- Email: [email protected]
13. Effects of a Brief Educational Intervention on HPV Knowledge and Vaccination Intent
S26
Poster Abstracts / 52 (2013) S21–S113
epidemiology of TV, particularly in adolescents and in men. We aimed to determine the prevalence and associations of TV infection using a newly FDA-approved, highly sensitive and specific nucleic acid amplification (NAAT) urine-based assay in youth. Methods: We enrolled 483 consecutive, sexually-active 13-25 yearold (mean 18.2 ⫹ 2.1 yrs.) youth (58% female; 58% Hispanic; 19% black) seeking medical care at either an urban pediatric emergency department, an inner-city school-based health center, or a college health service. Most participants sought care for sickness, injury, or a physical exam. Participants completed a questionnaire assessing sexual behaviors, and STI history and symptoms. A first-fraction voided urine sample was tested for TV using the APTIMA Trichomonas vaginalis assay (GenProbe, Inc). One hundred fifty-six (32%) participants were also tested using a NAAT for chlamydia (CT) and gonorrhea (GC) as part of clinical care. Results: Fifty percent of participants reported 2 or more sexual partners in the past year; 28% had more than 5 lifetime partners; 34% did not use a condom at last intercourse. Of the women, 55% did not use hormonal contraception. Ninety-two of 483 (19%) had ever been diagnosed with an STI (15% CT, 2% GC, 1% TV, 2% herpes [HSV]). Eighteen percent had anal sex, 9% had same-sex partners, 1.4% received money for sex, 18% of women reported douching, and 47% reported vaginal discharge, malodor, or pruritus. We found no cases of TV in the 202 men screened. Of the 281 women, we found 6 cases of TV with a prevalence of 2.1% (95% CI: 0.4-3.8). Of the 156 men and women tested, prevalence of CT was 11% (95% CI: 6-16); 10% in women; 14% in men. Prevalence of GC was 3.2% (95% CI: 0.4-5.9); 3.3% in women; 2.8% in men. Infection with TV in women was associated with non-use of either condom or hormonal birth control at last intercourse (80% of TV cases [TV⫹] vs. 14% of non-cases [TV⫺], p ⬍ .01), having 2 or more partners in the past year (100% of TV⫹ vs. 41% of TV-, p ⬍ .01), ever received money for sex (17% of TV⫹ vs. 0.7% of TV-, p ⬍ .01), douching (22% of TV⫹ vs. 2.3% of TV-, p ⫽ .04), past diagnosis of HSV (17% of TV⫹ vs. 2.2% of TV-, p ⫽ .03), and having same sex partners (33% of TV⫹ vs. 9% of TV-, p ⫽ .05). Conclusions: Although participants’ sexual history and CT and GC rates indicate that we screened a high-risk sample of both male and female youth, no men had TV whereas women had similar prevalence of TV to that of GC. This suggests important gender-based epidemiologic differences in TV infection in youth. In adolescent women, unexpected associations with TV infection include past diagnosis of HSV and having same sex partners, likely resulting from the greater persistence of TV infection in women. Sources of Support: GenProbe, Inc.
who had paired sera available from approximate time of enrollment and near the end of the study observation. All of the paired sera were analyzed via Total IgG Luminex-based immunoassay for antibody titers against the major capsid protein (L1) of 9 HPV types (6, 11, 16, 18, 31, 33, 45, 52, and 58). All women had quarterly (approximately every 3 months) vaginal swabs collected during the study, which were previously assessed for Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), and Chlamydia trachomatis (CT) by PCR and for HPV DNA types 6, 11, 16, 18, 31, 33 45, 52, and 58 using the Roche Linear Array. Each of the 95 women could potentially contribute up to 9 type specific infections (a total of 855 episodes) that could be assessed for seroconversion defined by the presence of HPV-type specific antibodies detected in the second sera collection of an individual who previously had no antibody detection in their first sera. Two types of multivariate logistic regression models were performed. First, in three separate logistic regression models, HPV DNA detection and each of the three STIs were examined for association with HPV seroconversion. Second, a multivariate logistic regression model was performed to evaluate the association of HPV DNA detection and all three STIs with HPV seroconversion. Results: Ninety-five participants were selected from the larger longitudinal sample of 146 women that were followed on average for 5.8 years. The mean duration of time between the first and second sera was 4.67 years (SD ⫽ 2.29) with 6.04 (SD ⫽ 3.38) years between first reported sex and second serum collection. There were a total of 162 episodes of seroconversion. Type-specific HPV DNA was detected at least once between the time of enrollment and second sera in 93% (151/162) of episodes of seroconversion. In the model examining HPV DNA detection and NG, detection of NG was found to approach statistically significant association with seroconversion (OR ⫽ 1.80, p ⬍ .08). However, TV (OR ⫽ 0.14, p ⫽ 1.64) and CT (OR ⫽ 1.06, p ⫽ .86) were not found to be associated with seroconversion. The multivariate model assessing CT, NG, and TV, and HPV type-specific DNA detection demonstrated that only the detection of HPV DNA (OR ⫽ 7.29, p ⬍ .001) during follow-up was significantly associated with serocoversion. Conclusions: Type specific HPV DNA was strongly associated with HPV seroconversion. In addition, the presence of Gonorrhea in individuals with HPV exposure may be associated with HPV seroconversion. Identifying factors that are associated HPV antibody serocoversion is important in better understanding why some HPV exposed individuals develop antibodies as well as for the evaluation of potential confounding in future epidemiological studies. Sources of Support: NIH R01 AI072020-01A2 (Brown, PI).
12. SEXUALLY TRANSMITTED INFECTIONS IN ASSOCIATION WITH HPV SEROCONVERSION IN A LONGITUDINAL STUDY OF ADOLESCENT WOMEN Laura M. Kester, MD1, Yan Tong, MS2, Brown R. Darron, MD2, J. Dennis Fortenberry, MD, FSAHM2, Marcia L. Shew, MD, MPH1. 1
Indiana University School of Medicine, Section of Adolescent Medicine; 2Indiana University School of Medicine Purpose: While human papillomavirus (HPV) serology is a useful marker of cumulative exposures, natural HPV seroconversion following exposure is inconsistent and factors associated with serological responses are not completely understood. We evaluated the association between HPV DNA detection, sexually transmitted infections (STIs) and HPV seroconversion. Methods: From a larger longitudinal sample of unvaccinated women (14-17 years old at enrollment), 95 women were identified
SESSION I: VACCINES 13. EFFECTS OF A BRIEF EDUCATIONAL INTERVENTION ON HPV KNOWLEDGE AND VACCINATION INTENT Laura M. Kester, MD1, Rivienne B. Shedd-Steele, BA2, Crystal A. Dotson, BA3, Gregory D. Zimet, PhD1. 1 Indiana University School of Medicine, Section of Adolescent Medicine; 2IU Simon Cancer Center; 3Indiana University Melvin and Bren Simon Cancer Center
Purpose: In 2010, the Advisory Committee on Immunization Practices (ACIP) recommended HPV vaccination for young adult women 11-26 and men 11-21 with permissive recommendation for men 22-26. We examined the effects of a HPV and HPV vaccine educa-
Poster Abstracts / 52 (2013) S21–S113
tional intervention on knowledge and intent to vaccinate among 18-26 year olds. Methods: A convenience sample of 131 men and female young adults, 18-26 years old, completed written surveys addressing knowledge and intent to receive HPV vaccine. The sample was recruited at the 2012 Annual National Black Expo Health Fair, which attracts individuals from Indianapolis and across the state. Individuals were randomized to one of two groups: survey completion followed by education (control group) or education followed by survey completion (intervention group). The educational component was available for all attendees at the health fair and consisted of a 5-10 minute review of HPV by an HPV educator. Areas covered included HPV transmission, HPV-related diseases, HPV detection, risk factors for infection, prevention of HPV infection, HPV vaccination, and additional references for HPV-related resources and services. The survey included 15 knowledge questions, which were summed to form an HPV knowledge score, as well as questions about HPV vaccination history, and a question assessing intent to get vaccinated in the future (for those who had not initiated vaccination). The effect of educational intervention on HPV knowledge was evaluated for all participants via Analysis of Variance (ANOVA). The effect of intervention on intent to vaccinate was evaluated for the subset of unvaccinated respondents via binary logistic regression. Results: Of the 131 participants, 52% (n ⫽ 68) were randomized to the intervention group and received education before completing the survey; the remainder (n ⫽ 63) were randomized into the control group and completed the survey before receiving any HPV education. Respondents were 18 to 26 (Mean age ⫽ 21.8) and 70% were female. Seventy-seven percent described themselves as non-Hispanic black, 11% as non-Hispanic white, with the remaining 12% from other racial/ethnic groups. The majority of the young adults were single (85%). Thirty-seven percent had received at least one dose of HPV vaccine and 19% had completed the series. ANOVA showed that individuals who received education before survey completion had significantly higher HPV knowledge scores (M ⫽ 9.10; SD ⫽ 1.773) compared to those who completed the survey before education (M ⫽ 6.98; SD ⫽ 2.899; F ⫽ 22.53, p ⬍ .001). Of those individuals who had not yet initiated vaccination (n ⫽ 79), the intervention group had a significantly higher intention to vaccinate (86%) as compared to the control group (67%) (OR ⫽ 3.09; 95% CI ⫽ 1.02–9.36; p ⬍ .05). Conclusions: The ACIP has recommended that HPV vaccination be offered to both men and women into young adulthood. However, there continues to be low awareness of the benefits of vaccination and low intention to vaccinate in young adults. We found that providing a brief educational intervention not only increased general knowledge of HPV and benefits of vaccination in young adults, but increased intent to initiate HPV vaccination as well. Sources of Support: Unrestricted Grant from GSK. 14. DEVELOPMENT, THEORETICAL FRAMEWORK, AND EVALUATION FROM IMPLEMENTATION OF A PARENT AND TEACHERDELIVERED INTERVENTION TO ENHANCE ADOLESCENT VACCINATION Lisa M. Gargano, PhD1, Natasha L. Herbert, MPH1, Julia E. Painter, PhD1, Jessica M. Sales, PhD1, Christopher Morfaw, RN2, LaDawna M. Jones, MPH1, Dennis Murray, MD3, Ralph J. DiClemente, PhD1, James M. Hughes, MD1. 1
Emory University; 2East Central Health District; 3Georgia Health Sciences University
S27
Purpose: The Advisory Committee on Immunization Practices currently recommends an adolescent immunization schedule that includes four vaccines: combined tetanus, diphtheria, and pertussis, human papillomavirus, meningococcal conjugate, and annual vaccination against influenza. Research suggests that both parental and adolescent attitudes may be important in determining vaccine uptake. Here, we describe the theoretical framework, intervention development, and results of an evaluation from the first year implementation of a multicomponent intervention designed to enhance adolescent vaccine acceptance among predominantly African American adolescents attending middle- and high-school in Georgia. Methods: Our study comprised a three-arm randomized control trial, where 11 schools in one county in Georgia were randomized to receive: Arm 1) an educational brochure targeted toward parents, Arm 2) the parent brochure plus a teacher-delivered intervention targeted toward students, or Arm 3) no intervention. Students, parents, and teachers were active participants in the development and implementation of all intervention materials. The three steps in the development of the intervention were 1) formative research through a series of focus groups with parents, adolescents, and teachers to ascertain existing attitudes related to each recommended adolescent vaccine and the disease(s) it protects against; 2) material development based on our theoretical framework (Health Belief Model and social norms), focus group findings, literature review, and previous work; and 3) a final round of focus groups with parents, adolescents, and teachers to obtain feedback regarding the prototype intervention materials. After our first year of implementation, we evaluated these methods of intervention development by administering 1) a parent phone survey about the educational brochure, and 2) tests of student knowledge and attitudes pre- and post-teacher-delivered curriculum to assess changes. Results: We identified 184 parents in the intervention counties (Arms 1 and 2) for the phone survey. Among respondents, 67% recalled receiving the brochure. Of those who reported receiving a bro¬chure, 90% reported reading the brochure, with 23% reading some, 37% reading most, and 40% reading the entire brochure. Most respondents (97%) believed that they understood the brochure, it was relevant to them (91%), and increased their knowledge about adolescent vaccination (93%). Fifty-six percent reported discuss¬ing the brochure with family/ friends. In Arm 2, significant increases were observed among middle school students. From pre-test (14.0%) to post-test (25.3%), more students were aware of how vaccines were made (p⬍0.001). There was a significant increase in both middle- and high-school students who recognized the four vaccines recommended for adolescents (p⬍0.001) and who were interested being vaccinated (p ⫽ 0.01). Conclusions: Process evaluation results indicate that the intervention development methods were successful in creating a theorybased edu¬cational intervention that garnered community support and met the cultural relevance and literacy needs of our target audience. To our knowledge, this study is the first to extensively engage middle- and high-school students, parents, and teachers in the design and implementation of key educational components of a theorybased adolescent vaccination intervention. Sources of Support: This project is funded by the Centers for Disease Control and Prevention grant 5U01IP000413. J.E.P was supported by grant T32AI074492 from the National Institutes of Health. 15. CHALLENGES TO IMPLEMENTING AN HPV EDUCATION AND VACCINATION PROGRAM IN NEW MEXICO Jessica A. Nodulman, PhD1, Alberta S. Kong, MD, MPH2, Randall Starling, PhD3, Angela D. Bryan, PhD4, Jerome Romero, BA3, Cosette M. Wheeler, PhD1, David B. Buller, PhD5, W. Gill Woodall, PhD3.
Poster Abstracts / 52 (2013) S21–S113
epidemiology of TV, particularly in adolescents and in men. We aimed to determine the prevalence and associations of TV infection using a newly FDA-approved, highly sensitive and specific nucleic acid amplification (NAAT) urine-based assay in youth. Methods: We enrolled 483 consecutive, sexually-active 13-25 yearold (mean 18.2 ⫹ 2.1 yrs.) youth (58% female; 58% Hispanic; 19% black) seeking medical care at either an urban pediatric emergency department, an inner-city school-based health center, or a college health service. Most participants sought care for sickness, injury, or a physical exam. Participants completed a questionnaire assessing sexual behaviors, and STI history and symptoms. A first-fraction voided urine sample was tested for TV using the APTIMA Trichomonas vaginalis assay (GenProbe, Inc). One hundred fifty-six (32%) participants were also tested using a NAAT for chlamydia (CT) and gonorrhea (GC) as part of clinical care. Results: Fifty percent of participants reported 2 or more sexual partners in the past year; 28% had more than 5 lifetime partners; 34% did not use a condom at last intercourse. Of the women, 55% did not use hormonal contraception. Ninety-two of 483 (19%) had ever been diagnosed with an STI (15% CT, 2% GC, 1% TV, 2% herpes [HSV]). Eighteen percent had anal sex, 9% had same-sex partners, 1.4% received money for sex, 18% of women reported douching, and 47% reported vaginal discharge, malodor, or pruritus. We found no cases of TV in the 202 men screened. Of the 281 women, we found 6 cases of TV with a prevalence of 2.1% (95% CI: 0.4-3.8). Of the 156 men and women tested, prevalence of CT was 11% (95% CI: 6-16); 10% in women; 14% in men. Prevalence of GC was 3.2% (95% CI: 0.4-5.9); 3.3% in women; 2.8% in men. Infection with TV in women was associated with non-use of either condom or hormonal birth control at last intercourse (80% of TV cases [TV⫹] vs. 14% of non-cases [TV⫺], p ⬍ .01), having 2 or more partners in the past year (100% of TV⫹ vs. 41% of TV-, p ⬍ .01), ever received money for sex (17% of TV⫹ vs. 0.7% of TV-, p ⬍ .01), douching (22% of TV⫹ vs. 2.3% of TV-, p ⫽ .04), past diagnosis of HSV (17% of TV⫹ vs. 2.2% of TV-, p ⫽ .03), and having same sex partners (33% of TV⫹ vs. 9% of TV-, p ⫽ .05). Conclusions: Although participants’ sexual history and CT and GC rates indicate that we screened a high-risk sample of both male and female youth, no men had TV whereas women had similar prevalence of TV to that of GC. This suggests important gender-based epidemiologic differences in TV infection in youth. In adolescent women, unexpected associations with TV infection include past diagnosis of HSV and having same sex partners, likely resulting from the greater persistence of TV infection in women. Sources of Support: GenProbe, Inc.
who had paired sera available from approximate time of enrollment and near the end of the study observation. All of the paired sera were analyzed via Total IgG Luminex-based immunoassay for antibody titers against the major capsid protein (L1) of 9 HPV types (6, 11, 16, 18, 31, 33, 45, 52, and 58). All women had quarterly (approximately every 3 months) vaginal swabs collected during the study, which were previously assessed for Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), and Chlamydia trachomatis (CT) by PCR and for HPV DNA types 6, 11, 16, 18, 31, 33 45, 52, and 58 using the Roche Linear Array. Each of the 95 women could potentially contribute up to 9 type specific infections (a total of 855 episodes) that could be assessed for seroconversion defined by the presence of HPV-type specific antibodies detected in the second sera collection of an individual who previously had no antibody detection in their first sera. Two types of multivariate logistic regression models were performed. First, in three separate logistic regression models, HPV DNA detection and each of the three STIs were examined for association with HPV seroconversion. Second, a multivariate logistic regression model was performed to evaluate the association of HPV DNA detection and all three STIs with HPV seroconversion. Results: Ninety-five participants were selected from the larger longitudinal sample of 146 women that were followed on average for 5.8 years. The mean duration of time between the first and second sera was 4.67 years (SD ⫽ 2.29) with 6.04 (SD ⫽ 3.38) years between first reported sex and second serum collection. There were a total of 162 episodes of seroconversion. Type-specific HPV DNA was detected at least once between the time of enrollment and second sera in 93% (151/162) of episodes of seroconversion. In the model examining HPV DNA detection and NG, detection of NG was found to approach statistically significant association with seroconversion (OR ⫽ 1.80, p ⬍ .08). However, TV (OR ⫽ 0.14, p ⫽ 1.64) and CT (OR ⫽ 1.06, p ⫽ .86) were not found to be associated with seroconversion. The multivariate model assessing CT, NG, and TV, and HPV type-specific DNA detection demonstrated that only the detection of HPV DNA (OR ⫽ 7.29, p ⬍ .001) during follow-up was significantly associated with serocoversion. Conclusions: Type specific HPV DNA was strongly associated with HPV seroconversion. In addition, the presence of Gonorrhea in individuals with HPV exposure may be associated with HPV seroconversion. Identifying factors that are associated HPV antibody serocoversion is important in better understanding why some HPV exposed individuals develop antibodies as well as for the evaluation of potential confounding in future epidemiological studies. Sources of Support: NIH R01 AI072020-01A2 (Brown, PI).
12. SEXUALLY TRANSMITTED INFECTIONS IN ASSOCIATION WITH HPV SEROCONVERSION IN A LONGITUDINAL STUDY OF ADOLESCENT WOMEN Laura M. Kester, MD1, Yan Tong, MS2, Brown R. Darron, MD2, J. Dennis Fortenberry, MD, FSAHM2, Marcia L. Shew, MD, MPH1. 1
Indiana University School of Medicine, Section of Adolescent Medicine; 2Indiana University School of Medicine Purpose: While human papillomavirus (HPV) serology is a useful marker of cumulative exposures, natural HPV seroconversion following exposure is inconsistent and factors associated with serological responses are not completely understood. We evaluated the association between HPV DNA detection, sexually transmitted infections (STIs) and HPV seroconversion. Methods: From a larger longitudinal sample of unvaccinated women (14-17 years old at enrollment), 95 women were identified
SESSION I: VACCINES 13. EFFECTS OF A BRIEF EDUCATIONAL INTERVENTION ON HPV KNOWLEDGE AND VACCINATION INTENT Laura M. Kester, MD1, Rivienne B. Shedd-Steele, BA2, Crystal A. Dotson, BA3, Gregory D. Zimet, PhD1. 1 Indiana University School of Medicine, Section of Adolescent Medicine; 2IU Simon Cancer Center; 3Indiana University Melvin and Bren Simon Cancer Center
Purpose: In 2010, the Advisory Committee on Immunization Practices (ACIP) recommended HPV vaccination for young adult women 11-26 and men 11-21 with permissive recommendation for men 22-26. We examined the effects of a HPV and HPV vaccine educa-
Poster Abstracts / 52 (2013) S21–S113
tional intervention on knowledge and intent to vaccinate among 18-26 year olds. Methods: A convenience sample of 131 men and female young adults, 18-26 years old, completed written surveys addressing knowledge and intent to receive HPV vaccine. The sample was recruited at the 2012 Annual National Black Expo Health Fair, which attracts individuals from Indianapolis and across the state. Individuals were randomized to one of two groups: survey completion followed by education (control group) or education followed by survey completion (intervention group). The educational component was available for all attendees at the health fair and consisted of a 5-10 minute review of HPV by an HPV educator. Areas covered included HPV transmission, HPV-related diseases, HPV detection, risk factors for infection, prevention of HPV infection, HPV vaccination, and additional references for HPV-related resources and services. The survey included 15 knowledge questions, which were summed to form an HPV knowledge score, as well as questions about HPV vaccination history, and a question assessing intent to get vaccinated in the future (for those who had not initiated vaccination). The effect of educational intervention on HPV knowledge was evaluated for all participants via Analysis of Variance (ANOVA). The effect of intervention on intent to vaccinate was evaluated for the subset of unvaccinated respondents via binary logistic regression. Results: Of the 131 participants, 52% (n ⫽ 68) were randomized to the intervention group and received education before completing the survey; the remainder (n ⫽ 63) were randomized into the control group and completed the survey before receiving any HPV education. Respondents were 18 to 26 (Mean age ⫽ 21.8) and 70% were female. Seventy-seven percent described themselves as non-Hispanic black, 11% as non-Hispanic white, with the remaining 12% from other racial/ethnic groups. The majority of the young adults were single (85%). Thirty-seven percent had received at least one dose of HPV vaccine and 19% had completed the series. ANOVA showed that individuals who received education before survey completion had significantly higher HPV knowledge scores (M ⫽ 9.10; SD ⫽ 1.773) compared to those who completed the survey before education (M ⫽ 6.98; SD ⫽ 2.899; F ⫽ 22.53, p ⬍ .001). Of those individuals who had not yet initiated vaccination (n ⫽ 79), the intervention group had a significantly higher intention to vaccinate (86%) as compared to the control group (67%) (OR ⫽ 3.09; 95% CI ⫽ 1.02–9.36; p ⬍ .05). Conclusions: The ACIP has recommended that HPV vaccination be offered to both men and women into young adulthood. However, there continues to be low awareness of the benefits of vaccination and low intention to vaccinate in young adults. We found that providing a brief educational intervention not only increased general knowledge of HPV and benefits of vaccination in young adults, but increased intent to initiate HPV vaccination as well. Sources of Support: Unrestricted Grant from GSK. 14. DEVELOPMENT, THEORETICAL FRAMEWORK, AND EVALUATION FROM IMPLEMENTATION OF A PARENT AND TEACHERDELIVERED INTERVENTION TO ENHANCE ADOLESCENT VACCINATION Lisa M. Gargano, PhD1, Natasha L. Herbert, MPH1, Julia E. Painter, PhD1, Jessica M. Sales, PhD1, Christopher Morfaw, RN2, LaDawna M. Jones, MPH1, Dennis Murray, MD3, Ralph J. DiClemente, PhD1, James M. Hughes, MD1. 1
Emory University; 2East Central Health District; 3Georgia Health Sciences University
S27
Purpose: The Advisory Committee on Immunization Practices currently recommends an adolescent immunization schedule that includes four vaccines: combined tetanus, diphtheria, and pertussis, human papillomavirus, meningococcal conjugate, and annual vaccination against influenza. Research suggests that both parental and adolescent attitudes may be important in determining vaccine uptake. Here, we describe the theoretical framework, intervention development, and results of an evaluation from the first year implementation of a multicomponent intervention designed to enhance adolescent vaccine acceptance among predominantly African American adolescents attending middle- and high-school in Georgia. Methods: Our study comprised a three-arm randomized control trial, where 11 schools in one county in Georgia were randomized to receive: Arm 1) an educational brochure targeted toward parents, Arm 2) the parent brochure plus a teacher-delivered intervention targeted toward students, or Arm 3) no intervention. Students, parents, and teachers were active participants in the development and implementation of all intervention materials. The three steps in the development of the intervention were 1) formative research through a series of focus groups with parents, adolescents, and teachers to ascertain existing attitudes related to each recommended adolescent vaccine and the disease(s) it protects against; 2) material development based on our theoretical framework (Health Belief Model and social norms), focus group findings, literature review, and previous work; and 3) a final round of focus groups with parents, adolescents, and teachers to obtain feedback regarding the prototype intervention materials. After our first year of implementation, we evaluated these methods of intervention development by administering 1) a parent phone survey about the educational brochure, and 2) tests of student knowledge and attitudes pre- and post-teacher-delivered curriculum to assess changes. Results: We identified 184 parents in the intervention counties (Arms 1 and 2) for the phone survey. Among respondents, 67% recalled receiving the brochure. Of those who reported receiving a bro¬chure, 90% reported reading the brochure, with 23% reading some, 37% reading most, and 40% reading the entire brochure. Most respondents (97%) believed that they understood the brochure, it was relevant to them (91%), and increased their knowledge about adolescent vaccination (93%). Fifty-six percent reported discuss¬ing the brochure with family/ friends. In Arm 2, significant increases were observed among middle school students. From pre-test (14.0%) to post-test (25.3%), more students were aware of how vaccines were made (p⬍0.001). There was a significant increase in both middle- and high-school students who recognized the four vaccines recommended for adolescents (p⬍0.001) and who were interested being vaccinated (p ⫽ 0.01). Conclusions: Process evaluation results indicate that the intervention development methods were successful in creating a theorybased edu¬cational intervention that garnered community support and met the cultural relevance and literacy needs of our target audience. To our knowledge, this study is the first to extensively engage middle- and high-school students, parents, and teachers in the design and implementation of key educational components of a theorybased adolescent vaccination intervention. Sources of Support: This project is funded by the Centers for Disease Control and Prevention grant 5U01IP000413. J.E.P was supported by grant T32AI074492 from the National Institutes of Health. 15. CHALLENGES TO IMPLEMENTING AN HPV EDUCATION AND VACCINATION PROGRAM IN NEW MEXICO Jessica A. Nodulman, PhD1, Alberta S. Kong, MD, MPH2, Randall Starling, PhD3, Angela D. Bryan, PhD4, Jerome Romero, BA3, Cosette M. Wheeler, PhD1, David B. Buller, PhD5, W. Gill Woodall, PhD3.