title: Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls.
abstract: Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates.
  
  
  
  We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N = 24) and 119 providers from these clinics were also recruited. The primary outcome was medical record-confirmed receipt of the first shot of the HPV vaccine 3 months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge.
  
  
  
  According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within 3 months of being sent the intervention materials compared with 4 (3.2%) daughters of comparison group participants (P = 0.061). By 6 months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared with eight (6.5%) daughters of comparison group participants (P = 0.002). Provider knowledge about HPV increased (P < 0.001, from baseline to after education).
  
  
  
  The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years; however, uptake was low.
  
  
  
  To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed. Cancer Epidemiol Biomarkers Prev; 25(4); 593-602. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio. electra.paskett@osumc.edu.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Krok-Schoen
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pennell
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Tatum
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Reiter
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Juan
authors.initials: J
authors.lastname: Peng
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Bernardo
authors.affiliation: Partners for Kids, Columbus, Ohio.
authors.forename: Rory C
authors.initials: RC
authors.lastname: Weier
authors.affiliation: Department of Neurology, College of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Morgan S
authors.initials: MS
authors.lastname: Richardson
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines