On the Path to Prevention from the St. Jude HPV Cancer Prevention Program

The phrase “knowledge is power” may be true, but it does not often lead to action when it comes to health behaviors such as HPV vaccination. Almost all studies find a statistical relationship between awareness and knowledge, but educational interventions may not lead to behavior change without additional support. We continue to encounter low levels of awareness and knowledge about HPV vaccination that inhibit action. Misinformation on social media platforms and even in everyday conversation has led to myths and misconceptions dominating discourse rather than what we know. What do we know? We know that HPV vaccination is safe and effective. We know that it provides long-lasting protection against HPV cancers. But knowledge is only powerful if someone acts on it. One of our pressing challenges is increasing awareness and knowledge while also providing opportunities for people to act on that knowledge in supportive, pro-vaccination conditions.

In this month’s newsletter, we feature people and programs that are focused on turning awareness and knowledge into action.

As always, we have much information to share with you. We welcome your contributions to our newsletter to further the reach of your own HPV cancer prevention efforts. Reach out to us at PreventHPV@stjude.org.

HPV vaccination is cancer prevention.

National Minority Health Month highlights the importance of improving the health of minority populations. One area that has seen improvement is HPV vaccination coverage among Black and Hispanic adolescents. Black, non-Hispanic adolescents ages 13-17 have higher HPV vaccination coverage than the U.S. average. Hispanic adolescents have the highest levels of HPV vaccination coverage among adolescent groups. These are important indicators of protection today for prevention tomorrow.

Despite these positive trends for HPV vaccination, the incidence of cervical cancer is 20% higher and mortality 70% higher among Black women compared to White women. Incidence is 40% higher and mortality 20% higher among Hispanic women compared to White women. But much can be done to change this: increased awareness, on-time HPV vaccination, cervical cancer screening and timely treatment.

In honor of National Minority Health Month, we profile Jennifer Cunningham-Erves, PhD, MPG, MAEd, MA, CHES, Meharry Medical College. Cunningham-Erves is a leader in the field of HPV and is working to change these unacceptable differences.

Jennifer Cunningham-Erves, PhD, MPG, MAEd, MA, CHES
Meharry Medical College

After losing both of her grandfathers to prostate cancer and seeing the physical, emotional and financial impact of cancer on family members and friends, Cunningham-Erves was moved to become a thought leader in cancer prevention behaviors. As a public health researcher, she focuses on cancer prevention and reducing cancer disparities. She is particularly focused on improving HPV vaccination among minority and underserved populations.

When discussing obstacles to HPV vaccination, Cunningham-Erves points to parental concerns and misinformation surrounding vaccinations. To overcome these barriers and improve HPV vaccination rates among underserved populations, she stresses the need for:

An easy-access, user-friendly tool for health care providers to address parents’ questions
The use of different strategies, messages and messengers to address concerns
Offering HPV vaccination early to help ensure on-time vaccination
Ongoing education, communication and partnership between health care providers, parents and patients

While health care providers are often primary sources of information on HPV vaccination for children, Cunningham-Erves says parents and adolescents can serve as advocates and champions by sharing their experiences with HPV vaccination. She encourages parents and caregivers to be educated and take their time when making decisions about their children’s health. Says Cunningham-Erves, “HPV vaccination is the first prevention tool for cancer, and it works!”

Did you know that oral HPV cancers are the most commonly diagnosed HPV cancers in the United States?

In April, we celebrate Oral, Head and Neck Cancer Awareness Month – a perfect time to highlight the fact that on-time HPV vaccination protects from 6 types of HPV cancers, including oral cancer.

We share the stories of two vibrant and exceptional oral cancer survivors – Ada Valdes and Jason Mendelsohn. Both participated in the St. Jude HPV Cancer Survivors School in October 2022, and both are super advocates for HPV vaccination to prevent HPV cancers.

Ada Valdes, Super Advocate

Backyard beekeeper Ada Valdes’s cancer journey began in 2018. While tending her bees, Valdes was stung on her neck and experienced a minor allergic reaction that caused her neck to swell. After the swelling subsided, she noticed a lump in the same area as the bee sting. She was treated with antibiotics, endoscopies, an inconclusive biopsy and a neck dissection. She then underwent surgery and biopsies of her tongue and tonsils. Eventually, she had her tonsils removed. A week after the surgery, the biopsy results confirmed a diagnosis of oral cancer. Valdes began therapy that included 33 rounds of radiation and 6 sessions of chemotherapy.

As the mother of 15- and 11-year-old daughters, following her diagnosis Valdes ensured that her daughters received their HPV vaccinations. She encourages other parents and caregivers to learn the facts about HPV and HPV vaccination and to “look at the vaccine as cancer prevention.” She added that “as parents, it’s up to us to make decisions to protect our children from harm, and becoming informed is one of our greatest tools.”

Jason Mendelsohn, SupermanHPV

Jason Mendelsohn, an oral cancer survivor, wears photos of his wife and children on the inside of his suit jacket to keep them close. Mendelsohn has joined us before to advocate for HPV vaccination to prevent oral HPV cancer. He believes a parent’s No. 1 responsibility is to protect their kids, and he encourages all parents to talk with their children’s health care providers about HPV vaccination.

“The most important thing I have learned is that my story touches people and often changes their perspective regarding HPV and HPV cancers,” Mendelsohn says. “Parents learn that they can protect their sons and daughters from HPV cancers. I have also learned that changing the stigma about an HPV cancer is important. Too many people are ashamed when they receive an HPV-related diagnosis. No one should ever be embarrassed when battling cancer.”

Jason recently took time to tell us his powerful story and how he advocates for HPV vaccination.

Click here to watch Jason’s story.

Efforts to improve HPV vaccination coverage and prevent HPV cancers are urgently needed in the southeastern U.S. This is a region characterized by low HPV vaccination coverage and a high burden of HPV cancers. As a result, the HPV Vaccination Roundtable of the Southeast was formed and designed to bring back together southeastern state representatives to improve. This efforts build on previous work facilitated by the National HPV Vaccination Roundtable and American Cancer Society.

On March 30, the first of three reconvening meetings with 12 southeastern states and Puerto Rico was held. More than 200 people registered and about 160 people attended to hear a level-setting data presentation and state updates from South Carolina, Mississippi, Tennessee, and West Virginia.

The data presentation pushed attendees to think about multiple data sources and comparing “apples to apples” when considering data-informed decision making. Key ingredients for success experienced by the four states discussed included collaboration and engagement, time and patience, and believing progress is possible. In addition, shared challenges were noted, such as addressing misinformation, ensuring access to HPV vaccination, and overcoming challenges related to the pandemic. Multiple opportunities were identified, including school-located HPV vaccination, starting HPV vaccination at age 9, and working with oral health care providers.

To close out the first meeting, priority action steps were summarized based on the data and state update presentations and also virtual engagement throughout the meeting.

Data deep dives to investigate how multiple data sources may be analyzed and used to inform geographic responses and gender disparities
Strategic activities result from strategic partnerships by engaging key groups
Explore innovative approaches to reach key populations, such as mobile units, roadshows, and communication campaigns
Address misinformation, disinformation, and malinformation through educational approaches to all key audiences and decision makers
Advance HPV vaccination through advocacy to close access gaps between communities and vaccination

These action steps and additional will be sourced at upcoming meetings and interactions with the HPV Vaccination Roundtable of the Southeast. Register for the next two meetings on April 27 with state updates from Alabama, Arkansas, Louisiana, and Virginia and May 25 with state updates from Florida, Georgia, Kentucky, North Carolina, and Puerto Rico.

Visit HPV Roundtable Southeast page at stjude.org/southeast-roundtable and join the listserv to stay updated on activities.

Email PreventHPV@stjude.org with any questions.

According to America’s Health Rankings, Kansas ranks 22nd for HPV vaccinations, with 64.3% of adolescents ages 13-17 receiving all recommended doses of the HPV vaccine. The Kansas Cancer Partnership recently hosted “HPV Education for Greek Life” at Emporia State University (ESU). Located in rural Emporia, Kansas, ESU has a student population of nearly 6,000. This presentation attracted 104 members from the Greek Life community and provided an engaging overview of HPV and the HPV cancers the vaccination can prevent. Following the presentation, a nurse from the ESU Student Health Department set appointments for the HPV vaccine series for interested students. An evaluation showed that many attendees had received the full vaccine series or at least one dose. It also showed that students had heard of HPV but didn’t know what HPV was or that the virus could cause cancer. According to the evaluation, the presentation was well received by the students, and most would recommend the HPV vaccine to others. The Kansas Cancer Partnership hopes to expand the program to other Kansas colleges and universities to educate more students on the HPV vaccine and its importance.

We invite guest contributors to share information on how they are working to improve HPV vaccination in rural areas. If you are interested in contributing or learning more about our efforts to improve HPV vaccination with rural communities, please email us at PreventHPV@stjude.org.

The 35th International Papillomavirus Conference & Basic, Clinical and Public Health Scientific Workshops will bring together researchers, clinicians and other health professionals to share knowledge and ideas on papillomaviruses and their associated diseases. The conference takes place on April 17-21 in Washington, D.C. You still have time to register.

This year’s theme, “Coming Together for HPV Elimination,” is in line with the International Papillomavirus Society mission of addressing the most recent advances across the spectrum of HPV research.

Conference topics include:

Expanding scientific knowledge to benefit the whole community
Prevention of HPV infection and its associated diseases and cancers, especially cervical cancer
The epidemiology and molecular biology of PVs
Animal models for the study of papillomavirus disease
Basic immunology and pathogenesis of PVs
Therapeutic and prophylactic vaccines
Changes in screening and HPV vaccination in Japan

The following presentations are associated with the St. Jude HPV Cancer Prevention Program:

Interdisciplinary Workshop 02: HPV Cancer Prevention: From Basic Science to Real-World Benefits, April 17, 10-11 a.m. EDT. Dr. Heather Brandt will present “HPV Cancer Prevention in Sexual and Gender Minorities” to increase knowledge and skills related to HPV vaccination.
Poster Viewing (Shift 1): Public Health, Epidemiology and Implementation Science, April 18, 7 a.m.-5 p.m. Dr. Heather Brandt will present “Analysis of Public Policy Decisions and Factors Driving HPV Vaccination Coverage in the United States,” describing the results of our HPV vaccination policy analysis conducted in 2022. Dr. Alison Footman will present, “Where We Are and What Needs to be Done to Improve HPV Vaccination among LGBTQIA+ People” and “Identifying Implementation Science Research Gaps for Increasing HPV Vaccination Coverage.”
Special Interest Satellite Symposium: Using Implementation Science to Accelerate and Improve HPV Vaccination, April 19, 7-8 a.m. EDT. Dr. Heather Brandt will present “Increasing Public Awareness and Uptake of HPV Vaccination for Cancer Prevention: Path to a Bright Future” to describe implementation science principles and methods and how they have and can be applied globally to improve HPV vaccination coverage.
Poster Viewing (Shift 2): Public Health, Epidemiology and Implementation Science, April 20, 7 a.m.-5 p.m. Dr. Debbie Saslow will present “Creation and Promotion of an Evidence Base for HPV Vaccination Starting at Age 9,” which is co-authored by Brandt. This presentation is based on the special issue of Human Vaccines & Immunotherapeutics focusing on HPV vaccination starting at age 9. Access articles on the HPV Vaccination Starting at Age 9 landing page.

During Adolescent Immunization Action Week, April 3-7, St. Jude will join the UNITY Consortium and its member organizations to urge parents, health care providers and adolescents to help keep adolescents up to date on vaccinations.

Launched in 2022 following a sharp decline in adolescent well visits and vaccinations during the COVID-19 pandemic, Adolescent Immunization Action Week raises awareness about the importance of adolescent vaccinations, including HPV vaccination at ages 9-12. The week also encourages parents and health care providers to help adolescents get caught up or stay up to date on their immunizations. Plus, it reminds us that vaccinations are a safe and effective way to help prevent adolescents and young adults from getting sick and missing school and other activities that are important to them.

Subscribe to the Unity mailing list. Check the AIAW webpage for more information and updates.

Click here to watch the Adolescent Immunization Action Week 2023 PSA

Maybe you have seen news reports on the World Health Organization (WHO) recommending one dose of HPV vaccination. Maybe you have been wondering why two or three doses are still recommended in the United States. If you have not seen or heard about these developments, we have information for you.

The World Health Organization Strategic Advisory Group of Experts on Immunization (SAGE) has evaluated emerging evidence that single-dose schedules work as well as two- or three-dose regimens to prevent HPV cancers. Possible benefits include cost savings (i.e., fewer doses) and eliminating missed opportunities for patients to come back to receive their second or third dose. Moving to a one-dose regimen is expected to improve access to the vaccine, giving countries the ability to vaccinate more people and alleviating the burden of follow-up to complete the vaccination series.

The WHO recommends:

A one- or two-dose schedule for girls ages 9-14
A one- or two-dose schedule for girls and women ages 15-20
Two doses with a 6-month interval for women older than 21

In the U.S., the CDC recommends two doses of HPV vaccination for girls and boys who get the first dose before their 15th birthday. They recommend three doses for those who start the series after their 15th birthday and for people with certain immunocompromising conditions. We expect the CDC will continue to monitor the number of doses needed as additional study data are reported.

In addition to focusing on one dose, the WHO strategy also recommends vaccination for females only. In the U.S., HPV cancer data show that oropharyngeal cancers are the most common type of HPV cancer, and more than 80% of these cases are among males. Therefore, males are an important target audience for HPV vaccination. The United States has maintained a gender-neutral approach to vaccination for nearly 10 years.

So which is it? One dose, or two, or three? In the U.S., recommendations remain unchanged. We have not yet reached the Healthy People 2030 goal of 80% vaccination among 13- to 15-year-olds. We continue our gender-neutral approach to encouraging on-time HPV vaccination by the 13th birthday.

Alabama

VAX 2 STOP CANCER hosts its 2nd annual A Shot at Prevention luncheon on April 26 from 11:30 a.m.-1 p.m. at The Club in Birmingham, Alabama. The luncheon will spotlight three key areas: cancer prevention, survivorship, and progress in Alabama. The event will raise funds to help decrease the burden of HPV-related cancers. It will feature Jennifer Y. Pierce, MD, leader of cancer control and prevention, Mitchell Cancer Institute, University of South Alabama Health; Traci Richter, cervical cancer survivor and advocate; and Barbara Schuler, MPH, CEO and founder VAX 2 STOP CANCER. Learn more and register.

Arkansas

The 2023 HPV Summit, HPV Vaccine Is Cancer Prevention, will take place May 5 at the Wyndham Riverfront Hotel, 2 Riverfront Plaza, North Little Rock, Arkansas. The event will highlight the connection between HPV and cancer, give providers tools to talk to patients about the benefits of the HPV vaccine, and share best practices on ways to increase HPV immunization rates. The summit has been approved for 5.75 hours of continuing education for physicians, nurses, pharmacists, dental professionals and Certified Health Education Specialists. Learn more and register.

Missouri

On April 26 and 27, the 2023 Missouri Immunization Conference will bring together bright minds to give action-oriented talks on a wide range of subjects related to immunization. The event aims to foster learning and inspiration as well as provoke conversations and actions that lead to increased vaccination rates for Missourians. The theme of this year’s conference is Vaccines: The Building Blocks of Better Health. Register here.

Tennessee

In April, the Vaccine-Preventable Diseases and Immunization Program of the Tennessee Department of Health (TDH) invites you to the Immunization Roadshow: Tools & Strategies to Cultivate Vaccine Uptake in Tennessee. During this hybrid event, TDH will present resources on topics ranging from vaccine confidence to motivational interviewing, as well as tools for building strong connections to maximize coverage in clinics and regions. The goal is to empower clinicians and practices with educational tools that emphasize the benefits of improving immunization coverage in their communities.

Roadshow dates are:

Chattanooga, April 4
Memphis, April 11
Nashville April 14

Register today.

Memphis and Shelby County, Tennessee

The Memphis and Shelby County HPV Cancer Prevention Roundtable is hosting Motivational Interviewing for HPV Vaccination Prevention in person on May 9 from 9 a.m.-12 p.m. at 600 Jefferson Avenue, Memphis, TN. Sayward Harrison, PhD, the University of South Carolina, and Laura Fish, PhD, Duke University, will serve as trainers.

A strong provider recommendation continues to be the greatest influencer of acceptance and uptake of HPV vaccinations. Motivational Interviewing (MI) is a strategy that heath care providers can use to make strong recommendations and build confidence in HPV vaccination that leads to behavior change. Through this training, providers will:

Understand foundations and key concepts of MI

Learn core skills of MI, including open-ended questions, affirmations, reflective listening and summarizing

Identify ways to implement MI to promote uptake of recommended immunizations

Develop hands-on MI skills through role playing and other interactive training activities

Enhance communication skills to address vaccination hesitancy and communicate more effectively with patients

Up to 50 physicians, physician assistants, advanced practice nurses and medical residents can register for this free event. Space is limited to 50 registrants. In-person attendance is required, and priority will be given to those working to promote vaccinations in Memphis and Shelby County. Become a member of the Memphis and Shelby County HPV Cancer Prevention Roundtable to learn more about this training and other activities aimed at increasing HPV vaccination. For more information, contact Carol Minor at carol.minor@stjude.org.

The St. Jude HPV Cancer Prevention Program is hiring someone who understands and shares our objectives and impetus to improve HPV vaccination uptake in the St. Jude area and beyond.

Program Coordinator-Cancer Center HPV Cancer Prevention

We are looking for someone who is an exceptional listener, communicator and teammate with a passion to lead and serve others. Ideal candidates will be able to identify, establish and sustain community partnerships and cultivate a workplace culture of uninhibited idea generation, collaboration and problem-solving. There will be ample opportunities for professional development and growth. Click here to apply today.

April is stress awareness month. The St. Jude HPV Cancer Prevention Program team shared what they do to help relieve stress:

“I spend quality time with my family to help relieve stress.” – Pragya Gautam Poudel, postdoctoral fellow

“When I’m stressed, I enjoy a good nap. I wake up feeling refreshed.” – Portia Knowlton, program coordinator

“ I enjoy online shopping to relieve stress!”– Ursula Leflore, administrative specialist

“To relieve stress, I go out for some ice cream! ”– Duha Magzoub, program coordinator

“I enjoy adult coloring books. While I haven’t done it in a while, it is very relaxing. I have a lion I colored and plan to have framed. It is beautiful...in my opinion.” – Carol Minor, program coordinator

“When I am stressed, I tend to think that long walks, nutritious meals, and bubble baths are the remedies for anything.“ – Julia Neely, program manager

“I truly believe that laughter is good for the soul, so I try to find a good comedy to watch to help me feel lighter and less stressed.” – Andrea Stubbs, administrative director

“I try to keep my stress levels manageable by exercising every day, getting plenty of sleep, and making sure to take time for myself to do whatever I want.” – Heather Brandt, director

The St. Jude HPV Cancer Prevention Program’s Path to a Bright Future campaign spotlights the benefits of on-time HPV vaccination to prevent cancer in children ages 9–12. The campaign also raises awareness of the dangers of HPV pre-cancers and cancers.

Join us:

Get your child vaccinated against HPV by their 13th birthday: If you or your child is in the recommended age range (ages 9–26 and possibly until age 45), get vaccinated.
Encourage others to get their children vaccinated: Normalize HPV vaccination as cancer prevention.
Share the facts: HPV vaccination is safe, effective, and durable. It prevents 6 types of cancer.

Learn more and join the campaign.