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

According to 2021 National Immunization Survey-Teen data, 77% of adolescents ages 13–17 had received one or more doses of HPV vaccine, and 62% were up to date. Differences by region and other demographics exist. It is notable that Black or African American adolescents have the second-highest rates of HPV vaccination coverage (after Hispanic adolescents), with 82% having had one or more doses and 65% up to date. These higher levels of coverage exist despite published research indicating knowledge gaps among Black or African American people compared to other races and ethnicities. Work is needed to increase awareness and knowledge while sustaining high levels of HPV vaccination coverage. This is especially important because Black or African American women are twice as likely as White women to die of cervical cancer. These differences are unacceptable and both result from and cause inequities. In our Path to a Bright Future and Path to Prevention programming, we focus on how we can provide messages to increase awareness and knowledge and also act to ensure we keep HPV vaccination rates high to address inequities.

In our program, we support efforts to address structural, systemic and individual barriers inhibiting equitable outcomes of HPV cancer prevention. International HPV Awareness Day is coming up on March 4. We hope you will join us for a seminar series focused on populations experiencing inequities in HPV vaccination coverage. These include residents of the southeastern United States, childhood cancer survivors, people who identify as LGBTQIA+, and people living in rural areas.

HPV vaccination is cancer prevention.

Each February, we recognize Black History Month to honor the achievements and contributions of Black Americans throughout U.S. history. What began as a week-long observance in 1926 grew into a month-long celebration in 1976 when President Gerald Ford extended the recognition to “honor the too-often neglected accomplishments of Black Americans in every area of endeavor throughout our history.”

The Association for the Study of African American Life and History (ASALH), established in 1915 by Dr. Carter G. Woodson, founded Black History Month and each year determines its theme. “Black Resistance” is the theme of this year’s Black History Month. It encourages us to recognize the historic and ongoing oppression of Black Americans and efforts to resist this oppression through sit-ins, boycotts, advocacy and education. It also puts a spotlight on the history of Black Americans’ responses to establish safe spaces where Black life can be sustained, fortified and respected.

From civil rights pioneers and activists to leaders in business, the arts, science, politics and culture, this month we honor both the history-making and everyday contributions of Black Americans – including Henrietta Lacks, whose fascinating story is below.

Access social media resources (like the image below) celebrating Cervical Health Awareness Month on the stjude.org/bright-future website.

At first glance, HPV cancer prevention and Black History Month may not appear to go hand-in-hand. But consider the story of Henrietta Lacks and the impact she has had on health and medicine for 72 years and counting.

Lacks, a Black American woman and a young mother of five children, visited Johns Hopkins Hospital in January 1951 complaining of vaginal bleeding. Upon examination, doctors found a large, malignant tumor on her cervix. Lacks began radium treatment for her cervical cancer but passed away nine months after her diagnosis.

Read more about Mrs. Lack's story.

Access social media resources (like the image below) celebrating Cervical Health Awareness Month on the stjude.org/bright-future website.

Join the HPV Cancer Prevention Program for a weeklong series of virtual seminars to celebrate International HPV Awareness Day on March 4. We aim to increase HPV vaccination awareness and coverage, especially among key populations for which disparities exist.

February 27: Addressing HPV Vaccination Gaps in the Southeastern U.S.
February 28: Improving HPV Vaccination Rates Among Childhood Cancer Survivors
March 1: Promoting PRIDE in HPV Vaccination Among LGBTQIA+ Communities
March 3: Wide Open Spaces: Improving HPV Cancer Prevention with Rural Communities

Seminars will be held from 12-1:15 p.m. CT. All seminars will be recorded. Register for one seminar or the entire series.

If you have questions, email PreventHPV@stjude.org.

Join us for three virtual meetings to encourage southeastern states to work together and improve HPV vaccination coverage.

Starting in September, representatives of southeastern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) and Puerto Rico, along with representatives from St. Jude Children’s Research Hospital, the American Cancer Society and the National HPV Vaccination Roundtable, united to discuss improving HPV vaccination in these regions. Historically, the Southeast has landed among the lowest levels of HPV vaccination coverage in the U.S. This was exacerbated by the COVID-19 pandemic.

Building on efforts led by the National HPV Vaccination Roundtable in 2019, The newly formed HPV Vaccination Roundtable of the Southeast aims to create a platform for idea sharing and strategic action planning. In a series of three initial meetings, we will explore how to move forward and prevent HPV cancers.

We will discuss:

Conditions surrounding HPV vaccination and HPV cancer prevention
HPV vaccination success stories and how they can be leveraged and replicated in other parts of the Southeast

Challenges facing HPV vaccination and how we can support each other to overcome such barriers
Opportunities to improve HPV vaccination coverage in each state and across the region

Register below to learn more and get involved. An agenda and supplemental materials will be provided before each meeting. These meetings are open to anyone who is interested. They will be recorded for those unable to attend.

March 30, 9–11 a.m. CT (virtual) Register
April 27, 9–11 a.m. CT (virtual) Register
May 25, 9–11 a.m. CT (virtual) Register

Email PreventHPV@stjude.org with questions.

Rural life is a choice made by 1 in 5 people, but they don’t choose to be at higher risk of cancers, including HPV cancers. We must do more to make sure those living in rural America are protected. People living in rural areas possess many strengths. It is these same strengths that can make them feel invincible when it comes to cancer, but that is not the case. HPV vaccination is cancer prevention for people living in rural communities, too. We must work with people in rural communities to understand how to change the pattern of low HPV vaccination rates and high HPV cancer rates.

In January, the St. Jude HPV Cancer Prevention Program hosted an introductory rural HPV vaccination meeting. This meeting brought together thought leaders, allies and partners interested in improving HPV vaccination with rural communities. The meeting featured ignite-style talks by six experts in rural health, rural cancer prevention and HPV vaccination. Participants discussed thoughts and next steps for how to move forward in improving HPV vaccination coverage in rural areas.

Register for a follow-up seminar set for March 3, Wide Open Spaces: Improving HPV Cancer Prevention with Rural Communities. Part of the St. Jude International HPV Awareness Day 2023 seminar series, this virtual session will focus on actions to improve HPV cancer prevention—and specifically HPV vaccination—with rural communities in the U.S. The seminar will feature presentations on efforts to improve HPV vaccination with rural communities, an engaging Q&A session between a physician and an HPV cancer survivor, and a moderated discussion.

Sign up for the rural HPV vaccination email list to receive information about rural HPV vaccination efforts. Access a recording of the introductory meeting here. Access the introductory meeting materials here.

Wide Open Spaces is a recently launched article series that addresses ways to improve HPV vaccination with rural communities. 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, please email us at PreventHPV@stjude.org.

Impact of COVID-19 on Behind-the-Scenes HPV Vaccination Work with Rural Clinics

Grace Ryan, PhD, MPH, is a postdoctoral fellow in the Department of Population and Quantitative Health Sciences at the University of Massachusetts Chan Medical School. She completed her doctorate at the University of Iowa College of Public Health where she first worked on rural HPV vaccination research. Now a fellow at UMass, she is building a research program to address rural-urban adolescent health inequities in New England. Most recently, her work has centered on translating lessons learned from HPV vaccination to respond to COVID-19 vaccine hesitancy.

The full impact of the COVID-19 pandemic is yet to be known; however, it has become clear over the last three years that the pandemic has significantly affected health care delivery. One area where that was evident, particularly early in the pandemic, was HPV vaccination. In spring 2020, clinics ordered fewer HPV vaccine doses compared to 2019 and the number of vaccines administered was significantly lower in this time period compared to previous years. This is especially concerning in rural areas given the pre-existing urban-rural inequities not only in HPV vaccination rates, but in rates of HPV-associated cancers as well. In a nationwide survey of rural health clinics conducted between April and September 2021, researchers found that the percentage of clinics offering the HPV vaccine fell from 71% to 52%. Similar declines were observed in the percentage of clinics offering pap smears and HPV DNA testing.

Beyond the quantifiable impact of the COVID-19 pandemic on HPV vaccine delivery and HPV cancer prevention services, there has been a hidden impact as well. In many clinics there is substantial behind-the-scenes work going on to promote HPV vaccination and ensure adolescents complete the series by age 13. For example, clinics may integrate evidence-based approaches such as reminder/recall systems using electronic health records or education sessions about best practices in communicating with vaccine-hesitant parents. However, these efforts require coordination and collaboration between not only clinicians and clinic staff, but also higher-level system leadership and external partners. In Iowa, a state where over 35% of the population lives in a rural area, we conducted a study to explore less-understood barriers to HPV vaccine promotion during the COVID-19 pandemic. Between August and November 2020, our team at the University of Iowa interviewed clinic managers, three-quarters of whom worked in a rural area, about their experiences early in the COVID-19 pandemic.

Clinic managers reflected on the difficulties of providing routine care during the pandemic and reported how competing priorities had shifted attention away from HPV vaccine promotion efforts. Nearly everyone we interviewed spoke about how their existing efforts to address low HPV vaccination rates had been halted to respond to the more pressing needs of the pandemic.

“Prior to COVID happening, we were putting plans in place on how to increase immunizations, whether that’s signage in the rooms and just communicating with patients and parents about why this is beneficial for your child or for yourself. And then obviously COVID, and that kind of just threw everything quality improvement out the window, while you’re trying to focus on ‘how the heck are we going to do this?’”

Several clinic managers explained that the need to respond to COVID-19 meant that not only were resources redirected, but existing efforts were halted. For example, one manager noted that they had been part of a quality improvement workgroup that discussed efforts to improve HPV vaccination on a monthly basis, but that group had been redirected to address COVID-19 exclusively. Another said that prior to the pandemic they had patient education materials about HPV vaccination in clinic waiting rooms, but that due to COVID-19, all of that was removed. Put simply, as one clinic manager summarized, “HPV is probably not at the top of our list.”

We know that even without the added stress of COVID-19, rural clinics faced challenges in implementing evidence-based interventions to address HPV vaccination.

Rural clinics may have few financial resources and little staff time or capacity to devote to implementation efforts. Additionally, the evidence for these types of interventions is often generated in urban and well-resourced clinical settings, and additional work is needed to adapt and tailor interventions to be appropriate and feasible in rural clinics. These challenges were compounded by COVID-19, leaving rural clinics with fewer resources to implement efforts to improve HPV vaccination rates. As the pandemic continues to have a significant impact on health care delivery and this behind-the-scenes implementation work, there is a need to not only refocus on rural HPV vaccine promotion but also to address larger issues of adapting and tailoring existing interventions to be successful in rural clinics.

“COVID-19 has highlighted pre-existing challenges in rural HPV vaccination promotion and delivery, and in the short term there is a need to refocus attention on getting rural HPV vaccination back on track by implementing strategies that we know work. In the long term, there is work to be done to identify more resilient and sustainable strategies and interventions to ensure that in future emergent situations that interrupt health care delivery, rural adolescents won’t miss out on critical vaccines, like HPV.”

St. Jude, along with the Unity Consortium and other partners, will recognize the importance of immunizations available to adolescents and young adults during Adolescent Immunization Action Week (AIAW) on April 3-7.

Advocates for adolescent vaccination, including on-time HPV vaccination at ages 9–12, continue to work through the issues of hesitancy, fear and misinformation to promote education and awareness around lifesaving vaccinations. AIAW is a critical time to shine light on the need for adolescents to get started or caught up with recommended vaccinations.

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

California

From 2020-2022, approximately 120,000 fewer 11- to-13-year-olds in California began their HPV vaccine series as compared to pre-pandemic levels in 2019 (California Immunization Registry). It is as critical as ever to catch up our kids on cancer prevention! SD PATH, a workgroup of Moores Cancer Center at UC San Diego Health, invites you to the 3rd annual Make SD HPV Cancer Free summit on February 27. This meeting will focus on:

Local and state HPV vaccination rates
The case for age 9 HPV vaccination promotion
SD PATH partnership spotlights: Success Stories and Future Promise of HPV Vaccination Interventions in SD County

The Impact of HPV Vaccinations – Oral Health at the Center

will host a virtual lecture and PowerPoint on Friday, February 10, from noon-1:30 p.m. Participants may receive 1.5 CDE, with no prerequisites required. The event is sponsored by the Missouri Department of Health and Senior Services Office of Dental Health. The speaker will be Missouri Dental Director Jacqueline Miller, DDS. Register here today. This event is part of the 2023 Missouri Oral Health Policy Conference.

Tennessee

The Tennessee Chapter of the American Academy of Pediatrics is excited to announce that its February training module will feature Sean O'Leary, MD, a nationally known expert on addressing vaccine confidence. The free webinar is open to all providers, clinicians and office staff. The session will take place February 16 at 11:30 a.m. CST. Register here.

Tennessee Families for Vaccines will host a “Day on the Hill” February 28 at the Tennessee State Capitol. Tennessee Families for Vaccines is a volunteer-led, grassroots network of family members dedicated to advocating for public health and evidence-based public policy and promoting immunizations for healthier kids and communities. Learn more and register here.

Washington

WA-CHIP Immunizations Learning Collaborative: Seeking Clinics for 5th Cohort
The 5th cohort of the WA-CHIP Immunizations Learning Collaborative kicks off in April 2023. WA-CHIP provides coaching and resources from expert faculty from WCAAP, Seattle Children’s, the Washington State Department of Health, Public Health Seattle-King County, and a community of peer clinics. The project helps clinics implement meaningful, feasible and sustained focus on childhood and adolescent vaccines. The initiative uses an equity lens to support participating clinics in identifying health care gaps for their patient populations by race, ethnicity and language. Register here today.

February is the time of love. The St. Jude HPV Cancer Prevention Program team shared what their love language is and why. Do you know your language? Find out today.

“My love language is quality time. I think spending quality time with loved ones is a priceless gift that we can give to our loved ones or receive from them. I know time is valuable and everyone is very busy, but finding some quality time for our loved ones is important. This helps to make us feel that we are not alone in any good or bad times that come in life. I believe that the quality time we spend with our loved ones is very precious, irreplaceable, and is valued forever even when we are far.” – Pragya Gautam Poudel, postdoctoral fellow

“My love language is a mixture of two: words of affirmation and quality time. I love to let individuals know how important they are to me and when they are doing a good job, and I like to hear it as well—it keeps me motivated. I also love spending quality time with my family and friends.” – Portia Knowlton, program coordinator

“My love language is acts of service. I like helping others.”– Ursula Leflore, administrative specialist

“Quality time is my love language because I enjoy hanging out with family and friends, but also being present in the moment.” – Duha Magzoub, program coordinator

“My love language is acts of service. Like giving is as good to the giver as it is to the receiver, service works the same way. Everyone wins when we serve each other.” – Carol Minor, program coordinator

“My love language is quality time. Nothing is more important to me than being able to spend time with my family and friends.” – Julia Neely, program manager

“I love spending meaningful quality time with friends and family. It brings my heart joy.” – Andrea Stubbs, administrative director

“My love language is words of affirmation. I value the verbal connections that come from those I love.” – 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.