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: 10551646
• 负责人: Stephanie A S Staras
• 金额: $ 84.54万
• 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/10551646
• 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; Dose; Effectiveness; Ethnic Origin; Florida; Food; Health; Healthcare; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Incidence; Institutes; Insurance; Intervention; Malignant Neoplasms; Measures; Misinformation; Mission; Modeling; Motivation; Parents; Patients; Pediatrics; Physicians; Prevention; Public Health; Race; Randomized; Recommendation; Research; Resources; Rivers; 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; base; biological sex; boys; cancer health disparity; cancer prevention; community center; community engagement; cost effective; cost effectiveness; 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.

在美国农村地区，人类乳头瘤病毒（HPV）疫苗接种的低率是 大量和不同的预防癌症的机会。佛罗里达是第二个特别关注的问题 与HPV相关的癌症的最高数量，但在HPV疫苗启动中排名第44的50个州中 （≥1剂量）和最新的第41剂（即，在15岁之前开始系列时2剂； 3剂 从15岁或以上开始）。在佛罗里达州北部11个农村地区，存在更大的差距 这是该提议的重点的国家。由于无数的因素，阻止了居住在农村的男孩和女孩 接收HPV疫苗的区域，需要一种多级方法来增加HPV疫苗。指导 通过综合行为模型，该提案的总体目标是解决多层次障碍 通过使用三臂聚类随机试验到农村地区的9至12岁儿童中的HPV疫苗接种 评估每个嵌套的HPV疫苗接种的临床和相关成本效益 基于证据的实施策略：（1）临床针对临床的建议培训，（2）靶向父母 通过诊所工作人员的设施发送提醒/召回消息并进行基于电话的动机辅助 需要在需要时进行励志面试，以鼓励跟随，（3）针对社区的医疗保健 获取运输援助，移动疫苗接种诊所以及医疗保险的导航。八 具有农村环境经验的社区注重组织将支持实施：大学 佛罗里达州（UF）食品与农业科学扩展研究所，UF临床和转化科学 UF癌症中心社区顾问委员会Institute社区参与计划，UF Oneflorida Suwannee河地区健康教育中心的临床研究财团，IT， 联邦指定的农村卫生网络和佛罗里达卫生部。具体目的是：（1） 估计靶向父母的动机艾滋病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，并与社区针对的医疗保健访问相结合 除了临床针对培训的影响之外的帮助； （2）估计 通过患者级因素（年龄，种族/种族，生物性别，距离距离的距离）实施策略 诊所，社会脆弱性）； （3）衡量临床水平实施策略有效性的适度 因素。拟议的研究对于通过增加HPV疫苗接种来预防癌症的潜力很重要。 居住在农村地区的9至12岁儿童的比率。该项目具有创新性：（1）评估有效性 以及分层循证策略的成本效益； （2）向社会决定者讲话 除临床建议效率和父母动机外，还可以防止疫苗接种。这 提出的分层基于证据的实施策略以防止与HPV相关的方法 可以扩展癌症，以预防其他癌症对农村地区的影响不成比例。