DESHA & SEHON: HPV VACCINE CAMPAIGN
LAWRENCE COUNTY HPV VACCINATION CAMPAIGN
In Collaboration with Dr. Ron Enders of the
Lawrence County Health Department
[ronald.enders@ky.gov]
GEO 509-001
Spring 2012
Pilar DeSha – iampilar@gmail.com
Alexandria Sehon – anse222@g.uky.edu
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DESHA & SEHON: HPV VACCINE CAMPAIGN
TABLE OF CONTENTS
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PROJECT SUMMARY
In conjunction with the Lawrence County Health Department, UK students examined the
spatial relationships between HPV vaccinations in Lawrence County and several factors
including income, education, and topography. With a grant from CancerFreeKY the Lawrence
County Health Department launched an educational HPV vaccine campaign in 2011 to mitigate
the HPV infection rate in Eastern Kentucky. The campaign offers a three-shot series to county
residents between the ages of 9 and 26.
In order to provide analysis and success rates of the
campaign, UK students mapped patient-provided home addresses to examine their proximity to
social, economic, and physical inhibitors. The goals of the project were to render data driven
maps, which in turn could be used as visualizations for future grant proposals. ESRI ArcMap
technology and geographic information attained from the US Census Bureau at census tract and
block levels were used to create visualizations. Maps displayed areas with high and low rates of
vaccination that overlaid information on population density, social provisions (areas with
high/low rates of telephone service), and other key demographic elements.
These outputs help prioritize the health department’s decision making in future HPV
vaccination campaigns by identifying and mapping areas of concern in the community. By
integrating census data with other map data sets the project was able to distinguish areas of
Lawrence County that had significantly different distribution rates of education, gender, and
social amenities.
DESHA & SEHON: HPV VACCINE CAMPAIGN
NEEDS ASSESSMENT REPORT:
February 10th, 2012
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Project Background Information
This project functions as a resource for the Lawrence County KY Health Department. In the
hopes of mitigating this problem, the LC Health Department in 2011 developed an educational outreach
campaign aimed at middle and high school students, which provides free HPV vaccinations for women
and men 11-26 years of age; The HPV vaccination is administered by public school nurses and the local
health department. The vaccination campaign is made possible by a KY wide grand from CanerFreeKY.
Surrounding counties have similar campaigns with little to no documentation of success rates.
The University of Kentucky has partnered with the Health department to develop a series of
ArcGIS maps. These maps will identify previous vaccination recipients in Lawrence County and help to
explore the social, economic, and physical inhibitors for the population targeted to receive the HPV
vaccination. This mapping project will provide essential data to other state departments of public health,
expanding the strategies & resources available for the development of future HPV campaigns.
Goals and Objectives of Project
Objective:
We will identify regions of Lawrence County underrepresented by the current vaccine recipient
distribution based upon patient-provided address data and begin to identity potential factors preventing
eligible residents from receiving the vaccine. This data will be used in a presentation arguing for the
continuance of funding for the Lawrence County HPV Vaccination Campaign.
Goals:
1. Show by census tract districts of Lawrence County, which have the highest rate of
completion of all three vaccine doses during the campaign and look for geographic
patterns in the number of individuals who begin the regiment but do not complete it.
2. Compare the rate of vaccination in Lawrence County in the past 3 months with that of
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neighboring counties that do not have similar HPV vaccine campaigns.
3. Use US Census Bureau data as well as community profile data available for Lawrence
County to begin positing geographic, demographic, and cultural barriers to eligible
residents not receiving the vaccine.
Data Acquisition and Preparation Steps
Steps required for completion of goals:
Goal 1:Data regarding vaccination recipients in the Lawrence County HPV campaign is collected through
school nurses and given to Ron Enders at the LC Health Department. This data is then received by the
University of Kentucky in an excel document containing street addresses, latitude, longitude and city
location. This data will need to be geocoded in order to prepare for mapping and analysis.
Goal 2: Data regarding HPV vaccinations from surrounding counties will be acquired through shared data
from their Health Departments and through CancerFreeKY, an organization that funds HPV vaccination
campaigns.
Goal 3. US Census Bureau data will be downloaded from: Data will be based on education, income, age,
and access to social amenities, such as telephone service.
http://www.census.gov/cgi-bin/geo/shapefiles2010/main &
http://factfinder2.census.gov
Maps and Other Analytical Products
In order for the numerical data regarding patient outreach as well as hypotheses regarding barriers to
the vaccine, a series of GIS maps (4-7) will be created in ESRI’s ArcMap software and prepared for
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presentation. These maps should symbolize:
1. How many residents of Lawrence County received the 1st, 2nd, and 3rd vaccine doses
and the generalized location of their home addresses.
2. Comparison of the rate of HPV vaccination for counties surrounding Lawrence County
over a similar time period.
3. Which regions within Lawrence County had the highest number of vaccinations and
which regions had lower rates of participation.
4. Geographic distribution of potential barriers to the vaccine. Terrain- digital Elevation
model data, resident demographics (age, income, etc.), and infrastructure will be
considered as sources of possible difficulty.
Further, a digital portfolio will be prepared for the Lawrence County Health Department Vaccine
Campaign coordinators and will contain relevant layer files, shape files and original map (.mxd) and
Excel files. The digital portfolio will be useful in the future as more patient data is added to understand
the long-term participation patterns of the vaccination campaign as well as a comparison tool for other
counties or future projects.
Steps Required
Name
Deadline
Task
1 Alli
2/13/2012 Geocode patient address provided by Ron.
2 Pilar
2/14/2012 Contact CancerFreeKY for county comparison data and/or more on Lawrence Co.
3 Pilar
2/16/2012 Download and process (shape files) Census Bureau data.
4 Alli
2/16/2012 Contact Ron and begin creating base map of LC regions.
5 Alli & Pilar 2/16/2012 Begin clipping and merging data and base maps for the LC and surrounding counties.
6 Pilar
3/1/2012 Symbolizing a terrain map for LC
DESHA & SEHON: HPV VACCINE CAMPAIGN
7 Alli
3/1/2012 Symbolize a local/county roads map for LC and surrounding counties.
8 Pilar
3/1/2012 Symbolize a map of local schools and health department.
9 Alli
3/3/2012 Overlaying patient data to created base maps.
10 Alli & Pilar
3/8/2012 Symbolize data for 3 stage vaccine process (heat map?)
11 Alli & Pilar 3/22/2012 Progress Report Due
12 Alli & Pilar 3/27/2012 Symbolize a map for available surrounding counties vaccination.
13 Alli
3/29/2012 Start on map for road wash-outs during past 3 months in LC.
Update and geocode patient address database
14 Alli & Pilar 4/17/2012 Review and Edit previous maps and consider creative options.
15 Alli & Pilar 4/19/2012 Compose digital portfolio of relevant files.
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PROGRESS REPORT:
March 22nd, 2012
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Completed Tasks
1. Collected and edited first half of patient addresses from Dr. Enders. Addresses were
converted to decimal degree format and saved in an Excel document readable by
ArcMap.
a. Patient_Addresses_v1.xls
2. Downloaded demographic data (educational attainment and income) from US Census
Bureau. Edited and formatted Excel documents to be readable by ArcMap.
a. Education_LC_CensusTract_v2.xls
b. Incomeexcelxlsx.xlsx
3. Downloaded a shape file containing polygon data for all Kentucky counties. The data was
clipped into two separate base maps: one displaying Lawrence County boundaries and a
second map showing boundaries for Lawrence County and all surrounding Kentucky
counties.
a. LawrenceCo_Base.mxd
b. SurroundingCo.shp
4. A local-road shape file was created by clipping road data for the state of Kentucky to the
boundaries of the Lawrence County base map above.
a. LC_roads.shp
5. A shape file showing the location of patient addresses was created by converting the
Patient_Addresses_v1 Excel file to XY coordinates in ArcMap and exporting the
resulting event layer as a shape file.
a. Visit1_Add_XY3.shp
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6. A shape file of prominent regions/cities in Lawrence County was created by clipping data
for the state of Kentucky to the Lawrence Co boundaries.
a. LC_Cities.shp
7. Map of Educational Attainment at the level of the census tract was created using above
data and symbolized as a choropleth map with patient address data overlaid.
a. LawrenceCo_HPV_Education.mxd
8. Map of Median Income at the census tract level was created using above data and
symbolzed as a choropleth map with patient address data overlaid.
a. LawrenceCo_HPV_Income.mxd
Problems and Questions

Part of the original objective is to identify physical barriers in Lawrence Co. preventing
eligible residents from receiving the vaccine. There is still a need to accumulate
meaningful terrain data that will enable us to produce a topographical map for this
purpose.

Goal two of the needs assessment report has not been met: Comparing the rate of
vaccination in Lawrence Co. in the past 3 months with that of neighboring counties that
do not have similar HPV vaccine campaigns. Originally it was thought CancerFreeKY
would have a centralized database on vaccines distributed by KY health departments, this
has not been the case due to lack of transparency. A possible solution to this would be to
individually contact surrounding county health departments to request any available data.

Further clarification is needed from Dr. Enders concerning our final deliverables. Should
a map portfolio be prioritized? Or would there be any need to create a PowerPoint
schematic outlining the significance of each product?
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Initially we had difficulties with matching the provided patient street addresses with
geographical coordinates. The first attempt to geocode resulted in a 25% match rate. A
solution was found by using Google maps to convert addresses to decimal degree format
(for latitude and longitude). This method resulted in a 95% match rate of all addresses.
Leading into a question concerning possible HIPPA violations—Our first two maps
identify streets in Lawrence Co., this is useful for map clarity but does it violate HIPPA
law? How should we present patient address data without exposing patients to
identification by the public or other individuals? Should this even be a concern?
Summary of Mid-Project Meeting
Our last meeting with Dr. Ron Enders helped to focus our project on the most appropriate
products to deliver at the end of the semester. Dr. Enders identified the areas he believes will
yield the most interesting results: education, income, distance from vaccine-equipped locations,
and availability of cable Internet for Lawrence County residents. We agreed that the most useful
format for the data would be in polished, finished maps (JPEG and MXD files) and associated
shape files, layer data, and excel files. The maps will be used in presentations and reports
submitted to the grant review committee and the digital data will be reserved for Dr. Enders’
reference and future use. Further, we set a deadline of April 10th for Dr. Enders to send data to
us to be included in the project. The deadline is designed to give Pilar and me enough time to
process and incorporate the data into a professional looking map without haste. We will also
abide by the deadline and collect no more data from the Census Bureau or other sources (unless
difficult circumstances arise) after April 10th. After going over the maps of Educational
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Attainment and Median Income we submitted to Dr. Enders (Appendix B), he approved of the
format and data richness of each map, giving us visual templates and foundations for the rest of
our project.
Explanations of Changes to Project Goals
Since the beginning of the semester, we have refocused the project due to data
availability and the refinement of mutual goals. For example, the data deadline is a new
addition, as well as the decision to only create publishable maps for the grant renewable
proposal. We’ve also narrowed our “demographic” mapping element to three key areas:
education, income, and accessibility of cable Internet in Lawrence County. The group has
decided these themes are relevant to the receipt of HPV vaccines and can be observed through
available datasets (online and through the Lawrence County Health Department). Other maps
will be created as well, comparing number of patient visits in various regions of Lawrence
County as well as road quality, but demographic data will be limited to the above areas and will
only be presented at the level of the census tract. We have also added the possibility of creating
a ‘flow map’ to visualize the relative distance between patient addresses and vaccine-equipped
locations, and the frequency of travel on those paths. This map may help distinguish ‘silent’
areas of Lawrence County that not only have no patient residents, but no or little road access.
DESHA & SEHON: HPV VACCINE CAMPAIGN
DATA DICTIONARY:
May 1st, 2012
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1. Name: LC_Patient_Round1.xls
a. Source: Ron Enders, 2-2-12
b. Includes addresses for all patients receiving at least one HPV vaccine shot from
the Lawrence County department of health during the initial trial period.
c. Steps:
i. Input addresses into Google Maps (one at a time)
ii. Convert to decimal degree format (for lat and long)
iii. Insert decimal degree address in excel file
iv. Upload excel file to ArcMap
v. Convert to XY coordinates geo-locator
vi. Create an event file that places each address on a base map of Lawrence
Co.
vii. Export the event file as a shape file  LC_Patient_Round1.shp
2. Name: LC_Patient_Round2.xls
a. Source: Ron Enders, 2-2-12
b. Includes addresses for all patients receiving at least one HPV vaccine shot from
the Lawrence County department of health during the second phase of the trial
period.
c. Steps:
i. Input addresses into Google Maps (one at a time)
ii. Convert to decimal degree format (for lat and long)
iii. Insert decimal degree address in excel file
iv. Upload excel file to ArcMap
v. Convert to XY coordinates geo-locator
vi. Create an event file that places each address on a base map of Lawrence
Co.
vii. Export the event file as a shape file  LC_Patient_Round2.shp
3. Name: Vaccine_Locations.xls
a. Source: Alli Sehon (via. Google Maps), 3-2-12
b. Includes addresses for schools and health department facilities administering the
vaccine in Lawrence Co.
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c. Steps:
i. Input addresses into Google Maps (one at a time)
ii. Convert to decimal degree format (for lat and long)
iii. Insert decimal degree address in excel file
iv. Upload excel file to ArcMap
v. Convert to XY coordinates geo-locator
vi. Create an event file that places each address on a base map of Lawrence
Co.
vii. Export the event file as a shape file  Vaccine_Locations_XY_v1.shp
4. Name: Education_LC_CensusTract_v2.xls
a. Source: US Census Bureau 5-year ACS estimates, 3-3-12
b. Includes educational attainment for residents of Lawrence County broken into
total population, male, female, and age brackets and showing percentages (of the
total population) of high school, associates, and bachelors degrees attained.
c. Steps:
i. Upload excel file to ArcMap base map of Lawrence Co Census Tracts
(LawrenceCo.shp).
ii. Join the attribute table for both files based on key CensusTract.
iii. Symbolize education data as a choropleth map overlain with patient
address data from both phases of the campaign
(LawrenceCo_Education_Round1.mxd and
LawrenceCo_Education_Round2.mxd).
5. Name: Incomeexcelxlsx.xlsx
a. Source: US Census bureau 5-year ACS estimates, 3-4-12
b. Includes median income data estimates for each of the 5 Lawrence Co census
tracts.
c. Steps:
i. Upload excel file to ArcMap base map of Lawrence Co Census Tracts
(LawrenceCo.shp).
ii. Join the attribute table for both files based on key CensusTractName.
iii. Symbolize education data as a choropleth map (Income.mxd).
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6. Name: LC_Telephone_Zip.xls
a. Source: US Census Bureau 2010, 4-10-12
b. Contains data on the presence of telephone service in homes in Lawrence County.
Data is divided by whether the resident is a home-owner or a home-renter and is
presented at the scale of the zip code.
c. Steps:
i. Upload excel file to ArcMap base map of Lawrence County
(LawrenceCo.shp).
ii. Join the attribute table for both files based on the keys “ZCTA5CE00” and
“Zip Code.”
iii. Symbolize telephone data as four choropleth maps overlain with patient
address data (LawrenceCo_HPV_TelephoneService_OwnersRound1.mxd;
LawrenceCo_HPV_TelephoneService_OwnersRound2.mxd;
LawrenceCo_HPV_TelephoneService_RentersRound1.mxd;
LawrenceCo_HPV_TelephoneService_RentersRound2.mxd).
7. Name: LawrenceCo_Demographics_v2.xlsx
a. Source: US Census Bureau 2010, 4-17-12.
b. Contains data on rates of age groups by census tract in Lawrence County.
c. Steps:
i. Upload excel file to ArcMap base map of Lawrence Co Census Tracts
(LawrenceCo.shp).
ii. Join the attribute table for both files based on key Census Tract.
iii. Symbolize age data as four choropleth maps overlain with patient address
data from both phases of the campaign
(LawrenceCo_HPV_FemPop_Round1.mxd;
LawrenceCo_HPV_FemPop_Round2.mxd;
LawrenceCo_HPV_MalePop_Round1.mxd;
LawrenceCo_HPV_MalePop_Round2.mxd).
8. Name: 10dem
a. Source: http://kymartian.ky.gov/
b. Contains digital elevation models of Lawrence County.
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c. Steps:
I.
II.
Upload Dem data to ArcMap
View-Toolbars and turn on the Spatial Analyst toolbar
III.
Check Hillshade
IV.
Symbolize shaded relief and overlay with patient address data from
both
(LawrenceCo_Topography_Round1)
(LawrenceCo_Topography_Round2)
DESHA & SEHON: HPV VACCINE CAMPAIGN
FINAL OUTPUTS: MAPS
May 1st, 2012
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Map 1a.
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Map 1b.
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Map 1c.
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Map 2a.
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Map 2b.
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Map 3a.
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Map 3b.
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Map 4a.
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Map 4b.
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Map 4c.
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Map 4d.
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Map 5a.
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Map 5b.
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Map 6a.
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Map 6b.
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Map 7a.
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Map 7b.
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Map 7c.
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Map 7d.
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CONCLUSION
In Lawrence County, there is a distinct pattern of vaccine recipients based upon several
key factors. Louisa, the largest residential area in Lawrence County, has the highest rate of
vaccine recipients for both the first and second campaigns. To an extent, this is likely due to the
higher population density in the city compared to outlying areas, such as Blaine and Martha
townships. However, Louisa also has the most institutions equipped to administer the vaccine,
three schools and the health department. Considering the relatively rough, mountainous terrain
in outlying areas of Lawrence County, living near vaccine administration centers may encourage
individuals to not only initiated vaccination but to complete the 3-shot series over a period of
several months. Further, it seems that the first campaign was more successful in reaching Louisa
residents, while the second campaign had greater success in reaching rural and out-of-county
residents, according to patience provided data.
Three key demographic factors were highlighted in maps over the course of the project:
median income, median age, and educational attainment of residents. Demographic information
was obtained from the US Census Bureau 10-year census as well as the 5-year ACS estimates
and was focused at the level of the five census tracts in Lawrence County. Choropleth maps
were created which symbolized the distribution of income, age, and education across the county
and were overlain with points depicting patient provided addresses. Relationships between the
demographic markers and patient residence can then by hypothesized in order to better
understand existing barriers preventing segments of the Lawrence County population from
receiving the HPV vaccine series.
The small sample size (between 30-50 residence points for each campaign) makes
finalizing conclusions problematic, however it is possible to see trends emerge. For example,
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while educational attainment as observed by rate of high school graduation does not seem to
have a direct impact on who seeks out the vaccine, areas with higher median income do appear to
be home to a higher number of vaccine recipients. There does not seem to be a pattern either
when considering total population of residents ages 10 to 25 of both sexes in relation to the
residence of patients; the areas with both the highest and lowest percentages of potential vaccine
recipients are seemingly underserved. However, the high population density and more even age
dispersal in Louisa means then that the lack of pattern elsewhere is not surprising.
Along with the location of facilities that offer the HPV vaccine for free, the topography
of Lawrence County seems to be one of the most significant factors. According to both
topographic maps, all patients who reported addresses to the health department live along major
county roads or in the Louisa city limits. Several addresses were eliminated from data
processing because they could not be located on a map, and these may well represent the noncounty road residents, yet even so a vast majority of the patients reside on larger thoroughfares.
Considering the apparent difficulty of intra-county transportation, the importance of maintaining
multiple vaccine locations outside of the Louisa city limits is very clear.