title: Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.
abstract: OBJECTIVE
  Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11-12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys.
  
  
  METHODS
  We targeted parents and providers of 9-13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered.
  
  
  RESULTS
  The Cox model showed an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11-12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously.
  
  
  CONCLUSIONS
  Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.
authors.affiliation: School of Journalism and Mass Communication, University of North Carolina at Chapel Hill, Campus Box 3365, Chapel Hill, NC 27599-3365, United States. Electronic address: JoanCates@unc.edu.
authors.forename: Joan R
authors.initials: JR
authors.lastname: Cates
authors.affiliation: NC TraCS Institute, Community Academic Resources for Engaged Scholarship (CARES), Home of the UNC Clinical and Translational Science Awards (CTSA), University of North Carolina at Chapel Hill, CB# 7064, Chapel Hill, NC 27599-7064, United States. Electronic address: diehl@unc.edu.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Diehl
authors.affiliation: School of Nursing and Department of Biostatistics, University of North Carolina at Chapel Hill, 2011 Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States. Electronic address: jbigelow@unc.edu.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Crandell
authors.affiliation: NC Child Health Research Network, Community Engagement NC TraCS Institute - Child Health Core Home of the UNC-CH Clinical and Translational Science Awards (CTSA), United States; Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, CB # 7225, 231 MacNider, Chapel Hill, NC 27599, United States. Electronic address: tamera_coyne-beasley@med.unc.edu.
authors.forename: Tamera
authors.initials: T
authors.lastname: Coyne-Beasley
mesh_terms: D000293:Adolescent; D002648:Child; D006282:Health Personnel; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010290:Parents; D016016:Proportional Hazards Models; D040241:Social Marketing; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescent immunization; HPV vaccine; Preteen boys; Social marketing