title: Application of the Carolina Framework for Cervical Cancer Prevention.
abstract: OBJECTIVE
  The Carolina Framework for Cervical Cancer Prevention describes 4 main causes of cervical cancer incidence: human papillomavirus (HPV) infection, lack of screening, screening errors, and not receiving follow-up care. We present 2 applications of the Carolina Framework in which we identify high-need counties in North Carolina and generate recommendations for improving prevention efforts.
  
  
  METHODS
  We created a cervical cancer prevention need index (CCPNI) that ranked counties on cervical cancer mortality, HPV vaccine initiation and completion, Pap smear screening, and provision of Pap tests to rarely- or never-screened women. In addition, we conducted in-depth interviews with 19 key informants from programs and agencies involved in cervical cancer prevention in North Carolina.
  
  
  RESULTS
  North Carolina's 100 counties varied widely on individual CCPNI components, including annual cervical cancer mortality (median 2.7/100,000 women; range 0.0-8.0), adolescent girls' HPV vaccine initiation (median 42%; range 15%-62%), and Pap testing in the previous 3 years among Medicaid-insured adult women (median 59%; range 40%-83%). Counties with the greatest prevention needs formed 2 distinct clusters in the northeast and south-central regions of the state. Interviews generated 9 recommendations to improve cervical cancer prevention in North Carolina, identifying applications to specific programs and policies in the state.
  
  
  CONCLUSIONS
  This study found striking geographic disparities in cervical cancer prevention need in North Carolina. Future prevention efforts in the state should prioritize high-need regions as well as recommended strategies and applications in existing programs. Other states can use the Carolina Framework to increase the impact of their cervical cancer prevention efforts.
authors: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors: Jennifer L
authors: JL
authors: Moss
authors: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors: Schatzi H
authors: SH
authors: McCarthy
authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors: Melissa B
authors: MB
authors: Gilkey
authors: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. Electronic address: ntb@unc.edu.
authors: Noel T
authors: NT
authors: Brewer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cancer prevention; Cervical cancer; Health disparities; Human papillomavirus (HPV) vaccine; Pap test