The impact of macrosomia on cardiometabolic health in preteens: findings from the ROLO longitudinal birth cohort study.

BACKGROUND: Macrosomia (birthweight ≥ 4 kg or ≥ 4.5 kg) is strongly associated with a predisposition to childhood obesity, which in turn is linked with adverse cardiometabolic health. Despite this, there is a lack of longitudinal investigation on the impact of high birthweight on cardiometabolic outcomes in youth. The preteen period represents an important window of opportunity to further explore this link, to potentially prevent cardiometabolic profiles worsening during puberty. METHODS: This is a secondary analysis of 9-11-year-olds (n = 405) born to mothers in the ROLO longitudinal birth cohort study, who previously delivered an infant with macrosomia. Preteens were dichotomised into those born with and without macrosomia, using two common cut-off criteria (birthweight ≥ 4 kg (n = 208) and < 4 kg; ≥ 4.5 kg (n = 65) and < 4.5 kg). Cardiometabolic health was assessed using anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance (20-m shuttle run test), and non-fasting serum biomarkers for a subgroup (n = 213). Statistical comparisons between the two groups were explored using independent t-tests, Mann-Whitney U tests, and Chi-square tests. Crude and adjusted linear regression models investigated associations between macrosomia and preteen cardiometabolic outcomes. RESULTS: In total, 29.3% (n = 119) of preteens had overweight/obesity based on their BMI z-score. Preteens born ≥ 4 kg had lower median (IQR) C3 concentrations (1.38 (1.22, 1.52) g/L vs. 1.4 (1.26, 1.6) g/L, p = 0.043) and lower median (IQR) ICAM-1 concentrations (345.39 (290.34, 394.91) ng/mL vs. 387.44 (312.91, 441.83) ng/mL, p = 0.040), than those born < 4 kg. Those born ≥ 4.5 kg had higher mean (SD) BMI z-scores (0.71 (0.99) vs. 0.36 (1.09), p = 0.016), and higher median (IQR) lean mass (24.76 (23.28, 28.51) kg vs. 23.87 (21.9, 26.79) kg, p = 0.021), than those born < 4.5 kg. Adjusted linear regression analyses revealed birthweight ≥ 4 kg was negatively associated with C3 concentration (g/L) (B = - 0.095, 95% CI = - 0.162, - 0.029, p = 0.005) and birthweight ≥ 4.5 kg was positively associated with weight z-score (B = 0.325, 95% CI = 0.018, 0.633, p = 0.038), height z-score (B = 0.391, 95% CI = 0.079, 0.703, p = 0.014), lean mass (kg) (B = 1.353, 95% CI = 0.264, 2.442, p = 0.015) and cardiorespiratory endurance (B = 0.407, 95% CI = 0.006, 0.808, p = 0.047). CONCLUSION: This study found no strong evidence to suggest that macrosomia is associated with adverse preteen cardiometabolic health. Macrosomia alone may not be a long-term cardiometabolic risk factor. Trial registration ISRCTN54392969 registered at  www.isrctn.com .

Subjective well-being of Thai pre-teen children: Individual, family, and school determinants.

Children's subjective well-being is crucial for ensuring decent child development. At present, evidence about children's subjective well-being is limited, particularly regarding insights from developing countries. This study aimed to assess overall life satisfaction, multi-dimensional life satisfaction of Thai pre-teens, and factors associated with the children's overall life satisfaction. A cross-sectional study was carried out with 2277 children in grade 4 to 6 at 50 public primary schools from nine provinces across all regions of Thailand. The data collection took place between September and December 2020. The children were satisfied with their overall life to a considerable degree (8.5 out of 10). Girls had higher life satisfaction and satisfaction with multiple life domains (except for "autonomy") than boys. Compared with older children, younger children had higher overall life satisfaction and satisfaction with multiple life domains except for "autonomy", "yourself" and "friends". The children's overall life satisfaction was increased in proportion to satisfaction with family, friends, oneself, physical appearance, health, teacher, school activity, and autonomy. Concerning individual factors, their social skills and time spent on gardening (≥1 h/day) and active recreational activities (1-3 h/day) had positive influence upon their overall life satisfaction, while too much time on screen (>1 h/day) and music (>3 h/day) had negative results. In terms of family factors, children having fathers owning a shop/business had higher life satisfaction than children having fathers who were manual workers, while children who lost their fathers had lower life satisfaction. For school factors, school connectedness had a positive relationship with their overall life satisfaction. Children's subjective well-being promotion should include family-based and school-based interventions to improve children's time use (e.g., more active outdoor lifestyle and less sedentary lifestyle), self-esteem, health, autonomy, and school connectedness.

Parenting Concerns: Uncovering Barriers and Identifying Ways to Support Pre-teen Flourishing.

Parenting capacity and family factors are positively correlated with children's flourishing. The purpose of this research is to describe parents' everyday concerns in caring for their children, to uncover barriers to pre-teen flourishing, and to identify ways to support pre-teen flourishing. The research method for this qualitative study was interpretive phenomenology. Semi-structured interviews were conducted with 20 participants in their homes. In this study, participants' stories revealed barriers to pre-teen flourishing, including shifting expectations around their children's independence and their children's exposure to digital environments. Study participants' stories also revealed that creating new daily routines and participating in traditional activities were the background that supported parents in helping their pre-teen children flourish. Researchers should use these findings as sources of insight to positively impact pre-teen flourishing as they seek contemporary ways to support parents, evaluate pre-teen child outcomes, and create interventions and social policies that aid parents in raising healthy pre-teen children.

Timing of Sexuality Education: Hong Kong Preteens' Perception of Sexual Health.

Although young people want to know more about sexuality, they do not feel they have received what they need to learn. In Chinese societies, scant research has solicited direct input from the youth to obtain their views on sexuality education (SE) deliverables. We found research gaps in the lack of Chinese preteens' input regarding SE timing, knowledge perception, learning readiness, and preteens' reasons for obtaining information about sexual health. In Hong Kong, a not-for-profit agency collected data from Chinese preadolescents who expressed opinions through a general survey. This agency surveyed students from 24 primary schools and provided anonymous secondary data for this team to analyze further. Among 4569 fifth- and sixth-grade students (average 11 years old), girls were more likely than boys to seek sex-related information from teachers, library books, and mothers. In contrast, boys were more likely than girls to obtain information from friends, pornographic comics, and the internet. Logistic regression analysis indicated that gender, age, instructional sources, openness to sexual health knowledge, and perceived and actual levels of knowledge predicted preteens' desire to receive SE earlier in grade school. Girls and older students were significantly more likely to report their preference to receive SE in an earlier grade. We recommend that preteens and their parents be encouraged to collaborate with teachers to participate in school-based SE programming.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study.

To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

Protective and risk factors of problematic smartphone use in preteens using panel study on Korean children.

Background: Increased smartphone use by children and adolescents places them at higher risk of overdependence. The problematic smartphone use of preteens is rapidly increasing. The preteen period is one of considerable developmental change and the influence of problematic smartphone use should be identified by reflecting on this change and considering its social psychological factors. Methods: This study employed a secondary analysis using data from the 10th (2017) to 11th (2018) wave of the Panel Study on Korean Children. STATA/BE 17 was used to analyze the panel logit model. Among the 1,286 participants aged 9-10 from the Panel Study on Korean Children, 342 with complete responses were selected as the participants of this study. Results: The risk group for problematic smartphone use showed an increase from 126 in 2017 to 149 in 2018. Factors influencing risk of preteens' problematic smartphone use were the child's externalizing problems (p = 0.015) and permissive parenting behavior (p = 0.003). Protective factors influencing preteens' problematic smartphone use were peer communication (p = 0.023), parental supervision (p = 0.020), and authoritative parenting behavior (p = 0.001). Conclusions: Preteens with externalizing problems are at a higher risk for problematic smartphone use and are therefore a group to be observed with caution. It is also required to guide them to form good relationships with friends. Finally, in the problematic smartphone use of preteens, parents are both a protective factor and a risk factor. Therefore, guidance is required so that children can behave properly.

Application of the RDoC Framework to Predict Alcohol Use and Suicidal Thoughts and Behaviors among Early Adolescents in the Adolescent Brain and Cognitive Development (ABCD) Study.

Alcohol use confers risk for suicidal thoughts and behaviors (ideation, attempt) in early adolescents. The Research Domain Criteria provides a framework for examination of multidimensional and modifiable risk factors. We examined distinct latent profiles based on patterns of positive valence (reward responsivity) and cognitive systems (neurocognition) from the ABCD Study (age 9−10, N = 10,414) at baseline enrollment. Longitudinal associations were determined between baseline positive valence and cognitive profiles and group classification (alcohol use, suicidal thoughts and behaviors, or their co-occurrence) two-years after initial assessment (ages 11−12). Three unique profiles of positive valence, cognition, alcohol use, and suicidal thoughts and behaviors were identified. Two baseline profiles predicted alcohol use and suicidal thoughts and behaviors, two-years after initial assessment. Low positive valence with high cognition (but low impulsivity) predicted alcohol use (OR = 1.414, p< 0.001), while high positive valence with low cognition (but high impulsivity) predicted suicidal thoughts and behaviors (OR = 1.25, p = 0.038), compared to average positive valence and cognition. Unique profiles of positive valence and cognitive systems among 9−12-year-olds may be predictive of alcohol use and suicidal thoughts and behaviors over a two-year period. Findings underscore the potential for trajectory research on positive valence and cognitive profiles to enhance prevention for early-adolescents.

Temporal oral microbiome changes with brushing in children with cleft lip and palate.

This cohort study aimed to characterize the oral microbiome of children with CLP, from two different age groups, and evaluate the effect of supervised or unsupervised toothbrushing on the microbiome of the cleft over time. Swab samples were collected from the cleft area at three different time points (A; no brushing, B; after 15 days and C; after 30 days) and were analyzed using next-generation sequencing to determine the microbial composition and diversity in these time points. Overall, brushing significantly decreased the abundance of the genera Alloprevotella and Leptotrichia in the two age groups examined, and for Alloprevotella this decrease was more evident for children (2-6 years old). In the preteen group (7-12 years old), a significant relative increase of the genus Rothia was observed after brushing. In this study, the systematic brushing over a period of thirty days also resulted in differences at the intra-individual bacterial richness.

Review of Recent Research about Parenting Generation Z Pre-Teen Children.

The purpose of this scoping review is to provide a timely update of available research describing parents' perspectives of parenting pre-teen children of Generation Z (born 1997 through 2012). The databases of Ovid MEDLINE, CIHAHL, SCOPUS, Web of Science, JUSTOR, and PsyINFO were searched using a combination of key words for manuscripts published in English. A limited collection of scientific literature documented experiences of parents, practices of parenting, styles of parenting, and interventions that influence parenting of Generation Z pre-teen children among various groups of parents. Although an emerging body of literature on parenting pre-teen children of Generation Z was identified, future research should consider systematic sample selection to further explore the roles of cultural and psychosocial factors that influence parents' perspectives of parenting "digital natives" in homes around the world.

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017.

Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P < .05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P = .11). Assessment of preteen sex and substance use-especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts-will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.

A Pilot Evaluation of I'M HAPPY: An Interactive Module to Halt Abuse of Prescriptions in Preteens and Youth.

Objective: The purpose of this project was to create a web-accessible drug education program that would positively impact student knowledge and perceptions. Materials and Methods: An interactive computer module (Interactive Module to Halt Abuse of Prescriptions in Preteens and Youth [I'M HAPPY]) was created using a combination of e-learning and animation software. The module used narrated illustrations, animations, and games to explain what over-the-counter (OTC) and prescription drugs are, how they are used correctly, and what risks they carry. Animated drug refusal scenarios with user-determined outcomes were also incorporated. Sixth-grade students were asked to complete the module online and were given a 14-question pretest and posttest on the definitions, adverse effects, and proper use of OTC and prescription medicines. They were also asked to rank the perceived helpfulness of several drug refusal strategies. Student opinions about the computer module itself were collected on the posttest. Results: Students (n = 34) scored better on quiz questions following the module. They also showed increased favorability toward three of four drug refusal strategies after completing the module, with a greater proportion ranking these strategies "Very Helpful." Most students indicated they learned new things from the module (79%) and found it enjoyable (88%) and easy to use (97%). Conclusion: The I'M HAPPY program improved student knowledge of OTC and prescription drugs and enhanced perceptions of the helpfulness of certain drug refusal strategies. The computer module was considered enjoyable and easy to use, and can be easily disseminated to any student or classroom having internet access.

Immediate Effect of a Yoga Breathing Practice on Attention and Anxiety in Pre-Teen Children.

Pre-teen children face stressors related to their transition from childhood to adolescence, with a simultaneous increase in academic pressure. The present study compared the immediate effects of 18 min of (i) high frequency yoga breathing with (ii) yoga-based breath awareness and (iii) sitting quietly, on (a) attention and (b) anxiety, in 61 pre-teen children (aged between 11 and 12 years; 25 girls). Attention was assessed using a six letter cancellation task and Spielberger's State Trait Anxiety Inventory STAI-S was used to measure anxiety before and after the three practices, practiced on separate days. Repeated measures ANOVA, followed by Bonferroni adjusted post-hoc analyses showed an increase in total attempts and net scores after high frequency yoga breathing (p < 0.05), while wrong attempts increased after yoga based breath awareness (p < 0.05). Anxiety decreased comparably after all three interventions. The 25 girls in the group had the same trend of results as the whole group with respect to the attention-based cancellation task, while boys showed no, how since change. For both girls and boys, anxiety decreased after all three 18min interventions. The results suggest that high frequency yoga breathing could be a short, useful school based practice to improve attention and reduce anxiety.

Preteen children's health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups.

BACKGROUND: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background. METHODS: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child's country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups. RESULTS: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1-1.3) and more mood problems (OR: 1.35, 95% CI: 1.2-1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents' occupation, however, children of parents with low or medium education levels reported less "mood problems" than those of parents with high education levels (OR: 0.65, 95% CI: 0.46-0.92) and (OR: 0.84, 95% CI: 0.73-0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14-2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08-6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations. CONCLUSION: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

Exposure to drinking mediates the association between parental alcohol use and preteen alcohol use.

OBJECTIVE: The aim of the present study was to test the link between exposure to parental alcohol use (i.e., preteens seeing their parents drinking) and preteen's alcohol use. Specifically, this study aimed to (a) replicate the association between parental alcohol use and preteen alcohol use and (b) test whether alcohol use exposure mediated this association. METHOD: Families were recruited from five regions in the Netherlands from 104 schools that agreed to participate. Preteens (N = 755, Mage = 11.27, SD = 0.56, 45.8% boys) and their mothers (N = 755) participated in the study. Preteens reported lifetime alcohol use and parental alcohol use exposure. Mothers reported on alcohol use for both parents. Structural Equation Modelling was used to assess direct and mediated paths between parental alcohol use, preteen's exposure to alcohol use and preteen alcohol use in one model. RESULTS: Unexpectedly, father's alcohol use was negatively associated (ß = -0.121, p = .012) and mother's alcohol use was not associated (ß = 0.056, p = .215) with preteen's alcohol use. A positive indirect effect emerged through alcohol use exposure, showing that exposure to father's alcohol use mediated the association between parent's and preteen's alcohol use (ß = 0.064, p = .001). This effect was absent for mother's alcohol use (ß = 0.026, p = .264). Gender differences were non-significant. CONCLUSIONS: Parental alcohol exposure positively mediated the association of parental alcohol use with preteen's alcohol use. These effects were found for both boys and girls and were most robust for father's drinking. The findings might provide clues for preventive action, for example, by emphasizing that exposure should be restricted to prevent preteen's alcohol use.

Developing a Serious Videogame for Preteens to Motivate HPV Vaccination Decision Making: Land of Secret Gardens.

INTRODUCTION: Vaccination against human papillomavirus (HPV) is routinely recommended for ages 11-12, yet in 2016 only 49.5% of women and 37.5% of men had completed the three-dose series in the United States. Offering information and cues to action through a serious videogame for preteens may foster HPV vaccination awareness, information seeking, and communication. MATERIALS AND METHODS: An iterative process was used to develop an interactive videogame, Land of Secret Gardens. Three focus groups were conducted with 16 boys and girls, ages 11-12, for input on game design, acceptability, and functioning. Two parallel focus groups explored parents' (n = 9) perspectives on the game concept. Three researchers identified key themes. RESULTS: Preteens wanted a game that is both entertaining and instructional. Some parents were skeptical that games could be motivational. A back-story about a secret garden was developed as a metaphor for a preteen's body and keeping it healthy. The goal is to plant a lush secret garden and protect the seedlings by treating them with a potion when they sprout to keep them healthy as they mature. Points to buy seeds and create the potion are earned by playing mini-games. Throughout play, players are exposed to messaging about HPV and the benefits of the vaccine. Both boys and girls liked the garden concept and getting facts about HPV. Parents were encouraged to discuss the game with their preteens. CONCLUSION: Within a larger communication strategy, serious games could be useful for engaging preteens in health decision making about HPV vaccination.

Polysomnographic Oxygen Saturation Findings for Preteen Children versus Adolescents.

Objective Home oximetry is commonly used to screen for obstructive sleep apnea (OSA) in children; however, normal oxygen desaturation levels by disease severity are not well known. It was our objective to determine if oxygen saturation levels differed by OSA severity category in children and if these differences were similar for preteen children and adolescents. Study Design Retrospective case series of children undergoing polysomnography from September 2011 to July 2015. Setting Tertiary pediatric hospital. Subjects and Methods Six- to 18-year-olds (preteen, 6-12 years old; adolescent, 13-18 years old). Chi-square, Wilcoxon rank sum test, and Kruskal-Wallis testing were used to compare variables between age groups. Results The study included 342 children with a mean age of 11.3 ± 2.4 years (range, 6.5-17.5) and a mean body mass index of 25.6 ± 9.2 kg/m2 (78 ± 29 percentile); 61% were white, 35% were black, and 4% were other or unknown. Of the children, 48% were female, and this was not a significant difference between age groups ( P = .81). Overall, 50% of the children had no OSA, 32% mild, 10% moderate, and 8% severe. When compared with the younger children, the adolescents had a longer sleep time ( P = .014) and a higher mean obstructive apnea-hypopnea index (3.53 ± 5.1 vs 3.03 ± 6.1 events per hour, P = .02). The 3% and 4% oxygen desaturation indices were not significantly different between age groups when accounting for OSA severity. Conclusion Adolescents have longer sleep times and higher obstructive apnea-hypopnea indexes than preteens, but oxygen saturations and desaturation indices were similar. This supports current triage algorithms for children with OSA, as we found no significant age-based differences.

Participation in extracurricular activities for children with and without siblings with autism spectrum disorder.

OBJECTIVE: To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation. METHODS: A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire. RESULTS: Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD. CONCLUSION: While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.

PREP-T1 (Preteen Re-Education With Parents-Type 1 Diabetes) Feasibility Intervention Results.

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the "driver's seat." The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens (n = 22) and parents (n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research.

Social marketing to promote HPV vaccination in pre-teenage children: talk about a sexually transmitted infection.

A significant barrier to the delivery of HPV vaccine is reluctance by both healthcare providers and parents to vaccinate at age 11 or 12, which may be considered a young age. This barrier has been called "vaccine hesitancy" in recent research. In this commentary, we suggest using social marketing strategies to promote HPV vaccination at the recommended preteen ages. We emphasize a critical public health message of a sexually transmitted infection (STI) as preventable and vaccination against HPV as a way to protect against its consequences. The message tackles the issue of vaccine hesitancy head on, by saying that most people are at risk for HPV and there is a way to prevent HPV's serious consequences of cancer. Our approach to this conversation in the clinical setting is also to engage the preteen in a dialog with the parent and provider. We expect our emphasis on the risk of STI infection will not only lead to increased HPV vaccination at preteen ages but also lay important groundwork for clinical adoption of other STI vaccines in development (HIV, HSV, Chlamydia, and Gonorrhea) as well as begin conversations to promote sexual health.

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.

OBJECTIVES: Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11-12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys. METHODS: We targeted parents and providers of 9-13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered. RESULTS: The Cox model showed an intervention effect (ß=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11-12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously. CONCLUSIONS: Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.