Using Message Framing to Promote HPV Vaccination

描述（由申请人提供）：持续感染被称为人乳头瘤病毒（HPV）的性传播感染是宫颈癌的主要原因。尽管巴氏试验在美国显著降低了宫颈癌的发病率，2007年仍有近4000名妇女死于宫颈癌。一种预防性四价HPV疫苗（Gardasil）最近被批准用于9-26岁的女孩和妇女。该疫苗可预防四种HPV感染，这四种类型的HPV导致90%以上的生殖器疣和70%的宫颈癌。建议对11-12岁的女孩进行常规HPV疫苗接种，对13-26岁以前未接种过疫苗的女孩/妇女进行“补种”疫苗接种。在“加德西”上市前进行的研究发现，年轻女性对这种疫苗表现出浓厚的兴趣。然而，高可接受性是否会转化为高接种率尚不清楚。此外，人们对促进年轻人接种HPV疫苗的有效方法知之甚少。因此，拟议的研究将评估一种行为干预措施，旨在促进女大学生（HPV感染的高风险人群）的补种疫苗接种。拟议的干预措施将采用信息框架，这是一种基于理论的卫生传播战略，涉及通过提出以得失为框架的同等呼吁来激励卫生行为改变。事实证明，信息框架是一种非常有效的策略，可促进包括癌症筛查和预防行为在内的广泛卫生实践中的行为改变。提出的随机对照实验的第一个目的是评估损失框架干预（相对于增益框架干预和标准护理控制）在促进补种HPV疫苗方面的有效性。在基线时，参与者将被随机分配到三种干预措施（失去、获得、控制）中的一种。2个月和8个月后将通过电话进行随访评估，以评估HPV疫苗接种情况。根据理论和先前的研究，假设相对于其他两种情况，暴露于失框干预可以提高HPV疫苗接种率。第二个目的是确定干预效果的中介。尽管有几项研究试图揭示框架健康信息对行为影响的认知和情感机制，但成功的研究相对较少。在拟议的研究中，观察到的框架效应预计将通过对HPV感染的感知易感性和接受HPV疫苗的自我效能的增加来介导。人乳头瘤病毒感染对公众健康构成巨大威胁。它增加了医疗费用，以及与异常的巴氏试验、生殖器疣和宫颈癌有关的心理和疾病负担。拟议研究的长期目标是促进发展以理论为基础的卫生宣传干预措施，以促进人乳头瘤病毒疫苗接种，并最终减少子宫颈癌的发病率。

DESCRIPTION (provided by applicant): Persistent infection with a sexually transmitted infection known as human papillomavirus (HPV) is the primary cause of cervical cancer. Although Pap testing has significantly reduced the incidence of cervical cancer in the U.S., nearly 4,000 women died of cervical cancer in 2007. A prophylactic quadrivalent HPV vaccine (Gardasil) was recently approved for girls and women ages 9-26. The vaccine protects against infection by four HPV types responsible for over 90% of all genital warts and 70% of all cervical cancers. Routine HPV vaccination is recommended in girls ages 11-12 and "catch-up" vaccination among girls/women ages 13-26 who have not been vaccinated previously. Studies conducted before Gardasil's release found that young women expressed keen interest in the vaccine. Whether high acceptability will translate into high rates of vaccination, however, is unclear. In addition, little is known about effective methods for promoting HPV vaccination in young adults. The proposed research therefore will evaluate a behavioral intervention aimed at promoting catch-up vaccination among female college students, a population that is at high risk for HPV infection. The proposed intervention will apply the use of message framing, a theoretically grounded health communication strategy that involves motivating health behavior change through presentation of equivalent appeals framed in terms of either gains or losses. Message framing has proven to be a highly effective strategy for promoting behavior change across a wide range of health practices, including cancer screening and prevention behaviors. The first aim of the proposed randomized controlled experiment is to assess the effectiveness of a loss-framed intervention (relative to a gain-framed intervention and standard-of-care control) in promoting catch-up HPV vaccination. At baseline, participants will be randomly assigned to one of three interventions (loss, gain, control). Follow-up assessments will be conducted by telephone 2 and 8 months later to assess HPV vaccination status. Based on theory and previous research, exposure to a loss-framed intervention is hypothesized to increase HPV vaccination rates relative to the other two conditions. The second aim is to identify mediators of the intervention effect. Although several studies have attempted to uncover the cognitive and affective mechanisms underlying the effects of framed health messages on behavior, relatively few have been successful. In the proposed research, observed framing effects are expected to be mediated by increases in both perceived vulnerability to HPV infection and self-efficacy to receive the HPV vaccine. HPV infection represents a tremendous threat to public health. It is responsible for increasing medical costs, as well as the psychological and disease burden associated with abnormal Pap testing, genital warts, and cervical cancer. The long-term objectives of the proposed research are to facilitate the development of theory-based health communication interventions for promoting HPV vaccination and, ultimately, to reduce the incidence of cervical cancer.