title: Increasing human papillomavirus vaccine initiation among publicly insured Florida adolescents.
abstract: OBJECTIVE
  We evaluated the feasibility of a multilevel intervention to increase the human papillomavirus (HPV) vaccine initiation among adolescents.
  
  
  METHODS
  We used a four-arm factorial, quasi-experimental trial to assess feasibility and short-term, preliminary effectiveness of a health system-level, gender-specific postcard campaign and an in-clinic health information technology (HIT) system. Between August and November 2013, we tested the intervention among 11- to 17-year-olds without prior HPV vaccine claims in the Florida Medicaid or Children's Health Insurance Program encounters (2,773 girls and 3,350 boys) who attended or were assigned to primary care clinics in North Central Florida.
  
  
  RESULTS
  At least one postcard was deliverable to 95% of the parents. Most parents (91% boys' and 80% girls') who participated in the process evaluation survey (n = 162) reported seeking additional information about the vaccine after receiving the postcard. Only 8% (57 of 1,062) of the adolescents assigned to a HIT provider with an office visit during the study used the HIT system. When compared with arms not containing that component, HPV vaccine initiation increased with the postcard campaign (girls, odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.3 and boys, not significant), the HIT system (girls, OR = 1.5; 95% CI = 1.0-2.3 and boys, OR = 1.4; 95% CI = 1.0-2.0), and the combined HIT and postcard intervention (girls, OR = 2.4; 95% CI = 1.4-4.3 and boys, OR = 1.6; 95% CI = 1.0-2.5).
  
  
  CONCLUSIONS
  A system-level postcard campaign was feasible. Despite low recruitment to the in-clinic HIT system, the intervention demonstrated short-term, preliminary effectiveness similar to prior HPV vaccine interventions.
authors: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida. Electronic address: sstaras@ufl.edu.
authors: Stephanie A S
authors: SA
authors: Staras
authors: Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida.
authors: Susan T
authors: ST
authors: Vadaparampil
authors: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida.
authors: Melvin D
authors: MD
authors: Livingston
authors: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida.
authors: Lindsay A
authors: LA
authors: Thompson
authors: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida.
authors: Ashley H
authors: AH
authors: Sanders
authors: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida.
authors: Elizabeth A
authors: EA
authors: Shenkman
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D002648:Child; D005260:Female; D005431:Florida; D006293:Health Promotion / Q000379:methods; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011177:Postal Service; D011203:Poverty; D011634:Public Health / Q000379:methods; D013221:State Health Plans
chemical_list: D053918:Papillomavirus Vaccines
keywords: Florida; HPV vaccine; Health information technology; Intervention; Medicaid and CHIP; Reminders