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

摘要 众所周知，青少年疫苗的益处是预防脑膜炎球菌感染和人类免疫缺陷。 乳头瘤病毒（HPV）相关的癌症。然而，美国的许多青少年仍然在- 农村青少年的疫苗接种率明显低于城市青少年。的 所有推荐的青少年疫苗，HPV覆盖率的城乡差距尤为明显 疫苗，特别是在南部各州，如北卡罗来纳州和南卡罗来纳州，目前远远低于健康水平。 到2020年，覆盖率达到80%以上。文献中确定的农村青年接种疫苗的障碍 包括农村地区缺乏儿科初级保健提供者，接种疫苗的财政障碍，以及 父母对疫苗的态度我们来自杜克大学和 南卡罗来纳州大学与北卡罗来纳州和南卡罗来纳州的州卫生部门合作， 建议检查南部农村青少年父母报告的HPV疫苗接种障碍， 利用这些发现来调整我们的团队以前在农村实施的青少年疫苗干预措施 北卡罗来纳州。定制的干预措施将解决青少年父母报告的疫苗接种障碍， 美国南部的农村社区。将对干预措施进行调整，以便通过公立学校进行宣传， 核心干预部分包括关于青少年疫苗的教育模块，在以下时间提供： 学校护士向10-11岁青少年的父母提供了一个人的疫苗，然后提醒他们促进疫苗的接种。 在南方8个州进行的定量调查以及来自农村和城市利益攸关方和父母的定性数据 北卡罗来纳州和南卡罗来纳州的县将确定农村和城市之间疫苗接种障碍的差异 父母和告知干预措施的适应;可行性和初步疗效将在一个受控的 审判前后核心假设是，经过调整的青少年疫苗干预措施将改善 农村青少年的HPV疫苗接种率。具体目标是：（1）审查青少年面临的障碍 农村和城市父母报告的疫苗接种情况，以便为调整“关注青少年疫苗”提供信息 （2）调整对青少年疫苗的干预，以解决 农村家长对疫苗接种的认识障碍，调整干预措施，在农村学校环境中传播 北卡罗来纳州和南卡罗来纳州，并评估其与关键利益相关者的可接受性，以及（3）评估可行性， 北方农村青少年疫苗接种率提高的适应性干预措施的初步效果 和南卡罗来纳州。如果成功，这个项目将大大提高我们对城市和农村的理解。 疫苗接种差距，并产生创新的、有针对性的干预措施，以增加疫苗接种覆盖率， 农村青少年中的HPV疫苗。该研究将描述可接受性、可行性和初始 调整后的Keen on Teen疫苗干预措施的有效性，并为今后扩大干预措施的努力提供信息 到美国南部的乡村。

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.