Project Summary/Abstract OHSU's Knight Cancer Institute Community Outreach and Engagement program and the NPAIHB's Northwest Tribal Comprehensive Cancer program (NTCCP) will collaboratively unite in the ongoing national, regional and tribal goal of improving Human Papillomavirus (HPV) vaccination uptake in Oregon tribes. The Knight's catchment area, the state of Oregon, has a large geographic footprint with communities ranging from densely populated Portland, to frontier regions of farmers, ranchers and agricultural workers along the Eastern border. Two-thirds of our 36 counties are categorized as “non-metropolitan” (Rural-Urban Continuum codes (RUCC) 4- 9), resulting in over a quarter of the population residing in rural or frontier areas with limited access to health care and prevention strategies. Additionally, Oregon is home to nine federally recognized tribes, most of which are located in rural regions. The Northwest Portland Area Indian Health Board (NPAIHB) is a regional non- profit organization that represents and serves the 43-federally recognized tribes of the Pacific Northwest as well as houses the NTCCP. Dr. Amanda Bruegl, a citizen of the Oneida Nation and descendant of the Stockbridge-Munsee Band of Mohican Indians and a gynecologic oncologist will be leading this project from KCI. A publication by Dr. Bruegl and the NPAIHB's Tribal Epidemiology Center shows that the disparities suffered by AI/AN women have persisted over time with 1.5X incidence and nearly 2X the mortality rate, as well as nearly 3X the mortality rate in older age groups, when compared to their NHW counterparts.2 Increasing awareness among AI/ANs of the relationship between HPV and cervical cancer is an established objective within NTCCP's Twenty-Year Cancer plan. Most recently available data in the Pacific Northwest show that up-to-date HPV vaccination rates in Tribal youth are higher than other rural youth. In 2020, 67.5% of AI/AN adolescents had completed their HPV immunization series, compared to 56.1% of White adolescents. However, these rates still remain below the Healthy People 2020 target of 80%. Overall up-to-date rates vary widely between clinics, with the highest up-to-date clinic rates at 80% and the clinic with the lowest rates at 32%, as of July 2020. This grant proposes leveraging the partnership between Knight COE and the NTCCP to 1) assure updated evidence-based guidelines are included in the Indian Health Service HPV Best Practices Guide, 2) increase provider knowledge and comfort with HPV vaccination as a cancer prevention tool, 3) increase provider knowledge and comfort with updated cervical cancer screening guidelines, 4) create culturally tailored HPV vaccination materials and media and 5) evaluate and disseminate all materials and trainings throughout Oregon tribal regions as well as within KCI clinics in which tribal youth receive care.