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TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

Human papillomavirus (HPV) vaccine uptake remains below the Healthy People 2030 goal of 80% series completion in the United States. Parental concerns about the efficacy and safety of the vaccine remain and may be addressed by digital interventions tailored to their concerns.

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, led a large study supported by the National Cancer Institute to increase HPV vaccination among adolescent boys . The results of the study have been published in the Journal of Adolescent Health. Specifically, the paper reports on the purpose, methods, and effectiveness of TeenVac, a mobile app to encourage HPV vaccination in families with adolescent boys.

A randomized trial was conducted between May 2019 and December 2020, testing the mobile web app (teenvac.org) that encouraged HPV vaccination for parents and sons aged 11–14 years old. Parents and 209 adolescent sons were randomized to receive either the TeenVac app or the Centers for Disease Control and Prevention (CDC) HPV vaccination pamphlet online. Participants had access to the TeenVac app or the CDC pamphlet for the 9-month study duration. Adolescent sons’ vaccination records were collected from the state vaccine registry at the end of the study.

Intent-to-treat and web usage analyses were conducted. Intent-to-treat analyses found that adolescent sons of parents randomized to the TeenVac app were significantly more likely to complete the HPV vaccination series than those randomized to the CDC pamphlet group. Web usage analysis confirmed that the TeenVac group parents who used the web app were significantly more likely to have sons complete the HPV vaccination series than those in the CDC pamphlet group.

The TeenVac app meaningfully impacted HPV vaccine series completion, particularly among parents who used the web app. The results provide further evidence that digital interventions can improve vaccine uptake when focused on parents’ and sons’ vaccine-related concerns.

This research was supported by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s coauthors include Dr. Gregory Zimet from Indiana University; Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Jennyfer Reither from Denver Health Hospital; and Dr. David Buller, Lila Martinez, Marita Brooks, and Noah Chirico from Klein Buendel.

KB Scientists Present HPV Vaccination Research

KB Scientists Present HPV Vaccination Research

Two Klein Buendel scientists presented HPV vaccination research at the 36th International Papillomavirus Conference in Edinburgh, Scotland, November 12-15, 2024.

Poster 1

Title: HPV Vaccine Uptake Improvement for Adolescent Boys via a Mobile Web App:  TeenVac.org

Presenter: W. Gill Woodall, PhD

Authors: W. Gill Woodall, PhD; David Buller, PhD; Gregory Zimet PhD; Alberta Kong, MD, MPH; Jeannyfer Reither, MS; Lance Chilton, MD; Lila Martinez; Marita Brooks, MS; Noah Chirico, MPH; Tamar Ginnosar, PhD

Dr. Gill Woodall

Human Papillomavirus (HPV) vaccine uptake remains below the U.S. national goal of 80% series completion. Parental concerns and misinformation about the HPV vaccine’s efficacy and safety remain and may be addressed by digital interventions tailored to their concerns.

Based on a previous intervention focused on parents and adolescent daughters, a randomized controlled trial was conducted testing a mobile web app (TeenVac.org) for parents and their adolescent sons (ages 11-14 years), responsive to their concerns and encouraging HPV vaccination. Two hundred nine (209) participants were randomized to receive either the TeenVac app (n=100) or the standard CDC HPV vaccination pamphlet (n=109) online. Adolescent sons’ vaccination records were collected from the New Mexico vaccine registry at the end of the study.

Intent-to-treat and web usage analyses were conducted. Intent-to-treat analyses found that adolescent sons of parents who were randomized to the TeenVac app were significantly more likely to complete the HPV vaccination series than the CDC pamphlet comparison group. Web usage analysis determined that those parents in the TeenVac group who used the web app were significantly more likely to complete the HPV vaccination series than those in the CDC pamphlet group. Modules focused on nature of HPV, the vaccine, and who recommends it were most used, with average durations ranging from 84 to 122 seconds.

The TeenVac app had a meaningful impact on HPV vaccine shot completion, particularly among parents who used the web app. The study trial’s recruitment and implementation were affected by the COVID-19 pandemic, with 86% of parent-adolescent pairs recruited during this period. Despite these challenges, the results provide further evidence that digital interventions can improve vaccine uptake when focused on parents and sons’ vaccine-related concerns.

This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators were from the University of New Mexico, Indiana University, and Klein Buendel.

Poster 2

Title: Development of Social Media Posts Promoting HPV Vaccination to Emerging Adults in Rural Communities of the united States

Presenter: David Buller, PhD

Authors: David Buller, PhD; Andrew Sussman, PhD; Echo Warner, PhD; Alishia Kinsey; W. Gill Woodall, PhD; Deanna Kepka, PhD; Barbara Walkosz, PhD; Julia Berteletti, MSW; Annelise Small; Dolores Guest, PhD; John Torres

Dr. David Buller

HPV-related cancers are increasing in rural areas of the United States and HPV vaccination rates of emerging adults are low. A social media campaign promoting HPV vaccine uptake, along with five other cancer risk-reduction behaviors, is being developed for emerging adults aged 18-26 living in rural counties in the western United States. Campaign posts were pilot-tested with emerging adults (n=188) in surveys on appropriateness, relevance, and trustworthiness and likelihood of engaging with them (such as read, scroll past, react [such as like, sad, etc.], comment, and click on a shared link). Also, emerging adults (n=26) were enrolled in a 4-week study where they received HPV vaccination posts in a Facebook private group and engagement (such as views, reactions, comments) was recorded.

Initially, 36 posts on HPV vaccination were developed addressing simplicity, benefits, response efficacy/cost, self-efficacy/perceived control, cancer risk perceptions, norms, relatedness, compatibility with goals/values, and intrinsic/extrinsic motivation. Posts debunked common misinformation on HPV vaccines, stressed that unvaccinated emerging adults should get vaccinated, and advised emerging adults on how to discuss HPV vaccination with family and friends. Emerging adults evaluated seven HPV vaccination posts in the surveys and rated them as appropriate, relevant, and trustworthy. Two-thirds of emerging adults said they would read the posts, but also might scroll past them. Over one-third would click on a shared link or leave a reaction, but few would comment. In the 4-week study, seven HPV vaccination posts received 115 views, 26 reactions, and 2 comments (both positive).

Social media is a primary health information source for young adults. Posts promoting HPV vaccination based on health behavior theories can reach and engage emerging adults with HPV vaccine-supportive messaging. The HPV posts will be included in a cancer prevention campaign evaluated in a randomized trial enrolling 1000 emerging adults in 2025.

This research was funded by a grant from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Collaborators were from the University of New Mexico Comprehensive Cancer Center, the University of Utah Huntsman Cancer Institute, and Klein Buendel.

Klein Buendel Opens a Second Location

Klein Buendel Opens a Second Location

Klein Buendel is pleased to announce the opening of its first satellite location in New Mexico. The new Albuquerque office will house Klein Buendel Senior Scientist Dr. Gill Woodall and a small staff, to conduct multiple health communication and behavior research projects with people in New Mexico and Texas.

The Vacteens project aims to raise the public health profile of human papillomavirus (HPV), increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers. The objectives of the project are to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine. This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators include Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller from Klein Buendel.

B-SMART is a project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members. Using smartphone web app technology, B-SMART teaches coping skills, communication skills, and strategies to help deter Driving While Impaired (DWI). Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator) through the Small Business Innovation Research Program (SBIR). Collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico; Dr. Gary Cutter from Pythagorus, Inc. in Alabama; and Julia Berteletti from Klein Buendel.

WayToServe Espanol: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers is a redesign of WayToServe®, an evidence-based training to promote responsible alcohol beverage service (RBS). WayToServe Espanol was created after discovering current RBS training had not been tailored to address Spanish-speaking populations that represent disproportionately high rates of alcohol-related injury and death in the United States. This project promotes a culturally and linguistically adapted RBS training for Spanish-speaking servers, and changes to organizational and community norms because preventing alcohol-related injury and death is a national priority. This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. Gill Woodall, Principal Investigator) through the SBIR. Collaborators include Dr. Victoria Sanchez from the University of New Mexico Health Sciences Center; and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.

BeVaccinated Web App Usability Testing

BeVaccinated Web App Usability Testing

Dr. W. Gill Woodall from Klein Buendel and the University of New Mexico presented findings from the BeVaccinated project at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018. The project tested the usability of a prototype web app for improving adolescent vaccination uptake.

While vaccination rates for young children in the U.S. currently meet recommended standards, the CDC reports adolescent vaccines uptake (Gardasil 9 for HPV, MCV4 for meningococcal infection, Tdap for Tetanus, Diptheria and Pertussis protection, and Varicella vaccine for Chickenpox protection) to be less than optimal. In the case of the Human Papillomavirus (HPV) vaccine, rates are seriously below desired uptake levels. Despite established safety and effectiveness information about these vaccinations, and a wide variety of medical organizations recommending them, parents continue to have concerns about them, particularly the HPV vaccine.

For health communication researchers focused on Diffusion of Innovations, this is a classic difficulty of lack of effective messaging to prompt the uptake of an innovation by closing a knowledge gap among parents, in this case, on effective adolescent vaccines. The CDC and the Presidents Cancer Panel call for the development of effective and accessible messaging to improve vaccine decision-making as well as uptake. Because parents drive the decision to, and action for, vaccine uptake, messaging should be focused on them, but not exclusively, as there are benefits from parents and adolescents communicating about vaccines specifically and health issues generally. Approaching the vaccines as a recommended adolescent vaccine panel instead of each vaccine singularly may provide adoption benefit, as a vaccine panel approach builds the normative expectation for getting all adolescent vaccines as a group.

To address this vaccine uptake deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via a smartphone. The majority of adults of parenting age own smartphones and use them to access online information, especially minority adults, and use mobile apps for information acquisition and decision support, making them a potentially efficacious channel for delivering vaccine information and tools. The prototype app was developed via formative research with focus group participants and guided by an Expert Advisory Board (EAB) comprised of vaccination experts and clinicians. Usability testing was conducted iteratively with nine parent and teen pairs in New Mexico and seven parent and teen pairs in Colorado. Pairs were comprised of one teen, ages 13-17, and their accompanying parent or guardian.

Usability testing was conducted individually with the parent and teen by trained research staff. Parents and teens reported that the prototype app was easy to use. Users reported that they could learn to use it quickly and that they were confident using it. With feasibility established, the full version of the app will be designed to improve dissemination of vaccine information, improve parent/teen communication around health behavior choices, and ultimately, improve the uptake of vaccinations.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R41HD082901; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Julia Berteletti from KB; Dr. Randall Starling, Dr. Alberta Kong, and Dr. Lance Chilton from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. Nathan Stupiansky from the University of Arizona.