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TRIO - Text Reminders to Immunize in a Managed Care Organization

Study Team Members

Principal Investigator

Additional Investigators

Collaborators and Consultants.

  • Howard Brill, Ph.D.
  • Joseph Stankaitis, M.D., M.P.H.

Project Coordinators

  • Christina Albertin, M.P.H., B.S.N.
  • Phyllis Vincelli, B.S.

Text-reminders to immunize in a managed care organization (TRIO) is an intervention study testing the impact of text message reminders sent from a large managed care organization to parents of adolescents due for HPV vaccination.


The human papillomavirus (HPV) vaccine has been recommended since 2007 for adolescent girls to prevent cervical cancer and genital warts The HPV vaccine is now recommended for boys as well to prevent male cancers (penile and anal cancer), oropharynegeal cancers, and genital warts. The vaccine is given in a 3-dose series. Only 53% of adolescent girls have started the series, and the percentage is even lower among boys. Many who begin the series do not complete it, and there are racial disparities in HPV vaccination, with lower percentages of Black and Hispanic teens receiving all 3 needed doses. This is important as these minority populations also have the highest rates of cervical cancer.

Currently, more than 75% of Americans use text messaging. Text messaging is expected to become a valuable method to reach parents of adolescents for healthcare reminders, including vaccination. Many pediatric and family medicine practices, which care for the majority of adolescents, do not have the resources needed to regularly send message reminders, so we have partnered with a managed care organization that manages the insurance plans for the majority of Medicaid and Child Health Plus enrolled adolescents in the Rochester area. Receipt of HPV vaccination among their adolescent clients is one of the quality measures (HEDIS) used to evaluate their organization and they are interested in finding the best ways to communicate with the families they insure.


To use a randomized-controlled trial (RCT) to determine whether targeted text-messaged reminders sent from a managed care organization can improve initiation (1 dose) of the HPV vaccine series and series completion (all 3 doses) among adolescents from 40 local primary care practices. Parents in the intervention group receive a message indicating their adolescent is due for a dose of HPV vaccine and encouraging them to call their adolescent’s primary care practice. The control group receives text-messages with general preventive health tips.

Study Aims

To evaluate the following:

  • The effectiveness of targeted text-messaged reminders to improve HPV vaccination rates (initiation of HPV series and HPV series completion)
  • The impact of the targeted text-messages among:
    • female versus male adolescents
    • younger versus older adolescents
    • pediatric versus family medicine practices