In this article series, we have been taking time to explore reasons why HPV vaccination is lower in rural areas and also, importantly, to identify solutions that ensure people living in rural areas are protected from HPV cancers too. In this month’s Wide Open Spaces article, we reached out to a few people who currently live or grew up in a rural area to share their thoughts on HPV vaccination. Their perspectives provide us with much to consider about why they have chosen rural living and also point to potential solutions. Our panelists included:

  • Jason, married father of three adult children
  • Erin, mother of two children under 5
  • Mindy, married mother
  • Susan, married grandmother of three middle schoolers

Heather Brandt, PhD, is the director of the HPV Cancer Prevention Program. See a full bio. 

Reflecting on my own experiences growing up in a rural community, I am reminded of the reasons why 1 in 5 people choose rural living. There is a strong sense of community, resiliency, hardiness, and solitude – not to mention the bucolic landscapes of these wide open spaces. These same strengths may make someone living in rural America less likely to seek preventive care, such as HPV vaccination. We asked our panel about the favorite parts of living in a rural area.

The beauty of being surrounded by nature every day. – Mindy 
  • Low cost of living
  • Quiet and peaceful
  • Slower paced and calm – not high pressure
  • Clear, starry skies

The 2022 NIS-Teen data were released last month, as we have noted in this newsletter, and HPV vaccination coverage among rural adolescents continues to lag national averages. The persistence of the disparity in vaccination coupled with the elevated HPV cancer rates require our attention. We wanted to know from the panel why some people living in rural areas may not be getting vaccinated against HPV.

  • Do not know and understand importance of HPV vaccination
  • Misinformation about HPV vaccination
  • Distrust the HPV vaccine, government, science, education
  • Not required for school, in most areas
  • Concerns about infertility
  • Encourages sexual activity
  • Fewer interactions with health care providers
  • Religious beliefs
  • Fear of needles 
Many people that I consider friends will elect not to get their children vaccinated for HPV because it is not required, and they think it will cause infertility or encourage sexual activity. – Erin 

Since HPV vaccination was recommended in the U.S., experts have been working to identify ways to improve HPV vaccination coverage with rural communities. There are certainly examples of successful programs built on local culture and leveraging trusted relationships. The panel was asked to recommend ways to help more people living in rural areas get vaccinated. Some panelists were uncertain and recognized the barriers. There was a common theme about at least part of the solution – the role of health care providers. 

Residents in rural areas generally trust health care providers and religious leaders. – Susan 
  • More health care providers strongly recommending HPV vaccination
  • Health care providers recommending HPV vaccination at every visit
  • More access to accurate, meaningful information
  • Make it real to those who think HPV cancer will never be their reality
  • Combat misinformation
  • Offer programming with trusted community organizations, such as churches

In our program at St. Jude Children’s Research Hospital, the perspectives of people living in rural areas are central to developing, implementing, and evaluating programming to reverse course with HPV cancer prevention. In the July newsletter, we shared information about the Rural HPV Vaccination Think Tank. In future months, we will share progress on recommended, priority action steps.

We invite guest contributors to share information on how they are working to improve HPV vaccination in rural areas. If you want to contribute or learn more about our efforts to improve HPV vaccination in rural communities, please visit or email us at