A Peer-Based Strategy to Overcome HPV Vaccination Inequities in Rural Communities: A Physical Distancing-Compliant Approach.

The human papilloma virus (HPV) vaccine is the world's first proven and effective vaccine to prevent cancers in males and females when administered pre-exposure. Like most of the US, barely half of Vermont teens are up-to-date with the vaccination, with comparable deficits in New Hampshire and Maine. The rates for HPV vaccine initiation and completion are as low as 33% in rural New England. Consequently, there is a compelling responsibility to communicate its importance to unvaccinated teenagers before their risk for infection increases. Messaging in rural areas promoting HPV vaccination is compromised by community-based characteristics that include access to appropriate medical care, poor media coverage, parental and peer influence, and skepticism of science and medicine. Current strategies are predominantly passive access to literature and Internet-based information. Evidence indicates that performance-based messaging can clarify the importance of HPV vaccination to teenagers and their parents in rural areas. Increased HPV vaccination will significantly contribute to the prevention of a broadening spectrum of cancers. Reducing rurality-based inequities is a public health priority. Development of a performance-based peer-communication intervention can capture a window of opportunity to provide increasingly effective and sustained HPV protection. An effective approach can be partnering rural schools and regional health teams with a program that is nimble and scalable to respond to public health policies and practices compliant with COVID-19 pandemic-related modifications on physical distancing and interacting in the foreseeable future.

Cost Effectiveness of Two Lifestyle Interventions in the Vermont WISEWOMAN Program.

INTRODUCTION: Low-income women are disproportionately overweight or obese. The Vermont WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) program, which serves Vermont women whose annual income is less than 250% of the federal poverty level, pays for members to attend 1 of 2 different evidence-based weight loss programs, Weight Watchers or Curves Complete. PURPOSE AND OBJECTIVES: We evaluated cost effectiveness of the weight-loss programs, conducted from April 2014 through March 2016, to determine which represented the best investment of WISEWOMAN program funds. INTERVENTION APPROACH: Vermont WISEWOMAN members who were overweight or obese during screening and who identified weight loss as a goal were invited to participate in 1 of the 2 programs on the basis of their place of residence and local Weight Watchers or Curves Complete contractual agreements with the Vermont WISEWOMAN program. EVALUATION METHODS: Program costs and benefits were collected for a 2-year period and used to calculate the cost per participant who completed the program and the cost per participant who achieved the weight reduction goal of a 5% or more loss in body weight. RESULTS: The cost per participant achieving the weight reduction goal with Curves Complete ($8,613) was approximately 5 times the cost for Weight Watchers ($1,610). IMPLICATIONS FOR PUBLIC HEALTH: Weight Watchers, the evidence-based program with the simplest administrative structure, was significantly more cost effective than Curves Complete. Results suggest that overweight or obese low-income women aged 30 to 64 can lose 5% or more of their body weight more cost effectively through Weight Watchers than through Curves Complete.