Award Date


Degree Type


Degree Name

Master of Public Health (MPH)


Environmental and Occupational Health

First Committee Member

Sheniz Moonie

Second Committee Member

Chad Cross

Third Committee Member

Brian Labus

Fourth Committee Member

Dieu-My Tran

Number of Pages



Despite decreasing incidence in cervical cancer in the U.S., there continues to be an increase in public health concern for cervical cancer worldwide. Recent studies report that individuals are disproportionately affected based on region, sex, and race. Additionally, the human papillomavirus (HPV) attributable cancers may be reduced between 70% and 90% through the universal use of HPV-vaccines. In order to expand current knowledge and implement intervention programs in Nevada, it is critical to examine the associations among the Gardasil vaccine, cervical cancer screening, and adverse events following immunization as well as to understand the different socio-demographic subgroups affected. To our knowledge, this study provided a novel analysis of the Gardasil vaccine usage trends within Nevada and will use an adjacent state (California) and the U.S. as comparators. This study used 2008-2018 data from TeenVaxView, Behavioral Risk Factor Surveillance System (BRFSS), and Vaccine Adverse Event Reporting System (VAERS) data reporting adverse events following an HPV vaccination. We found that California (68.4%) had the highest Gardasil vaccine usage compared to Nevada (55.9%) and the U.S. (56.4%). Chi-square trend analysis in this study showed no significant change in cervical cancer screening in Nevada (p=0.829); however, chi-square test for trend in California did show a significant change through time (p<0.001). Kolmogorov-Smirnov (KS) test with a Bonferroni adjustment examining the differences among curves representing outcome temporal rates for Nevada compared to California showed a significant difference (p=0.031). No association was seen between Gardasil vaccine estimates and cervical cancer screening rates. There was also no association between Gardasil estimates and adverse events through time in Nevada or the U.S.


Gardasil vaccine; Nevada; California


Biostatistics | Epidemiology

File Format


File Size

996 KB

Degree Grantor

University of Nevada, Las Vegas




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