Influence of yearly cycles in adolescent vaccination on cancer prevention

描述（由申请人提供）：人乳头瘤病毒（HPV）每年导致数千例癌症，但在美国只有大约一半的青春期女孩接受甚至一剂的三剂HPV疫苗系列，可以预防这些癌症。尽管HPV疫苗的安全性和有效性已得到证实，但近年来HPV疫苗的覆盖率几乎没有提高，即使其他青少年疫苗，包括破伤风，白喉和百日咳加强剂（Tdap），继续取得稳步进展。包括疾病控制和预防中心在内的公共卫生机构一直在寻求通过实施疫苗提供者的质量改进计划以及针对家长和青少年的宣传活动来解决令人失望的HPV疫苗接种水平。这些计划通常是全年实施的，但这项工作的大部分可能是不合时宜的。传闻证据表明，卫生保健提供者在夏季的几个月里接种的青少年疫苗剂量比一年中其他时间多得多。我们在北卡罗来纳州的试点研究发现，与12月相比，8月份提供者提供的HPV疫苗剂量是2.02倍，Tdap剂量是4.70倍。推动今年夏季疫苗接种高峰的原因尚不清楚，但可能涉及各州要求学生在入学前接种Tdap疫苗的政策。拟议研究项目的具体目标是（1）确定HPV和Tdap疫苗接种的夏季高峰，以及在全国和美国各州同一次访问期间同时接种两种剂量的疫苗，以及（2）建立各州入学要求之间的关系，夏季疫苗接种高峰，以及青春期女孩中HPV疫苗启动的全州水平。该项目将使用从2008年至2012年全国青少年免疫调查中抽取的具有全国代表性的约45 000名少女样本的数据。数据分析将采用Edwards方法（周期趋势的规范检验）和纵向结构方程模型。这项研究的结果具有重要意义，了解国家政策影响疫苗接种的机制，并为时间免疫质量的改善工作，以最大限度地发挥作用。例如，促进HPV疫苗接种的运动可以将活动集中在夏季，以利用根据Tdap入学要求寻求疫苗的青少年数量增加。这些影响可能最终导致HPV疫苗接种水平的提高和HPV相关癌症发病率的降低，从而改善美国未来的健康状况。该奖学金将建立在申请人之前的研究基础上，通过支持她在公共卫生癌症预防的概念基础，先进的统计方法，以及通过教师赞助商的指导进行研究的道德行为，诺埃尔·T.博士布鲁尔这些活动将支持申请人的目标，成为一个终身制的轨道癌症预防科学家，专门研究健康行为的地理差异。

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) causes thousands of cases of cancer each year, but only about half of adolescent girls in the U.S. receive even one dose of the three-dose HPV vaccine series that can prevent these cancers. Despite its demonstrated safety and effectiveness, coverage with HPV vaccine has improved little in recent years, even as other adolescent vaccines, including tetanus, diphtheria, and pertussis booster (Tdap), continue to achieve steady gains. Public health agencies, including the Centers for Disease Control and Prevention, have sought to address disappointing levels of HPV vaccination by implementing quality improvement programs for vaccine providers and promotional activities for parents and adolescents. These programs are typically implemented on a year-round basis, but much of this work may be ill-timed. Anecdotal evidence suggests that healthcare providers administer many more doses of adolescent vaccines during the summer months than they do during the rest of the year. Our pilot study in North Carolina found that providers delivered 2.02 times as many doses of HPV vaccine and 4.70 times as many doses of Tdap in August compared to December. The reasons driving this summertime peak in vaccination are unclear, but they likely involve states' policies requiring that students receive Tdap vaccine prior to school entry. The specific aims of the proposed research project are to (1) identify summer peaks in HPV and Tdap vaccination, as well as concomitant vaccination with both doses during the same visit, nationally and in U.S. states, and (2) establish the relationships among states' school entry requirements, summer peaks in vaccination, and statewide levels of HPV vaccine initiation among adolescent girls. This project will use data from a nationally-representative sample of ~45,000 adolescent girls, drawn from the National Immunization Survey-Teen from 2008 to 2012. Data analyses will employ Edwards' method (a canonical test of cyclical trends) and longitudinal structural equation modelling. Results of this study have important implications for understanding the mechanism by which state policies influence vaccination and for timing immunization quality improvement efforts to be maximally effective. For instance, campaigns promoting HPV vaccination can concentrate their activities during the summer to capitalize on the increased volume of adolescents seeking vaccines in accordance with Tdap school entry requirements. These implications may ultimately lead to increased levels of HPV vaccination and reductions in the incidence of HPV-attributable cancers, thereby improving future health outcomes in the U.S. This fellowship will build on the applicant's prior research by supporting her training in conceptual underpinnings of cancer prevention in public health, advanced statistical methodologies, and the ethical conduct of research through the mentorship of the faculty sponsor, Dr. Noel T. Brewer. These activities will support the applicant's goal of becoming a tenure-track cancer-prevention scientist specializing in geographic disparities in health behaviors.