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Purpose and Objectives The human papillomavirus (HPV) vaccine is an effective but underused method for preventing multiple cancers, particularly cervical cancer. Although interventions have successfully targeted barriers to HPV vaccine uptake in various clinical settings, few studies have explored their implementation. Our study examines the delivery of the HPV VACs (Vaccinate Adolescents Against Cancer) Program and elicits information on barriers and facilitators to implementation. Intervention Approach The VACs Program pilot was a multilevel, evidence-based intervention conducted by the American Cancer Society in 30 federally qualified health centers (FQHCs) in the United States. Evaluation Methods We conducted in-depth interviews (N = 32) by telephone with representatives of 9 FQHC partners. We structured the interview guides on Consolidated Framework for Implementation Research (CFIR) domains. We asked about project start-up activities, implementation strategy selection, policy- and practice-level changes, staffing structure, challenges, and key factors leading to project success. At least 2 researchers coded each interview transcript verbatim. Results Participants most frequently identified the electronic health record system, training and education, concrete tools and resources, and provider champions as facilitators to implementing HPV VACs. Limited staff resources, challenges of electronic health records, issues with state immunization registries, patient misinformation about vaccines and vaccine stigma, cultural/language barriers, competing priorities, levels of funding, staff buy-in, training needs, and low health literacy were identified as barriers. Implications for Public Health Providing appropriate training for FQHC staff members and providers along with technical assistance and facilitation tools were critical for increasing provider confidence in recommending HPV vaccine. Addressing capacity-building and implementation barriers in FQHCs can increase effective implementation of evidence-based interventions to increase HPV vaccination uptake and reduce the burden of future cancers.

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Purpose -The purpose of this study was to examine the effects of living in "green" dorms on students' environmentally responsible behaviors (ERBs), in concert with other factors, including individual identity and social context in the form of behavior modeling by peers. Design/methodology/approach -The sample of 243 consists of students who resided in two newly constructed, Leadership in Energy and Environmental Design Gold-certified dorms and two conventional dorms. The authors analyze the data collected at the end of the respondents' freshmen year at Emory University using seemingly unrelated regression analysis. Findings -Findings indicate that students who live in "green" dorms engage in more recycling and advocacy behaviors than students in conventional dorms. Environmental identity and perceived behavior modeling by peers positively affect recycling, advocacy and conservation. Furthermore, results indicate an interaction between dorm and identity whereby students with weak environmental identities experience a greater increase in ERBs from living in green dorms than do students with strong environmental identities. Practical implications -These results show that universities do promote students' ERBs through the construction of green residence halls. Universities can also facilitate ERBs by encouraging students to develop strong environmental identities and fostering opportunities for them to engage in ERBs with their peers. Originality/value -This study is valuable for both its practical implications and the theoretical implications for predicting ERBs. The findings indicate that to predict ERBs, it is necessary to consider both contextual and individual level factors.

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This study examines how perceptions of the legitimacy of university sustainability efforts-support by the administration (authorization) or from students' peers (endorsement)-as well as the physical context in which students live, matter in shaping students' environmentally responsible behaviors (ERBs). Using survey data collected from fourth-year students at a university in the Southeastern US, we employ Seeming Unrelated Regression to analyze the impact of perceived legitimacy and context on recycling and conservation behaviors, controlling for demographic characteristics, pro-environmental attitudes, and environmental identity. Our findings indicate that students' perceptions of what university administrators support affect the likelihood of students to enact recycling and conservation behaviors, and peer support influences conservation behaviors. This research contributes to the literature on legitimacy by examining how legitimacy processes work in natural, rather than experimental, settings.Keywords: environmentally responsible behaviors; legitimacy; university administration IntroductionIn the United States (US), individuals and institutions increasingly emphasize environmentally responsible behavior (ERB), whether in the form of recycling bottles, using reusable grocery bags, or investing in hybrid cars and solar panels. College campuses constitute a part of this movement as well, with recycling efforts, energy saving competitions, and "green" methods of construction (see [1]). American institutions of higher education formally acknowledged their commitment to ERBs by signing the Talloires Declaration in 1990 and the American College and University Presidents Climate Commitment (ACUPCC) in 2007.Two goals of this green movement on college campuses are to increase student awareness about sustainability and shape related ERBs. As an important component of these efforts, campus-housing initiatives involve green construction, operation, and programming. Research illustrates that educational programs and campus demonstrations enhance the likelihood that students will perform sustainable behaviors such as recycling or turning off lights [2,3], and that living in green buildings can increase the frequency of self-reported recycling and environmental advocacy behaviors [4]. Universities use such initiatives to create and maintain a culture of sustainability in which ERB becomes common practice by all university actors. The present study examines how perceptions of university sustainability efforts help to shape students' ERBs. Although previous research demonstrates university effects on ERBs, rarely do studies ask why such effects emerge. Using a legitimacy framework [5,6], we argue that perceived university support for sustainability efforts enhances students' frequency of enacting such behavior owing to an obligation to comply and abide by collective norms. Johnson, Dowd and Ridgeway argue "Something is legitimate if it is in accord with the norms, values, beliefs, practices, and procedures accepted b...

In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site’s project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.

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