Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Linda M. Niccolai

Abstract

Background: Current vaccines protect against human papillomavirus (HPV) types 16 and 18, which are associated with approximately 70% of cervical cancer and 50% of high-grade cervical lesions. Monitoring trends in HPV 16/18-associated lesions is important to assess vaccine impact.

Methods: Cervical intraepithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (AIS) cases of women residing in the catchment area of New Haven County, CT were reported to the Connecticut HPV-IMPACT surveillance system, and diagnostic specimens were obtained for HPV DNA testing. Cases were geocoded to census tracts and linked to area-based measures of race, ethnicity, and poverty. Statistical analysis included logistic regression modeling and generalized estimating equations. This analysis included 1,820 New Haven County women aged 21-39 years diagnosed with CIN2+ from 2008-2014 who had at least one of the fifteen high-risk HPV types detected in the diagnostic specimen.

Results: A total of 825 (45.3%) cases had HPV 16 or 18. Declines in prevalence of HPV 16/18 in lesions were observed, and in a model controlling for age and diagnosis grade, the year 2012 was associated with a lower likelihood of HPV 16/18 compared to the year 2008 (p=0.004). There was a significant interaction between year and area-based race with less of a decline in women living in areas with higher proportion of black residents (p=0.028). Among 21-24 year old women (n=552), there was a more evident decline in likelihood of HPV 16/18 in the lesions controlling for diagnosis grade, but the decline did not occur for women in areas of higher proportions of black, Hispanic, and poor residents.

Conclusion: These results suggest that the proportion of lesions attributed to HPV 16/18 have declined in New Haven County, CT, particularly among young women, but the declines are not observed in areas of higher minorities and higher area-poverty.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018

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