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INTRODUCTION: Despite strong CDC recommendations and a state school requirement, nearly half of all adolescents in Virginia have not completed the HPV vaccine series. Using ArcGIS software, we aimed to explore the relationship between provider density, socioeconomic status, and HPV vaccination uptake in the state of Virginia. METHODS: HPV vaccination rates among adolescents 11 to 17 years were retrieved at the zip-code level from the Virginia Immunization Information System. Choropleth maps of vaccination rates were produced. The ArcGIS Hot Spot Analysis tool identified spatial clusters of zip codes with high and low vaccination rates. Student t-test was used to compare provider density and various socioeconomic indicators between statistically significant clusters of higher (RR>1.0) or lower (RR<1.0) than expected vaccination rates. RESULTS: High series completion rates were noted in central Virginia and the eastern shore. Regions of northern Virginia, including Shenandoah and Page counties, had lower than expected initiation and completion rates. Clusters with significantly lower initiation rates had a lower number of primary care providers, were less educated, and had a lower median household income (MHI). Regions with significantly lower series completion rates had a higher MHI. While regions with lower rates of series completion for males had a higher concentration of providers and were more educated, there was no difference among these factors for female series completion. CONCLUSION: Regional socioeconomic indicators are significant predictors of HPV vaccination, but may have contrasting implications for series initiation and completion. These findings emphasize the utility of spatial analysis and GIS methodology for identifying cancer prevention disparities.

IntroductionTransgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth.MethodsAs part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH.Results21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth.ConclusionsThere was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.

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