In a U.S. state-level study reported as a research letter in JAMA Oncology, Garg et al found that awareness of human papillomavirus (HPV), HPV vaccination, and the association between HPV infection and development of cancers was “overwhelmingly low.”
As stated by the investigators, “Each year, an estimated 48,000 new cases of … HPV–associated cancers are diagnosed in the [United States], … with nearly 62% occurring in Midwestern and Southern states.”
Study Details
The cross-sectional study involved data from all 50 states and Washington, DC, from the 2017–2020 Health Information National Trends Survey (HINTS) 5 (cycles 1–4) and 2022 HINTS (cycle 6). Individuals aged ≥ 18 years were asked: “Have you ever heard of HPV?” and “Before today, have you ever heard of the cervical cancer vaccine or HPV shot?” Respondents who had heard of HPV were asked, “Do you think HPV can cause oral cancer?” and “Do you think HPV can cause cervical cancer?” Responses of “no” or “not sure” were classified as indicating lack of awareness about HPV, HPV vaccine, and the association of HPV with cancer.
Key Findings
The analysis included 22,344 respondents (51.1% female; mean age = 49 years).
Overall, 34.3% (95% confidence interval [CI] = 33.2%–35.4%) of adults were unaware of HPV and 37.6% (95% CI = 36.5%–38.8%) were unaware of the HPV vaccine.
More than 40% of respondents lacked HPV awareness in seven states, most from the Midwest (Kansas, Nebraska, and Illinois) and the South (Mississippi, Arkansas, and Alabama).
More than 40% of respondents were unaware of the HPV vaccine in 13 states, including 9 from the Midwest (South Dakota, Kansas, and Illinois) and the South (Mississippi, South Carolina, Arkansas, Oklahoma, Florida, and Alabama).
Overall, among all respondents who knew about HPV, 70.8% (95% CI = 69.2%–72.3%) were unaware that HPV causes oral cancer and 28.3% (95% CI = 27.0%–29.6%) were unaware that HPV causes cervical cancer.
In 45 states and Washington, DC, more than 60% of individuals lacked awareness that HPV causes oral cancers. Lack of awareness that HPV causes cervical cancer was less common overall (6.9%–57.4%).
The investigators stated: “In this cross-sectional study, public awareness about HPV, HPV vaccination, and the link between HPV and cancers was overwhelmingly low, particularly in Midwestern and Southern U.S. states. These findings are troubling because these regions have recently seen a marked rise in HPV-associated cancers…. Notably, the lack of HPV and HPV vaccine awareness in the Midwest and South is alarming, as a majority of states in these regions have suboptimal HPV vaccination rates.”
Kalyani Sonawane, PhD, of the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the National Institute on Minority Health and Health Disparities, National Library of Medicine, and National Cancer Institute. For full disclosures of all study authors, visit jamanetwork.com.
