ReMARk: A multi-level strategy to address disparities in rural HPV-related cancer prevention

ReMARk：解决农村 HPV 相关癌症预防差异的多层次战略

• 批准号: 10551646
• 负责人: Stephanie A S Staras
• 金额: $ 84.54万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551646
• 关键词: 12 year old; 15 year old; Academy; Address; Affect; Age; Agriculture; American; American Cancer Society; Area Health Education Centers; Behavior; Cancer Center; Child; Clinic; Clinic Visits; Clinical; Clinical Research; Clinical Sciences; Cluster randomized trial; Code; Communities; County; Dose; Effectiveness; Ethnic Origin; Florida; Food; Health; Healthcare; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Incidence; Institutes; Insurance; Intervention; Malignant Neoplasms; Measures; Misinformation; Mission; Modeling; Motivation; Parents; Patients; Pediatrics; Physicians; Prevention; Public Health; Race; Randomized; Recommendation; Research; Resources; Rivers; Rural; Rural Community; Rural Health; Rural Population; Schedule; Science; Series; Telephone; Training; Translational Research; Transportation; United States; United States National Institutes of Health; Universities; Vaccination; arm; base; biological sex; boys; cancer health disparity; cancer prevention; community center; community engagement; cost effective; cost effectiveness; demographics; effectiveness evaluation; evidence base; experience; girls; health care availability; implementation strategy; improved; innovation; motivational enhancement therapy; prevent; primary outcome; programs; rural area; rural health network; rural setting; social determinants; social vulnerability; success; transportation access; urban area

The low rates of human papillomavirus (HPV) vaccination within rural areas of the United States present a substantial and disparate missed opportunity to prevent cancer. Florida is a particular concern with the second highest number of HPV-related cancers, yet a rank among the 50 states of 44th in HPV vaccine initiation (≥ 1 dose) and 41st for up to date (i.e., 2 doses when starting the series before age 15 years; 3 doses when starting at 15 years or older). Even greater disparity is present within the 11 rural North Central Florida counties that are the focus of this proposal. Due to the myriad of factors preventing boys and girls living in rural areas from receiving the HPV vaccine, a multilevel approach is needed to increase HPV vaccination. Guided by the Integrated Behavior Model, the overall objective of this proposal is to address the multilevel barriers to HPV vaccination among 9- to 12-year-olds living in rural areas by using a three-arm cluster randomized trial to assess the added clinical- and associated cost-effectiveness on HPV vaccination of each additional nested evidence-based implementation strategy: (1) clinician-targeted recommendation training, (2) parent-targeted motivational aids via facilitation of clinic staff sending reminder/recall messages and conducting phone-based motivational interviewing, when needed, to encourage follow through, (3) community-targeted healthcare access to transportation assistance, mobile vaccination clinics, and navigation to healthcare insurance. Eight community-focused organizations with experience in rural settings will support implementation: University of Florida (UF) Institute of Food and Agricultural Sciences Extension, UF Clinical and Translational Science Institute Community Engagement Program, UF Cancer Center Community Advisory Board, UF OneFlorida Clinical Research Consortium, Suwannee River Area Health Education Center, CommunityHealth IT, a federally designated Rural Health Network, and the Florida Department of Health. The specific aims are: (1) Estimate the added clinical- and associated cost-effectiveness of parent-targeted motivational aids (reminder/recall and phone-based MI) alone and when combined with community-targeted healthcare access assistance beyond the effects of clinician-targeted training; (2) Estimate the differential effectiveness of the implementation strategies by patient-level factors (age, race/ethnicity, biologic sex, distance from home to clinic, social vulnerability); and (3) Measure moderation of implementation strategy effectiveness by clinic-level factors. The proposed research is significant for its potential to prevent cancer by increasing HPV vaccination rates among 9- to 12-year-olds living in rural areas. The project is innovative by: (1) Evaluating effectiveness and cost-effectiveness of layered evidence-based strategies; and (2) Addressing social determinants preventing vaccination in addition to clinician recommendation effectiveness and parent motivation. The proposed approach of layering nested evidence-based implementation strategies to prevent HPV-related cancers can be expanded to prevention of other cancers disproportionately affecting rural areas.

美国农村地区的人乳头状瘤病毒(HPV)疫苗接种率较低 大量和完全不同的预防癌症的机会被错失。佛罗里达州是第二个特别令人担忧的问题 与HPV相关的癌症数量最多，但在HPV疫苗启动的50个州中排名第44位 (≥1剂)和最新第41剂(即15岁之前开始该系列时为2剂；当 15岁或15岁以上)。在佛罗里达州中北部的11个农村地区，差距更大 这项提案的重点是县。由于种种因素阻碍男孩和女孩生活在农村 从接种HPV疫苗的地区来看，需要采取多层次的方法来增加HPV疫苗接种。引导式 根据综合行为模型，该提案的总体目标是解决以下多层障碍 采用三臂整群随机试验在农村地区9至12岁儿童中接种HPV疫苗 评估每个额外套式接种HPV疫苗的额外临床和相关成本效益 循证实施策略：(1)以临床医生为目标的推荐培训；(2)以家长为目标 通过为诊所工作人员发送提醒/召回消息和进行电话访问提供便利的激励帮助 激励性访谈，在需要时，鼓励跟进，(3)以社区为目标的医疗保健 获得交通援助、流动疫苗接种诊所和导航到医疗保险。八 具有农村环境经验的专注于社区的组织将支持实施： 佛罗里达(UF)食品和农业科学推广研究所，UF临床和转化科学 密歇根州立大学癌症中心社区咨询委员会社区参与计划，佛罗里达大学 临床研究联盟，苏万尼河地区健康教育中心，社区健康IT，a 联邦指定的农村卫生网络和佛罗里达州卫生部。具体目标是：(1) 估计以父母为目标的激励辅助工具增加的临床和相关成本效益 (提醒/召回和基于电话的MI)单独以及与针对社区的医疗保健服务相结合 提供超出临床医生目标培训效果的帮助；(2)评估 按患者层面因素(年龄、种族/民族、生物性别、从家到家的距离)实施策略 临床、社会脆弱性)；和(3)按临床级别衡量执行战略有效性的适度性 各种因素。这项拟议的研究具有重要意义，因为它有可能通过增加HPV疫苗接种来预防癌症。 居住在农村地区的9至12岁儿童的发病率。该项目的创新之处在于：(1)评估效果 和分层循证战略的成本效益；和(2)解决社会决定因素 预防接种疫苗除了临床医生推荐的有效性和家长的激励外。这个 提出分层嵌套循证实施策略预防HPV感染 癌症可以扩大到预防对农村地区影响不成比例的其他癌症。