Examining the Association Between Socioeconomic Status and Potential Human Papillomavirus-associated Cancers

Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia 30341, USA.
Cancer (Impact Factor: 4.89). 11/2008; 113(10 Suppl):2910-8. DOI: 10.1002/cncr.23742
Source: PubMed


This study examined the association between county-level measures of socioeconomic status (SES) and the incidence rate of human papillomavirus(HPV)-associated cancers, including cervical, vulvar, vaginal, anal, penile, and oral cavity and oropharyngeal cancers.
The authors collected data from cancer registries for site-specific invasive cancer diagnoses between 1998 and 2003, inclusive, among adults aged >20 years at the time of diagnosis. County-level variables that included education, income, and poverty status were used as factors for socioeconomic status. Measures of rural-urban status, the percentage of the population that currently smoked, and the percentage of women who reported having ever had a Papanicolaou (Pap) test were also studied.
Lower education and higher poverty were found to be associated with increased penile, cervical, and vaginal invasive cancer incidence rates. Higher education was associated with increased incidence of vulvar cancer, male and female anal cancer, and male and female oral cavity and oropharyngeal cancers. Race was an independent predictor of the development of these potentially HPV-associated cancers.
These findings illustrate the association between SES variables and the development of HPV-associated cancers. The findings also highlight the importance of considering SES factors when developing policies to increase access to medical care and reduce cancer disparities in the United States.

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    • "limited access to needed resources to mitigate the violence and address the health needs of victims (Breiding et al. 2008b; Cho 2012; Powers and Kaukinen 2012; Vest et al. 2002). They also have dramatically higher cervical cancer morbidity and mortality (Benard et al. 2008; US Cancer Statistics Working Group 2010). However, the literature has not explored the possibility that higher exposure and severity of IPValong with prolonged duration of IPVamong low-income, Black and Hispanic women may explain why these women suffer from dramatically higher morbidity and mortality rates of cervical cancer. "
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    ABSTRACT: The purpose of this paper is to critically examine the literature and present a comprehensive model of three pathways through which IPV increases the risk for cervical cancer. The first pathway is increased exposure to cervical cancer risk factors among IPV victims, including smoking, psychosocial stress, risky sexual behaviors, and sexually transmitted infections (STDs/STIs), particularly human papillomavirus infection. The second pathway is poor compliance with cervical cancer screening. The third pathway is delay/discontinuation in treatment for cervical dysplasia and neoplasia. Control imposed by the abusive partner, competing life priorities, and limited access to financial/support resources restrict a woman’s ability to seek cancer services. Higher rates, severity, and duration of IPV among low-income, Black, and Hispanic women may explain the pervasive cervical cancer disparities.
    Full-text · Article · May 2015 · Journal of Family Violence
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    • "HPV vaccination rates are low among socioeconomic disadvantaged groups, and in states and regions with low cervical cancer screening participation and greater cervical cancer morbidity and mortality [8]. Uninsured and low-income women suffer disproportionate cervical cancer morbidity, mortality and late-stage diagnosis [9] [10]. Provider recommendation is a key facilitator to vaccination among low-income, medically underserved populations [11] [12]. "
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    ABSTRACT: Introduction: In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations. Methods: Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated. Results: 93% of providers recommended the HPV vaccine, most frequently for females aged 13-26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%). Conclusion: Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9-12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.
    Full-text · Article · Aug 2014 · Vaccine
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    • "Over the past decades, a steady decrease in the cervical cancer incidence and mortality has been reported [2]. Still, cervical cancer disproportionately affects poor minority women [3]; along with increased incidence of cervical cancer among female population groups with lower education and income, and higher poverty [4,5], substantial disparities in stage at diagnosis and mortality also remain by race/ethnicity [3-8]. "
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    ABSTRACT: Although lower uptake rates of the human papillomavirus (HPV) vaccine among socioeconomically disadvantaged populations have been documented, less is known about the relationships between awareness and acceptability, and other factors affecting HPV vaccine uptake.The current study aimed to estimate the potential effectiveness of increased HPV vaccine awareness on the acceptability of HPV vaccination in a nationally representative sample of women, using a methodology that controlled for potential non-random selection. This study used a population-based sample from the 2007 Health Information National Trends Survey, a cross-sectional study of the US population aged 18 years or older, and focused on the subsample of 742 women who have any female children under the age of 18 years in the household. An instrumental variables bivariate probit model was used to jointly estimate HPV vaccine awareness and acceptability. The proportion of HPV vaccine acceptability among the previously aware and non-aware groups was 58% and 47%, respectively. Results from the instrumental variables bivariate probit model showed that the estimated marginal effect of awareness on acceptability was 46 percentage points, an effect that was even greater than observed. Among populations who are not currently aware of the HPV vaccine, the potential impact of raising awareness on acceptability of HPV vaccination is substantial. This finding provides additional support to strengthening public health programs that increase awareness and policy efforts that address barriers to HPV vaccination.
    Full-text · Article · Jan 2012 · BMC Public Health
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