barriers. Previous HPV vaccination efforts among young adults aged 18-26, have identified several barriers to vaccination including a lack of insurance, a lack of transportation, not seeking medical care unless they were ill, a lack of awareness of that they should receive the HPV vaccine and health care providers missing opportunities to recommend the vaccine to this age group. Plans to overcome barriers. We will implement a provider-directed intervention (PDI), practice-level intervention (PLI) and community education and outreach. Organizational capacity and readiness assessments will identify the factors that influence the HPV vaccination practices of health care providers. Using a participatory approach, we will (1) survey providers to evaluate baseline HPV vaccine knowledge, attitudes and behaviors, and practice policy; and (2) observe patients and clinic staff to understand vaccination practices in each clinic and identify barriers. The results will identify baseline levels of health care provider knowledge of the vaccine and inform the development of the PDI and PLI to increase HPV vaccination (initiation and completion) among patients. The PDI will emphasize meeting the ACIP recommendations and best practices for HPV vaccination. We will implement community level education and outreach for residents and training for health care professionals. Our comprehensive approach promotes best practices by training providers and clinic staff to disseminate information on HPV and the HPV vaccine. It improves patient-provider communication; and enhances health care systems capacity to improve the delivery of HPV vaccines to clinic patients. Priority population to be served. The goal of project is to increase HPV vaccination (initiation and completion) among underserved, predominantly low-income, young adult patients served by five clinics in Brazoria and Galveston Counties and seven clinics in Bastrop, Caldwell, Gonzales, Guadalupe and Victoria Counties. Increasing HPV vaccination among young adults in these counties has the potential to reduce HPV-associated cancers in MUA/HPSA counties in Texas.

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