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Are HPV vaccination services accessible to high-risk communities? A spatial analysis of HPV-associated cancer and Chlamydia rates and safety-net clinics

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Abstract

Purpose

While HPV vaccines can greatly benefit adolescents and young women from high-risk areas, little is known about whether safety-net immunization services are geographically accessible to communities at greatest risk for HPV-associated diseases. We explore the spatial relationship between areas with high HPV risk and proximity to safety-net clinics from an ecologic perspective.

Methods

We used cancer registry data and Chlamydia surveillance data to identify neighborhoods within Los Angeles County with high risk for HPV-associated cancers. We examined proximity to safety-net clinics among neighborhoods with the highest risk. Proximity was measured as the shortest distance between each neighborhood center and the nearest clinic and having a clinic within 3 miles of each neighborhood center.

Results

The average 5-year non-age-adjusted rates were 1,940 cases per 100,000 for Chlamydia and 60 per 100,000 for HPV-associated cancers. A large majority, 349 of 386 neighborhoods with high HPV-associated cancer rates and 532 of 537 neighborhoods with high Chlamydia rates, had a clinic within 3 miles of the neighborhood center. Clinics were more likely to be located within close proximity to high-risk neighborhoods in the inner city. High-risk neighborhoods outside of this urban core area were less likely to be near accessible clinics.

Conclusions

The majority of high-risk neighborhoods were geographically near safety-net clinics with HPV vaccination services. Due to low rates of vaccination, these findings suggest that while services are geographically accessible, additional efforts are needed to improve uptake. Programs aimed to increase awareness about the vaccine and to link underserved groups to vaccination services are warranted.

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Acknowledgments

The analysis for the study was conducted under funding by the UCLA Jonsson Comprehensive Cancer Center Pre-doctoral Fellowship Grant and the UCLA NIH/NCI R25 Cancer Education and Career Development Program. Jennifer Tsui is currently funded by the NIH/NCI T32 Postdoctoral Research Fellowship program at Columbia University, which supported the completion and submission of this manuscript. We thank Myles Cockburn, Ph.D, for providing the Los Angeles Cancer Surveillance Program’s geographic data. We also thank our colleagues at the Los Angeles County Department of Public Health’s Sexually Transmitted Disease Program for providing Chlamydia data. We gratefully acknowledge Myles Cockburn, Ph.D and Andrew Rundle, Dr.PH, for their feedback on this manuscript.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., R-719, New York, NY, 10032, USA

    Jennifer Tsui

  2. Department of Health Policy and Management, University of California, Berkeley, CA, USA

    Hector P. Rodriguez

  3. Department of Community Health Sciences, University of California, Los Angeles, CA, USA

    Gilbert C. Gee

  4. Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA, USA

    Loraine A. Escobedo

  5. Department of Health Policy and Management, University of California, Los Angeles, CA, USA

    Gerald F. Kominski & Roshan Bastani

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  1. Jennifer Tsui
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  2. Hector P. Rodriguez
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  3. Gilbert C. Gee
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  4. Loraine A. Escobedo
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  5. Gerald F. Kominski
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  6. Roshan Bastani
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Correspondence to Jennifer Tsui.

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Tsui, J., Rodriguez, H.P., Gee, G.C. et al. Are HPV vaccination services accessible to high-risk communities? A spatial analysis of HPV-associated cancer and Chlamydia rates and safety-net clinics. Cancer Causes Control 24, 2089–2098 (2013). https://doi.org/10.1007/s10552-013-0286-x

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