PROJECT SUMMARY - OVERALL The goal of this Program Project is to address the burden of cervical cancer incidence and mortality in Appalachia through the delivery of a clinic-based integrated prevention program that focuses on the major causes of cervical cancer (tobacco smoking, Human Papillomavirus (HPV) infection, and lack of cervical cancer screening) designed to target individual, social and community, health system and broader contextual-level barriers related to the burden of cervical cancer. Building upon our long history of collaborative research and community partnerships, the Program will test the effectiveness of health system-based interventions focused on tobacco use, HPV vaccination and cervical cancer screening (Pap test and/or self-testing with follow-up of positive tests), as part of an integrated clinic-based cervical cancer prevention program. The multi-level interventions (directed to three levels of influence – clinic, provider and patient) will be offered to eligible female patients and age-eligible children and young adults in four Appalachian states (Ohio, Kentucky, West Virginia and Virginia). Our research process is guided by a socio-ecological model based on the Social Determinants of Health, the Proctor Model for Implementation Science and a Community-Based Participatory Research (CBPR) framework. The aims of this Program Project are to: 1) Test the effectiveness of an integrated cervical cancer prevention program, consisting of three established interventions, designed to address three causes of cervical cancer in a region with one of the highest cervical cancer incidence and mortality rates in the United States; and 2) Evaluate the impact of the cervical cancer prevention program, including implementation, and acceptability, with attention to both short- and long-term impact and sustainability at the clinics. Four cores – Intervention and Consortium, Survey and Data Collection, Biostatistics and Evaluation, and Administrative – will facilitate the smooth and integrated operation of all projects. Integration and interaction of the projects in this Program is evident in several ways: 1) all projects focus on one health disparity; 2) participants will be recruited from the same health systems; 3) a core set of measures is being used by all projects; 4) all projects include transdisciplinary teams; 5) all projects build upon and extend findings from our long history of collaborative research and community partnerships; 6) all projects focus on multi-level assessment and/or interventions using the Warnecke model as a framework and utilize the Proctor et al. Implementation Science Framework; 7) all projects involve interaction with the community in some way, thus enhancing the CBPR nature of the Program; and 8) evaluation will assess implementation, service and client outcomes at the project and overall Program levels including: cost, satisfaction, effectiveness, sustainability, and safety, to name a few outcomes. If successful, this Program Project will provide evidence for a novel and innovative approach to address disparities in underserved communities with plans for sustainability and dissemination, as well as cost-effectiveness data.

PROJECT NARRATIVE - OVERALL Building upon our long history of collaborative research and community partnerships, this Program Project will test the effectiveness of health system-based interventions focused on tobacco use, HPV vaccination and cervical cancer screening (Pap test and/or self-testing with follow-up of positive tests), as part of an integrated clinic-based cervical cancer prevention program in health systems in four Appalachian states. If successful, this Program Project will provide evidence for a novel and innovative approach to address disparities in underserved communities with plans for sustainability and dissemination, as well as cost-effectiveness data.