Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls

Abstract

Purpose Human Papillomavirus (HPV) vaccine uptake remains low. Although publicly funded programs provide free or low cost vaccines to low-income children, barriers aside from cost may prevent disadvantaged girls from getting vaccinated. Prior studies have shown distance to health care as a potential barrier to utilizing pediatric preventive services. This study examines whether HPV vaccines are geographically accessible for low-income girls in Los Angeles County and whether proximity to safety-net clinics is associated with vaccine initiation. Methods Interviews were conducted in multiple languages with largely immigrant, low-income mothers of girls ages 9 to 18 via a county health hotline to assess uptake and correlates of uptake. Addresses of respondents and safety-net clinics that provide the HPV vaccine for free or low cost were geo-coded and linked to create measures of geographic proximity. Logistic regression models were estimated for each proximity measure on HPV vaccine initiation while controlling for other factors. Results On average, 83% of the 468 girls had at least one clinic within 3-miles of their residence. The average travel time on public transportation to the nearest clinic among all girls was 21 minutes. Average proximity to clinics differed significantly by race/ethnicity. Latinas had both the shortest travel distances (2.2 miles) and public transportation times (16 minutes) compared to other racial/ethnic groups. The overall HPV vaccine initiation rate was 25%. Increased proximity to the nearest clinic was not significantly associated with initiation. By contrast, mother’s awareness of HPV and daughter’s age were significantly associated with increased uptake. Conclusions This study is among the first to examine geographic access to HPV vaccines for underserved girls. Although the majority of girls live in close proximity to safety-net vaccination services, rates of initiation were low. Expanding clinic outreach in this urban area is likely more important than increasing geographic access to the vaccine for this population.

Identifying Hispanic mothers’ salient beliefs about human papillomavirus vaccine initiation in their adolescent daughters

“…It is possible that since mothers live in an urban area, they have access to public transportation when private transportation is not available, which facilitates vaccine initiation. Existing research supports this finding (Tsui et al., 2013). On a related note, not having a clinic close by was a salient barrier to vaccine initiation.…”

Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation among Adolescent Girls in the United States

“…We developed geographic factors using measures of community disadvantage previously included in health disparities research (38, 39) and research on vaccination uptake and use of cancer screening services (16, 33, 34, 40-42). Using the 2008- 2012 US Census American Community Survey we developed the following community-level geographic factors: (a) percentage of a ZCTA's residents living below the federal poverty level (36); (b) median household income of ZCTA; (c) population density, and (d) the racial–ethnic residential composition of the ZCTA.…”

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial

“…1,2 Safety-net clinics are an important medical home for underserved adolescents and have tremendous potential to address disparities. 3,4 HPV vaccine delivery is challenging because of the dosing schedule, target population, and parental ambivalence. [5][6][7][8][9] Unlike other adolescent vaccines, guidelines recommend 3 doses over a 6-month period.…”