Normalizing preteen HPV vaccination with practice-based communication strategies

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: NIH / UNC

Project Summary:

Despite growing evidence of its effectiveness in protecting against sexually transmitted infection (STI) and certain cancers, vaccination against human papillomavirus (HPV) in the United States has stalled. HPV vaccination completion among females was actually lower in 2012 than in 2011. HPV is the most common STI in the US, causes genital warts, and is associated with cervical, vaginal, vulvar, anal, penile, and throat cancers. HPV vaccine is most effective when given before exposure to the virus, and is recommended for routine administration to 11-12 year old females and males. Health care providers play the primary influential role in parents' decisions to vaccinate, yet too often provie weak recommendations for HPV vaccination. Many parents think their preteens are too young for HPV vaccination and teens are not routinely included in the decision to vaccinate. Missed opportunities to vaccinate against HPV at the same clinical visit with other preteen vaccines are far too frequent. Among unvaccinated girls in 2012, 84% had a health-care encounter where they received another adolescent age vaccine but not HPV vaccine. This research aims to eliminate this gap by transforming clinical care through an improved communication system and ultimately normalizing HPV vaccination at the optimal ages of 11-12. Principles of dissemination (conscious effort to spread an evidence- based innovation, the HPV vaccine) and implementation (adoption of an innovation in specific settings) science are used. The multiple baseline design will include an intervention with communication strategies adapted to rolling groups of practices (n=48) that (1) report to the North Carolina Immunization Registry (NCIR); and (2) agree to use mobile devices and web-based modalities to keep up to date on HPV vaccine and to educate parents and preteens about HPV vaccination. The overall objective is to assess the extent to which providers, parents and preteens respond to these proactive communication strategies by vaccinating preteen girls and boys. The long term goal is to prevent HPV-related disease through early intervention and protection against this STI. The central hypothesis is that providers, parents and preteens are relevant decision makers who can be motivated to complete the HPV vaccination series according to public health recommendations. The aims are to (1) Develop new and adapt existing theory-driven dissemination and implementation strategies to motivate providers, parents and preteens to initiate and complete the HPV vaccine series; (2) Evaluate theory driven dissemination and implementation strategies to stimulate communication among providers, parents and preteens to motivate HPV vaccination and completion of the series; and (3) Determine practice characteristics related to adoption, implementation, and maintenance of these dissemination and implementation strategies to motivate HPV vaccination of preteens. The positive impact is that effective HPV vaccination dissemination and implementation strategies will be available for use in practices to reduce HPV infection and related diseases.

Neurodevelopment and Improving Children's Health Following EtS exposure (NICHES)

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: NIH / Duke University

Project Summary:

The overall goal of the Administrative Core is to provide infrastructure and oversight to maximize NICHES scientific success. The Director, Susan K, Murphy, Ph.D., the Center's Child Health Specialist, Scott Kollins, Ph.D., and the Program Administrator, Ms. Dale Montana will work together closely within the Administrative Core to coordinate Center operations. The investigators will be supported in this role by an External Advisory Committee (EAC) and by an Executive Committee (EC), which consists of the key investigators participating in the Community Outreach and Translation Core (COTC) and the Research Projects. The Administrative Core has the following specific aims: 1) foster and maintain communication among team members, with the EAC, with the NIEHS and EPA, and with other Children's Centers; 2) organize and integrate NICHES research, investigator training, and outreach activities to promote synergy and maximize the Center's impact on children's health in the community; 3) promote the training of experts in cross-disciplinary fields in children's environmental health; 4) manage fiscal and other resources; and 5) track NICHES outputs and outcomes to ensure timely progress towards Center goals.

Maternal Obesity, Child Executive Functions and Child Weight Gain

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: NIH / Duke University

Project Summary:

This project seeks to evaluate a model of childhood obesity that begins with maternal pre-pregnancy obesity as a distal risk factor contributing to the development of appetite dysregulation and poor executive functioning, increasing a child's risk for excess weight gain. The study will take advantage of a perinatal birth cohort with over 2000 births that has obtained prospectively collected data from the first trimester through infancy, inclusive of pre-pregnancy weight at the first prenatal visit, gestational weight gain, surveys regarding nutrition, stress and lifestyle behaviors, data from medical records on pregnancy and birth complications, maternal blood at the first trimester, and umbilical cord blood at delivery. The proposed study will recruit mother/child dyads from this cohort and conduct detailed assessments of IQ, executive functions (attention, inhibitory control, memory, affective-based decision making), appetite regulation using the eating in the absence of hunger laboratory paradigm, dietary intake, and anthropometric growth among 400 children at ages 4 years and two- years later at 6 years. Maternal blood specimens collected during the first trimester and cord blood at birth will be used to assay Interleuken-6 (IL-6) and monocyte chemoattractant protein 1 (MCP-1), two cytokines important in both metabolism and normal brain development. The primary hypothesis is that maternal obesity influences neurodevelopmental processes that regulate appetite and executive functions resulting in increased risk for obesity in offspring. A secondary/exploratory hypothesis is that markers of prenatal neuro-inflammatory processes mediate the effect of maternal obesity on adverse child outcomes. Conducting this study in the context of an established perinatal birth cohort provides a cost-effective opportunity to achieve our aims. The study will aid in disentangling the associations between maternal pre-pregnancy obesity, childhood appetite regulation, executive functions and child weight gain. By understanding how developmental factors shape individual differences that predict child obesity, it is possible to markedly improve prevention interventions by targeting key risk factors for childhood obesity at earlier developmental periods and create tailored prevention programs that shift children's weight trajectory toward more healthy outcomes.