Community-level Geographic Factors and HPV Vaccination in the U.S.

 描述(由申请人提供)：虽然个人和提供者层面的因素导致美国人乳头瘤病毒(HPV)疫苗接种率较低(美国)在美国，社区层面的地理因素在HPV疫苗启动和三剂接种完成中的作用尚不清楚。地理和社区因素可通过与社区物质资源、获得保健设施和服务的可获得性和难易程度、社会资本(例如，社会传染、类似的行为规范)以及居住隔离等多种途径影响疫苗接种。利用国家青少年免疫调查(NIS-Teen)的数据，将审查青少年接种HPV疫苗与社区层面地理因素(包括贫困、城乡居住地和种族构成)之间的关系。NIS-Teen是美国疾病控制和预防中心为监测美国的疫苗接种情况而进行的年度调查。邮政编码和县级地理识别符在公共使用的NIS-Teen数据集中不可用，因此将通过受限使用NIS-Teen文件访问和链接这些地理识别符，以提供地理因素在HPV疫苗接种中的作用的新检查。首先，我们将确定 社区层面的地理因素是疫苗启动和系列完成的独立预测因素，分别在美国青少年女孩和男孩中。接下来，我们将调查地理和社区层面的社会经济因素如何影响与HPV疫苗启动和完成相关的个人层面因素，并与之相互作用。这将是第一次在美国具有全国代表性的青少年样本中提供关于社区层面地理因素对HPV疫苗启动和完成的影响的急需信息的研究。鉴于美国HPV疫苗接种率较低，拟议研究的结果将有助于为公共卫生实践和开发地理目标干预措施提供信息，以改善美国的HPV疫苗接种。

 DESCRIPTION (provided by applicant): While individual- and provider-level factors for low Human Papillomavirus (HPV) vaccination rates in the United States (U.S.) have been well examined, the role of community-level geographic factors in HPV vaccine initiation and 3-dose completion in the U.S. is unknown. Geographic and neighborhood factors could influence vaccination through several pathways linked to material resources of the neighborhood, availability and ease of access to health-care facilities and services, social capital (e.g., socia contagion, similar norms of behavior), and residential segregation. Using data from the National Immunization Survey-Teen (NIS-Teen), an annual survey conducted by the Centers for Disease Control and Prevention to monitor vaccination uptake in the U.S., associations between HPV vaccination among adolescent girls and boys and community-level geographic factors including poverty, rural/urban residence, and racial composition will be examined. Zip code and county- level geographic identifiers are not available in the public-use NIS-Teen datasets, and therefore these geographic identifiers will be accessed and linked via the restricted use NIS-Teen files to provide a novel examination of geographic factors' role in HPV vaccination. First, we will identify community-level geographic factors that are independent predictors of both vaccine initiation and series completion, among U.S. teen girls and boys separately. Next, we will investigate how geographic and community level socioeconomic factors impact and interact with individual level factors associated with HPV vaccine initiation and completion. This will be the first study to provide much needed information on the influence of community-level geographic factors on HPV vaccine initiation and completion among a nationally representative sample of adolescents in the U.S. Given the low rates of HPV vaccination in the U.S., the results from the proposed study will help inform public health practice and the development of geographically targeted interventions to improve HPV vaccination in the United States.