Increasing HPV Vaccine Uptake in a Low Income Ethnic Minority Population

描述(申请人提供)：洛杉矶县宫颈癌发病率明显高于全国平均水平，其中拉丁裔和亚洲/太平洋岛民的发病率最高。HPV作为宫颈癌主要致病因子的发现以及随后HPV疫苗的开发使宫颈癌预防的潜力发生了革命性的变化。然而，美国适龄女孩的疫苗使用率仍然低得令人无法接受，包括最高风险群体。加州大学洛杉矶分校公共卫生学院和琼森综合癌症中心与洛杉矶县公共卫生部妇女健康办公室(OWH)合作，解决洛杉矶宫颈癌负担不均的问题。这项研究的主要目标是在随机试验中评估一种理论驱动的、文化敏感的和个性化的干预措施，以增加洛杉矶服务不足、高危女孩的HPV疫苗接种量。干预将通过现有的OWH电话教育和服务转介热线以六种语言(英语、西班牙语、广东话、普通话、韩语和亚美尼亚语)提供。这项针对适龄女孩(11-18岁)母亲的多组成部分干预措施将包括一个简短的电话干预，提供基本的HPV疫苗信息，个别定制的信息，以解决来电者接种HPV疫苗的障碍，以及量身定做地转介到提供低成本/免费疫苗的诊所。还将向与会者邮寄一份加强电话信息的定制印刷品干预。对照组将接受常规护理和疾控中心关于HPV疫苗的标准情况说明书。主要结果将是在符合年龄条件的女孩中启动疫苗接种(接受至少一剂疫苗接种)，对母亲进行3个月的电话跟踪评估。9个月的随访将评估疫苗完成率(接受3剂系列疫苗)和疫苗剂量启动和完成的总体模式。这项研究还试图描述目标人群中HPV相关知识、信念和障碍的特征，并了解干预可能达到预期效果的中介因素(例如，知识、障碍减少)。还将评估干预对样本亚群(例如，更适应文化的人群)的不同影响。这项研究是创新的，因为我们与县卫生系统合作，这是我们目标人口唯一现实的卫生保健来源。县公共卫生部门承诺增加HPV疫苗接种率，并利用现有的县基础设施(OWH热线)提供干预措施，这将确保在试验完成后将干预措施制度化。

DESCRIPTION (provided by applicant): Cervical cancer incidence in Los Angeles County is significantly higher than the national average, with highest rates among Latinas and Asian/Pacific Islanders. The discovery of HPV as the primary causal agent in cervical cancer and subsequent development of HPV vaccines have revolutionized the potential for cervical cancer prevention. However, vaccine utilization rates in the US remain unacceptably low among age-eligible girls, including among the highest risk groups. The UCLA School of Public Health & Jonsson Comprehensive Cancer Center have teamed with the Los Angeles County Department of Public Health, Office of Women's Health (OWH) to address the unequal burden of cervical cancer in Los Angeles. The primary goal of the study is to evaluate, in a randomized trial, a theoretically driven, culturally sensitive and individually tailored intervention to increase HPV vaccine receipt among underserved, high risk girls in Los Angeles. The intervention will be delivered via the existing OWH telephone education and service referral hotline in six languages (English, Spanish, Cantonese, Mandarin, Korean, Armenian). The multi-component intervention, directed at mothers of age-eligible girls (11-18 years), will consist of a brief telephone intervention that will deliver basic HPV vaccine information, individually tailored messages to address callers' barriers to HPV vaccination, and tailored referral to a clinic offering low cost/free vaccine. A tailored print intervention reinforcing the telephone messages will also be mailed to participants. The control group will receive usual care and a standard CDC fact sheet on the HPV vaccine. The primary outcome will be vaccine initiation among age-eligible girls (receipt of at least one vaccine dose) assessed at a 3 month telephone follow-up with mothers. A 9 month follow-up will assess vaccine completion rates (receipt of 3-dose series) and overall patterns of vaccine dose initiation and completion. The study also seeks to characterize HPV related knowledge, beliefs and barriers in the target population, and understand the mediators (e.g., knowledge, barriers reduction) through which the intervention may have achieved its desired effect. Differential effects of the intervention on subgroups of the sample (e.g., more acculturated) will also be assessed. The study is innovative in that we are partnering with the county health system which is the only realistic source of health care for our target population. The commitment of the county department of public health to increasing HPV vaccine uptake and the utilization of existing county infrastructure (the OWH hotline) for intervention delivery will ensure institutionalization of the intervention upon trial completion.