UCLA

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. 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, including lack of geographic accessibility to safety-net immunization clinics, may prevent disadvantaged adolescent girls from obtaining the vaccine. Current disparities in cervical cancer will likely persist as a result of HPV vaccine under-utilization among disadvantaged populations.

This dissertation is comprised of three studies that explore the roles of geographic and neighborhood factors on HPV vaccine access and uptake among low-income, racial/ethnic minority populations in Los Angeles County (LAC). Data collected from mothers of HPV vaccine age-eligible girls as well as secondary data from the U.S. Census Bureau, LAC Sexually Transmitted Diseases Program and LAC Cancer Surveillance Program were used in the analyses. Geographic information system mapping (GIS) techniques and multivariate logistic regression models for clustered data were employed.

This research found that HPV vaccination services via safety-net clinics are, in general, geographically accessible for low-income, high-risk populations in Los Angeles County. Some exceptions to the primary findings should be noted: (1) some racial/ethnic differences in proximity to clinics emerged and warrant further exploration, (2) a few specific neighborhoods with high cervical cancer risk may benefit from targeted improvements in geographic access to HPV vaccination services, and (3) particular attention should be paid to low-income girls living in moderately poor neighborhoods where geographic access to nearby safety-net services is limited. Increased proximity to safety-net clinics was not significantly associated with increased vaccine uptake. While vaccination rates were highest among low-income girls in neighborhoods with the greatest poverty and proportion of minority residents, these factors were not independently related to vaccination after controlling for individual factors. Mother's awareness of HPV, age of girl, and having public insurance were also significant predictors of uptake.

Findings suggest that low-income communities continue to need increased access to information about HPV. Results also suggest health care coverage, specifically underinsurance among low-income adolescents, and clinic-based operational factors are worth exploring in future research as barriers to HPV vaccination. Future research should continue to focus on individual, physician, and organizational strategies to increase vaccine uptake, especially in relation to high-risk populations that could benefit most from the HPV vaccine.