Need: Women in the Lower Rio Grande Valley (LRGV) experience higher incidence and mortality from cervical cancer compared to the state and nation. Prevention of cervical cancer is possible through use of two vaccines (a bivalent and a quadrivalent vaccine), which protect against two strains of HPV (16, 18) that cause 70% of cervical cancer cases. The vaccine is recommended for women/men (aged 18-26) and girls/boys (aged 11-17).

A smaller proportion of Hispanic girls in Texas aged 13-17 compared to Hispanic girls nationwide initiate the vaccine series (57% vs. 63%), and fewer receive all three doses (31% vs 36%). This proportion falls short of the Healthy People 2020 target of 80% of girls ag...

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Need: Women in the Lower Rio Grande Valley (LRGV) experience higher incidence and mortality from cervical cancer compared to the state and nation. Prevention of cervical cancer is possible through use of two vaccines (a bivalent and a quadrivalent vaccine), which protect against two strains of HPV (16, 18) that cause 70% of cervical cancer cases. The vaccine is recommended for women/men (aged 18-26) and girls/boys (aged 11-17).

A smaller proportion of Hispanic girls in Texas aged 13-17 compared to Hispanic girls nationwide initiate the vaccine series (57% vs. 63%), and fewer receive all three doses (31% vs 36%). This proportion falls short of the Healthy People 2020 target of 80% of girls aged 13-15 receiving all three doses. Further, although U.S. vaccination rates in boys have only been reported since 2010, early indications suggest that only 13% of U.S. Hispanic males age 13-17 have completed the vaccine series, compared to just 10% of males in Texas. Infrequent healthcare visits, missed opportunities for vaccination during urgent visits, lacking health insurance and/or a usual source of care, have been identified as barriers to receiving timely vaccinations. Our program uses the following outreach and education strategies to overcome these barriers: promotoras (lay community members trained to deliver health messages to parents/caregivers and adolescents), netbooks, and collaborations with local community organizations and clinics.

The proposed project is an expansion of Entre Madre e Hija (EMH), a CPRIT-funded (2011-2013) cervical cancer prevention and outreach program delivered by promotoras and student peer educators to Hispanic women and their daughters from Hidalgo and Cameron counties in the LRGV. Promotoras provided health education, referrals, and navigation support for HPV vaccination to enrolled women if their daughter had never been vaccinated or had not completed the vaccine series. Implemented at three local Community Resource Centers (CRCs; 2 in Hidalgo and 1 in Cameron), promotoras delivered group health education sessions to women. Promotoras also provided referrals and navigation for women who requested assistance with vaccination appointments for their daughters.

For the proposed project, we will continue to use promotoras to deliver a tailored version of the EMH program to Hispanic families and provide referrals and navigation support (e.g., vaccine reminders). Promotoras will provide health education sessions to adult Hidalgo County residents in two formats: group with a flipchart or one-on-one with a print brochure. Our new partner, Nuestra Clínica del Valle, will also provide vaccinations to our program participants, lists of vaccine eligible clinic patients to promotoras for recruitment purposes, and reports of vaccine status from medical charts for program participants. We will not only expand our population to include 11-17 year old Hispanic boys and male caregivers of the adolescents, but also our service area to include additional cities, CRCs, and clinic locations within Hidalgo County.

The overall goal of the proposed project is to increase HPV immunization rates (initiation and completion) using public education and clinic in-reach strategies (e.g., patient lists) among Hispanic adolescent males and females in NCDV clinics within Hidalgo County. From 8/2014 to 8/2016, we estimated (1) reaching 3,000 Hispanic adult residents of Hidalgo County through outreach; (2) educating 1,500 adult residents of Hidalgo County using EMH’s evidence-based education sessions; (3) meeting or exceeding Texas’ vaccine initiation (33%) and completion (10%) rates for males; and (4) meeting the vaccine initiation (88%) and completion (46%) rates for girls exposed to the initial EMH program.

By increasing vaccine initiation and completion, this program has the potential to reduce cervical cancer incidence and mortality among Hispanic women in Texas’ LRGV. If the program is successful in increasing knowledge and immunization uptake, this model can be exported to other high-risk populations in South Texas and other largely populated Latino areas in Texas.

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