A tailored school-based intervention to increase vaccine uptake among adolescents in the rural South

摘要 众所周知，青少年疫苗的好处是预防脑膜炎双球菌感染和人类 与乳头瘤病毒(HPV)相关的癌症。然而，美国的许多青少年仍然处于-- 农村青少年的疫苗接种率明显低于城市同龄人。的 在所有推荐的青少年疫苗中，HPV覆盖率的城乡差异格外明显 疫苗，特别是在南方的州，如北卡罗来纳州和南卡罗来纳州，目前远远低于健康 People 2020的目标是≥覆盖率达到80%。文献中确定的农村青年接种疫苗的障碍 包括农村地区儿科初级保健提供者缺乏、接种疫苗资金障碍以及 父母对疫苗的态度。我们的多学科调查团队来自杜克大学和 南卡罗来纳大学与北卡罗来纳州和南卡罗来纳州的州卫生部门合作， 建议检查南方农村青少年父母报告的HPV疫苗接种障碍，然后 利用这些发现来定制我们团队以前在农村实施的热衷于青少年疫苗干预 北卡罗来纳州。这项量身定制的干预措施将解决#年青少年父母报告的疫苗接种障碍。 美国南部的农村社区。干预措施将被调整为通过公立学校传播， 核心干预部分由青少年疫苗教育模块组成，在-- 学校护士亲自向10-11岁青少年的父母发放疫苗，随后提醒他们促进接种疫苗。 南方8个州的定量调查和来自城乡利益相关者和父母的定性数据 北卡罗来纳州和南卡罗来纳州的县将确定城乡疫苗接种障碍的差异 并告知家长对干预的适应性；可行性和初步效果将在对照研究中进行评估 审判前和审判后。中心假设是，适应的热衷于青少年疫苗干预将有所改善 农村青少年人乳头瘤病毒疫苗接种率。具体目的是(1)检查青少年的障碍 农村和城市父母报告的疫苗接种情况，以便为热衷于青少年疫苗的人提供信息 对美国南部农村社区的干预，(2)裁缝热衷于青少年疫苗干预以解决 农村家长对疫苗接种的感知障碍、适应农村学校传播的干预措施 北卡罗来纳州和南卡罗来纳州，并评估其与关键利益攸关方的可接受性，以及(3)评估可行性和 适应性干预提高北方农村青少年疫苗接种率的初步效果 还有南卡罗来纳州。如果成功，这个项目将极大地提高我们对城乡的理解 疫苗接种差距，并产生创新的、量身定做的干预措施，以扩大疫苗接种覆盖面，特别是 在农村青少年中开展了HPV疫苗接种。这项研究将描述可接受性、可行性和初步 调整后的热衷于青少年疫苗干预的有效性并为未来扩大干预的努力提供信息 到美国南部的农村县。

ABSTRACT The benefits of adolescent vaccines are well known for preventing meningococcal infection and human papillomavirus (HPV)-related cancers. Yet, many adolescents in the United States (US) remain under- vaccinated, with vaccination rates among rural adolescents significantly lower than among their urban peers. Of all recommended adolescent vaccines, the urban-rural disparity is exceptionally stark for coverage of HPV vaccine, particularly in Southern states like North and South Carolina, which currently fall far below the Healthy People 2020 goal of ≥80% coverage. Barriers to vaccine uptake among rural youth identified in the literature include a paucity of pediatric primary care providers in rural areas, financial barriers to vaccinations, and negative parental attitudes towards vaccines. Our multidisciplinary team of investigators from Duke University and the University of South Carolina, in partnership with the state health departments from North and South Carolina, proposes to examine barriers to HPV vaccination reported by parents of adolescents in the rural South and then use these findings to tailor the Keen on Teen Vaccines intervention previously implemented by our team in rural North Carolina. The tailored intervention will address vaccination barriers reported by parents of adolescents in rural communities across the Southern US. The intervention will be adapted for dissemination via public schools, with the core intervention component consisting of educational modules on adolescent vaccines, delivered in- person by school nurses to parents of adolescents ages 10-11, followed by reminders to promote vaccine uptake. A quantitative survey in 8 Southern states and qualitative data from stakeholders and parents in rural and urban counties in North and South Carolina will identify differences in barriers to vaccination between rural and urban parents and inform the adaptation of the intervention; feasibility and initial efficacy will be evaluated in a controlled before-after trial. The central hypothesis is that the adapted Keen on Teen Vaccines intervention will improve rates of HPV vaccination among rural adolescents. The specific aims are to (1) Examine barriers to adolescent vaccinations reported by rural versus urban parents in order to inform the tailoring of the Keen on Teen Vaccines intervention for rural communities in the US South, (2) Tailor the Keen on Teen Vaccines intervention to address rural parents' perceived barriers to vaccination, adapt the intervention for dissemination in school settings in rural North and South Carolina, and assess its acceptability with key stakeholders, and (3) Evaluate feasibility and preliminary efficacy of the adapted intervention for increasing vaccine uptake among adolescents in rural North and South Carolina. If successful, this project will significantly improve our understanding of urban-rural vaccination disparities and yield an innovative, tailored intervention to increase vaccination coverage, particularly of the HPV vaccine, among rural adolescents. The study will describe the acceptability, feasibility, and initial efficacy of the adapted Keen on Teen Vaccines intervention and inform future efforts to scale up the intervention to rural counties across the Southern US.