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: 10708885
• 负责人: Stephanie A S Staras
• 金额: $ 80.81万
• 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/10708885
• 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; Disparate; Disparity; Dose; Effectiveness; Ethnic Origin; Florida; Food; Health; Healthcare; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Incidence; Insurance; Intervention; Licensing; Malignant Neoplasms; Measures; Misinformation; Mission; Modeling; Motivation; Parents; Patients; Pediatrics; Physicians; Prevention; Public Health; Race; Randomized; Recommendation; Research; Resources; 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; biological sex; boys; cancer health disparity; cancer prevention; community center; community engagement; cost effective; cost effectiveness; cost-effectiveness evaluation; 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.

美国农村地区人乳头瘤病毒 (HPV) 疫苗接种率较低，这导致了 大量不同程度的错失了预防癌症的机会。佛罗里达州特别关注第二个 HPV 相关癌症数量最多，但在 HPV 疫苗接种方面在 50 个州中排名第 44 （≥ 1 剂）和最新第 41 剂（即 15 岁之前开始该系列时 2 剂；15 岁之前开始该系列时 3 剂） 从 15 岁或以上开始）。佛罗里达州中北部 11 个农村地区的差距甚至更大 是本提案重点关注的县。由于种种因素阻碍男孩和女孩在农村生活 HPV 疫苗接种地区，需要采取多层次的方法来增加 HPV 疫苗接种。引导 根据综合行为模型，该提案的总体目标是解决多层次的障碍 通过使用三臂整群随机试验对农村地区 9 至 12 岁的儿童进行 HPV 疫苗接种 评估每个额外嵌套的 HPV 疫苗接种的附加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 通过协助诊所工作人员发送提醒/召回消息并进行基于电话的激励辅助 必要时进行动机性访谈，以鼓励坚持到底，(3) 以社区为目标的医疗保健 获得交通援助、流动疫苗接种诊所以及医疗保险导航。八 具有农村环境经验的以社区为中心的组织将支持实施： 佛罗里达大学 (UF) 食品与农业科学研究所扩展、佛罗里达大学临床与转化科学 研究所社区参与计划、佛罗里达大学癌症中心社区咨询委员会、佛罗里达大学 OneFlorida 临床研究联盟、Suwannee 河地区健康教育中心、CommunityHealth IT、a 联邦政府指定的农村卫生网络和佛罗里达州卫生部。具体目标是：（1） 估计以家长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）单独使用以及与社区针对性的医疗保健服务相结合 超出针对临床医生的培训效果的援助； (2) 估计差异有效性 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 诊所、社会脆弱性）； (3) 按诊所级别衡量实施策略有效性的调节 因素。拟议的研究因其通过增加 HPV 疫苗接种来预防癌症的潜力而具有重要意义 居住在农村地区 9 至 12 岁儿童的比率。该项目的创新之处在于：（1）评估有效性 分层循证策略的成本效益； (2) 解决社会决定因素 除了临床医生建议的有效性和家长的动机之外，还要预防疫苗接种。这 提出的分层嵌套循证实施策略以预防 HPV 相关的方法 癌症可以扩展到对农村地区影响尤为严重的其他癌症的预防。