Adaptation of an HPV Education Resource to Promote HPV Vaccination Among Latino Young Men Who Have Sex With Men in Puerto Rico and Florida -- Proyecto Hombres Previniendo el VPH (Proyecto HPV)
Conditions: HPV Vaccine, HPV
Sponsor: H. Lee Moffitt Cancer Center and Research Institute

 
Adaptation of an HPV education resource to 
promote HPV vaccination among Latino Young Men 
who Have Sex with Men in Puerto Rico and Florida 
(Proyecto Hombres Previniendo el VPH (Proyecto 
HPV) 
 
NCT04974619 
 
Protocol V9 
Dated 06/17/2022 

 PI: Shannon M. Christy, PhD 
 
Title:   
 
 
  
 
     Adaptation of an HPV education resource to promote HPV 
vaccination among Latino Young Men who Have Sex with 
Men in Puerto Rico and Florida 
 
 
 
 
 
 
 
 
 
Proyecto Hombres Previniendo el VPH (Proyecto HPV) 
 
Coordinating Center: 
H. Lee Moffitt Cancer Center and Research Institute 
 
Principal Investigator: 
Shannon M. Christy, PhD 
 
 
 
 
Email: shannon.christy@moffitt.org 
 
Co-Principal Investigator: Melissa Marzán-Rodriguez, DrPH 
 Ponce Health Sciences University 
 
 
 
 Email: mmarzan@psm.edu 
 
Research Team: 
Cathy D. Meade, PhD (Co-Investigator at H. Lee Moffitt 
Cancer Center and Research Institute) 
Susan T. Vadaparampil, PhD (Co-Investigator at H. Lee  
 
Moffitt Cancer Center and Research Institute) 
Julian Sanchez, MD (Co-Investigator at H. Lee Moffitt  
 
 
Cancer Center and Research Institute) 
 Julio Jimenez, MD (Co-Investigator at Ponce Health  
  
Sciences University 
 
 
Protocol Version #9 Date: 06/17/2022 
 
 

 PI: Shannon M. Christy, PhD 
2 
 
TABLE OF CONTENTS 
 
 
Page 
 
1. Specific Aims  ........................................................................................................ 3 
 
2. Background  and Significance ................................................................................ 4 
 
3. Research Design and Methods ............................................................................... 6 
 
4. Human Subjects Considerations .......................................................................... 12 
 
 
5.   References  ............................................................................................................ 17 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 PI: Shannon M. Christy, PhD 
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1. Specific Aims 
Persistent infections from oncogenic human papillomavirus (HPV) strains can develop into 
several types of cancers in both men and women (i.e., oropharyngeal, cervical, anal, 
penile, vaginal, and vulvar cancers).1 Rates of oropharyngeal and anal cancers have been 
increasing in recent years,2 and HPV disproportionately affects men who have sex with 
men (MSM).2 Indeed, compared to heterosexual men, MSM are 17 times more likely to 
develop anal cancer.3 MSM infected with human immunodeficiency virus (HIV) are at even 
higher risk.3 Geographic disparities in HPV-related cancer incidence and mortality also 
exist. For example, Florida (FL) has among the highest incidence of HPV-related cancers 
in the United States (U.S.)4 and men in Puerto Rico (PR) experience higher incidence and 
mortality from oropharyngeal and penile cancers than those in the continental U.S.5,6 
Given the risk for HPV infection and HPV-related cancers among young MSM (YMSM) 
and the HPV-related geographic disparities in FL and PR, HPV prevention efforts for this 
underserved population are vitally needed in both FL and PR. To date, no Spanish 
language HPV educational interventions have been targeted for young adult MSM. 
 
The HPV vaccine can protect 9 HPV strains, including 7 oncogenic strains, and has the 
potential to prevent against 92% of HPV-related cancers.4 Young adults experience the 
highest prevalence of HPV infection.7 Yet, nationwide, HPV vaccine rates among young 
adult males ages 19-26 are suboptimal (21.2% in 2017).8 In FL, HPV vaccine rates among 
adult males is even lower (only 2% in 2015).9 For the same age groups, HPV vaccine 
rates in PR among males is 23.7%.10 Despite their increased risk for HPV infection, HPV 
vaccination rates are most suboptimal among YMSM, with only 13.7% reported receiving 
any doses of HPV vaccine.11 Prior research has demonstrated low knowledge about HPV 
and HPV vaccine among Latinos and MSM.12 However, little is known about HPV 
knowledge, HPV vaccine attitudes, health beliefs, and intentions among Latino MSM 
(YLMSM). Educational interventions that promote HPV vaccination are critical to prevent 
HPV-related cancer incidence and mortality among this high-risk and underserved group. 
However, no prior HPV vaccine educational interventions have been targeted to YLMSM. 
Previously, an educational resource was developed as part of the Ponce Health Sciences 
University-Moffitt Cancer Center Partnership (U54) Outreach Core. The module is titled 
“Cancer 101 HPV” and was developed in Spanish language for a wide community 
audience including information for individuals born male and female, of adult age, and 
presented in a Microsoft PowerPoint presentation format.13, 14  
 
Prior studies adapting educational materials for Latino communities incorporate culture, 
language, context, and other characteristics that enhance meaning and value for the 
target audience.13, 14Researchers have found that language preference influences 
intervention adoption.15 About two thirds of young adult Latinos in the U.S. and about 45% 
of young adult Latinos born in Puerto Rico or abroad speak English proficiently.16 
Furthermore, our Community Advisory Board (CAB) has voiced that Latino young adults 
in Florida may prefer English language materials (and may or may not be fluent in 
Spanish). Recognizing that young Latinos in Florida and Puerto Rico may have different 
language preferences, we seek to simultaneously adapt and refine the Cancer 101 
modules considering culture, Spanish or English language preferences, and relevancy to 
our specific audience (YLMSM ages 18-26 years old).18,19 Intervention material content 
will be identical aside from language. That is, the color scheme, photos, infographics, 

 PI: Shannon M. Christy, PhD 
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graphics, intervention modality, and intervention delivery methods, etc. will be the same. 
In the current study, a transcreation process20 will be utilized to adapt the Cancer 101 
module to a Latino MSM population. Transcreation aims to culturally and linguistically 
adapt a resource for a different population while allowing for flexibility to create something 
new that is meaningful for the new audience.20 We expect that transcreating the Cancer 
101 module will yield a culturally-responsive educational resource that incorporates 
content that is targeted to Latino MSM in preferred format(s) (delivery modality/modalities) 
and including content and aesthetics that are salient, appealing, meaningful, and 
actionable for young adult Latino MSM.  This study, informed by the Theory of Planned 
Behavior (TPB)21 and Health Belief Model (HBM),22 will be carried out in both PR and FL. 
The specific aims are: 
 
Specific Aim #1. To assess HPV and HPV vaccination knowledge, awareness, 
attitudes, health beliefs, and behaviors as well as educational preferences among 
260 Spanish-speaking YLMSM ages 18-26 in Florida and Puerto Rico. We will identify 
knowledge gaps, health beliefs, attitudes, and educational learning preferences through a 
cross-sectional survey. 
 
Specific Aim #2. To conduct 20 in-depth interviews with key stakeholders (10 in PR 
and 10 in FL) eliciting feedback to inform intervention content and delivery methods 
and identify potential facilitators and barriers to intervention implementation. 
Informed by the Consolidated Framework for Implementation Research model (CFIR),23 
we will conduct individual interviews with key stakeholders (i.e., healthcare clinic 
leadership, providers and staff, community-based organization staff, and individuals who 
serve and/or have provided services to YLMSM within the past 12 months).  
 
Specific Aim #3. To culturally adapt an existing Cancer 101 educational resource in 
English and Spanish for YLMSM ages 18-26 and to conduct focus groups or 
individual interviews with 24 YLMSM in PR (n=12) and FL (n=12) to gain feedback 
on the acceptability, accessibility, content, delivery preferences, and aesthetics of 
the theoretically informed, HPV educational intervention targeted for English and/or 
Spanish-speaking YLMSM. We will leverage a previously-developed educational 
resource and transcreate the educational intervention based upon Aim 2 and Aim 3 
feedback.  
 
The goal of this research program is to promote HPV vaccination to reduce HPV-related 
cancer incidence and mortality among Hispanic/Latino sexual minority men. Our team is 
ideally suited to complete the proposed study and will submit an R34 or R01-equivalent 
grant application in 2022 or 2023 aimed at testing the efficacy of the targeted educational 
intervention through a multi-site randomized controlled trial in PR and FL. The current 
protocol outlines the activities to be conducted by the Moffitt Cancer Center-based team 
(led by Dr. Shannon Christy) and the complementary activities that will be conducted by 
the team at Ponce Health Sciences University (led by Dr. Melissa Marzán-Rodriguez).  
 
2. Background and Significance 
 
2.1 HPV Infection Risk among YMSM  
MSM are at increased risk for acquiring an HPV infection24 and subsequently developing 

 PI: Shannon M. Christy, PhD 
5 
 
an HPV-related cancer.24 In 2014, the prevalence of an anal HPV infection was 57.8% 
among high-risk men (of whom 84.% were MSM) in PR.24 Prevalence of genital HPV 
infection was approximately 50.1% among MSM in the Tampa area, with 29.7% 
experiencing a high-risk infection.25 Among MSM in the Tampa area, 44.7% had an anal 
HPV infection and 34.1% had a high-risk HPV anal infection.26 In addition, HIV+ MSM are 
at higher risk of anal HPV infection, anal cancer precursors, and anal cancer compared 
with persons who do not have HIV.27,28 There are currently no Food and Drug 
Administration (FDA)-approved HPV tests or HPV-related cancer screening tests for 
men.29 Correct and consistent condom use can lower HPV transmission risk, but does not 
offer complete protection.29 Thus, HPV vaccination is the best method for protecting males 
from developing HPV-related cancers.30 
 
2.2 HPV Vaccine Recommendations 
The nine-valent HPV vaccine has been shown to be safe and provide effective and long-
lasting protection from 9 HPV strains, including 7 oncogenic strains.31,32 In 2018, the Food 
and Drug Administration (FDA) approved administration of the vaccine in individuals ages 
9-45, extending the previous licensure from those aged 9-26 years.33 A two doses series 
is recommended for those aged 9-14 and a three doses series is recommended for those 
ages 15 and older.34 In 2019, the Advisory Committee on Immunization Practices (ACIP) 
continued to recommend routine vaccination in individuals aged 11-12 and updated their 
recommendations to include catch-up vaccination for all individuals ages 15-26 who did 
not previously complete the HPV vaccine series.35 Also, in 2019, ACIP updated their 
recommendations for individuals ages 27-45, suggesting that patients in this age group 
and their providers engage in a discussion and shared decision-making about HPV 
vaccination.36 Thus, we focus upon young adults ages 18-26, as all males in this age 
cohort are recommended to receive the HPV vaccine series. 
 
2.3 Barriers and Facilitators to Vaccination among YMSM  
Prior studies have identified multiple barriers to YMSM receiving HPV vaccination, 
including lack of knowledge that men can have HPV-related health concerns, that men 
can receive the vaccine, low perceived HPV risk, beliefs related to sexual promiscuity, 
lack of awareness that the vaccine cost is covered by health insurers, lack of provider 
recommendation, among others.37,38,39,40,41,42 HPV vaccine knowledge, disclosure of 
sexual orientation to one’s provider, and completion of a STI test in the prior year have 
been predictive of vaccine uptake among MSM.43 
 
2.4 Theoretical Framework  
The Theory of Planned Behavior (TPB) and Health Belief Model (HBM) have been used 
to effectively guide prior HPV research. Relevant TPB constructs include attitudes, 
subjective norms, and behavioral intentions.44 HBM constructs to be utilized include 
perceived barriers, perceived efficacy, cues to action, self-efficacy, and perceived risk.44 
In addition, the role of precipitating factors, awareness, and affect will be considered (see 
Figure 1). 
 

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2.5 Consolidated Framework for Implementation Research (CFIR)  
Implementation research seeks to understand the processes and factors that are 
associated with successful integration of evidence-based interventions within a setting 
(e.g., a clinic).45 The CFIR framework focuses on organization-level measures about the 
settings in which an intervention could be implemented by exploring five domains: 
intervention characteristics; outer setting; inner setting; individuals/organization 
characteristics and process effects intervention implementation. CFIR will guide the key 
stakeholder interviews, whereby we will explore possible facilitators and barriers in the 
intervention implementation, reach, and engagement processes to inform a multi-level 
intervention to promote HPV vaccination among English- and/or -speaking YLMSM. 
  
 
2.6 Innovation 
The proposed study is innovative for multiple reasons. First, no prior interventions have 
been developed to improve HPV knowledge and promote HPV vaccination and targeted 
to young Latino MSM, an understudied population significantly and disproportionately 
impacted by sexual transmitted infections including HPV. Second, using mixed-methods 
approaches, we will enroll participants in both PR and FL. Finally, although the current 
Cancer 101 HPV module covers topics such as HPV natural history, descriptive 
epidemiology, modes of transmission and prevention measures, it is not culturally adapted 
to YLMSM, a population who are at increased risk for HPV infection.47,47 Our proposed 
study will result in an intervention that is responsive to culture, language and context, it 
will be targeted to English- or Spanish-speaking YLMSM, and designed with input from 
the target audience and key stakeholders and with implementation and dissemination in 
mind. Although the current Cancer 101 HPV module was designed to be delivered in a 
group setting via PowerPoint, YLMSM may prefer HPV education to be delivered in 

 PI: Shannon M. Christy, PhD 
7 
 
another format or modality. Thus, we seek to also adapt the intervention to a preferred 
modality based upon feedback from YLMSM and key stakeholders. 
 
3. Research Design and Methods 
 
3.1 Study Design Overview  
We are proposing a mixed-method study with three research aims that uses rigorous, 
systematic steps (see Figure 2). For Aim 1, we will recruit 260 YLMSM to assess HPV 
knowledge, awareness, health beliefs, attitudes toward the HPV vaccine, healthcare 
experiences, behaviors, and among those unvaccinated, intentions to receive the HPV 
vaccination, HPV vaccine education learning preferences, social media use, health 
literacy, sociodemographic characteristics, among others. For Aim 2, we will interview 20 
key stakeholders to inform intervention content and delivery methods as well as to identify 
potential implementation facilitators and barriers and receive feedback on the intervention. 
In Aim 3, informed by PHM and HBM and the data collected in Aim 2, we will adapt and 
update the Cancer 101 HPV module to develop an educational intervention in Spanish 
targeted for YLMSM. Finally, we will receive feedback on the educational intervention 
(e.g., content, aesthetics, appeal, modality, format) from 24 YLMSM in PR (up to n=12) 
and FL (up to n=12) via focus groups or individual interviews.  
 
The study as a whole will be enhanced by input from a community advisory board (CAB) 
comprised of 4-10 community members. At least two members will be in FL and at least 
two will be in PR. We anticipate that CAB members will be individuals who work for an 
organization or government agency that provides healthcare or social services to YLMSM 
or that they themselves identify as a YLMSM. The CAB will meet with the team on a 
quarterly basis to provide guidance on recruitment, procedures, and interpretation of 
results. Additional meetings may be scheduled if further guidance is needed during the 
progression of the project. Additionally, CAB members will work with the study team to 
adapt existing Cancer 101 education materials to produce a draft intervention to be utilized 
in initial Aim 3 focus groups or individual interviews. CAB members may also assist with 
recruitment efforts by sharing recruitment materials in various means (e.g., social media 
platforms, websites, etc.). CAB members in both FL and PR will be compensated $400 
per year for their participation on the CAB. In-person meetings with CAB members may 
also include refreshments. Review and approval of study by the MCC Scientific Review 
Committee and MCC and PHSU Institutional Review Board (IRB) of Records and the IRBs 
of the community partners, as applicable, will be sought prior to initiation of study activities.

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3.2 Study Methods 
 
3.2.a. Aim 1 Participant Recruitment  
We will recruit a total of 260 YLMSM in PR and FL between 18 to 26 years of age using 
multiples recruitment strategies: 1) advertisements on social media platforms and dating 
applications such as Instagram®, Snapchat®, and/or Grindr®;2) broadcasting media such 
as television, radio, magazine, newspaper, or newletter; 3) in-person recruitment through 
organizations or healthcare clinics that  serve YLMSM; 4) printed materials (e.g., flyers in 
community sites); 5) study flyers in physical spaces, via social media, via presentations, 
and via email, and among other dissemination methods shared by our team, other Moffitt 
and PHSU teams/departments/cores, and groups, organizations, and networks in the 

 PI: Shannon M. Christy, PhD 
9 
 
community, and 6) a study invitation to online survey using organizations or clinics who 
serve YLMSM or participants from prior studies who have indicated interest in taking part 
in future studies. CAB members may also assist with recruitment efforts by sharing 
recruitment materials in various means (e.g., emails, websites, etc.). For those aged 18-
20 living in PR, a parental waiver is requested in order to promote participation and protect 
sexual rights. Studies in the United States, regulated by Federal Law, who included 
Hispanic/Latino samples also emphasizing the need for policy changes to allow parental 
consent waivers for research targeting Sexual Minorities Youth. Also, public health 
practices in PR allow individuals under 21 years old request Sexual Transmitted Infections 
(STIs) testing and treatment without parental permission (PR Law #36, 2008). 
 
3.2.b. Eligibility Criteria for Aims 1 and 3 
Inclusion criteria for Aims 1 and 3 will include self-identification as: (1) having had sex with 
a man and/or being attracted to men; (2) Hispanic/Latino ethnicity; (3) able to read, write, 
and understand Spanish (for Aim 1) and Spanish or English (for Aim 3); (4) aged 18-26 
years; (5) primary residence in either FL or PR. An additional eligibility criterion for Aim 1 
is having access to the internet (to complete the online survey). Additional eligibility criteria 
for Aim 3 are having either regular access to a working telephone or being able to attend 
an in-person focus group (modifications related to COVID-19 situation will allow virtual 
modality to complete the focus groups or individual interviews). Exclusion criteria for Aims 
1 and 3 will include self-identification as: (1) transman or transwoman or (2) aged <18 
years or ≥27 years. Individuals who contact the research team about interest in 
participating on Aims 1 or 3 can be directed to Aims 1 or 3 for possible recruitment. 
Individuals can participate in more than 1 aim, but not more than one time in a single aim. 
 
3.2.c. Aim 1 Procedures  
For the quantitative Aim 1 survey, we will recruit participants via Spanish-language social 
media, broadcasting media, online dating applications advertisements, Spanish-language 
flyers in community locations (e.g., community clinics, community events, other 
community locations), in-person (e.g., community clinics or community events), and at 
virtual events (e.g., cancer education events). In addition, Aim 1 study flyers may be 
disseminated in physical spaces, via social media, via presentations, and via email, 
among other dissemination methods by our team, other Moffitt and PHSU 
teams/departments/cores, and groups, organizations, and networks in the community. 
Flyers will contain a QR code that will re-direct individuals to the study email address (or 
an institutional website) to learn more about the study and receive an online survey link. 
Interested individuals will be asked to contact the study team to learn more about the study 
and eligibility, and may be emailed an online survey link. CAB members may also assist 
with recruitment efforts by sharing recruitment materials in various means (e.g., social 
media platforms, websites, etc.). For in-person recruitment, participants will be provided 
with an information sheet and a QR code that will be clipped to the information sheet. 
During in-person recruitment, participants will be able to complete the survey by scanning 
the QR code on their own device, or with assistance of a research team member who can 
scan the QR code on an iPad; the QR code will re-direct participants to the survey. After 
completing eligibility screening in Spanish via a web-based platform (i.e., Qualtrics, a 
HIPAA-compliant system), eligible participants will be presented with study information in 
Spanish, asked to provide informed consent electronically, and complete a Re-CAPTCHA 
task prior to start of the survey. Consenting participants will complete a survey in Spanish 

 PI: Shannon M. Christy, PhD 
10 
 
requiring approximately 30 minutes. The survey will be programmed and maintained by 
the Moffitt Participant Research, Interventions, and Measurement (PRISM) Core. PRISM 
will program the survey such that only 260 participants will be able to complete the survey. 
PRISM will collect IP addresses, web browser, device ID, as well as, GeoLocation 
coordinates and may enable additional available settings to identify and prevent multiple 
null survey submissions that may affect data integrity. For in-person recruitment, surveys 
will be administered either via the participants’ personal device or via password-protected 
tablets containing a link to the survey. At the end of survey, the following information is 
requested: 1) incentive delivery preference and 2) contact information to send the 
incentive (e.g., name, email or mailing address). Eligible participants who complete a valid 
survey will receive the incentive in the chosen modality. Participants will be removed from 
the study without compensation if the research team finds evidence of fraudulent 
responses. 
 
After completing the online survey, participants will be automatically directed to a separate 
online survey that will ask them to provide their contact information in order to receive their 
incentive (a $25 gift card). IP addresses, web browser, device ID, as well as, GeoLocation 
coordinates will be recorded, and additional settings may be enabled by PRISM to identify 
and prevent multiple gift card entries by the same participant. Gift card survey entries will 
be forwarded by PRISM to the research team through a project-specific, institutional e-
mail developed by PHSU. The e-mail will only be managed by designated research staff 
members. At the end of the survey, participants will indicate whether they are interested 
in potentially participating in other parts of the study (e.g., Aim 3).  
 
Recruitment of Seeds: Instances where the recruitment needs a booster to achieve the 
sample goal of 260 participants for Aim 1, we will conduct a respondent driven sampling 
approach. When each eligible participant is able to identify up to three peers with the study 
characteristics. HPV project team will recruit an initial group of approximately 10-15 seeds. 
The number of initial seeds will depend on the capacity of the project team as well as the 
locations and community partners population scope. The eligibility criteria for the seeds 
will be the same for aim 1. When a potential seed is identified or contacted thru the HPV 
team or Community-Based or Clinic Partner, HPV project team will briefly describe the 
current HPV Survey and ask the potential seed if he would be willing to share with peers 
a study coupon to invite them to the study. If the potential seed do so at that time, he will 
be given a referral card to provide to their peers who has the eligibility criteria (a 
recruitment coupon may also serve as a referral card for seeds, see Appendix A). The 
referral card (coupon) will have: 1) QR code to access the survey, 2) ID Number, 3) 
general information about the study.  
 
Eligibility Criteria for Valid Seeds: Once eligible seeds agreed they would be willing to 
recruit other participants for a small incentive. After a brief training on the recruitment 
process, those who agree to recruit will be given up to 3 coded, non-replicable coupons 
(Appendix A). The participant will be told to give one coupon to each of up to 3 individuals 
he knows and has seen in the past 30 days who live in the project area and meet certain 
specific criteria. Each coupon will have the current HPV logo, location(s) of field site 
locations, phone number(s) where staff can be reached in case of any question or 
concern, and a Survey ID number printed on it. The Survey ID on the coupon will be linked 

 PI: Shannon M. Christy, PhD 
11 
 
to (but not identical to) the Survey ID of the participant the coupon is issued to (i.e., the 
recruiter), which will be documented in the coupon manager log (Appendix B). 
Coupon Redemption: All persons who bring a valid coupon will scan QR code for 
eligibility. Those found to be eligible and who give consent to participate in the survey. 
After completion of the survey, the HPV team will identify the valid seed entries to 
provide the small incentive ($5.00 per valid seed recruited) and send through electronic 
gift card to the recruiter.   
 
3.2.d. Aim 2 Participant Recruitment  
Participants will be recruited via flyers in English and Spanish distributed by email or in 
person (depending on COVID restrictions) at community partner locations, community 
health clinics, health departments, colleges/universities, and interest groups that have 
served or provided services to YLMSM within the last twelve months. In addition, Aim 2 
study flyers may be disseminated in physical spaces, via social media, via presentations, 
and via email, among other dissemination methods by our team, other Moffitt and PHSU 
teams/departments/cores, and groups, organizations, and networks in the community.  
Additionally, English and Spanish-language emails will be sent to community 
organizations. In FL, examples of these community partner and clinic locations might 
include Metro Inclusive Health and Ybor Youth Clinic, clinics associated with the University 
of South Florida and Florida Department of Health (e.g., HIV/HCV Ryan White Specialty 
Care Center), LGBTQ student organizations, among others. In PR, examples of 
community partners include COAI, Inc., a non-profit organization dedicated to promoting 
health and preventing diseases from a perspective of social justice and human rights for 
lesbian, gay, bisexual, transgender, transgender, questioning, queer and intersex people 
[LHBTTQQI]). Interested individuals will be asked to contact the study team who will 
assess eligibility. Community partners in FL will be compensated $200 per year to allow 
us to post study recruitment flyers for Aims 1, 2, and 3 and to send the Aim 2 emails to 
their organization staff or group members. Community partners in PR will receive a stipend 
for recruitment support for Aims 1, 2 and 3 during the study period.  
 
3.2.e. Eligibility Criteria for Aim 2  
Eligibility criteria includes: (1) Individuals with a current or prior role (within last twelve 
months) in a community-based organization, private or public healthcare clinic, health 
department, college/university organization, or interest group that provides services to 
sexual minorities in FL or PR as a healthcare provider, staff member, group member, or 
in a leadership role; (2) aged 21 or older; (3) able to understand, read, and speak either 
Spanish or English; and (4) have access to a working telephone or computer.  
 
3.2.f. Aim 2 Procedures  
Using a CFIR-informed semi-structured guide (see Aim 2 Semi-structured Interview 
Guide), initially 10 key stakeholders (5 in PR and 5 in FL) will be engaged to review the 
current Cancer 101 HPV module content and will be interviewed to provide suggestions 
for intervention content updates and delivery modalities as well as to explore potential 
structural facilitators and barriers to implementing a multi-level intervention that includes 
the culturally-adapted intervention to promote HPV vaccination among YLMSM. Following 
the Aim 3 focus groups and/or individual interviews, we will ask 10 additional key 
stakeholders (5 in PR and 5 in FL) to provide feedback on the culturally-adapted 
intervention. Participants will be interviewed in-person or remotely (e.g., Zoom, phone) by 

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12 
 
trained study staff. Interviews are anticipated to last between 30 to 90 minutes and will be 
audio digitally recorded. Interviews will be transcribed verbatim. Participants will receive a 
$30 gift card. If recruitment has completed for first half of Aim 2, remaining potential 
participants who were identified for this aim will be recontacted for the second half of Aim 
2 recruitment. 
 
3.2.g. Aim 3 Participant Recruitment  
Participants will be recruited through a variety of approaches including 1) Spanish and 
English Language flyers at community partner locations, community events (e.g., PRIDE 
events), and community locations, 2) broadcasting media including television, newspaper, 
magazine, radio, or newsletter; 3) Spanish and English-language online ads (e.g., social 
media platforms), 4) Aim 3 study flyers may be disseminated in physical spaces, via social 
media, via presentations, and via email, among other dissemination methods by our team, 
other Moffitt and PHSU teams/departments/cores, and groups, organizations, and 
networks in the community, 5) email invitation to participants from prior studies who have 
indicated interest in taking part in future studies, and 6) from ResearchMatch.org. 
ResearchMatch is a national health volunteer registry that was created by several 
academic institutions and supported by the U.S. National Institutes of Health as part of the 
Clinical Translational Science Award (CTSA) program. ResearchMatch has a large 
population of volunteers who have consented to be contacted by researchers about health 
studies for which they may be eligible. Upon IRB approval and when ready to start data 
collection, the research team will register the study on ResearchMatch.org. Utilizing the 
study eligibility criteria for men ages 18-26 who identify as Latino and reside in FL or PR, 
a list of potentially eligible volunteers will be generated. The research team will then send 
our IRB-approved initial recruitment message to potential matches who will have the 
option of replying “yes,” “no”, or providing no response. The study’s home page in 
ResearchMatch will provide information about volunteers who have responded “yes.” After 
the volunteer has authorized ResearchMatch to provide their contact information to the 
study team, the study team will contact the participant about potential participation, assess 
eligibility, explain the study, and informed consent through email, phone call, or a mailed 
letter. 
 
3.2.h. Aim 3 Procedures  
 
Cultural adaptation of the Cancer 101 HPV module will be informed by data results from 
Aims 2 and CAB members, and it will be guided by TPB and HBM theories. Individuals 
interested in participating in Aim 3 will be asked to contact the study team who will assess 
eligibility. Following development of an initial draft of the educational materials in English 
and Spanish, using a semi-structured interview guide (see Aim 3 Semi-structured 
Interview Guide) and established procedures, we will conduct Spanish and/or English-
language focus groups and/or individual interviews with 24 YLMSM (12 in each site) to 
obtain feedback on the intervention. Focus groups or individual interviews will be 
conducted in-person or remotely (e.g., Zoom, phone) by trained study staff. Focus groups 
or individual interviews will be conducted in-person or remotely (e.g., Zoom, phone) by 
trained study staff. Focus groups or individual interviews may be conducted in Spanish or 
English, depending upon participant preference. Participants will be asked to complete a 
brief sociodemograhics survey (examples include: age, race, employment status) either 
online (for those participating remotely) or with a pen-and-paper version (for those 

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13 
 
participating in person). During the interview and guided by a semi-structured interview 
guide, participants will be shown examples of platforms and prototypes of materials to 
solicit their feedback and preferences. Examples include PowerPoint Presentation, 
Brochure, YouTube and TikTok videos of HPV-related content. We expect that Aim 3 
findings will: (1) provide feedback on the acceptability, accessibility, content, and 
aesthetics of the intervention to be iteratively adapted based upon participant feedback; 
and (2) identify the preferred dissemination/learning platform(s) and format(s) to deliver 
the adapted intervention to YLMSM. Focus groups or individual interviews will be audio 
digitally recorded. Focus groups or individual interviews are anticipated to last between 
90-120 minutes. Interviews will be transcribed verbatim. Participants will receive a $50 gift 
card. At the end of the interviews, participants will indicate whether they are interested in 
participating in other parts of the study (e.g., Aim 1). 
 
3.2.i. Assessment of Study Related Variables in Aim 1  
Validated scales used in prior studies (e.g., BRFSS, HINTS) will be included for 
assessment: sociodemographics (location [PR or FL], age, sexual orientation, gender 
identification, relationship status, race/ethnicity, household income, health insurance 
status, employment status, education; Hispanic/Latino-specific cultural items; health 
literacy; numeracy; prior health behaviors and health care experiences; HPV and HPV 
vaccine 
awareness/knowledge; 
HBM 
constructs; 
TPB 
constructs, 
information 
sources/trust in information sources; educational preferences; vaccine receipt 
preferences; vaccine behaviors; vaccine intentions (among those unvaccinated); comfort 
with sexual health; sexual experiences & social media use, among others (see Aim 1 
Quantitative Survey).  
 
3.2.j. Statistical Considerations  
 
3.2.j.i. Data Analysis  
For Aim 1, standard descriptive statistics (e.g., frequencies, proportions, means, standard 
deviations) will summarize all variables and provide excellent estimates of population 
parameters. The dependent variables are HPV vaccination status and HPV vaccine 
intentions. The factors to be evaluated for potential associations will be: sociodemographic 
characteristics, sexual practices, sexual orientation disclosure, social media preferences, 
vaccination history, among others. Covariation among variables, including predictors of 
intentions, will also be estimated, using measures appropriate for the paired variables 
(e.g., r, beta, odds ratio). For Aims 2 and 3, thematic-content analysis techniques using 
the principles of Grounded Theory will be performed47,48 whereby themes from the focus 
group transcripts and key stakeholder interviews are identified.   
 
3.2.j.ii. Sample Size/Power Calculations  
The overarching goal of Aim 1 is to generate excellent parameter estimates for the design 
of subsequent research proposals. With a precision of 0.05 and an 80% of statistical 
power, we estimate a total of n=260 participants, both estimates of single variable means 
or proportions and the relationships among predictors and outcome variables will have 
relatively small 95% confidence intervals. If data collection yields complete and high-
quality data, a sample size of n=227 is required to achieve 80% power with a 0.05 
precision.  
 

 PI: Shannon M. Christy, PhD 
14 
 
3.2.j.iii. Data Management  
MCC and PHSU will complete a data sharing agreement to safely share the database for 
secondary analysis. The data sharing agreement will include all the HIPAA requirements. 
A data entry system, designed by the PRISM Core, will store and manage study flow 
information and questionnaire data. Data will be stored on password-protected computers 
on the secure MCC and PHSU network servers. Study documents will be secured in 
locked filing cabinets. Following data cleaning, de-identified data will be sent electronically 
to Dr. Sutton who will convert the Excel file into SAS (SAS Institute, Inc., Cary, NC) to 
conduct data analyses. Drs. Marzan, Christy (MPIs), and Sutton (Co-I; biostatistician) the 
staff statistician will meet regularly to discuss Aim 1 data processing and analyses. NVivo® 
transcription will be used to transcribe all audio files according to HIPAA requirements. 
For Aims 2 and 3, all transcriptions will be submitted to review process for accuracy.49 All 
qualitative data will be gathered, organized, and managed using NVivo®.  
 
To ensure integrity of responses in the survey in Aim 1, a multi-step approach informed 
by recommendations in the literature will be conducted. This includes the addition of re-
CAPTCHA tasks50and/or attention checks throughout the survey.51 To verify the validity 
of the data post-survey, staff members (including PRISM and study staff) will check IP 
addresses to identify duplicates, assess response times to identify fast respondents, 
identify consecutive responses using a straight lining method, and check the quality of 
open-ended survey responses. Participants will be removed from the study without 
compensation if the research team finds evidence of fraudulent responses. Respondents 
who fail these checks will be removed from the final analytic sample.    
 
3.3 Future Plans  
 
3.3.a. Future Directions/Summary 
Guided by health behavior theories and applying systematic and rigorous methods, the 
proposed innovative study seeks to address multiple cancer disparities through the 
development of a salient HPV vaccine educational intervention targeted to YLMSM. The 
culturally-adapted intervention will be tested in a future multi-site randomized controlled 
trial among YLMSM in FL and PR. Ultimately, this line of research has a significant 
potential to reduce cancer morbidity and mortality and improve public health. 
 
4. Human Subjects Considerations  
 
4.1.a. Human Subjects Involvement and Characteristics 
 
Procedures for Aim 1:  
We will recruit a total of 260 YLMSM in PR and FL using multiple strategies, including in-
person recruitment in community settings and at community clinic or community 
organization locations, social media and dating applications advertisements in Spanish, 
on platforms such as Instagram®, Snapchat®, and Grindr®, broadcasting media,  
recruitment flyers in the community, and email invitation to participants from prior studies 
who have indicated interest in taking part in future studies. CAB members may also assist 
with recruitment efforts by sharing recruitment materials in various means (e.g., social 
media platforms, websites, etc.). Individuals who contact the research team about interest 
in participating on Aims 1 or 3 can be directed to Aims 1 or 3 for possible recruitment when 

 PI: Shannon M. Christy, PhD 
15 
 
they indicate that they are interested in participating in other parts of the study. Individuals 
can participate in more than 1 aim, but not more than one time in a single aim. 
 
For Aim 1 Participants: 
For Aim 1, 260 participants will be enrolled.  To be eligible participants must self-identify 
as: (1) having had sex with a man and/or being attracted to men; (2) Hispanic/Latino 
ethnicity; (3) able to read, write, and understand Spanish; (4) aged 18-26 years; (5) 
primary residence in either FL or PR; and (6) having internet access (either via personal 
device or research team tablet). Exclusion criteria for the online survey will include self-
identification as: (1) transman or transwoman, and (2) aged >26 years, 364 days. For the 
online survey, we will recruit participants with the help of CAB members through the 
dissemination of recruitment materials (e.g., flyers, social media posts, emails, 
messages), in-person recruitment in community clinics and/or community organization 
locations, virtual events (e.g. virtual cancer education events), and by using social media, 
broadcasting media, and online dating applications advertisements in Spanish. In addition, 
Aim 1 study flyers may be disseminated in physical spaces, via social media, via 
presentations, and via email, among other dissemination methods by our team, other 
Moffitt and PHSU teams/departments/cores, and groups, organizations, and networks in 
the community. Participants may contact the study team from the contact information or 
QR code linked to the study lab email address for more information, eligibility inquiry, and 
for the online survey link. For in-person recruitment, participants will be provided with an 
information sheet and a QR code that will be clipped to the information sheet. They will be 
able to complete the survey by scanning the QR code on their own device, or with 
assistance of a research team member who can scan the QR code on an iPad. The QR 
code will re-direct participants to the survey. After completing eligibility screening in 
Spanish via a web-based platform (i.e., Qualtrics, a HIPAA-compliant system), eligible 
participants will be presented with study information in Spanish, asked to provide informed 
consent electronically, and complete a Re-CAPTCHA task prior to start of the survey. 
Consenting participants will complete a survey in Spanish requiring approximately 30 
minutes. The survey will be able to be completed on various devices with internet 
capabilities, including desktop computers, laptops, tablets, and mobile phones. The 
survey will be programmed and maintained by the Moffitt Participant Research, 
Interventions, and Measurement (PRISM) Core. PRISM will collect IP addresses as well 
as GeoLocation Coordinates and may enable additional available settings to identify and 
prevent multiple null survey submissions that may affect data integrity.  
 
After completing the online survey, participants will be auto directed to a separate online 
survey that will ask them to provide their contact information in order to receive their 
incentive (a $25 gift card). IP addresses as well as GeoLocation coordinates will be 
recorded, and additional settings may be enabled by PRISM to identify and prevent 
multiple gift card entries done by the same participant. Gift card survey entries will be 
forwarded by PRISM to the research team through a project-specific, institutional e-mail 
developed by PHSU. The e-mail will only be managed by designated research staff 
members.  
 
Procedures for Aim 2:  
We will conduct 20 in-depth interviews with key stakeholders (i.e., healthcare clinic 
leadership, providers and staff, community-based organization staff, staff and leadership 

 PI: Shannon M. Christy, PhD 
16 
 
from health departments, colleges/universities, and interest groups who have served or 
provided services to YLMSM within the last 12 months in PR and FL (10 in PR, 10 in FL). 
This will elicit their feedback and inform intervention content and delivery methods and 
identify potential facilitators and barriers to intervention implementation. Participants will 
be interviewed in-person or remotely (e.g., Zoom, phone) by trained study staff. If 
recruitment has completed for first half of Aim 2, remaining potential participants who were 
identified for this aim will be recontacted for the second half of recruitment in the Spring. 
 
For Aim 2 Participants: 
For Aim 2, initially 10 key stakeholders will be interviewed (5 in PR and 5 in FL) in English 
or Spanish. Following Aim 3 focus groups or individual interviews and adaptation of the 
materials, an additional 10 key stakeholders will be interviewed (5 in PR and 5 in FL) in 
English or Spanish. Participants will be recruited via flyers in English and Spanish 
distributed by email or in person (depending on COVID restrictions) at community partner 
locations, community health clinics, health departments, colleges/universities, and interest 
groups who have served or provided services to YLMSM within the last 12 months. In 
addition, Aim 2 study flyers may be disseminated in physical spaces, via social media, via 
presentations, and via email, among other dissemination methods by our team, other 
Moffitt and PHSU teams/departments/cores, and groups, organizations, and networks in 
the community. Additionally, English and Spanish-language emails will be sent to 
community organizations. Interested individuals will be asked to contact the study team 
who will assess eligibility. To be eligible participants must be (1) individuals with a current 
or prior role (within last 12 months) in a community-based organization, private or public 
healthcare clinic, health department, college/university organization, or interest group that 
provides services to sexual minorities in FL or PR as a healthcare provider, staff member, 
or in a leadership role; (2) aged 21 or older; (3) able to understand, read, and speak either 
Spanish or English; and (4) access to a working telephone. Interviews are anticipated to 
last between 30-90 minutes and will be audio digitally recorded. Participants will receive 
a $30 gift card.  
 
Procedures for Aim 3:  
We will conduct focus groups or individual interviews (i.e., approximately 2-3 in FL and 2-
3 in PR) with 24 YLMSM in Spanish and English. Participants will be recruited via Spanish 
and English flyers at community partner locations, community locations, and community 
events in PR and FL (e.g., PRIDE events), broadcasting media, online ads (e.g., on social 
media platforms commonly-used by YLMSM), disseminated in physical spaces, via social 
media, via presentations, and via email, among other dissemination methods by our team, 
other Moffitt and PHSU teams/departments/cores, and groups, organizations, and 
networks in the community, and/or ResearchMatch. For ResearchMatch recruitment, our 
study will be registered on ResearchMatch.org. The research team will then send our IRB-
approved initial recruitment message to potential matches who will have the option of 
replying “yes,” “no”, or providing no response. The study’s home page in ResearchMatch 
will provide information about volunteers who have responded “yes.” After the volunteer 
has authorized ResearchMatch to provide their contact information to the study team, the 
study team will contact the participant about potential participation, assess eligibility, 
explain the study, and informed consent through encrypted email, phone call, or a mailed 
letter. Focus groups or individual interviews will be conducted in-person or remotely (e.g., 
Zoom, phone) by trained study staff in either English or Spanish, depending upon 

 PI: Shannon M. Christy, PhD 
17 
 
participant preference. A brief sociodemographic online or in-person survey will be 
completed by Aim 3 participants prior to the focus group or individual interview. Individuals 
who contact the research team about interest in participating on Aims 1 or 3 (when 
recruitment cap has been completed for that aim) can be directed to Aims 1 or 3 for 
possible recruitment. Individuals can participate in more than one aim, but not more than 
one time in a single aim.  
 
For Aim 3 Participants:  
Eligibility criteria for Aim 3 participants have been described previously. Inclusion criteria 
for Aims 3 will include self-identification as: (1) having had sex with a man and/or being 
attracted to men; (2) Hispanic/Latino ethnicity; (3) able to read, write, and understand 
Spanish or English; (4) aged 18-26 years; (5) primary residence in either FL or PR. 
Additional eligibility criteria for Aim 3 is having either regular access to a working telephone 
or being able to attend an in-person focus group (modifications related to COVID-19 
situation will allow virtual modality to complete the focus groups or individual interviews). 
Exclusion criteria for Aim 3 will include self-identification as: (1) transman or transwoman; 
(2) aged <18 years or ≥27 years. Cultural adaptation of the Cancer 101 HPV modules will 
be informed by data results from Aim 2 and guided by TPB and HBM. A brief 
sociodemographic survey will be completed by Aim 3 participants either online or in-
person prior to completing an individual interview or focus group. Following development 
of an initial draft, using a semi-structured interview guide and established procedures, we 
will conduct focus groups or individual interviews with approximately 24 YLMSM to obtain 
feedback on the intervention. During the interview and guided by a semi-structured 
interview guide, participants will be shown examples of platforms and prototypes of 
materials to solicit their feedback and preferences. Examples include YouTube and TikTok 
videos of HPV-related content. We expect that Aim 3 findings will: (1) provide feedback 
on the acceptability, accessibility, content, and aesthetics of the intervention to be 
iteratively adapted based upon participant feedback; and (2) identify the preferred 
dissemination/learning platform(s) and format(s) to deliver the adapted intervention to 
YLMSM. Focus groups or individual interviews will be audio digitally recorded. Focus 
groups and individual interviews are anticipated to last between 90-120 minutes. 
Participants will receive a $50 gift card. Refreshments may also be served at in-person 
focus groups or individual interviews.  
 
4.1.b. Sources of Materials  
 
4.1.c Potential Risks  
We do not expect that participants will have "more than the minimal risk" associated with 
this type of research. Participants can feel uncomfortable sharing their sexual practices or 
sexual orientation experiences. First, the interviewers will be trained to create a safe space 
and group rules to increase participants comfort and minimize distress. Furthermore, all 
participants will be informed that participation is voluntary, and that any information 
provided will be kept strictly confidential. Finally, staff will be trained to recognize 
symptoms of distress and to provide assistance when they see evidence of distress or 
any emergency situation. Loss of confidentiality is a potential risk. To minimize risk of loss 
of confidentiality, participants will be reminded that their information will not be shared with 
other entities not involved in research. The network is password protected with daily back 
up for increased security. Furthermore, identifying information will not be reported to the 

 PI: Shannon M. Christy, PhD 
18 
 
funding agency or in publications. Data exchanged electronically among the researchers 
will contain no name or medical record numbers or will be in aggregate form with no direct 
identifiers. The study database will be password protected and only our research team 
members will have access to it. The PI will monitor the welfare of each participant and 
report any adverse events to the IRB as they occur. Participants may withdraw 
participation at any time for any reason by notifying the study PI or staff. 
 
4.2. Adequacy of Protection Against Risks 
 
4.2.a. Recruitment and Informed Consent 
Review and approval of study by the MCC Scientific Review Committee and MCC and 
PHSU Institutional Review Board of Records will be sought prior to initiation of study 
activities. For Aim 1 recruitment, we will recruit a total of 260 YLMSM in PR and FL using 
social media and dating applications advertisements on platforms such as Instagram®, 
Snapchat®, and Grindr®, in-person recruitment at community events and locations, and 
flyers posted in the community. Individuals that agree to participate will be directed to a 
web-based platform to complete eligibility screening electronically (e.g., Qualtrics). Eligible 
individuals will be asked to provide informed consent electronically. Consenting 
participants will complete a survey requiring approximately 30 minutes via an approved 
HIPAA-compliant system (i.e., Qualtrics). The survey will be able to be completed on 
various devices with internet capabilities, including desktop computers, laptops, tablets, 
and mobile phones. The survey will be programmed and maintained by the Moffitt 
Participant Research, Interventions, and Measurement (PRISM) Core. Participants will 
receive an incentive for participation in the form of a $25 gift card that will be sent 
electronically or by mail depending on the participant’s preference. For Aim 2 recruitment, 
Participants will be recruited via flyers in English and Spanish distributed by email or in 
person (depending on COVID restrictions) at community partner locations, community 
health clinics, health departments, colleges/universities, and interest groups who have 
served or provided services to YLMSM within the last 12 months. Additionally, English and 
Spanish-language emails will be sent to community organizations. Interested individuals 
will be asked to contact the study team who will assess eligibility. For Aim 3 recruitment, 
participants will be recruited via English and Spanish- language flyers at community 
partner locations, community locations, and community events in PR and in FL (e.g., 
PRIDE events) as well as via social media platforms. In addition, ResearchMatch will be 
utilized to recruit for Aim 3. After study information is presented, individuals will be asked 
if they would like to participate in the study. 
 
4.2.b. Protections Against Risk  
There are no potential physical risks to participants posed by this study. This study 
involves minimal risk for emotional or psychological distress. However, these risks are not 
expected to be any greater than risks posed in everyday life. Participant documents, 
including participant tracking documents, will be kept in a locked cabinet in a locked 
location. Computers will be password-protected and data will be backed-up daily on a 
secure server. Only authorized research staff will have access to data. Research staff will 
be trained to interact with participants in a sensitive manner during all study components. 
For Aim 1, consenting participants will complete a survey via an approved HIPAA-
compliant system (i.e., Qualtrics). The survey will be able to be completed on various 
devices with internet capabilities, including desktop computers, laptops, tablets, and 

 PI: Shannon M. Christy, PhD 
19 
 
mobile phones. The survey will be programmed and maintained by the Moffitt Participant 
Research, Interventions, and Measurement (PRISM) Core. PRISM will collect IP 
addresses as well as GeoLocation Coordinates and may enable additional available 
settings to identify and prevent multiple null survey submissions that may affect data 
integrity. Once the participant completes the survey, it will automatically be returned to the 
study staff in a confidential manner. For Aim 2, key stakeholders will be asked to refrain 
from using identifying information. For Aim 3, focus group participants will be told not to 
share their full names (use first name only), and are encouraged to use a pseudonym if 
they prefer to maintain confidentiality. Focus group participants will be told to keep private 
anything discussed in the focus group. In addition, any data transmitted within the 
research team will be stripped of identifying information and labeled with a unique 
identification number. 
 
4.3. Potential Benefits of the Proposed Research to Human Subjects and Others 
There are no definitive or guaranteed benefits to participants. The overall goal is to 
promote HPV vaccination in order to reduce HPV-related cancer incidence and mortality 
in Latino Sexual and Gender Minorities. Also, the completion of the proposed study will 
lay the groundwork for a multi-site randomized controlled trial (e.g., NIH R01 or R34) in 
PR and FL. 
 
4.4. Importance of the Knowledge to be Gained 
We will identify knowledge gaps, health beliefs, attitudes, and educational learning 
preferences in this high-risk population which will inform content for the educational 
intervention to promote HPV vaccination. The goal of this research program is to promote 
HPV vaccination in order to reduce HPV-related cancer incidence and mortality. 
 
4.5. Gender and Minority Inclusion for Research Involving Human Subjects 
The overall goal is to promote HPV vaccination in order to reduce HPV-related cancer 
incidence and mortality in Latino Sexual and Gender Minorities, including Hispanic/Latino 
individuals that self-identify as gay, bisexual and, queer cis-male and are able to read, 
speak, and understand Spanish. 
 
5. References  
1. CDC. 
(2019). 
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Appendix A. Referral Card (SPA) 
 
 
 
       
 
 
 
 
Appendix A. Referral Card (ENG) 
 
 
 
 
 
 
 
 
 
 
 
 
 

 PI: Shannon M. Christy, PhD 
26 
 
Appendix B. Coupon Manager Log (SPA) 
 
Fecha 
 
Mm/dd/aaaa 
Localización 
ID Reclutador 
Semilla 
(Ej. A-001) 
ID Válido 
 
Y/N 
Initials Staff or 
CBO member 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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27 
 
Appendix B. Coupon Manager Log (ENG) 
 
Date 
 
Mm/dd/yyyy 
Location 
Seed Recruiter ID 
(Ej. A-001) 
Valid ID 
 
Y/N 
Initials Staff or 
CBO member