title: A community-based intervention in middle schools to improve HPV vaccination and cervical cancer screening in Japan.
abstract: OBJECTIVE
  Japan has low rates of cervical cancer screening and Human papilloma virus (HPV) vaccination. This research examines the effectiveness of a family medicine resident-led, intervention in increasing knowledge about HPV and cervical cancer in middle school-girls and increasing knowledge and intention to have cervical cancer screening in their mothers.
  
  
  METHODS
  We utilized a pre-test/post-test intervention design in three rural middle schools with 7(th) grade middle school-girls and their mothers. A school-based activity educated girls about HPV and cervical cancer. A home-based activity utilized a homework assignment for girls and their mothers. Pre/post intervention surveys were completed by the girls and their mothers. Major outcomes included changes in knowledge among girls and mothers and barriers to be screened for cervical cancer among mothers.
  
  
  RESULTS
  Sixty-five students and sixty-three mothers completed the study. Two out five mothers were not in compliance with current screening recommendations. Identified barriers included: embarrassment (79%), poor access (56%), fear of having cancer (52%), and cervical cancer screening being an unknown procedure (46%). Forty-four percent of mothers deemed their daughters to be at risk for cervical cancer. Trusted sources of information included: doctors (97%), newspapers/television (89%), government (79%), the Internet (78%), and friends (62%). Student knowledge scores (7-point scale) improved significantly from pre- to post-intervention (4.8 vs. 5.9, p < 0.001). Knowledge scores (14-point scale) among mothers also significantly improved (11.7 vs. 12.0, p = 0.024).
  
  
  CONCLUSIONS
  These data suggest a community-based intervention on a sensitive topic by family medicine residents can be implemented in middle schools, can improve school-girls' knowledge about HPV and cervical cancer, and can reach their mothers. Additional research could examine whether those intending to be screened receive screening and how to reach women who still resist screening.
authors.affiliation: Shiga Center for Family Medicine, 1825 Yuge, Ryuo, Gamo District, Shiga Prefecture, 520-2501 Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ito
authors.affiliation: Shizuoka Family Medicine Program, Shizuoka, Japan ; Mori Machi Family Medicine Clinic, 387-1 Kusagaya, Mori, Shuchi District, Shizuoka Prefecture, 437-0214 Japan.
authors.forename: Remi
authors.initials: R
authors.lastname: Takenoshita
authors.affiliation: Shizuoka Family Medicine Program, Shizuoka, Japan ; Department of Obstetrics, Gynecology and Family Medicine, Hamamatsu University, School of Medicine, Hamamatsu, Shizuoka Japan ; Mori Machi Family Medicine Clinic, 387-1 Kusagaya, Mori, Shuchi District, Shizuoka Prefecture, 437-0214 Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Narumoto
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Plegue
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey USA.
authors.forename: Benjamin Franklin
authors.initials: BF
authors.lastname: Crabtree
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan USA.
authors.forename: Michael Derwin
authors.initials: MD
authors.lastname: Fetters
keywords: Early detection of cancer; Intervention; Japan; Papillomavirus vaccines; Vaccination