Purpose Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey‐Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11‐17 of a rural health clinic. Methods This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence‐based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow‐up. Findings The proportion of adolescent patients ages 11‐17 who had initiated the HPV vaccine series was significantly greater at follow‐up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11‐17 who had completed the HPV vaccine series was also significantly greater at follow‐up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. Conclusions The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11‐17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large‐scale randomizing‐controlled trial.

Accelerating the uptake of Human Papillomavirus (HPV) vaccinations is a priority for cancer prevention and an issue for mitigating cancer health disparities particularly among rural youth, both Native American and non-Native. The rate of HPV vaccinations for rural and Native adolescents is markedly lower than urban adolescents. Based on a Memorandum of Collaboration between the UC Davis Comprehensive Cancer Center and Northern Valley Indian Health (NVIH), a tribal health organization serving rural youth; funding from the National Cancer Institute; and the principles of community-based participatory research, we developed a multi-level approach to accelerate the HPV vaccination rates at the NVIH rural clinic in Willows, CA. Ultimately, the goal is to raise the HPV vaccination rates among patients ages 11-17 from the current 27% at this clinic to the Healthy People 2020 goal of 80%. Our presentation documents a year’s relationship-building that includes the intentional input and promising data from multiple levels for launching an accelerated HPV vaccination program, exemplifying the collaboration between NVIH and a NCI Comprehensive Cancer Center. Starting with community outreach and engagement, our multiple levels included provider and staff trainings; and parent workshops. We began by surveying 12 community members on their HPV vaccination knowledge, attitudes, and behaviors and learned that they had low knowledge of the HPV vaccine and stressed the importance of educating both the community as well as parents. We followed with training of 26 clinic providers and 44 staff (participants were from all four of NVIH’s medical clinics). Pre-tests were administered prior to the training and post-tests administered four months later. The training content had 3 objectives: (1) explaining the importance of HPV vaccinations and the rationale for vaccinating at ages 11-12; (2) providing an effective recommendation by clinicians; and (3) providing support to families to decide in favor of HPV vaccination. While there was attrition from pre to post tests, we achieved significant quantitative realignment of the rank order of HPV vaccination (from 3rd to most important) over other vaccinations and increased confidence in their ability to make a strong HPV vaccination recommendation (14% and 6% respectively). Interviews from parents provided insights on their perspectives of HPV vaccination that should be incorporated. Our next steps will be to apply these findings into a multi-pronged HPV vaccination intervention program for rural Native and non-Native adolescents. Citation Format: Julie HT Dang, Duke LeTran, Alexandra Gori, Arzoo Mojadedi, Teresa Martens, Sharon McClure, Inder Wadhwa, Chester Austin, Moon S Chen, Jr. A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C132.

The purpose of this presentation is to report accomplishments of a 3-year [5/1/2018-4/30/2021] Bristol-Meyers Squibb Foundation-funded collaboration between UC Davis and the Health and Life Organization (HALO), a Federally Qualified Health Center Look-Alike in increasing cancer screenings and cancer prevention/control behaviors among Asian Americans. HALO was selected for this study becuase it is the largest health system serving Asian Americans in Sacramento Co., CA. About one-third of their patients (9000) are Asian [primarily Hmong and other SE Asains). The hypothesis we tested was based on UC Davis's prior completed research that bilingual/bicultural Hmong lay health workers significantly increased screenings for HBV and colorectal cancer screening in randomized controlled community trials among Asians who largely had limited English proficiency. Our premise was to apply this concept to a clinical setting through HALO's bilingual/bicultural medical assistants (MAs). By comparing baseline (prior to the initiation of our funding) to 3 years of collaboration, we observed an overall 13.3% increase (surpassing our 10% goal) in cancer screenings & prevention/control behaviors. The largest percentage increases were in mammography (20.3%), colorectal cancer screening (11.6%), and Pap tests (7.9%). The smallest increases were in HBV vaccination (0.5%), tobaccco cessation counseling (2.2%), and HPV vaccination (2.8%). Since this was our first collaboration, much was shared through our monthly UCD-HALO leadership meetings where adjustments were made. A major adjustment was to learn that the electronic health systems used by community health centers such as HALO were not intended for reseearch purposes. While primary care provider time was less flexible, we found that MAs who reflect the HALO patient population were very receptive to training. We provided training through 10 Saturday academies, in-person and later delivered virtually during the COVID-19 pandemic. All of the topics related to the above metrics as well as other topics such as cultural competence, resources for patients, and optimizing patient workflows. Effectiveness of these academies were documented through gains in average scores from pre-tests [58%] to post-tests [84%] and qualitative feedback. Fifity-eight participants attended. More rigorous evaluation approaches to link our efforts to the impact of our work would have been preferred, but would have needed to be more resource-intensive. However, we anticipate that the equipping of MAs in new competencies and tools we provided for patients in various languages as infographics will be the bases for sustained effectiveness. Another measure of success was that this collaborative contributed to the receipt of a major Federal grant to eliminate perinatal HBV transmission through HALO. A UC Davis You-Tube style interactive modules as refresher materials and for new MAs will be another means of sustaining impact. Citation Format: Moon S. Chen, Jr., Ian Johnson, Ulissa K. Smith, Miguel Suarez, Alexandra Gori, Kit Tam, Eric W. Chak, Julie Dang. Overcoming challenges through an academic-community health center collaborative to conduct cancer screening, prevention, & control among Asian Americans and sustainability initatives [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-209.