HPV and HPV-related cancer prevention prevalence among people experiencing homelessness in the United States, 2006-2018 - Project Summary/Abstract Human Papillomavirus (HPV) causes over 36,000 cancer cases annually despite the existence of highly effective prevention methods, such as HPV vaccination and cervical cancer screening. The approximately 653,100 people experiencing homelessness or housing instability in the U.S. have higher rates of exchange sex, which increases the risk for sexually transmitted infections such as HPV. People experiencing homelessness or housing instability had significantly higher age-adjusted HPV-related cancer incidence and mortality compared to the general population. Despite the strong existing evidence for HPV prevention and health promotion for other vaccines and sexually transmitted infections among people experiencing homelessness or housing instability, evidence-based strategies intersecting these two domains do not exist. It is critical to examine a baseline prevalence of HPV and HPV prevention behaviors to clarify to what extent these homelessness-specific considerations must be accounted for when bolstering HPV vaccination and cervical cancer screening behaviors through other evidence- based strategies. Examining this variation in a larger, representative sample of people experiencing homelessness or housing instability would better distinguish how to address barriers and intersecting risk factors to HPV-related cancer prevention that are especially burdensome without housing. Using a behavioral epidemiology approach to apply behavioral and public health theory (i.e., Gelberg-Anderson Behavioral Model for Vulnerable Populations) for health outcomes and behaviors, this study will examine disparities in HPV and HPV-related cancer prevention among people experiencing homelessness using restricted-use National Center of Health Statistics (NCHS) data from 2006-2018, linked to data from the U.S. Department of Housing and Urban Development (HUD). Specific aims: (1) estimate the prevalence of HPV infection, and compare it to related predisposing, enabling, and need factors between people seeking housing assistance and people who have not sought housing assistance; (2) estimate the prevalence of HPV-related cancer prevention behaviors, and compare it to related predisposing, enabling, and need factors between people seeking housing assistance and those who have not sought housing assistance. Expected outcomes include establishing a baseline of HPV-related health disparities for people experiencing homelessness or housing instability. This study will increase rigor and consistency in housing measurement and cancer preventive behavior adherence to provide a better picture of HPV and cancer prevention. Findings will lay the groundwork for the intersectional nature of specific risk factors among people who are homeless or unstably housed to design better tailored, relevant intervention development that provides HPV-related cancer prevention support for those unstably housed who require balancing several basic need priorities.
