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Evaluating dissemination strategies to promote preteen HPV vaccination


Adoption of vaccination against human papillomavirus (HPV) has been slow in the US. Routine HPV vaccination of 11-12 year old boys was recommended by CDC in late 2011, five years after the recommendation for routine vaccination was issued for girls. We developed and evaluated a social marketing intervention with parents and healthcare providers to stimulate adoption for preteen boys.


Our intervention promoted HPV vaccine with both parents of preteen boys and health providers in 13 south central NC counties, July-September, 2012. The 'Protect Him' campaign included distribution of posters and brochures (English and Spanish) to county health departments (n = 13) plus 184 providers, two radio PSAs, a one hour online training for providers and a website. To assess changes in awareness, knowledge, attitudes, beliefs and vaccination actions, we evaluated the campaign using: 1) two independent, cross-sectional telephone surveys of parents with 9-13 year old boys (pre n = 516, post n = 455); 2) pre- and post-intervention surveys with enrolled providers; and 3) NC Immunization Registry (NCIR) data to compare vaccination rates in the 13 intervention vs. 14 control counties.


Post intervention, providers reported increased likelihood of discussing (p=.03), recommending (p=.004) and vaccinating (P < .0001) 11-12 year old boys against HPV. Parents with campaign recall (62%; n = 284) were more likely to have heard of the HPV virus and vaccine (adjusted OR = 5.44 and 9.70 respectively, P < .0001). A Cox proportional hazards model for the NCIR data showed an intervention effect (HR = 1.34, p=.0024), as the probability of vaccination increased by 34% in the intervention counties relative to control counties during the three months of the intervention.

Implications of research

This focused, time-limited, low intensity dissemination intervention boosted preteen HPV vaccination. Multiple evaluation strategies provide insight into intervention impact and potential explanatory mechanisms.


This study was supported by grants from the National Institutes of Health

1R21A1095590-01A1 (Cates PI), and by the North Carolina Translational and Clinical Sciences Institute, through support from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Grant Award Number 1UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Cates, J.R., Diehl, S.J., Crandell, J.L. et al. Evaluating dissemination strategies to promote preteen HPV vaccination. Implementation Sci 10 (Suppl 1), A5 (2015).

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