Need: The human papillomavirus (HPV) vaccine can protect youth from acquiring nine types of HPV that cause cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers, in additional to genital warts. Texas HPV vaccine completion rates are steadily improving. Although 2018 series completion rates for the City of Houston (50.9%) and Tarrant County (45.9%) are higher than the series completion rate for Texas (39.7%), these HPV vaccination rates are still well below the Healthy People 2020 goal of 80% completion. Completion rates in the project target populations are even lower, at 15.6% or less. Barriers to HPV vaccination include no provider recommendation, vaccine safety or efficacy co...

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Need: The human papillomavirus (HPV) vaccine can protect youth from acquiring nine types of HPV that cause cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers, in additional to genital warts. Texas HPV vaccine completion rates are steadily improving. Although 2018 series completion rates for the City of Houston (50.9%) and Tarrant County (45.9%) are higher than the series completion rate for Texas (39.7%), these HPV vaccination rates are still well below the Healthy People 2020 goal of 80% completion. Completion rates in the project target populations are even lower, at 15.6% or less. Barriers to HPV vaccination include no provider recommendation, vaccine safety or efficacy concerns, lack of knowledge about the vaccine, and lost work time for parents. The target populations for this project are 11-13-year-old youth attending public middle schools in medically underserved areas (MUAs) in four Texas communities and their parents. Participating schools have MUAs within or adjacent to their attendance boundaries. Overall Project Strategy: All for Them (AFT) is a multilevel multicomponent program that comprises three synergistic evidence-based strategies to effectively increase HPV vaccine initiation and completion. This expansion project will implement AFT among youth in MUAs in four diverse Texas communities. Using the Transtheoretical Model (TTM) as a framework, we designed the first strategy, the AFT parent-focused social marketing campaign, to normalize and help parents view the HPV vaccine as part of routine healthcare for their adolescents. The AFT campaign messaging changes the conversation around HPV vaccination from one that addresses parents’ concerns regarding the HPV vaccine to one that begins by empathizing with parents and empowering them to make the best choices for their families, at the same time that it reframes HPV vaccination as cancer prevention. AFT provides a variety of colorful creative media with a simple, positive message that all parents can endorse – get your children all of the vaccines they need to be healthy. We developed the campaign messaging to address parents in all stages of change. We will deliver the campaign through community-based small and digital media for each participating school. The second strategy is continuing nursing education (CNE) to increase school nurses’ knowledge, positive attitudes, and effective communication with parents regarding HPV vaccine, HPV vaccine advocacy, and the importance of recording HPV vaccination in school health records. We will offer the CNE to school nurses statewide. Finally, the social marketing campaign is designed to help parents decide to have their children participate in the third strategy, which is comprehensive adolescent school-based vaccination clinics (SBVCs) held in public middle schools, at which youth will be offered all ACIP-recommended adolescent vaccinations. Specific Goals: In four diverse Texas communities, use the AFT social marketing campaign and SBVCs to increase HPV vaccine initiation and completion rates in participating school districts. We will deliver the social marketing campaign to communities that include the parents of 30,000 public middle school youth in participating schools annually. We will offer the CNE annually to school nurses in all 1,031 Texas school districts. SBVCs will be offered in 37 public middle schools, with a specific goal of increasing HPV vaccination initiation by 15 percentage points over baseline and series completion by 10 percentage points over baseline. The SBVCs will serve 3,200 youth in targeted schools. Innovation: All for Them provides bilingual and culturally appropriate messages that are designed to appeal to parents at different stages of readiness to adopt the HPV vaccine for their adolescent. Once the AFT campaign is underway, we will offer the SBVCs to all students in participating schools to remove vaccination access barriers. School nurse CNE will be offered prior to the first SBVCs. Few projects have paired social marketing, SBVCs, and school nurse education to increase uptake of the HPV vaccine. Developing innovative messaging to improve perceptions and increase acceptance and adoption of the HPV vaccine, together with providing comprehensive adolescent vaccination opportunities in school is a unique approach to increasing HPV vaccine uptake. Significance and Impact: This project will increase positive perceptions of and acceptance of the HPV vaccine for parents of adolescents, as it endorses the HPV vaccine as part of routine adolescent healthcare. It can reduce the prevalence of vaccine-type HPVs in Texas communities. Providing easy access to vaccines at no cost for the highest risk youth can reduce HPV prevalence. This project can increase access to immunization services for youth in MUAs and establish an ongoing program of SBVCs in public middle schools that can continue once the project has ended.

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