Journal of Immigrant and Minority Health

, Volume 15, Issue 4, pp 732–740 | Cite as

Exploring the Role of Neighborhood Socio-Demographic Factors on HPV Vaccine Initiation Among Low-Income, Ethnic Minority Girls

  • Jennifer TsuiEmail author
  • Gilbert C. Gee
  • Hector P. Rodriguez
  • Gerald F. Kominski
  • Beth A. Glenn
  • Rita Singhal
  • Roshan Bastani
Original Paper


Little is known about whether neighborhood factors are associated with human papillomavirus (HPV) vaccine uptake, especially among disadvantaged groups that can benefit most from the vaccine. We used data collected from immigrant, low-income mothers of adolescent girls and data from the 2005–2009 American Community Survey to investigate the relationship between HPV vaccine initiation and neighborhood characteristics. We compared initiation rates across levels of neighborhood disadvantage and employed multilevel logistic regression models to examine contextual effects on uptake. Overall, 27 % of girls (n = 479) initiated the vaccine. Initiation rates were highest among girls from the most disadvantaged neighborhoods (30 %), however, neighborhood factors were not independently associated with vaccine initiation after adjusting for individual factors. Mother’s awareness of HPV, age, and insurance status were strong predictors for initiation. Future interventions should focus on improving awareness among low-income mothers as well as targeting vulnerable families outside the catchment area of public programs.


Human papillomavirus (HPV) vaccine Cervical cancer Neighborhood characteristics Immigrant Low-income 



This study was supported by the UCLA NIH/NCI R25 Cancer Education and Career Development Program and the AHRQ Grants for Health Services Research Dissertation Program (1-R36-HS020172-01). We would like to thank the Office of Women’s Health hotline operators for conducting the telephone surveys and the mothers who participated in the study.


  1. 1.
    American Cancer Society. Cancer facts and figures 2012. Atlanta: American Cancer Society; 2012. Accessed at
  2. 2.
    Freeman HP, Wingrove BK. Excess cervical cancer mortality: a marker for low access to health care in poor communities. Rockville: National Cancer Institute, Center to Reduce Cancer Health Disparities; 2005.Google Scholar
  3. 3.
    Krieger N, et al. Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988–92 (United States). Cancer Causes Control. 1999;10(6):525–37.CrossRefPubMedGoogle Scholar
  4. 4.
    McDougall JA, et al. Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992–2003. Cancer Causes Control. 2007;18(10):1175–86.CrossRefPubMedGoogle Scholar
  5. 5.
    Saraiya M, et al. Cervical cancer incidence in a prevaccine era in the United States, 1998–2002. Obstet Gynecol. 2007;109(2 Pt 1):360–70.CrossRefPubMedGoogle Scholar
  6. 6.
    Coughlin SS, et al. Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002. Soc Sci Med. 2008;66(2):260–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Datta GD, et al. Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis. Cancer. 2006;106(3):664–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsui J, et al. Cervical cancer screening among foreign-born women by birthplace and duration in the United States. J Womens Health (Larchmt). 2007;16(10):1447–57.CrossRefGoogle Scholar
  9. 9.
    Ponce NA, et al. Is there a language divide in pap test use? Med Care. 2006;44(11):998–1004.CrossRefPubMedGoogle Scholar
  10. 10.
    Coughlin SS, Uhler RJ. Breast and cervical cancer screening practices among Asian and Pacific Islander women in the United States, 1994–1997. Cancer Epidemiol Biomarkers Prev. 2000;9(6):597–603.PubMedGoogle Scholar
  11. 11.
    Krieger N, et al. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156(5):471–82.CrossRefPubMedGoogle Scholar
  12. 12.
    McCarthy AM, et al. Racial/ethnic and socioeconomic disparities in mortality among women diagnosed with cervical cancer in New York City, 1995–2006. Cancer Causes Control. 2010;21:1645.CrossRefPubMedGoogle Scholar
  13. 13.
    Singh GK, Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004;95(3):I14–21.PubMedGoogle Scholar
  14. 14.
    CDC. Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). In: MMWR early release. Centers for Disease Control and Prevention; 2007. p. 1–24.Google Scholar
  15. 15.
    CDC. National, state, and local area vaccination coverage among adolescents aged 13 through 17 years—United States, 2011. In: Morbidity and mortality weekly report 2012. p. 671–677.Google Scholar
  16. 16.
    Bastani R, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomarkers Prev. 2011;20(7):1463–72.CrossRefPubMedGoogle Scholar
  17. 17.
    Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Prev Med. 2007;45(2–3):107–14.CrossRefPubMedGoogle Scholar
  18. 18.
    Cates JR, et al. Racial differences in HPV knowledge, HPV vaccine acceptability, and related beliefs among rural, southern women. J Rural Health. 2009;25(1):93–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Constantine NA, Jerman P. Acceptance of human papillomavirus vaccination among Californian parents of daughters: a representative statewide analysis. J Adolesc Health. 2007;40(2):108–15.CrossRefPubMedGoogle Scholar
  20. 20.
    Dempsey AF, et al. Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus. Ann Epidemiol. 2009;19(8):531–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Gerend MA, Weibley E, Bland H. Parental response to human papillomavirus vaccine availability: uptake and intentions. J Adolesc Health. 2009;45(5):528–31.CrossRefPubMedGoogle Scholar
  22. 22.
    Hughes J, et al. Disparities in how parents are learning about the human papillomavirus vaccine. Cancer Epidemiol Biomarkers Prev. 2009;18(2):363–72.CrossRefPubMedGoogle Scholar
  23. 23.
    Rosenthal SL, et al. Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes. J Adolesc Health. 2008;43(3):239–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Tiro JA, et al. Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics. Vaccine. 2012;30(13):2368–75.Google Scholar
  25. 25.
    Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000;51(8):1143–61.CrossRefPubMedGoogle Scholar
  26. 26.
    Kawachi I, Berkman LF. Neighborhoods and health. New York: Oxford University Press; 2003. p. 352.CrossRefGoogle Scholar
  27. 27.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.PubMedGoogle Scholar
  28. 28.
    Achat H, et al. Social networks, stress and health-related quality of life. Q Life Res. 1998;7(8):735–50.CrossRefGoogle Scholar
  29. 29.
    Borrell LN, et al. Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study. Int J Epidemiol. 2004;33(2):398–407.CrossRefPubMedGoogle Scholar
  30. 30.
    Browning CR, Cagney KA, Wen M. Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health. Soc Sci Med. 2003;57(7):1221–35.CrossRefPubMedGoogle Scholar
  31. 31.
    Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005;46(1):15–31.CrossRefPubMedGoogle Scholar
  32. 32.
    Rogers EM. Diffusion of innovations. New York, NY: Free Press, A division of Simon & Schuster, Inc.; 2003.Google Scholar
  33. 33.
    CDC, ACIP-VFC. Vaccine resolutions for vaccines to prevent human Papillomavirus. 2011. p. 1–2.Google Scholar
  34. 34.
    Mobley LR, et al. Heterogeneity in mammography use across the nation: separating evidence of disparities from the disproportionate effects of geography. Int J Health Geogr. 2008;7:32.CrossRefPubMedGoogle Scholar
  35. 35.
    Kawachi I, Berkman L. Social cohesion, social capital, and health. In: Social epidemiology. New York: Oxford University Press; 2000. p. 174–90.Google Scholar
  36. 36.
    Chao C, et al. Correlates for human papillomavirus vaccination of adolescent girls and young women in a managed care organization. Am J Epidemiol. 2010;171(3):357–67.CrossRefPubMedGoogle Scholar
  37. 37.
    Pruitt SL, Schootman M. Geographic disparity, area poverty, and human papillomavirus vaccination. Am J Prev Med. 2010;38(5):525–33.CrossRefPubMedGoogle Scholar
  38. 38.
    Bastani R, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomarkers Prev. 2011;20(7):1463–72.CrossRefPubMedGoogle Scholar
  39. 39.
    U.S. Census Bureau. American Community Survey. 2012 [cited 2012 March 10]; Available from:
  40. 40.
    U.S. Census Bureau. U.S. Census Geographic Terms and Concepts. In: 2008 Redistricting Data Prototype (Public Law 94-171) Summary File U.S.C. Bureau, editor. 2008: Washington, D.C.Google Scholar
  41. 41.
    ACIP. ACIP Provisional Recommendations for HPV Vaccine. In: ACIP Meeting, October, 21, 2009. 2009. Atlanta.Google Scholar
  42. 42.
    Smith PJ, et al. Underinsurance and adolescent immunization delivery in the United States. Pediatrics. 2009;124(Suppl 5):S515–21.CrossRefPubMedGoogle Scholar
  43. 43.
    Kneebone E, Nadeau C, Berube A. The re-emergence of concentrated poverty: metropolitan trends in the 2000s. In: Metropolitan Policy Program at Brookings, editor. Metropolitan opportunity series. Washington: The Brookings Institute; 2011.Google Scholar
  44. 44.
    Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health. 2012;14(2):350–5.Google Scholar
  45. 45.
    Gowda C, Dempsey AF. Medicaid reimbursement and the uptake of adolescent vaccines. Vaccine, 2012.Google Scholar
  46. 46.
    Lavarreda SA, Brown ER, Bolduc CD. Underinsurance in the United States: an interaction of costs to consumers, benefit design, and access to care. Annu Rev Public Health. 2011;32:471–82.CrossRefPubMedGoogle Scholar
  47. 47.
    Bednarczyk RA, Birkhead GS. Reducing financial barriers to vaccinating children and adolescents in the USA. Curr Opin Pediatr. 2011;23(1):105–9.CrossRefPubMedGoogle Scholar
  48. 48.
    Freed GL, Cowan AE, Clark SJ. Primary care physician perspectives on reimbursement for childhood immunizations. Pediatrics. 2009;124(Suppl 5):S466–71.CrossRefPubMedGoogle Scholar
  49. 49.
    Young JL, et al. Human papillomavirus vaccination recommendation may be linked to reimbursement: a survey of Virginia family practitioners and gynecologists. J Pediatr Adolesc Gynecol. 2011;24(6):380–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Schootman M, et al. Self-report by elderly breast cancer patients was an acceptable alternative to surveillance, epidemiology, and end results (SEER) abstract data. J Clin Epidemiol. 2005;58(12):1316–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Jennifer Tsui
    • 1
    Email author
  • Gilbert C. Gee
    • 3
  • Hector P. Rodriguez
    • 4
  • Gerald F. Kominski
    • 4
  • Beth A. Glenn
    • 2
  • Rita Singhal
    • 5
  • Roshan Bastani
    • 2
  1. 1.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Department of Health Policy and Management, Fielding School of Public Health, Cancer Prevention and Control Research, Jonsson Comprehensive Cancer CenterUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of Community Health Sciences, Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  4. 4.Department of Health Policy and Management, Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  5. 5.Office of Women’s HealthLos Angeles County Department of Public HealthEl MonteUSA

Personalised recommendations