In June of 2006, the FDA approved Merck's vaccine "Guardasil" which protects against 4 types of HPV infections, two which cause abnormal cervical dysplagia and two which cause genital warts. In the 15 months since the approval and the subsequent recommendation by the Advisory Committee on Immunization Practice (ACIP) that the vaccine be routinely administered to 11-12 year old girls, legislators in 41 states and the District of Columbia have introduced legislation to require, fund, or educate the public about the HPV vaccine, and at least 17 states have enacted some sort of legislation, including the state of New Mexico. In this application we propose to study the process of implementing policy regarding the HPV vaccine in the state of New Mexico, and related programmatic efforts to offer the vaccine and relevant education to parents and the public. This study is responsive to the call for proposals to conduct research on three areas of action: public policy, health care, and disease prevention. The Specific Aims are as follows: 1. Using a participatory process, identify and convene a stakeholder group composed of individuals involved in the health policy context 2. Explore the translation and impact of health policy initiatives regarding the dissemination of HPV vaccine and the promotion of informed decision making in New Mexico public schools and primary care settings. a. Conduct semi structured interviews with health policy makers, primary care providers, school based health providers and school administrators, in order to determine their perceptions of the roles b. Conduct focus group discussions with parents of 5th grade children c. Conduct ethnographic observations of the ongoing debate about the HPV vaccine dissemination policy 3. Together with the stakeholder group, interpret the data, develop and disseminate health policy recommendations regarding initiatives to support HPV vaccine dissemination and informed decision making leading to the reduction of cervical cancer health disparities in New Mexico. PUBLIC HEALTH RELEVANCE: The recent approval of the HPV vaccine is an important scientific advance but faces challenges in dissemination and implementation. This study will help to develop a better understanding of the factors that contribute to the development of HPV vaccine policy. These findings will be used to work toward the creation of strategies, both at the primary care and health policy level, to promote informed decision among patients with regard to the HPV vaccine that are consistent with community values.