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首页> 外文学位 >Exploring the Roles of Geographic and Neighborhood Level Factors on HPV Vaccine Access and Uptake among Low-income Populations in Los Angeles County.
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Exploring the Roles of Geographic and Neighborhood Level Factors on HPV Vaccine Access and Uptake among Low-income Populations in Los Angeles County.

机译：探索地理和邻里水平因素对洛杉矶县低收入人群HPV疫苗获取和摄取的影响。

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摘要

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.
机译：宫颈癌对少数民族，移民和低收入妇女的影响尤其严重。人乳头瘤病毒（HPV）疫苗具有潜在的实质性预防高危HPV感染和未来宫颈癌病例的能力。最近的研究表明，高危人群的HPV疫苗摄入率仍然很低。即使有向低收入人群免费提供疫苗的可用程序，多重障碍，包括缺乏安全网络免疫诊所的地域可及性，也可能阻止处境不利的少女获得疫苗。由于弱势人群中HPV疫苗使用不足，目前宫颈癌的差异可能会持续。本论文由三项研究组成，探讨了地理和邻域因素在低收入，种族，低收入人群中对HPV疫苗的获取和吸收的作用。洛杉矶县（LAC）的少数民族。分析中使用了从符合HPV疫苗年龄要求的女孩的母亲那里收集的数据，以及美国人口普查局，LAC性传播疾病计划和LAC癌症监视计划的次要数据。运用地理信息系统制图（GIS）技术和聚类数据的多元Logistic回归模型;该研究发现，通过安全网诊所进行的HPV疫苗接种服务通常可在洛斯地区的低收入，高风险人群中使用安吉利斯县。应注意一些主要发现的例外情况：（1）在诊所附近出现了种族/种族差异，需要进一步探索；（2）一些宫颈癌高风险的特定社区可能会受益于HPV地理位置的有针对性的改善疫苗接种服务；（3）应特别关注居住在中等贫困地区的低收入女孩，这些地区在地理上无法获得附近的安全网服务。距离安全网诊所的距离增加与疫苗摄入量增加没有显着相关。虽然在贫困和少数民族居民比例最高的社区中，低收入女孩的疫苗接种率最高，但在控制了个人因素之后，这些因素与疫苗接种并不独立相关。母亲对HPV的了解，女孩的年龄以及是否有公共保险也是摄入量的重要预测指标。研究结果表明，低收入社区继续需要更多有关HPV信息的途径。结果还表明，医疗保健覆盖率，尤其是低收入青少年的保险不足，基于临床的操作因素值得作为HPV疫苗接种的障碍，在未来的研究中值得探讨。未来的研究应继续关注于个人，医师和组织策略，以增加疫苗的摄取，尤其是与可能从HPV疫苗中受益最大的高风险人群有关。

著录项

  • 作者

    Tsui, Jennifer.;

  • 作者单位

    University of California, Los Angeles.;

  • 授予单位 University of California, Los Angeles.;
  • 学科 Health Sciences Public Health.;Health Sciences Health Care Management.;Urban and Regional Planning.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 185 p.
  • 总页数 185
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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