Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial.
OBJECTIVE
Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects.


METHODS
Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity.


RESULTS
Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45).


CONCLUSIONS
Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms).
University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas; jasmin.tiro@utsouthwestern.edu.
Jasmin A
JA
Tiro
University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;
Joanne M
JM
Sanders
University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;
Sandi L
SL
Pruitt
Rand Corporation, Arlington, Virginia; and.
Clare Frey
CF
Stevens
University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;
Celette Sugg
CS
Skinner
University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;
Wendy P
WP
Bishop
Parkland Health and Hospital System, Dallas, Texas.
Sobha
S
Fuller
Parkland Health and Hospital System, Dallas, Texas.
Donna
D
Persaud
D000293:Adolescent; D001741:Black or African American; D002648:Child; D005260:Female; D006266:Health Education; D006293:Health Promotion; D006630:Hispanic or Latino; D006801:Humans; D053918:Papillomavirus Vaccines; D064876:Safety-net Providers; D014611:Vaccination / Q000706:statistics & numerical data*; D044465:White People
D053918:Papillomavirus Vaccines