Grant Number:	3R01CA268014-04S1 Interpret this number
Primary Investigator:	Staras, Stephanie
Organization:	University Of Florida
Project Title:	REMARK: a Multi-Level Strategy to Address Disparities in Rural HPV-Related Cancer Prevention
Fiscal Year:	2026

Worldwide, an estimated 38% of cancers are attributable to modifiable behavioral factors, with 10% attributable to preventable infections. A major contributor to the infection-attributable cancers is human papillomavirus (HPV), which causes nearly 50,000 cancers each year in the US, including cancers of the cervix, oropharynx, vulva, vagina, anus, or penis. Two effective prevention options are available: (1) HPV vaccines that prevent HPV infections and related cancers and (2) cervical cancer screening that prevents cancer by detecting high-risk HPV types or cervical pre-cancers and finds cancers earlier enabling more treatment options. Rural areas, like the 23 Florida counties included in the parent study, ReMARk, are at especially high risk of these cancers with low prevention uptake and demonstrated high cancer incidence. In most studies, the wide variety of social contexts influencing cancer prevention that occur within communities is masked by county-level estimates of HPV vaccination, and cervical cancer screening, and cancer incidence. A logical next step in reducing HPV-related cancers is to identify smaller geographic areas with the greatest burden and unmet need to efficiently allocate prevention resources. Building off the cancer prevention uptake data collected for the 23 rural counties in ReMARk, the overall goal of this proposal is to identify neighborhoods (i.e., census tracts) with the highest cancer risk and burden as well as evaluate the benefit of our enhanced methods. The specific aims are: (1) Estimate census tract–level HPV vaccination rates and quantify the extent to which county-level aggregation masks within-county geographic heterogeneity in vaccination in the 23 ReMARk rural, northern Florida counties; (2) Evaluate whether census tract–level HPV-related cancer profiles using three metrics—vaccination, cervical cancer screening, and HPV-related cancer incidence—better capture geographic variation and improve prevention planning than two-metric profiles: vaccination and incidence or screening and incidence. This proposed research is significant because it will enable improved targeting and tailoring of public health resources at the neighborhood level within the 23 rural Florida ReMARk counties, as well as guide researchers in other states to enhance monitoring and accelerate progression in cancer prevention. Our project is innovative in addressing the limited availability of census tract-level data rather than relying on county-level summaries, harnessing medical record data rather than relying on surveys for cervical cancer screening, and considering all three rather metrics (HPV vaccination, cervical cancer screening, and cancer incidence). The proposed project will build evidence on geographic areas where cancer prevention is most needed.





None. See parent grant details.