Grant Number:	5R37CA234119-05 Interpret this number
Primary Investigator:	Bednarczyk, Robert
Organization:	Emory University
Project Title:	TWEENVAX: a Comprehensive Practice-, Provider-, and Parent/Patient-level Intervention to Improve Adolescent HPV Vaccination
Fiscal Year:	2023

PROJECT SUMMARY/ABSTRACT Persistent human papillomavirus (HPV) infection is responsible for over 30,000 new cases of cancer annually in the United States (US). HPV infection can be prevented by immunization, but 12 years after being recommended for use, HPV immunization rates among US adolescents remain suboptimal. While uptake of other vaccines recommended for 11-12 year-olds is at or near 90%, only 43% of adolescent boys and girls are up-to-date for HPV vaccination. Prior efforts to improve HPV vaccine uptake have followed standard best practices for immunization programs, including education provision for parents and adolescent patients, and Health Belief Model-inspired appeals to disease severity. One key barrier to improving HPV vaccine uptake is that healthcare providers often do not recommend this vaccine with the same strength as they do for other adolescent vaccines. Continued low uptake of HPV vaccine indicates that new systems-level approaches, beyond standard public health education campaigns, are needed. These systems-level approaches – incorporating the healthcare practice and provider as well as the patient - must be designed and packaged in a way to address the quality of, and context around, provider recommendations. Our research team has developed and pilot-tested an intervention package – TweenVax – designed to improve HPV vaccine uptake at the practice-, provider-, and patient/parent-level. Evaluation of TweenVax identified key elements for expansion to improve the provision and strength of provider recommendations. Gaps remain in terms of how best to address missing or substandard provider recommendations, including addressing moment-to-moment patient and data flow and various points of intervention during the clinic visit including desk check-in through clinical examination and vaccination and follow-up appointment scheduling. Enhancements to the TweenVax intervention will include improvements in practice-level communication in the context of patient flow and additional training for non-clinical staff, development of enhanced training modules for clinical staff, including interactive experiential training and provision of continuing education credits, and updates to the content and presentation of the TweenVax tablet- and web-based educational program. The proposed multi-phase study will 1) assess, using ethnographic observations and in-depth interviews, both best practices and deficiencies in all clinical aspects of the adolescent healthcare encounter, with findings used to refine existing intervention tools to improve HPV vaccination of 11-12 year-olds; and 2) evaluate the efficacy of our comprehensive intervention in improving HPV vaccine uptake among 11-12 year-old girls and boys in Georgia and Tennessee. This assessment, through a three-arm trial, will provide the opportunity to assess the efficacy of the intervention package as a whole, as well as to determine the efficacy of individual components (e.g. practice-/provider-level components independent of patient/parent-level components).




The Continued Risk of Measles Outbreaks in the United States Resulting From Suboptimal Vaccination Coverage.
Authors: Bednarczyk R.A. , Sundaram M.E. .
Source: Public Health Reports (washington, D.c. : 1974), 2025-01-03 00:00:00.0; , p. 333549241306608.
EPub date: 2025-01-03 00:00:00.0.
PMID: 39749889
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Changes in general and COVID-19 vaccine hesitancy among U.S. adults from 2021 to 2022.
Authors: Nguyen K.H. , Chung E.L. , McChesney C. , Vasudevan L. , Allen J.D. , Bednarczyk R.A. .
Source: Annals Of Medicine, 2024 Dec; 56(1), p. 2357230.
EPub date: 2024-05-30 00:00:00.0.
PMID: 38813804
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Prior COVID-19 Diagnosis, Severe Outcomes, and Long COVID among U.S. Adults, 2022.
Authors: Nguyen K.H. , Bao Y. , Chen S. , Bednarczyk R.A. , Vasudevan L. , Corlin L. .
Source: Vaccines, 2024-06-17 00:00:00.0; 12(6), .
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The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study.
Authors: Kumsa F.A. , Fowke J.H. , Hashtarkhani S. , White B.M. , Shrubsole M.J. , Shaban-Nejad A. .
Source: Arxiv, 2024-05-28 00:00:00.0; , .
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COVID-19 Diagnosis, Severity, and Long COVID Among U.S. Adolescents, National Health Interview Survey, 2022.
Authors: Nguyen K.H. , Chen S. , Bao Y. , Lu Y. , Bednarczyk R.A. , Vasudevan L. .
Source: American Journal Of Health Promotion : Ajhp, 2024 May; 38(4), p. 534-539.
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Novel, Granular Methods to Monitor Vaccine Uptake and Associated Factors Within States.
Authors: Bednarczyk R.A. .
Source: American Journal Of Public Health, 2024 Apr; 114(4), p. 359-360.
EPub date: 2024-02-22 00:00:00.0.
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Child and adolescent COVID-19 vaccination coverage by educational setting, United States.
Authors: Nguyen K.H. , McChesney C. , Rodriguez C. , Vasudevan L. , Bednarczyk R.A. , Corlin L. .
Source: Public Health, 2024 Apr; 229, p. 126-134.
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Vaccination patterns and up-to-date status of children 19-35 months, 2011-2021.
Authors: Nguyen K.H. , Chen S. , Zhao R. , Vasudevan L. , Beninger P. , Bednarczyk R.A. .
Source: Vaccine, 2024-03-07 00:00:00.0; 42(7), p. 1617-1629.
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Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021.
Authors: Nguyen K.H. , Zhao R. , Chen S. , Vaish A.K. , Bednarczyk R.A. , Vasudevan L. .
Source: American Journal Of Epidemiology, 2024-01-08 00:00:00.0; 193(1), p. 121-133.
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The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study.
Authors: Kumsa F.A. , Fowke J.H. , Hashtarkhani S. , White B.M. , Shrubsole M.J. , Shaban-Nejad A. .
Source: Frontiers In Oncology, 2024; 14, p. 1343070.
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Descriptive epidemiology of age at HPV vaccination: Analysis using the 2020 NIS-Teen.
Authors: Bednarczyk R.A. , Brandt H.M. .
Source: Human Vaccines & Immunotherapeutics, 2023-12-31 00:00:00.0; 19(1), p. 2204784.
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Human papillomavirus vaccination at the first opportunity: An overview.
Authors: Bednarczyk R.A. , Brewer N.T. , Gilkey M.B. , Zorn S. , Perkins R.B. , Oliver K. , Saslow D. .
Source: Human Vaccines & Immunotherapeutics, 2023-12-31 00:00:00.0; 19(1), p. 2213603.
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Exclusive and dual influenza and COVID-19 vaccination among U.S. adults and adolescents in 2021.
Authors: Nguyen K.H. , Zhao R. , Chen S. , Bednarczyk R.A. .
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Disparities in child and adolescent COVID-19 vaccination coverage and parental intent toward vaccinations for their children and adolescents.
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Digital Personal Health Coaching Platform for Promoting Human Papillomavirus Infection Vaccinations and Cancer Prevention: Knowledge Graph-Based Recommendation System.
Authors: Ammar N. , Olusanya O.A. , Melton C. , Chinthala L. , Huang X. , White B.M. , Shaban-Nejad A. .
Source: Jmir Formative Research, 2023-11-15 00:00:00.0; 7, p. e50210.
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An effective vaccine is only the first step: the need to create and sustain demand for TB vaccines.
Authors: Nelson K.N. , Shah N.S. , Cranmer L.M. , Vasudevan L. , Bednarczyk R.A. .
Source: The International Journal Of Tuberculosis And Lung Disease : The Official Journal Of The International Union Against Tuberculosis And Lung Disease, 2023-10-01 00:00:00.0; 27(10), p. 718-720.
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Trends in vaccination schedules and up-to-date status of children 19-35 months, United States, 2015-2020.
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Source: Vaccine, 2023-01-09 00:00:00.0; 41(2), p. 467-475.
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Exploring celebrity influence on public attitude towards the COVID-19 pandemic: social media shared sentiment analysis.
Authors: White B.M. , Melton C. , Zareie P. , Davis R.L. , Bednarczyk R.A. , Shaban-Nejad A. .
Source: Bmj Health & Care Informatics, 2023 Jan; 30(1), .
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Fine-tuned Sentiment Analysis of COVID-19 Vaccine-Related Social Media Data: Comparative Study.
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Source: Journal Of Medical Internet Research, 2022-10-17 00:00:00.0; 24(10), p. e40408.
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Toward a Deeper Understanding of the Spectrum of Parental Human Papillomavirus Vaccine Hesitancy.
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Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries.
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U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents: an exploration of practice-, provider-, and patient-level influences.
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Understanding the Factors Influencing Health Care Provider Recommendations about Adolescent Vaccines: A Proposed Framework.
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U.S. Vietnamese Mothers' HPV Vaccine Decision-Making for Their Adolescents: A Qualitative Study.
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Healthcare professionals' perceptions and recommendations regarding adolescent vaccinations in Georgia and Tennessee during the COVID-19 pandemic: A qualitative research.
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Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations.
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Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic.
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Experience and lessons learned from multi-modal internet-based recruitment of U.S. Vietnamese into research.
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A Digital Personal Health Library for Enabling Precision Health Promotion to Prevent Human Papilloma Virus-Associated Cancers.
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