Tailoring an Intervention with Parents in Rural Areas to Reduce HPV Transmission

描述(申请人提供)：与农村地区的父母进行干预以减少HPV传播农村地区的妇女死于与人乳头状瘤病毒(HPV)感染相关的宫颈癌的比率高于城市妇女，但每年用于治疗HPV感染、生殖器疣和宫颈癌的医疗保健资金却高达37亿美元。1-4如果在第一次性接触之前接种HPV疫苗，在六个月内连续接种三针，这些人力和财政成本可以显著减少。4-6然而，为了保护儿童免受HPV感染，必须得到父母的同意。6不幸的是，在农村地区，HPV疫苗接种率非常低，在一些国家不到20%。4 2006年批准了针对女孩的HPV疫苗，2009年12月批准了针对9至26岁男性的HPV疫苗接种，尽管目前还没有关于男性接种的统计数据。7-10全国宫颈癌和其他与HPV相关的癌症的发病率对于居住在农村地区的妇女来说高得不成比例，因为农村地区的妇女由于长途旅行获得医疗保健资源而出现地理差距。9-11格鲁吉亚农村地区家庭受到的健康差距有很好的记录，11-15过去的研究侧重于父母和接种HPV疫苗，但其中许多研究是在疫苗可用之前完成的，依赖于自我报告，主要集中在生活在城市地区寻求临床服务的妇女。16-23这些研究提供了宝贵的信息，但不能推广到农村地区的父母。此外，没有针对佐治亚州农村地区较低的幽门螺杆菌疫苗接种率的定性研究。为减少HPV传播和HPV相关癌症(如宫颈癌)而开发的任何干预措施都必须包括父母的投入，因为只有父母/照顾者(P/C)才能同意接种HPV疫苗。24-26由于有证据表明对保健干预措施的不信任依然存在，特别是在非裔美国人中，拟议的研究将使用匿名焦点小组方法来提供叙述性数据，以更好地理解为什么父母选择为9至13岁的孩子接种HPV疫苗。27-29来自完成的定量试点的结果形成了在拟议的焦点小组研究中提出的问题的基础；这些问题将由由首席调查员(PI)培训的焦点小组负责人提出。我们希望使用这种定性方法收集更多深入的、文化丰富的信息，然后开发一种从焦点小组数据中产生的量身定制的干预措施，以提高HPV疫苗接种率，从而减少HPV传播。 公共卫生相关性： 项目简介每年花费近40亿美元用于治疗HPV感染，包括生殖器疣、宫颈癌和其他HPV相关癌症。如果在第一次性接触之前接种HPV疫苗，这些人力和财政成本可以减少。然而，为了保护儿童免受HPV感染，必须得到父母的同意。这项研究将收集居住在佐治亚州农村地区、有9至13岁孩子的父母的焦点小组数据，以确定他们为孩子接种或不接种HPV疫苗的原因。

DESCRIPTION (provided by applicant): Tailoring an Intervention with Parents in Rural Areas to Reduce HPV Transmission Women who live in rural areas are dying at higher rates from cervical cancer related to Human Papillomavirus (HPV) Infection than their urban counterparts, and yet 3.7 billion healthcare dollars are spent each year for the treatment of HPV infection, genital warts, and cervical cancer.1-4 These human and fiscal costs could be markedly reduced if the HPV vaccine, a series of three shots over six months, is given prior to first sexual contact.4-6 However, for children to be protected against HPV infection, parents must give consent.6 Unfortunately in rural areas, rates of HPV vaccination are very low, less than 20% in some counties.4 The HPV vaccine was approved in 2006 for girls and in December 2009 for males ages 9 to 26 though there are no statistics available for male vaccination yet.7-10 National incidence rates of cervical cancer and other HPV related cancers are disproportionately higher for women living in the rural areas where geographic disparities emerge from large distances traveled to access healthcare resources.9-11 The health disparities affecting families living in rural areas of Georgia are well documented, providing a compelling reason to choose this population for study.11-15 Past research studies have focused on parents and HPV vaccination but many of these were completed prior to vaccine availability, relied on self-report, and focused predominantly on women living in urban areas seeking clinical services.16-23 These studies provided valuable information though they cannot be generalized to parents living in rural areas. In addition, there are no qualitative studies that address low HP vaccination rates in rural areas of Georgia. Any intervention developed to reduce HPV transmission and HPV-related cancers, such as cervical cancer, must include parental input as only the parent/caregiver (P/C) can provide consent for HPV vaccination.24-26 Since there is evidence that mistrust of healthcare interventions persists, particularly among African Americans, the proposed study will use an anonymous focus group approach to provide narrative data to explicate a better understanding of why parents choose to vaccinate their children ages 9 to 13 with the HPV vaccine.27-29 Results from a completed quantitative pilot form the basis of the questions to be asked in this proposed focus group study; these questions will be posed by focus group leaders who are trained by the Principal Investigator (PI). We expect to collect greater amounts of in-depth, culturally rich information using this qualitative method and then develop a tailored intervention that will emerge from the focus group data to increase HPV vaccine rates thereby reducing HPV transmission. PUBLIC HEALTH RELEVANCE: Project Narrative Almost 4 billion healthcare dollars are spent each year for the treatment of HPV infection including genital warts, cervical cancer and other HPV-related cancers. These human and fiscal costs can be reduced if the HPV vaccine is given prior to first sexual contact. However, for children to be protected against HPV infection, parents must give consent. This study will collect focus group data from parents with children ages 9 to 13 who reside in rural Georgia to identify the reasons why they do or do not vaccinate their children with the HPV Vaccine.