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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.

Collaborator Spotlight: Arizona Investigators on the #4Corners 4Health Project

Collaborator Spotlight: Arizona Investigators on the #4Corners 4Health Project

Thirteen scientists from universities and NCI Comprehensive Cancer Centers in Arizona, Colorado, New Mexico, and Utah are collaborating with Dr. David Buller, Klein Buendel’s Director of Research, on the #4Corners4Health study (CA268037). This Collaborator Spotlight features the Investigators from the State of Arizona.

The 4Corners study aims to aid rural emerging adults (ages 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and to help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically dispersed, underserved rural communities in the Mountain West.

Dr. Judith Gordon, Co-Investigator, University of Arizona

Judith S. Gordon, Ph.D., is a professor and Associate Dean for Research in the University of Arizona College of Nursing. She is also a professor in the University of Arizona Department of Family and Community Medicine. Dr. Gordon’s areas of expertise include public health tobacco cessation and vaping interventions delivered in dental and medical settings, self-help tobacco and vaping cessation programs, educational tobacco and vaping cessation programs for healthcare practitioners, computer-based tobacco and vaping prevention programs, multi-behavioral interventions to address weight, physical activity, and tobacco, the use of mobile apps for lifestyle change and medication adherence, and the use of guided imagery for tobacco cessation, lifestyle change, exercise motivation, and stress reduction. Dr. Gordon has been a Principal Investigator or Co-Investigator on more than 40 projects funded by the National Institutes of Health, the Department of Defense, and the Robert Wood Johnson Foundation. She has authored and co-authored numerous publications in peer-reviewed journals and has presented widely at national and international scientific conferences. She has served on several proposal review committees, editorial boards, and professional societies.

Dr. Meghan Skiba, Co-Investigator, University of Arizona

Dr. Meghan Skiba, PhD, MS, MPH, RDN, is an Assistant Professor in the College of Nursing Biobehavioral Health Science Division at the University of Arizona. She received her doctorate in Health Behavior Health Promotion from the Mel & Enid Zuckerman College of Public Health. She has additional formal graduate training in epidemiology and nutritional sciences, and completed post-doctoral training at Oregon Health & Science University. Dr. Skiba has extensive training in nutritional sciences, health promotion, behavior measurement, and epidemiology. The focus of her research is to connect cancer survivors and their caregivers to the tools and skills to live their healthiest life. She focuses on healthy aging, women’s health, rural populations, and dyadic health. She takes an integrative approach to research to understand the synergistic effects of nutrition, exercise, energetics, and bioactives and their roles in managing accelerated biological aging in cancer survivorship. She strives to build an innovative research program that incorporates analysis of large datasets, community-based participatory research methods, and sequential interventions to better understand and mitigate and the biological aging cascade in cancer.

Collaborator Spotlight: Utah Investigators on the #4Corners 4Health Project

Collaborator Spotlight: Utah Investigators on the #4Corners 4Health Project

Thirteen scientists from universities and NCI Comprehensive Cancer Centers in Arizona, Colorado, New Mexico, and Utah are collaborating with Dr. David Buller, Klein Buendel’s Director of Research, on the #4Corners4Health study (CA268037). This Collaborator Spotlight features the Investigators from the State of Utah.

The 4Corners study aims to aid rural emerging adults (ages 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically dispersed, underserved rural communities in the Mountain West.

Dr. Deanna Kepka, Co-Investigator, Huntsman Cancer Institute, University of Utah

Deanna Kepka, PhD, MPH, is a Huntsman Cancer Institute research investigator and a tenured Associate Professor in the College of Nursing. Dr. Kepka is dedicated to improving the quality of primary health care services for cancer prevention and control among underserved populations locally and globally. She has specific expertise in HPV vaccination, HPV-related cancer prevention, and health equity research. She is the founder and director of the Mountain West HPV Vaccination Coalition and the Director of Global and International Health in the College of Nursing.

As a Pre-Doctoral Biobehavioral Cancer Prevention and Control Fellow at the University of Washington and Fred Hutchinson Cancer Research Center, Dr. Kepka developed a rural-focused community-based HPV vaccination intervention that included fotonovela educational pamphlets and a radionovela. These educational tools improved knowledge and sparked interest in the HPV vaccine among rural Latino parents. She also received training in epidemiological and behavioral research methods as a National Cancer Institute Cancer Prevention Post-Doctoral Fellow. As a Fellow, she received the Cancer Prevention Fellowship Merit Award. In the years since, Dr. Kepka’s work has been recognized with 20 awards for excellence at the international, national, local levels.

Dr. Echo Warner, Co-Investigator, Huntsman Cancer Institute, University of Utah

Echo Warner, Ph.D., MPH, is an Associate Member of the Huntsman Cancer Institute and an Assistant Professor in the College of Nursing. Her research targets improving cancer health outcomes and reducing cancer health disparities among adolescent and young adult cancer patients, survivors, and care partners. Dr. Warner has experience with diverse patient populations and an extensive range of methods and analytical approaches, especially in mixed-methods study designs and data integration. Her research establishes methods to study social media and online health (mis)information to improve cancer information seeking online.

Dr. David Wetter, Co-Investigator, Huntsman Cancer Institute, University of Utah

David Wetter, Ph.D., M.S., is the distinguished Jon M. and Karen Huntsman Presidential Professor, Director of the Center for Health Outcomes and Population Equity (HOPE), Senior Director for Cancer Health Equity Science, and Associate Director for Practice Engagement and Translation at the Clinical and Translational Sciences Institute at the University of Utah and Huntsman Cancer Institute. His research focuses on promoting health equity in cancer and chronic disease through translational research. Specific research topics include (a) theoretical models of health risk behaviors; (b) the development and evaluation of theoretically-based interventions; and, (c) translational research to implement and disseminate those interventions in real world settings. His work addresses populations that have been historically marginalized, with a major focus on low socioeconomic status, rural/frontier, and diverse groups. Dr. Wetter has conducted an extensive portfolio of grants funded by the National Institutes of Health over 25 years. He has published nearly 300 peer-reviewed manuscripts. His research program has received awards from the Society of Behavioral Medicine, American Society for Preventive Oncology, Society for Health Psychology, and AstraZeneca/Scientific American.

Collaborator Spotlight: New Mexico Investigators on the #4Corners4Health Project

Collaborator Spotlight: New Mexico Investigators on the #4Corners4Health Project

More than a dozen scientists from universities and NCI Comprehensive Cancer Centers in Arizona, Colorado, New Mexico, and Utah are collaborating with Dr. David Buller, Klein Buendel’s Director of Research, on the #4Corners4Health study (CA268037). This Collaborator Spotlight features the Investigators from the State of New Mexico.

The 4Corners study aims to aid rural emerging adults (ages 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically dispersed, underserved rural communities in the Mountain West.

Dr. Andrew Sussman, Multiple Principal Investigator, University of New Mexico

Andrew Sussman, PhD, MCRP, is a medical anthropologist and an Associate Professor in the Department of Family Community Medicine and the  Associate Director for Community Outreach and Engagement at the University of New Mexico Comprehensive Cancer Center (Cancer Control and Population Sciences). At the Cancer Center, he served as the Founding Director of the Behavioral Measurement and Population Science Shared Resource.

Dr. Sussman has expertise in qualitative and mixed method research, formative assessment, and process evaluation. His research focuses on cancer care delivery research, patient-provider communication, clinical decision making, health service delivery, community-based participatory research, and health disparities in primary care and community settings. He has received funding to conduct research on cancer prevention, obesity and diabetes, substance use, and complementary and alternative medicine, among other topics.

In addition to research, he teaches and mentors students, and serves on several university committees, including evaluating the Physician Assistant Program in the Department of Family and Community Medicine and the Advancing Institutional Mentoring Excellence Program through the Office for Diversity.

Dr. Cindy Blair, Co-Investigator, University of New Mexico

Cindy Blair, MPH, PhD, is an epidemiologist and an Associate Professor in the Department of Internal Medicine at the University of New Mexico. She also has an appointment at the Comprehensive Cancer Center in Cancer Control and Population Sciences.

Dr. Blair’s research focuses on developing lifestyle behavior change interventions to improve the physical health and quality of life of cancer survivors. Her primary research interests include physical activity and the interface between aging and cancer, including interventions that utilize a whole-of-day approach to physical activity. This approach focuses on increasing light-intensity activity throughout the day, while reducing and disrupting sedentary activity. Her research includes the development of home- and technology-based interventions to reach the underserved and understudied survivor populations, especially older individuals from racial-ethnic minorities and rural dwellers, who may be unable to travel to clinical research centers to participate in research studies.

She has received a Career Development Award (K07) from the National Cancer Institute (2018-2023) and completed a Postdoctoral Research Fellowship (R25) with the National Cancer Institute Cancer Prevention and Control Training Program (2011-2013).

Indoor Tanning Policies Are Insufficient to Protect Young Adults

Indoor Tanning Policies Are Insufficient to Protect Young Adults

Ms. Anna Mitarotondo, a Research Program Manager from Rutgers University, gave a Research Spotlight presentation on the Indoor Tanning Policy research project at the 45th Annual Sessions and Meeting of the Society of Behavioral Medicine in Philadelphia, PA, March 13-16, 2024. Dr. Carolyn Heckman from Rutgers and Dr. David Buller from Klein Buendel are the project’s Multiple Principal Investigators.

Ms. Anna Mitarotondo, Rutgers University

Five million Americans are treated for skin cancer annually with the incidence of melanoma tripling in the last 40 years. Even a single session of indoor tanning is a well-established cause of melanoma especially at younger ages. Indoor tanning is also associated with sunburn, another major risk factor. In addition to FDA safety regulations, 46 states restrict minor indoor tanning access. More stringent laws (such as age bans vs. parental consent or no law) have been associated with less youth indoor tanning. However, enforcement and compliance are essential for successful law implementation. This study investigates regulation stringency, behavior, facility compliance, and sunburns.

The research team conducted an online, nationally representative survey of 1000 individuals aged 18-29 who indoor tanned in the last three years. 82% identified as female, and 74% as white, non-Hispanic. A majority (89%)  indoor tanned multiple times in the past three years. Participants reported being most likely to tan in indoor tanning salons, gyms, and beauty salons. They also reported indoor tanning in homes, spas, and apartment complexes, with participants indoor tanning in more types of facilities after age 18. Despite FDA recommendations, participants reported that only 16% of facilities prohibited daily or unlimited tanning. Nearly half (48%) of participants were not informed of time limits when indoor tanning. Half (50%) reported that over half of the time, they were able to avoid indoor tanning facility rules. Nearly two-thirds (61%) of participants reported burning from an indoor tanning device in the past three years, with 15% reporting a burn from their most recent session. Of participants who reported indoor tanning as minors, 61% reported burns and 30% reported getting medical attention.

This is the first study to show rates of indoor tanning at facilities other than tanning salons, both before and after age 18, in a representative national sample. Participants reported insufficient facility compliance with, and enforcement of, indoor tanning regulations, which in some cases may have led to severe burns. Analyses are underway to further investigate regulation stringency, enforcement, and compliance by type of facility and state, adjusting for demographic factors and additional key covariates. The goal is to inform future indoor tanning policies at the state and federal level.

This research was supported by a grant to Rutgers from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Coauthors included and Ms. Maame Araba Assan from Rutgers University, Dr. Jerod Stapleton from the University of Kentucky, and Ms. Julia Berteletti from Klein Buendel.

#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are leading a large multiple state research team on the design, implementation, and evaluation of #4Corners4Health. The research study aims to decrease cancer risk factors among emerging adults (ages 18-26) living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah using a targeted social media campaign. The team has published a full description of their study procedures in JMIR Research Protocols.

Many emerging adults are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among emerging adults delivered over social media is limited. Cancer prevention information and recommendations may reach emerging adults more effectively over social media than in settings such as health care, schools, and workplaces, particularly for emerging adults residing in rural areas.

Specifically, the research team will recruit a sample of 1000 emerging adults aged 18 to 26 years residing in rural counties in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and HPV vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and emerging adults and focus groups with emerging adults. The emerging adults will complete assessments at baseline and five additional data after randomization. Assessments will measure six cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign.

The trial is being led by a steering committee. Team members are working in three subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by emerging adults, and community resources available. A framework for the social media intervention with topics, format, and theoretical mediators has been created, along with protocols for social media management.

In summary, the researchers believe that social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among emerging adults. Because of the popularity of web-based information sources among emerging adults, an innovative, multiple risk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

This research is supported by a 5-year R01 grant from the National Cancer Institute (CA268037) to Klein Buendel. Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are the project’s Multiple Principal Investigators. The JMIR publication has 24 collaborating authors from multiple institutions.

Collaborator Spotlight:
Dr. Andrew Sussman

Collaborator Spotlight:
Dr. Andrew Sussman

Dr. Andrew Sussman

Andrew Sussman, Ph.D., MCRP, is an Associate Professor in the Department of Family and Community Medicine at the University of New Mexico (UNM) and the Associate Director of the Office of Community Outreach and Engagement at the UNM Cancer Center. He received his Ph.D. from the University of New Mexico.

Dr. Sussman focuses his research efforts on primary health and cancer care delivery research and patient-provider counseling dynamics among health disparity populations in New Mexico. He also has research interests in clinical decision making, health service delivery, community-based participatory research, and health disparities in community settings. He also has expertise in qualitative and mixed method research, formative assessment, and process evaluation.

Currently, Dr. Sussman is serving as a Multiple Principal Investigator along with Klein Buendel’s Dr. David Buller on the study, #4Corners4Health: A Social Media Cancer Prevention Program for Rural Emerging Adults (CA268037). This study aims to aid rural emerging adults (aged 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically-dispersed, underserved rural communities in the Mountain West.