The HPV vaccine is a proven defense against the 6 types of cancer that can be caused by certain types of the human papillomavirus (HPV) later in life – cancers of the cervix, throat, vulva, and anus in girls and cancers of the throat, penis, and anus in boys.
The ACS recommends that boys and girls start the vaccine series between the ages of 9 and 12. But, not all kids get vaccinated during these ages when the vaccine is most effective.
Vaccination rates among adolescents are lower than those of younger children. And teens who live in rural areas have much lower vaccination rates compared to kids who live in urban and suburban cities.
That geographic disparity affects a states that are mostly rural, like Oregon, where rural areas that cover more than 85% of the state and where 1 in 3 residents lives.
“Overall, most kids get their childhood immunizations, but the adolescent population is less likely to be up to date with their immunizations compared to younger children for a variety of reasons,” said Lyle Fagnan, MD, a family doctor and professor at Oregon Health & Science University in Portland and an American Cancer Society (ACS) grantee.
One reason, Fagnan said, is lack of a school requirement to get an HPV vaccine. “Here in Oregon, DTaP (diphtheria, tetanus, acellular, pertussis) vaccinations, are required for school, and about 90% of kids are up to date with them. But only about 50% of teens are up to date with the HPV vaccine.” In rural Oregon, only about 30% of teens’ get all the recommended HPV vaccine.
In his experience, Fagnan said, people who live in rural areas are more likely to be hesitant about getting vaccines than those who live in a more urban area. “For whatever reason, they're concerned that vaccines aren’t safe. They believe that natural immunity is better, and they say, ‘I just don’t think that we want our children to get the shot.’”
Some parents, he adds, don’t think that vaccines against sexually transmitted infections, like the HPV vaccine, are appropriate for children.
Fagnan wants to close the gaps in HPV immunization rates between rural and urban adolescents. The ACS research scholar grant is helping him carry out his 4-step plan to do so.
Fagnan and his co-researcher Patricia Carney, PhD, have completed the first step of RAVE (the Rural Adolescent Vaccine Enterprise), an Oregon-based study, designed to uncover why rural vaccination rates lag behind urban and suburban ones.
They’ve assessed 12 rural clinics to learn why some achieve higher HPV vaccination rates than others. A few tactics that seem to make a difference include offering the vaccine every time an adolescent has an appointment at the clinic and having a staff person dedicated to maintaining the clinic’s supply of vaccine.
Next, Fagnan will lead 46 rural Oregon clinics in implementing strategies learned from the initial 12 clinics to improve HPV vaccination rates. Over the course of 18 months, research coordinators will follow up with the clinics regularly to check on their progress.
After they’ve nailed down effective strategies, the clinics will team up with a local partner, such as a community pharmacist or a school, to help them further their mission. A school nurse, for example, might help reinforce the recommendations for the HPV vaccine. Based on what Fagnan and his team learn from their research, he said, they’ll create a toolkit that rural clinics across North America can use to increase HPV vaccination rates.
“Rural practices need help improving quality of care for adolescents, and this grant is making that happen,” said Fagnan. “We’ve already seen – and I would not have predicted this – a real surge in the amount of interest in HPV from rural citizens. It seems like everyone wants to talk to us about it.”