Date of Award

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health Sciences

College

College of Graduate Studies

First Advisor

Edith M. Williams

Second Advisor

Kathleen B. Cartmell

Third Advisor

Renee' H. Martin

Fourth Advisor

James R. Roberts

Fifth Advisor

Brian Neelon

Sixth Advisor

Jeffrey E. Korte

Abstract

Since its introduction in 2006, the human papilloma virus (HPV) vaccine has made substantial developments. The use of the vaccine was expanded to include males. The completion dose series was decreased from three to two shots, if started before the age of 15. The cost of the vaccine is fully covered by private insurance and public programs for various ages ranging from 9 to 26 years old1. With these improvements the HPV vaccine has the capability to safely and significantly prevent and reduce many cancers that cause the deaths of women and men across the United 1,2. Therefore, the underuse of the HPV vaccine is a serious but correctable threat to progress against cancer3,4. During 2012-2016, an estimated average of 34,800 HPV-attributable cancers were diagnosed each year. Among these estimated cancers, 92% were attributable to the HPV types that are included in the 9-valent HPV vaccine and could have been prevented if HPV vaccine recommendations were followed5. However, HPV vaccination rates across the U.S. remain low6. Using public health data sources, choropleth maps, new variables of Health Department (HD) clinic access and prediction modeling, this research advanced the field of health services research by informing the third goal of the President’s Cancer Panel 2012-2013 report: maximize access to HPV vaccination3. The short-term impact of this research quantified and located HPV vaccination for adolescents, in addition to highlighting prognostic indicators of access and identifying barriers to HPV vaccination uptake among HD clinics at the county level in Georgia. The long-term impact of this research provided greater insight for targeting efforts to optimize HPV vaccine uptake at the county level in South Carolina and in other states with low HPV vaccination coverage. This research demonstrated the important use of small area estimation by public health professionals in states with low HPV vaccination coverage and limited or no immunization registry data for small geographic areas. This research provided valuable data toward the access of vaccination services and the dissemination and implementation of HPV vaccination interventions at the county level. Ultimately the findings from this study may be used to predict correlations to the incidence of HPV-associated cancers, which may help reduce public health costs, morbidity and mortality related to HPV infections in the United States.

Comments

Citations in abstract listed in dissertation.

Rights

All rights reserved. Copyright is held by the author.

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