Need Most cancers are diagnosed in adults; however, many cancer risk factors, including exposure to human papillomavirus (HPV) and initiation of tobacco product use, occur during adolescence. Moreover, while healthcare providers play a critical role in promoting health behaviors, healthcare provider visits become increasingly infrequent as children and adolescents become young adults. There is thus growing recognition of the essential role of pediatric providers in addressing lifelong cancer prevention. In particular, pediatric providers can play an important role in HPV vaccination and tobacco prevention. In the case of HPV vaccination, the most important factor influencing parents’ decisi...
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Need Most cancers are diagnosed in adults; however, many cancer risk factors, including exposure to human papillomavirus (HPV) and initiation of tobacco product use, occur during adolescence. Moreover, while healthcare providers play a critical role in promoting health behaviors, healthcare provider visits become increasingly infrequent as children and adolescents become young adults. There is thus growing recognition of the essential role of pediatric providers in addressing lifelong cancer prevention. In particular, pediatric providers can play an important role in HPV vaccination and tobacco prevention. In the case of HPV vaccination, the most important factor influencing parents’ decision to initiate the HPV vaccine series for their children is a strong provider recommendation. For tobacco prevention, screening and counseling from a healthcare provider is an evidence-based intervention to reduce the risk of smoking initiation. There is much need for HPV vaccine and tobacco prevention services in the larger Houston are, a geographic area that encompasses Harris and seven surrounding counties. Houston, the fourth most populous city in the U.S., also has one of the highest uninsured rates in the nation. HPV-associated cervical cancer risk is concentrated in poorly insured, income-unequal areas and its incidence is 30% higher in Houston compared to the U.S. Tobacco use shows similar patterns. While Houston has an overall current smoking prevalence of 13%, smokers are largely concentrated in medically under-resourced areas, where smoking prevalence remains above 23%. This is set to increase as use of e-cigarettes among adolescents has risen over the past ten years, threatening to set back decades of public health progress against tobacco use in youth. Overall Project Strategy We currently have a CPRIT prevention services grant to implement and evaluate an HPV vaccination program and a comprehensive tobacco screening, counseling, and referral program within Harris Health System in Houston, Texas, the third largest safety net health system in the U.S. Our program is targeted to healthcare providers, parents, and pediatric patients ages 11-18 years. Our program utilizes multi-level evidence-based strategies including provider education and training, practice facilitation, systems improvement, patient (parent) education, and patient reminder, recall, and navigation. Over the past five years, the program has led to markedly higher vaccine initiation and up to date (UTD) rates within the health system, which respectively increased between 2015 and 2021 from 72% to 87% and from 28% to 80%. For tobacco prevention, providers and staff in the system have undergone training in e-cigarette screening, counseling, and Quitline referral. E-cigarette language and educational materials have also been incorporated into the electronic health record (EHR), as has direct EHR-based referral to the Texas Quitline. In this continuation/expansion grant, we propose to leverage the infrastructure and strategies of our current program to expand the role of pediatric providers in cancer prevention, specifically by expanding our work to additional safety net clinics and health systems. These include Legacy Community Health, a federally qualified health center (FQHC) system that provides outpatient care for over 17,100 adolescent patients and operates 15 community and 35 school-based clinics serving pediatric patients; as well as Community Health Network, an FQHC that serves the southeastern counties around Harris County. We will also sustain and grow our successes at Harris Health by continuing to implement our program within the health system, a continued effort that is especially important given systems disruptions due to the COVID-19 pandemic. Specific Goals The specific goals of our program are: 1) To increase the proportion of pediatric patients who are up to date on HPV vaccination. 2) To increase the delivery of comprehensive tobacco (including e-cigarette) screening, counseling, referral, and treatment to pediatric patients. Significance and Impact The proposed project will significantly increase the proportion of adolescent patients within a network of safety net clinics who are protected against HPV- and tobacco-associated cancers. It will do so by dramatically improving HPV vaccination rates among patients seen at our new partner health systems in an expanded geographic area and sustaining the remarkably high HPV vaccination rates attained in our current partner health system. It will also strengthen our partner health systems’ tobacco prevention efforts for youth by expanding screening, counseling, referral, and treatment for e-cigarettes and other tobacco products. Finally, it will disseminate, expand, and further refine a successful, comprehensive model that can be used in other healthcare systems to engage pediatric providers in cancer prevention.
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