Geographic access to care and HPV vaccine uptake among ethnic minority girls

描述（由申请人提供）：子宫颈癌对少数族裔、移民和低收入妇女的影响不成比例。人乳头瘤病毒（HPV）疫苗有可能大大预防高危HPV感染和未来的宫颈癌病例。然而，最近的研究表明，高危人群的HPV疫苗接种率仍然很低。即使有向低收入人群免费提供疫苗的现有规划，多重障碍，如缺乏地理/空间可达性的安全网免疫诊所，可能会阻止弱势女孩获得HPV疫苗。由于HPV疫苗在低收入、少数民族人群中的利用不足，目前宫颈癌的差异可能会持续下去。本横断面研究将检查地理/空间获得护理和邻里因素，除了个人层面的因素，影响HPV疫苗接种（接受1剂HPV疫苗）在洛杉矶县（LAC）低收入，少数民族女孩。该研究将建立在从主要居住在拉丁美洲和加勒比地区贫困地区并经常使用县安全网系统的符合HPV疫苗接种年龄的女孩的母亲收集的主要数据的基础上。这些个人层面的数据将在人口普查区层面与美国人口普查局的社区社会人口统计数据和LAC性传播疾病项目的社区宫颈癌风险数据联系起来。将采用地理信息系统制图技术，利用符合接种年龄的女童的居住地址和安全网免疫接种诊所的位置，制定地理/空间获取措施（到诊所的最短旅行距离，家庭3英里半径内的e- 1诊所的覆盖范围）。该研究将评估免疫诊所的空间可及性是否与HPV疫苗接种相关，以及空间可及性与疫苗接种之间的关系是否受个体种族/民族的影响，同时控制其他个体水平的风险因素。除了空间可及性和个人层面的风险因素外，还将使用分层逻辑回归模型来评估社区因素（社会人口特征和宫颈癌风险）对HPV疫苗启动的影响。这项研究的独特之处在于，它超越了个人水平的预测因素，评估了影响服务不足的城市人口接种HPV疫苗的地理和社区因素。研究结果将告知当地县卫生官员导致HPV疫苗使用率低的因素，并为拉丁美洲和加勒比地区癌症预防和控制项目的资源分配决策提供相关信息。结果还将为卫生政策制定者和研究人员提供基于地理的干预措施，以提高HPV疫苗的吸收率。

DESCRIPTION (provided by applicant): Cervical cancer disproportionately affects minority, immigrant, and low income women. Human Papillomavirus (HPV) vaccines have the potential to substantially prevent high-risk HPV infections and future cases of cervical cancer. However, recent studies show that HPV vaccine uptake in high risk groups remains low. Even with available programs that provide the vaccine for free to low income populations, multiple barriers, such as lack of geographic/spatial accessibility to safety-net immunization clinics, may prevent disadvantaged girls from obtaining the HPV vaccine. Current disparities in cervical cancer will likely persist as a result of HPV vaccine under-utilization among low income, ethnic minority populations. This cross-sectional study will examine geographic/spatial access to care and neighborhood factors, in addition to individual level factors, that influence HPV vaccine initiation (receiving e 1 dose of the HPV vaccine) among low-income, minority girls in Los Angeles County (LAC). The study will build on primary data collected from mothers of HPV vaccine age-eligible girls who primarily reside in disadvantaged areas of LAC and routinely access the county safety-net system. This individual-level data will be linked at the census tract level to neighborhood socio-demographic data from the U.S. Census Bureau and neighborhood cervical cancer risk data from the LAC Sexually Transmitted Diseases Program. Geographic information systems mapping techniques will be employed to create geographic/spatial access measures (shortest travel distance to clinic, coverage of e 1 clinic within a 3-mile radius of household) using residential addresses of vaccine age-eligible girls and locations of safety-net immunization clinics. The study will evaluate whether spatial access to immunization clinics is associated with HPV vaccine initiation, as well as whether the relationship between spatial access and vaccine initiation is modified by individual race/ethnicity, while controlling for other individual level risk factors. Hierarchical logistical regression modeling will also be used to assess the impact of neighborhood factors (socio-demographic characteristics and cervical cancer risk), in addition to spatial access and individual level risk factors, on HPV vaccine initiation. The study is unique in that it moves beyond individual level predictors to assess geographic and neighborhood factors that impact HPV vaccine initiation in an underserved, urban population. Study results will inform local county health officials about factors that contribute to low HPV vaccine utilization and provide information relevant to resource allocation decisions for cancer prevention and control programs in LAC. Results will also inform health policymakers and researchers on geographically based interventions that could improve HPV vaccine uptake. PUBLIC HEALTH RELEVANCE: This study will examine the impact of geographic/spatial access to safety-net immunization clinics and other neighborhood socio-demographic and cervical cancer risk factors on HPV vaccine initiation among low- income, ethnic minority girls in Los Angeles County. Individual survey data, collected from mothers of HPV vaccine age-eligible girls, will be combined with data from the Los Angeles County Department of Public Health STD Program and the U.S. Census Bureau to conduct geographic information systems (GIS) mapping and multi-level analysis. Findings will provide an understanding of how spatial and neighborhood factors influence HPV vaccine uptake in a large urban setting and inform cervical cancer control programs and policies.