Objective: Research describing the uptake and geographic variability in the human papillomavirus (HPV) vaccine is limited and has relied on data collected from large national surveillance programs. The overarching goal of this dissertation was to estimate the uptake of the HPV vaccine at the ZIP code level and to determine if uptake varied geographically.<bold>Methods:</bold> In Manuscript 1, we recruited 1,003 men and women via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. In Manuscript 2, we examined the geographic variation in HPV vaccine uptake using ZIP code level data from 760 individuals nested within 99 ZIP codes surrounding the downtown area of Minneapolis, Minnesota to identify predictors of vaccination while accounting for spatial dependence. In Manuscript 3, women aged 21-30 years were recruited online to participate in either (1) self-collected testing for HPV and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. A variety of statistical methods were used to answer our research questions including logistic regression and proper spatial conditional autoregressive (CAR) models. Results:</bold> In Manuscript 1, we found that receipt of at least 1 dose of HPV vaccine for women was 65.6% and 12.5% for men, which differs from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men). In Manuscript 2, HPV vaccination was found to exhibit strong spatial dependence (rho =0.9966). Accounting for spatial dependence, older age, male gender, and liberal political preference were found to be significant predictors of HPV vaccination. In Manuscript 3, we found that self-collection was acceptable to women, and that women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey.<bold>Conclusions:</bold> Local estimates to assess the variation in HPV vaccine uptake are needed, as these estimates differ considerably from those obtained using survey data that is aggregated to the state or federal level. In addition, studies that examine geographic variation in HPV vaccination need to account for spatial dependence in order to identify predictors associated with vaccine receipt. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds.
University of Minnesota Ph.D. dissertation. June 2014. Major: Epidemiology. Advisors: Shalini L. Kulasingam, PhD. and James S. Pankow, PhD, MPH. 1 computer file (PDF); viii, 87 pages.
Nelson, Erik John.
HPV vaccination uptake and cancer screening practices in the Twin Cities metropolitan area: a pilot study.
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