Using Data as Our Guide

Beginning in January 2023, the St. Jude HPV Cancer Prevention Program team began our focus on addressing disparities in HPV vaccination and HPV cancers in rural communities across the U.S. This included hosting an introductory meeting attended by rural thought leaders and HPV vaccination and HPV cancer experts, coupled with presentations by selected leaders in rural HPV cancer prevention. We learned the latest in HPV cancer prevention data and also about opportunities for action. This meeting was followed by convening a “think tank” with a smaller number of subject matter experts to consider priority actions to improve rural HPV vaccination coverage with rural communities. The six priority actions focused on examining data, utilizing existing resources, improving communication efforts, training health care providers and professionals, promoting starting HPV vaccination at age 9, and advocacy and policy efforts. Progress is provided regularly through quarterly update meetings open to anyone interested in the topic. Learn more at stjude.org/HPVrural.

To address the data priority action, we started working with Whitney Zahnd, PhD at the University of Iowa who previously authored key publications on HPV cancers among people living in rural areas; Jason Semprini, PhD at Des Moines University; and Gabe Benavidez, PhD at Baylor University. This collaboration, led by Dr. Semprini, has resulted in two publications updating and expanding on the Zahnd et al. publication in the Journal of Rural Health from 2019. Additional publications are forthcoming to continue describing rural HPV vaccination and HPV cancers to inform action.

As a reminder, in the 2019 Zahnd et al. publication, authors reported rural females had significantly higher rates of cervical, vaginal, vulvar, oropharyngeal, and anal cancer compared to urban peers, while rural males had higher rates of penile cancer. When examining trends, rural females and males experienced greater rate increases or smaller rate decreases overall for nearly every HPV cancer site. 

In the Semprini research letter published in Rural and Remote Health in October 2024, similarly rising trends were confirmed in incidence and mortality, including accelerations following 2020 disruptions to the health care system as a result of the pandemic. In 2021, the increase in the percentage of HPV cancer cases in rural areas (18% increase) exceeded the urban rate (6% increase) for the first time in at least 20 years.

In Semprini et al. published last month in Journal of Rural Health, we wanted to understand which types of HPV cancer contributed to the widening HPV cancer disparity. We found the rural-urban disparity has significantly grown for anal and cervical cancers in females and oropharyngeal cancers in both sexes.

Data, including data analyzed and reported on in these articles and more, are available to serve as our guide. However, data – like knowledge – are only beneficial if we act on this information. Action is needed to change the direction of this trend. It will take time for on-time HPV vaccination to prevent HPV cancers. But if we do not act now, we risk the rural-urban gap continuing to widen. Here are some actions we can take now with resources to put them into place.

• Cultivate a pro-HPV vaccination environment across rural communities by embracing strengths of rural life and addressing factors driving lower coverage, such as through the ACS Rural HPV Vaccination Learning Community.

• Build confidence in HPV vaccination through messaging and communication campaigns designed by people living in rural communities for their neighbors, such as resources available from We The People Vax.

• Confront misinformation by providing accurate information from trusted sources and by trusted messengers, such as these promising interventions identified in Whitehead et al.

• Train health care providers and professionals with the most effective tools to recommend HPV vaccination and begin conversations when a child is age 9, such as the Announcement Approach Training and age 9 resources from the ACS National HPV Vaccination Roundtable.

• Increase access points for HPV vaccination administration, including at pharmacies, mobile units, dental practices, urgent care settings, and more, while also ensuring Vaccines for Children program enrollment for all vaccine providers.

• Address HPV vaccination policy factors influencing the availability and administration of HPV vaccination in rural communities, such as by addressing lower reimbursement types for some provider types practicing in rural areas (Zhu et al.).

These actions require collaboration across multiple sectors and people serving rural communities as well as those who choose rural life. We can use the data as our guide and reverse current trends. Join us at the St. Jude HPV Cancer Prevention Program rural HPV cancer prevention quarterly updates meetings and as part of the ACS Rural HPV Vaccination Learning Community to learn more and join our efforts.