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Preventing HPV cancers through HPV vaccination.
November 21 is National Rural Health Day. Rural life is a choice made by more than 61 million people in the United States, but they don’t choose to be at higher risk of cancers, including HPV cancers. People living in rural communities have the power to prevent cancer through HPV vaccination. The St. Jude HPV Cancer Prevention Program is
committed to addressing disparities in rural HPV vaccination coverage. We are working with partners and people serving and living in rural communities to act to improve on low HPV vaccination rates and high HPV cancer rates.
Last year, with the assistance of a national group of subject matter experts, we identified six priority actions for preventing HPV cancers with rural communities. Each quarter, we send an email and host an updates meeting to share progress and report on impact. The
quarterly updates meetings also feature other partners addressing rural HPV cancer prevention. Register for our next quarterly updates virtual meeting on November 21 from 1-2 p.m. Central Time. This meeting will include progress on the six priority actions and presentations from Sara
Dillard, communications director for We the People Vax and Deanna Kepka, PhD, Huntsman Cancer Institute investigator and associate professor in the College of Nursing at the University of Utah who will present on communications efforts to improve HPV vaccination coverage in the
Mountain West. In this special communication, we have included social media posts that are ready for you to use. We hope you will share them – and also post your own.
We also want to share the American Cancer Society (ACS) with the ACS National HPV Vaccination Roundtable have launched a rural learning community to share information about HPV cancer prevention for people living in rural areas and mobilize healthcare providers and
professionals to employ strategies for improvements in HPV vaccination. The National Roundtable also has established a working group focused on rural HPV vaccination. Access the rural HPV vaccination evidence summary here. Learn more about the rural learning community here.
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| Celebrating the power of rural communities.
Rural communities face higher rates of HPV cancers and lower HPV vaccination rates yet are built on strong foundations of creativity, resiliency, and ingenuity. People living in rural communities are heterogenous reflecting the vast diversity of people who make up our country. People who live in rural areas also are not only one box at one time; they may simultaneously experience advantage and disadvantage. Our approaches to improve rural HPV vaccination cannot be singular and must account for and embrace differences.
There is so much good happening in rural communities across the U.S. Through our efforts in the St. Jude HPV Cancer Prevention Program and with other partners, we remain committed to harnessing and celebrating the power of rural throughout the year and improving HPV cancer outcomes among people living in rural areas.
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Rural America offers a beautiful and challenging
landscape, requiring unique approaches.
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Rural America is a great place for mission-minded health professionals to provide individualized care.
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Rural America is fueling an innovative rural health infrastructure.
Join the National Organization of State Offices of Rural Health (NOSORH) on November 21 at 1 p.m. Central Time for an engaging live webinar celebrating National Rural Health Day. This year’s event spotlights the
transformative impact of the Rural Communities Opioid Response Program (RCORP) featuring powerful success stories and innovative strategies from grantees and key partners. Discover how these community-driven approaches can be adapted to drive lasting change in your own community. Register here for the Power of Rural in Action: RCORP Success Stories and Strategies.
Learn more about National Rural Health Day here and rural America in these key messages and data
points provided by the NOSORH. Though the statistics and facts presented in this resource do not tell the whole story, they are essential to understand when developing policies and programs that affect the health of rural communities.
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Understanding low HPV vaccination and high rates of HPV cancers in rural communities.
What are HPV cancer rates in rural communities?
HPV is linked to six types of cancer affecting everyone – oropharyngeal, cervical, anal, vaginal, vulvar, and penile. The only type of HPV cancer for which cancer screening recommendations exist is cervical cancer.
Here are key facts about HPV cancer incidence and mortality in rural communities.- HPV cancers are elevated in rural areas. Rural HPV cancer incidence is rising faster than urban and metro incidence. HPV cancer incidence declined 7-8% during 2020; however, in 2021, urban incidence increased 5-6% while rural HPV cancer incidence increased 18%, according to an analysis
by Semprini in Rural and Remote Health.
- For specific types of HPV cancers, there are differences as well. Improvements in cervical cancer incidence among people who have a cervix have been slower in rural areas as compared to urban areas. Oropharyngeal cancer incidence rates are increasing more rapidly among men in rural areas.
- Rural HPV cancer mortality has surpassed rates in urban areas as of 2017 and
continues to climb.
The following figure shows incidence of HPV cancer in rural areas is rising faster than the urban rate. Further, this is concerning since the period of 2000-2004 shows rural and urban areas had the same incidence rate for HPV cancers. The difference between rural and urban HPV cancers has been widening over time with rural rates higher than urban.
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| What are HPV vaccination rates in rural communities?
HPV vaccination is safe, it works to prevent HPV diseases, including pre-cancers and cancers affecting men and women, and it provides long-lasting protection. Current HPV vaccination recommendations are to start at ages 9-12 and complete by the 13th birthday. HPV vaccination is recommended for everyone through age 26 and for some people
through age 45 after discussing with a healthcare provider.
The most recently available NIS-Teen data to assess rural-urban differences show HPV vaccination coverage for >1 dose is 10% lower for rural areas compared to urban and for HPV UTD is 11% lower for rural areas compared to urban.
Over the past several years, the difference between rural and urban areas has stayed steady at about 10%.
The following figure shows the comparison between rural and urban HPV vaccination initiation and completion percentages for the period of 2018-2022.
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Why aren’t more children living in rural areas being vaccinated?
There may be several reasons why an individual child may not be vaccinated against HPV. However, here are some of the more common reasons why a child may be unvaccinated.
- Lack of awareness about safety, timing, relevance, and benefits of HPV vaccination in rural communities
- Lack of a strong health care provider recommendation by those caring
for rural children
- Vaccination hesitancy on the part of health care providers, people working in health care settings, parents, caregivers, and general public is highly prevalent in rural communities
- Fear stemming from misinformation and disinformation – health information seeking behavior and information exchange operates uniquely in rural communities
- Access points for HPV vaccination and accessibility in terms of cost, transportation, and time may be limited in rural areas
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Acting today to prevent HPV cancers tomorrow.
In 2023, the St. Jude HPV Cancer Prevention Program convened rural health, cancer prevention, and vaccination experts to develop priorities for action to improve rural HPV vaccination coverage. In fall 2023, the resulting six priority actions were released and actions undertaken. Each quarterly updates meeting hosted by the St. Jude HPV Program include updates on priority actions. A few are summarized here.
Age 9: Start HPV vaccination at age 9
The ACS National HPV
Vaccination Roundtable has an extensive suite of resources to promote HPV vaccination at age 9. Therefore, our focus has been on promoting these resources rather than developing new ones. Starting at age 9 may result in more time for discussions to optimize on-time completion by the 13th birthday. Access resources here.
In addition, here are other resources on starting HPV vaccination
at age 9:
Existing resources: Compile and share existing resources for addressing
HPV vaccination with rural communities
Rather than develop new resources, we have gathered existing resources to
disseminate. Here are selected resources available for use:
Training providers: Develop or adapt healthcare provider and professional HPV vaccination training resources for those serving rural communities
Healthcare providers and professionals serving rural communities need support. In order to enhance existing approaches, provider training is needed, especially on addressing HPV vaccination hesitancy. The St. Jude HPV Program is offering healthcare provider training programs – Announcement Approach Training and Unity 3Cs Program. As noted, the ACS has established the rural learning community.
Advocacy and policy: Explore policy influences on HPV vaccination in rural areas
Policy and advocacy analyses have occurred to elucidate structural factors driving rural HPV vaccination coverage. Through a partnership with FTI Consulting, the St. Jude HPV Program has published reports with information on policy factors available at stjude.org/hpv-policy-summary.
- Updated Analysis of Public Policy Decisions and Factors Driving HPV Vaccination Coverage in the United States, 2023 report and summary
- Preventing HPV Cancers Through Increased Medicaid Eligibility fact
sheet
- Insights on HPV Vaccination Coverage in the Southeast report
In the August quarterly updates meeting, we shared new results showing family physicians serving rural communities are reimbursed at lower levels than other provider types. We will
soon be sharing more details on the results of this analysis and an emerging partnership with the American Academy of Family Physicians to address this discrepancy.
Communication: Develop, test, and disseminate easy-to-use messages for rural audiences
We the People Vax serves a website focused on improving overall vaccination rates that captures prevalent belief systems among people living in rural areas. In addition, the American Academy of Pediatrics has been using social media to reach rural areas. The St. Jude HPV Program has been working on expanding our current communication campaign to include options for rural communities.
Data: Review and update existing resources and data on HPV vaccination and HPV cancers in rural communities
Updated data on rural HPV vaccination coverage and HPV cancer incidence are essential to inform our efforts and understand our impact. We contracted with Jason Semprini, PhD, Des Moines University to update a previous publication by Zahnd et al. describing the burden of HPV cancers in rural communities and by Swiecki- Sikora et al. to describe HPV vaccination in rural communities. Pingali et al. published 2023 NIS-Teen data to include persistent rural disparities available for further view on Teen Vax View. Some of these results are provided earlier in this special communication and recently published by Semprini in Rural and Remote Health on rural-urban disparities. Additional publications will be forthcoming and results shared in quarterly updates meetings. |
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Keep rural communities strong.
We must work with people living in rural areas to understand how to change the pattern of low HPV vaccination rates and high HPV cancer rates. We need to meet these communities where they are to change this trajectory. People living in
rural communities have the power to choose HPV cancer prevention.
Here are some ways healthcare providers and public health professionals can help:
- Provide HPV vaccination education aligned with local context
- Start HPV vaccination at age 9
- Recommend HPV vaccination with other routinely recommended vaccines like Tdap and flu
- Inform patients about the link between HPV and six types of cancer
- Provide personal examples and clear answers
- Increase access to accurate, meaningful information
- Build relationships with the people and organizations these communities trust
- Set up supports, like provider reminders and advisors, patient reminder and recalls
HPV vaccination can prevent a huge percentage of the more than 40,000 HPV cancer cases each year. This is especially true in rural communities where vaccination rates are lower and HPV cancer rates are higher. Let’s encourage providers, patients, families, friends, and loved ones to get vaccinated against HPV — it’s safe, it works, and it lasts a lifetime.
The St. Jude HPV Cancer Prevention Program also offers health care provider and professional training programs on the announcement
approach and Unity Consortium 3Cs Program. Email us at PreventHPV@stjude.org to request more information and schedule a training program in-person or virtually. The ACS Rural HPV Vaccination Learning Community includes several examples of strategies for improving coverage.
This National Rural Health Day, share the facts: HPV vaccination prevents HPV cancers in rural communities across the U.S. People living in rural areas have the power to prevent HPV cancers through HPV vaccination.
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| Share the power of rural HPV cancer prevention.
Share the importance of rural HPV cancer prevention through HPV vaccination on social media. Realizing the power of rural communities will take all of us normalizing HPV vaccination as cancer prevention. Use #EndHPVcancers, #PowerofRural, and #NationalRuralHealthDay hashtags with your social posts.
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Celebrate and honor National Rural Health Day on November 21 by raising community awareness about HPV vaccination for cancer prevention with rural communities across the U.S. Take a step towards a healthier future for rural families and communities. Join the next Preventing HPV Cancers with Rural Communities Quarterly Updates Meeting on November 21 from 1-2 p.m. Central Time to learn more. Register at
stjude.org/hpvrural. #EndHPVcancers #PowerofRural #NationalRuralHealthDay
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Access St. Jude HPV Cancer Prevention Program rural HPV vaccination resources.
We also want to encourage you to use and share the following rural HPV vaccination resources from the St. Jude HPV Cancer Prevention Program:
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About the St. Jude HPV Cancer Prevention Program.
St. Jude Children's Research Hospital is leading the way the world understands, treats and cures childhood cancer and other life-threatening diseases. That’s why St. Jude is raising awareness on vaccination for HPV, which can prevent six types of cancer caused by the virus. As the only NCI-designated Comprehensive Cancer Center dedicated solely to children, St. Jude has an important role and responsibility in increasing the number of children who benefit from the HPV vaccine and reducing their risk of preventable cancers later in life.
On-time HPV vaccination provides safe, effective, and long-lasting protection against the most common types of HPV linked to cancers. The vaccine is most effective when started at age 9 and completed by the 13th birthday, but it’s
recommended for everyone through age 26 and for some people through age 45.
HPV vaccination has been routinely recommended by health care professionals in the U.S. since 2006. Most children can receive an HPV vaccine at no cost, and it can be administered safely along with other routine vaccinations. With more than
500 million doses administered worldwide, HPV vaccines are preventing new cases of cancer every day. However, some people – like those living in rural communities – are being vaccinated at lower rates than the rest of the U.S. and have higher rates of HPV cancers compared to the rest of the U.S. Learn more about our efforts to improve HPV vaccination coverage with rural communities at stjude.org/hpvrural.
It’s not too late to help protect your child against HPV cancers later in life. Learn more at stjude.org/PreventHPV and ask your doctor about HPV vaccination today. Email PreventHPV@stjude.org with any questions.
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St. Jude Children's Research Hospital
262 Danny Thomas Place
Memphis, TN 38105
United States
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