Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
School of Social Work, University of Alabama, Tuscaloosa, AL, USA.
J Community Health. 2019 Dec;44(6):1214-1223. doi: 10.1007/s10900-019-00690-1.
Despite availability of a safe, effective vaccination, uptake and completion rates of human papillomavirus (HPV) vaccination remain low in the United States. This is particularly true in the southeast, which also sees some of the highest rates of HPV-associated (HPVa) cancers. We aimed to identify areas in Alabama in need of intervention with respect to HPVa cancers and HPV vaccination, and factors potentially associated with these rates by performing county-level secondary data analysis using state and national data sources. Alabama ranks 15th nationally in HPVa cancer rates, with 66.7% and 80.8% of counties having higher HPVa cancer rates than the national incidences of males and females, respectively. Regarding HPV vaccination, 95.5% and 98.5% of Alabama's counties have uptake rates less than the national averages for males and females, respectively. The seven counties with the highest HPV vaccination uptake ranged in rates from 60.2 to 73.6%. Counties with the highest HPV vaccination rates for adolescents were majority African American with low adult educational attainment rates and high rates of poverty and publicly-insured children/adolescents. These counties were also located in Alabama's Black Belt region, traditionally known for low socioeconomics, reduced access to social services, and negative health outcomes. Some counties with the highest rates of HPVa cancers also had among the highest rates of HPV vaccination, indicating a potential association between perceived susceptibility and desire to get HPV vaccine in these communities, warranting further investigation. Future work is needed to translate these findings into actionable intervention practices to increase HPV vaccination.
尽管有安全有效的疫苗，但在美国，人乳头瘤病毒（HPV）疫苗的接种率和全程接种率仍然很低。这在东南部尤其如此，东南部也是 HPV 相关癌症（HPVa）发病率最高的地区之一。我们旨在确定阿拉巴马州需要干预的 HPVa 癌症和 HPV 疫苗接种领域，以及通过使用州和国家数据源进行县级二级数据分析，确定与这些比率相关的潜在因素。阿拉巴马州的 HPVa 癌症发病率在全国排名第 15 位，男性和女性的 HPVa 癌症发病率分别有 66.7%和 80.8%的县高于全国发病率。关于 HPV 疫苗接种，阿拉巴马州 95.5%和 98.5%的县的接种率均低于男性和女性的全国平均水平。HPV 疫苗接种率最高的七个县的接种率范围在 60.2%至 73.6%之间。青少年 HPV 疫苗接种率最高的县主要是非洲裔美国人，成人受教育程度低，贫困率和参保儿童/青少年比例高。这些县还位于阿拉巴马州的“黑带”地区，该地区传统上以低社会经济水平、社会服务获取机会减少以及不良健康结果为特征。一些 HPVa 癌症发病率最高的县也有最高的 HPV 疫苗接种率，这表明这些社区中对 HPV 疫苗的可感知易感性和接种意愿之间可能存在关联，值得进一步调查。需要进一步的工作来将这些发现转化为可操作的干预措施，以增加 HPV 疫苗接种。
