Objective:Cancer prevention can be improved through increasing the uptake of the human papillomavirus (HPV) vaccine resulting from enhanced pediatric primary care clinician recommendations. Although clinician recommendation has been shown repeatedly to be associated with increased vaccination, quality recommendations are not always given. Study design:Thirty pediatric clinics and their 58 respective clinicians were randomized using a cluster design to 3 groups regarding trainings for recommending the HPV vaccine to parents of 11- to 12-year-olds: (1) the Counsel-Listen-Empathize-Answer-Recommend (C-LEAR) approach with bundled counseling (all 3 vaccines together) (n = 20), (2) the C-LEAR approach with benefits counseling (focused on HPV vaccine benefits) (n = 17), and training deferred to after the trial (n = 21). Training consisted of a 1-hour virtual session, including small group role play. As a secondary outcome, we evaluated clinicians' adherence through simulated and real patient visits and self-reported surveys. Results:Of the 37 clinicians, 36 completed the training. Adherence to the C-LEAR approach averaged 77% during simulated patient visits (n = 35), 68% in real patient visits (n = 22), and 82% on monthly surveys (n = 31). During the simulated patient visits, the clinicians trained in the bundled group had significantly greater adherence than the benefits group to the C-LEAR approach. During real patient visits, some, but not all, of the counseling statement components were more likely to be used by clinicians trained to use them, compared with untrained clinicians. Comparing the self-reported counseling statements of HPV vaccine recommendation before and 1 year after the training, the frequency of using 3 or more of the trained components remained similar in the deferred and bundled groups and increased within the benefits group. Conclusion:Following a brief, virtual, communication skills workshop using the C-LEAR approach for vaccine communication, trained clinicians were more likely than untrained clinicians to use some of the counseling strategies consistent with recommended approaches.

Background:Cancer clinical trials (CCTs) are essential to advancing treatment, yet enrollment remains low. An oncologist's recommendation influences participation, but many eligible patients are never offered the option, and discussions often lack clarity or equity. CCT communication skills training can improve oncologists' confidence and patient-centered communication behaviors, yet most Hematology-Oncology fellowship programs lack structured curricula in this area. To address this gap, we implemented a CCT communication skills workshop (COMM-CCT) for Hematology-Oncology fellows. Methods:We implemented the COMM-CCT workshop at seven Hem-Onc fellowship programs in 2024. The three-hour, synchronous web-based workshop included a one-hour didactic session followed by two hours of small-group role play with cancer survivors acting as patients. We evaluated reach, acceptability, feasibility, and fidelity using post-course surveys and semi-structured interviews. Results:Across seven sites, 72% (n = 62) of eligible fellows attended with 87% (n = 54) completing the post-workshop survey and 23% (n = 14) participating in interviews. Fellows reported high acceptability, including satisfaction with the workshop (M = 4.30, SD = 0.79) and content (M = 4.28, SD = 0.79). Feasibility was also high, with communication skills taught being viewed as compatible (M = 4.35, SD = 0.70) and useful (M = 4.33, SD = 0.73) to their clinical practice. Interview findings reinforced survey results. Conclusions:The COMM-CCT workshop is acceptable and feasible to implement in Hem-Onc fellowship programs. Findings will inform its refinement, broader scaling, and continued integration into graduate medical education programs. Innovation:This study's innovation is in its integration of a nationwide communication-focused intervention on clinical trials into existing training structures.

Abstract BackgroundOpioid use disorder (OUD) remains a critical public health crisis in the United States. Despite widespread policy and clinical interventions, early identification of individuals at risk for developing OUD remains challenging due to limitations in traditional screening approaches and a lack of individualized risk stratification methods. Machine learning (ML) methods offer an opportunity to develop timely, high-performing, and explainable predictive models that can enhance OUD prevention strategies in clinical settings. ObjectiveThis study aims to develop and validate an ML model using electronic health record (EHR) data to predict the 3-month risk of incident OUD among adults initiating opioid therapy and to stratify patients into clinically actionable risk groups. MethodsThis prognostic modeling study used 2017‐2022 OneFlorida+ EHR data to develop and validate ML algorithms predicting 3-month incident OUD risk. We included 182,083 adults (≥18 y) without cancer, overdose, or OUD or hospice history who received ≥1 outpatient, noninjectable opioid prescription. Using 183 predictors measured in sequential 3-month intervals, we developed an elastic net, least absolute shrinkage and selection operator, gradient boosting machine (GBM), and random forest models on randomly split training, testing, and validation sets. Model performance was assessed using C-statistics, predictive values, and number needed to evaluate, with patients stratified into risk deciles for clinical applicability. Model explainability was assessed using Shapley additive explanations, and fairness was evaluated using standard metrics. We externally validated the best-performing model using an independent cohort from the 2018‐2020 UPMC (formerly University of Pittsburgh Medical Center) health system. ResultsIn the validation sample (n=60,694), GBM (C-statistics=0.879, 95% CI 0.874‐0.884) and elastic net (C-statistics=0.872, 95% CI 0.867‐0.877) outperformed least absolute shrinkage and selection operator (C-statistics=0.846, 95% CI 0.840‐0.851) and random forest (C-statistics=0.798, 95% CI 0.792‐0.804), with GBM model requiring the fewest predictors (n=75) for predicting 3-month incident OUD. Using the GBM algorithm to predict the subsequent 3-month OUD risk, the top decile subgroup had a positive predictive value of 3.26%, a negative predictive value of 99.8%, and a number needed to evaluate of 31. The top decile (n=6696) captured ~68% of patients with OUD. Shapley additive explanations analysis identified age, number of outpatient visits, history of back and other pain conditions, comorbidity burden, and opioid prescribing patterns as the strongest predictors of incident OUD. Fairness assessment showed an acceptable false negative rate parity across race, age, and sex. In external validation on the UPMC cohort, the GBM model maintained good discrimination (C-statistics=0.756, 95% CI 0.750‐0.762) and effective risk stratification. ConclusionsAn ML algorithm predicting incident OUD derived from OneFlorida+ EHR data performed well in external validation with data using UPMC. The algorithm might be valuable for incident OUD risk prediction and stratification across health systems, with potential to inform early intervention.

e13793 Background: Timely diagnosis and treatment initiation are critical for optimizing cancer survival outcomes. However, periods of reduced healthcare accessibility and shifts in patients' routines, such as during holidays, may contribute to delays. This study aims to assess whether end-of-year holiday schedules influence the timing of cancer diagnoses and impact care until the start of the new year. Methods: The NPCR-SEER database, representing almost the entire U.S. population, was utilized to analyze the month of a cancer diagnosis, merged summary stage at diagnosis, and trends over the study period. The SEER Research Plus 22 registries dataset was used to compare survival outcomes between months of diagnosis. Results: Between 2001 and 2020, a total of 31,845,368 cancer diagnoses were reported. By month, January had the highest number of diagnoses (n = 2,824,204) while December had the lowest (n = 2,483,880) (Table 1). When stratified by stage, January had the highest proportion of distant stage cancers at 24.48% (n = 691,296) and the lowest proportions of in-situ stage 1.80% (n = 50,813), localized stage 42.66% (n = 1,204,755) and regional stage 19.65% (n = 555,000) compared to all other months. Over the years, cancer cases increased for both months, but the disparity between them remained. For instance, in December 2019 there were 34,064 distant-stage diagnoses (21,611 in 2001), while in January 2020, there were 39,501 diagnoses (27,810 in 2001). When 5-year overall observed survival was compared, cases diagnosed in January were found to have the worst survival 59.10% (95% Confidence Interval (CI): 59.00 – 59.20) compared to cancers diagnosed in any other month. The month of October had comparatively the highest proportion of localized stage 44.56% (n = 1,230,826) and the best 5-year survival of 60.3% (95% CI: 60.1 – 60.4). Conclusions: Throughout the year, the highest number of cancer diagnoses occur in January, while the fewest occur in December. These New Year cancer patients had a higher burden of advanced disease and comparatively worse 5-year survival when compared to patients diagnosed during other months. Further research is necessary to determine whether the observed disparities are attributable to patient preference, healthcare accessibility during end-of-year holidays, payor factors, or other variables. Distribution of reported cases diagnosed by month from 2001 – 2020. Month Reported Cases (%) Month Reported Cases (%) January 2,824,204 (8.87) July 2,612,396 (8.20) February 2,495,900 (7.84) August 2,698,061 (8.47) March 2,702,753 (8.49) September 2,558,890 (8.04) April 2,607,534 (8.19) October 2,743,718 (8.62) May 2,659,799 (8.35) November 2,507,150 (7.87) June 2,739,798 (8.60) December 2,483,880 (7.80)

9026 Background: Effective physician-patient communication about cancer clinical trials (CCTs) is critical for improving participation, particularly in underrepresented populations. Most eligible patients are willing to participate when invited through clear, patient-centered discussions, yet treating oncologists often do not discuss trials or do so ineffectively. Communication skills training is well-suited for the fellowship stage; however, most Hematology/Oncology (Hem-Onc) education programs do not formally teach CCT communication skills. To address this gap, we implemented COMM-CCT, a previously developed CCT communication skills workshop for Hem-Onc fellows and assessed the acceptability and feasibility of its implementation in Hem-Onc fellowship programs. Methods: We implemented the COMM-CCT workshop at seven Hem-Onc programs in the U.S. The three-hour, synchronous Zoom-based workshop included a one-hour didactic session that covered barriers to patient trial participation (e.g., patient, physician, institutional) and introduced the COMM-CCT framework (Check-In, Outline Options, Make a Shared Decision, Map Out Next Steps) for discussing CCTs. This was followed by a two-hour role-play session where fellows practiced communication skills with cancer survivors who were trained to act as patients, while faculty facilitators and peers gave constructive feedback. At each site, “fellow champions” encouraged peers to participate in the workshop. We assessed implementation (i.e., feasibility and acceptability) by surveying and interviewing participating fellows. Results: Regarding acceptability, fellows (n=54) reported high satisfaction (on a 1-5 scale) with the workshop (M=4.30, SD=0.79), its content (M=4.28, SD=0.79), its organization and execution (M=4.5, SD=0.61), and the faculty and facilitators (M=4.56, SD=0.63). They were comfortable with communication skills taught (M=4.15, SD=0.71) and felt the skills were compatible with the realities and resources of their clinical practice (M=4.35, SD=0.70). Fellows further agreed what they learned would be useful to (M=4.33, SD=0.73) and able to be incorporated into (M=4.22, SD=0.72) their clinical practice. When interviewed, fellows (n=9) found the workshop acceptable, describing it as “well-organized,” “very helpful,” and relevant. The role-plays with “real survivors” were noted as a strength, as was learning by observation in a group setting. Feasibility was evidenced by fellows reporting incorporating COMM-CCT concepts into practice, such as by initiating discussions with patients about cancer clinical trials since participating in the workshop. Conclusions: The COMM-CCT workshop is acceptable and feasible to implement in Hem-Onc fellowship programs. Findings will inform its refinement, broader scaling, and continued integration into graduate medical education programs.

Background/Objectives: The Developing and Evaluating a Machine Learning Opioid Prediction & Risk-Stratification E-Platform (DEMONSTRATE) trial aims to assess the usability, acceptability, feasibility, and effectiveness of implementing a machine learning (ML)-based clinical decision support (CDS) tool—the Overdose Prevention Alert—which predicts a patient’s risk of opioid overdose within three months. Methods: This single-arm study uses a pre–post implementation design with mixed-methods evaluation in 13 University of Florida Health, Gainesville, internal medicine and family medicine clinics. Eligible patients are aged ≥18 years, received an opioid prescription within the year prior to their upcoming primary care visit, are not receiving hospice care, do not have a malignant cancer diagnosis, and are identified by the ML algorithm as high risk for overdose. The Overdose Prevention Alert triggers when a primary care provider (PCP) signs an opioid order in electronic health records. We will evaluate effectiveness by comparing pre- and post-implementation outcomes using a composite patient-level measure defined by the presence of any of the following 6 favorable indicators: (1) evidence of naloxone access; (2) absence of opioid overdose diagnoses and naloxone administration; (3) absence of emergency department (ED) visits or hospitalizations due to opioid overdose or opioid use disorder (OUD); (4) absence of overlapping opioid and benzodiazepine use within a 7-day window; (5) absence of opioid use ≥50 morphine milligram equivalent daily average; (6) receipt of referrals to non-pharmacological pain management. Additional quantitative metrics will include alert penetration, usage patterns, and clinical actions taken. Usability and acceptability will be assessed using a 12-item questionnaire for PCPs and semi-structured interviews. Expected Results: The trial will provide insights into real-world ML-driven CDS implementation and inform future strategies to reduce opioid-related harm.

Globally, Sub-Saharan Africa (SSA) has the highest rate of cervical cancer incidence and mortality. Cervical cancer screening (CCS) is essential for identifying and treating pre-cancer and early-stage cancer. However, CCS rates throughout SSA are substantially low due to a multitude of health system barriers, including poor access to CCS services and limited skilled providers and or resources. The aim of this scoping systematic review was to identify evidence-based health system-level strategies addressing barriers to implementing CCS in SSA. A systematic literature search was conducted across multiple databases, including PubMed and EMBASE, published in English from January 2010 to March 2024. The article review process involved independent screening by three trained research team members using Covidence software. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The systematic search returned 4,682 articles, 42 of which were included in the final analysis. The included studies were conducted in 17 SSA countries. Most effective implementation strategies included offering women the option of human papillomavirus (HPV) self-collection, single-visit CCS and treatment, providing CCS services at nonclinical community settings, training nonclinical providers to deliver CCS via task-sharing, and integrating CCS into existing nonprimary care or gynecologic settings such as HIV screening clinics. We identified successful strategies to address health system barriers to CCS in SSA. Health care systems should consider implementing these strategies to maximize the outcome of reaching the World Health Organization’s cervical cancer elimination goal of screening 70% of women.

BACKGROUND:Hypertension (HTN) is a complex condition with significant heterogeneity in presentation and treatment response. Identifying distinct subphenotypes of HTN may improve our understanding of its underlying mechanisms and guide more precise treatment or public health initiatives. METHODS:Using EHR and Medicaid claims data from the OneFlorida+ research consortium (2012-2021), we identified a cohort of adult Floridians with newly diagnosed HTN (first diagnosis following two outpatient blood pressures ≥140/90 mmHg & no prior anti-HTN treatment). We extracted demographic and clinical data from the diagnosis visit and ≤1 year prior. We used hierarchical clustering (unsupervised machine learning) to identify distinct subphenotypes within the OneFlorida+ HTN population. RESULTS:A total of 40,686 patients were included (mean ± SD age, 60.9 ± 17.5 y; 55% women). Five subphenotypes (S1-5) were identified. S1 was characterized by older age, higher Body Mass Index (BMI), and prevalent type 2 diabetes. S2 included over 50% of Black patients who were primarily women, younger, with higher BMI, but living in communities with higher levels of socioeconomic vulnerabilities. S3 contained a higher percentage of Hispanic patients with comparatively lower BMI. S4 is characterized by higher age and co-morbidities. S5 had 94% of patients with chronic kidney disease. Distinctions in social determinants of health factors were also observed. CONCLUSIONS:Unsupervised learning identified 5 HTN subphenotypes varying in demographic, socioeconomic, and risk profiles. Further investigation into the biological mechanisms of these subphenotypes and the relationships to social factors may enhance our ability to deliver targeted interventions that consider social policy implications in addition to the traditional behavioral and physiological interventions.

Background: Human papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers, yet vaccination rates remain suboptimal, particularly in Florida. Social influence, including family and peer support, may shape parental decisions to vaccinate their children. In this study, we examined the role of social networks (online and offline) in parental intention to vaccinate their 11- to 12-year-old children against HPV. Methods: We conducted a cross-sectional survey among 746 parents in Florida as part of the Text & Talk trial (2022–2023). Among other questions, parents reported on their intention to vaccinate, perceived social norms, and support received from up to three reported confidants. We performed logistic regression and multivariable analyses to assess the relationship between network support, social norms, and vaccination intent. Results: Seventy percent of parents intended to vaccinate their children. Greater support from the first reported confidant was significantly associated with higher vaccination intention (OR = 1.30, p < 0.0001). Perceived norms among friends (p = 0.01) and higher overall network support (p < 0.0001) were also predictive of intent. The higher the percentage of reported family members, the higher the support received for the vaccine (p = 0.04). Conclusions: Social support, particularly from close confidants and peers, plays a critical role in shaping parental HPV vaccination decisions while accounting for perceived social norms. Public health interventions can leverage peer networks alongside family support to enhance HPV vaccine uptake.

Interventions are needed to increase low HPV vaccination rates within rural areas in the United States, particularly in the state of Florida, which has the seventh highest number of HPV-related cancers. Florida also ranks low compared to other states in terms of HPV vaccination. Rural-residing parents may benefit from two evidence-based strategies to increase vaccination rates: reminder messages informing and prompting vaccination appointments and mobile clinics to reduce transportation barriers. We sought to identify parental attitudes towards (1) message features that promote rural-residing parents’ receptivity to HPV vaccination; (2) parents’ acceptability of three reminder message modalities (text, postcard, phone); and (3) implementation factors that promote parents’ acceptability of using a mobile clinic for vaccination. We recruited 28 rural-residing parents of 9- to 12-year-old children (unvaccinated for HPV) for focus group and individual interviews and thematically analyzed transcripts. Three features promoted parents’ receptivity to HPV vaccination messages: source credibility, specific information coverage, and personalization (name and birthday wishes). Parents most preferred text messages and identified three factors promoting parents’ mobile clinic use: convenience and feasibility, trustworthiness, and detailed information. The findings indicate rural-residing parents’ acceptability of reminder messages and mobile clinics as well as the importance of trust and feasibility when implementing these evidence-based strategies for rural-residing parents.

BackgroundIn the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents’ vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. ObjectiveThis study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app’s usability. MethodsOn designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. ResultsOut of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child’s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents’ children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). ConclusionsThis mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient.

Objectives Only 5–8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists’ communication skills may enhance the frequency and quality of their discussions with patients about CCTs, consequently increasing participation. However, little is known about interest in or presence of CCT-related communication training during Hematology-Oncology (Hem-Onc) fellowships. This study aimed to describe, from the perspective of Hem-Onc fellowship program directors (PDs): (1) the current landscape of CCT education for Hem-Onc fellows; (2) the acceptability and feasibility of implementing a CCT communication skills workshop for Hem-Onc fellows. Methods We used an explanatory sequential mixed-methods approach. PDs were surveyed and interviewed about their graduate medical education (GME) programs’ current CCT curriculum, training challenges, fellows’ CCT knowledge and CCT communication skills, and preferences for a CCT communication workshop. Results PDs were surveyed (n = 40) and interviewed (n = 12). PDs reported that their institutions prioritize CCT accrual (M = 4.58, SD = .78; 1-5 scale, 5 = “Strongly Agree”) and clinical research training (M = 4.20, SD = .85). CCT skills that programs least often addressed were how to (1) discuss CCTs with newly diagnosed patients, (2) talk to patients about CCTs when none are available, and (3) help patients find CCTs at other institutions. PDs were interested in a CCT communication workshop for fellows (“yes” = 67.5%, “maybe” = 32.5%) and said training would be feasible (M = 4.28, SD = .78) and useful (M = 4.47, SD = .78). Qualitative results described programs’ current approaches to CCT education and insights about developing and implementing CCT communication training. Conclusions There is a clear need to improve CCT communication skills training in Hem-Onc fellowship programs and to implement and scale such training to increase CCT participation, especially among diverse patient populations. Furthermore, Hem-Onc GME PDs view such training as feasible and useful.

Abstract Background Integrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system. Methods We used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs’ feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances. Results The backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term “high risk” of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs’ workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability. Conclusions The final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability.

Purpose: Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. Methods: In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements.Results: Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11-to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n = 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11 years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p = .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), impor-tance at 11-12 years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12 years, and 8% bundling vaccines).Discussion: HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.(c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

Cervical cancer screening is credited with dramatically reducing cervical cancer mortality in the United States. There is a lack of consensus on whether women with behavioral health conditions (mental health or substance use) receive cervical cancer screening at rates similar to women without the conditions. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched for articles and abstracts of conference proceedings in PubMed, EMBASE, Web of Science and the EBSCO databases: CINAHL, PsycINFO, Psychosocial and Behavioral Science Collection, Academic Search Premier Databases, and the ProQuest database Applied Social Sciences Index and Abstracts from January 1, 2000 to July 31, 2020. Eligibility criteria included studies conducted in the United States, published in English, and comparing cervical cancer screening rates of women with and without behavioral health conditions. Of 1,242 unique articles screened, 52 were included in the full text review. And after title/abstract/and full-text review, 14 articles met the eligibility criteria. Six studies examined both mental health and substance use conditions, two studies only examined substance use disorders, and six studies examined only mental health conditions. Substance use disorders were associated with a decreased likelihood of receiving screening. This study yeilded inconclusive findings on the relationship between mental health conditions and cervical cancer screening. More research is needed to better understand the relationship between behavioral health conditions and cervical cancer screening.

Precision public health holds promise to improve disease prevention and health promotion strategies, allowing the right intervention to be delivered to the right population at the right time. Growing concerns underscore the potential for precision-based approaches to exacerbate health disparities by relying on biased data inputs and recapitulating existing access inequities. To achieve its full potential, precision public health must focus on addressing social and structural drivers of health and prominently incorporate equity-related concerns, particularly with respect to race and ethnicity. In this article, we discuss how an antiracism lens could be applied to reduce health disparities and health inequities through equity-informed research, implementation, and evaluation of precision public health interventions. (Am J Public Health. 2023;113(11):1210-1218. https://doi.org/10.2105/ AJPH.2023.307386)

AbstractBackgroundRecruitment of cancer clinical trial (CCT) participants, especially participants representing the diversity of the US population, is necessary to create successful medications and a continual challenge. These challenges are amplified in Phase I cancer trials that focus on evaluating the safety of new treatments and are the gateway to treatment development. In preparation for recruitment to a Phase I recurrent head and neck cancer (HNC) trial, we assessed perceived barriers to participation or referral and suggestions for recruitment among people with HNC and community physicians (oncologist, otolaryngologist or surgeon).MethodsBetween December 2020 and February 2022, we conducted a qualitative needs assessment via semistructured interviews with a race and ethnicity‐stratified sample of people with HNC (n = 30: 12 non‐Hispanic White, 9 non‐Hispanic African American, 8 Hispanic and 1 non‐Hispanic Pacific Islander) and community physicians (n = 16) within the University of Florida Health Cancer Center catchment area. Interviews were analyzed using a qualitative content analysis approach to describe perspectives and identify relevant themes.ResultsPeople with HNC reported thematic barriers included: concerns about side effects, safety and efficacy; lack of knowledge and systemic and environmental obstacles. Physicians identified thematic barriers of limited physician knowledge; clinic and physician barriers and structural barriers. People with HNC and physicians recommended themes included: improved patient education, dissemination of trial information and interpersonal communication between community physicians and CCT staff.ConclusionsThe themes identified by people with HNC and community physicians are consistent with research efforts and recommendations on how to increase the participation of people from minoritized populations in CCTs. This community needs assessment provides direction on the selection of strategies to increase CCT participation and referral.Patient or Public ContributionThis study focused on people with HNC and community physicians' lived experience and their interpretations of how they would consider a future Phase I clinical trial. In addition to our qualitative data reflecting community voices, a community member reviewed the draft interview guide before data collection and both people with HNC and physicians aided interpretation of the findings.

Background: In the United States, human papillomavirus (HPV) vaccine initiation and up-to-date (UTD) status are associated with multiple factors at the individual level such as racial/cultural (e.g., race, immigration status), socioeconomic status (e.g., living below poverty level, education), and healthcare access (e.g., insurance status/type). HPV vaccination rates differ dramatically by US geographic areas and within states. To tailor interventions to local areas, it is important to un-derstand county-level characteristics associated with HPV vaccination rates.Methods: Using linear regression, we assessed the association between county-level HPV vacci-nation initiation and UTD rates for 11-year-olds to 12-year-olds in Florida (collected from the Florida SHOTS immunization registry) and county-level variables. Factors found significant in bivariate analysis and with a variance influence factors <4 were included in multivariable models.Results: In 2019, county-level HPV vaccine coverage among Florida 11-year-olds to 12-year-olds ranged from 31% to 92% initiation and 3%-36% UTD. Counties with the lowest HPV vaccine coverage were concentrated in Florida's North-Central and Panhandle regions. In multivariable models, counties with primarily rural populations had lower vaccination initiation and UTD coverage. Above and beyond the association with rurality, UTD coverage was associated with family physicians per 100,000 residents and uninsured or Medicaid-enrolled populations.Discussion: While Florida county-level HPV vaccine initiation rates among 11-year-olds to 12 -year-olds varied by county in 2019, UTD rates remained universally low despite recommenda-tions. Tailoring interventions toward healthcare access in rural communities may increase HPV vaccine coverage.(c) 2022 Society for Adolescent Health and Medicine. All rights reserved.

Cervical cancer and Type 2 Diabetes (T2D) share common demographic risk factors. Despite this, scarce research has examined the relationship between race/ethnicity, having T2D, and cervical cancer incidence. We analyzed statewide electronic health records data between 2012 and 2019 from the OneFlorida+ Data Trust. We created a 1:4 nested case-control dataset. Each case (patient with cervical cancer) was matched with four controls (patients without cervical cancer) without replacement by year of encounter, diagnosis, and age. We used conditional logistic regression to estimate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between race/ethnicity, T2D, and cervical cancer incidence. A total of 100,739 cases and 402,956 matched controls were identified. After adjusting for sociodemographic characteristics, non-Hispanic Black women with T2D had higher odds of cervical cancer compared with non-Hispanic White women with T2D (OR: 1.58, 95% CI 1.41-1.77). Living in a rural area, having Medicaid/Medicare insurance, and having high social vulnerability were associated with higher odds of having a cervical cancer diagnosis. Our findings imply the need to address the higher burden of cervical cancer diagnosis among non-Hispanic Black women with T2D and in underserved populations.