Rural Realities: Understanding and Reducing Differences in HPV Cancer Prevention

By Sarah Edward, St. Jude HPV Cancer Prevention Program Graduate Student Intern

Each year, approximately 50,000 HPV cancers are diagnosed, at least 90% of which are preventable through vaccination. Although two decades have passed since the introduction of the HPV vaccine, vaccination coverage among U.S. adolescents remains well below the Healthy People 2030 target of 80%. According to the most recent National Immunization Survey-Teen (2024), only 63% of adolescents aged 13–17 years are up to date with the HPV vaccination series. Coverage is even lower in rural parts of the country, where just 55% of adolescents have completed the recommended series. While HPV vaccination coverage increased substantially during the 2010s, with receipt of at least one vaccine dose rising from approximately 56% in 2015 to nearly 78% in 2024, progress slowed following the COVID-19 pandemic. Since 2020, coverage of at least one dose has only increased approximately 2-3% percentage points, suggesting gains have largely plateaued. In rural parts of the country, the difference in uptake is notable. These differences have changed little over the past decade, highlighting that geographic differences in HPV vaccination continue to persist.

A health care provider recommendation remains one of the strongest and most consistent influencing factors for HPV vaccine uptake, but even among adolescents who received a provider HPV vaccination recommendation, the percentage of adolescents who were up to date with HPV vaccination was almost 11% lower in mostly rural areas than in mostly urban areas. Additionally, rural counties have 50% greater odds than urban counties of experiencing provider shortages, not having a single pediatric or family medicine physician, and from 2010 to 2020, rural counties saw a 3% decline in their already limited availability of primary care providers.

Despite these challenges, meaningful improvements in HPV vaccination coverage are achievable through coordinated efforts at multiple levels. Solutions to increasing vaccine uptake, especially in rural communities, require approaches that are both data-informed and community-driven. Those who live and serve in rural areas are uniquely positioned to identify local barriers and opportunities, ensuring that evidence-based interventions are tailored to community needs as no single intervention can address key barriers that vary widely from community to community as to what will encourage a parent or guardian to choose HPV vaccination their child. Large-scale policy and systems interventions remain essential for creating an environment where HPV vaccination becomes routine care rather than an optional discussion. Evidence consistently demonstrates that health systems that implement provider reminder prompts, standing orders, immunization registry utilization, and HPV vaccination quality improvement initiatives experience fewer missed opportunities for HPV vaccination. Likewise, policies that improve access through the Vaccines for Children (VFC) program, expand pharmacist vaccination authority, support school-based vaccination initiatives, and reduce financial barriers have all been associated with higher HPV vaccination coverage. States that have implemented stronger immunization infrastructure and supportive vaccination policies continue to outperform states that rely solely on individual provider or parent decision-making. These large-scale interventions create sustainable systems that normalize HPV vaccination and ensure that adolescents have multiple opportunities to be vaccinated regardless of where they live or access care.

However, broad policy initiatives alone are unlikely to eliminate persistent rural disparities. Rural communities are remarkably diverse with respect to culture, health care infrastructure, geography, political climate, and available resources. Community-specific approaches that identify and address local barriers remain essential. In some rural communities, strengthening health care provider and professionals’ communication through training may be the most effective strategy, while in others, expanding vaccination opportunities through community pharmacies, federally qualified health centers, mobile vaccination clinics, or school-based programs may produce greater improvements. Communities with substantial vaccine hesitancy may benefit most from trusted local messengers, including clergy, teachers, cancer survivors, agricultural leaders, and community organizations who can frame HPV vaccination as cancer prevention. Similarly, reminder and recall systems, text messaging interventions, and partnerships with schools and community or faith-based organizations have demonstrated promise when adapted to meet the needs of local populations.

Recognizing the complexity of improving HPV vaccination in the rural U.S., the St. Jude HPV Cancer Prevention Program has prioritized five rural HPV vaccination priority actions for increasing HPV vaccination coverage. The data priority, Preserve and Expand Data Resources, aims to leverage existing data and bolster data assets to guide informed actions, protect, strengthen, and expand rural-specific HPV data systems to inform action, support advocacy, and empower communities with accessible, actionable data. In response to this priority, Sarah Edward, student intern of the St. Jude HPV Cancer Prevention Program has dedicated her Master of Public Health (MPH) practicum project to exploring and synthesizing data and literature related to HPV vaccination and cancers in rural communities during the Summer 2026 Term.

“As a student intern with the HPV Cancer Prevention Program at St. Jude Children's Research Hospital, I have been working to develop a rural HPV data profile, a resource that brings together national surveillance data and peer-reviewed literature to provide a comprehensive picture of HPV vaccination and HPV cancer prevention in rural areas. The process has involved reviewing national datasets and scientific literature to identify trends in vaccination coverage, cancer burden, and evidence-based prevention strategies and recommendations. These findings will be synthesized to help health care providers and professionals better understand rural HPV strengths and opportunities and inform HPV cancer prevention efforts.” 

The rural data profile will be made available leading up to National Rural Health Day and will be a starting point for many discussions about the importance of data-informed strategies. Partners working to prevent HPV cancers with rural communities are encouraged to engage in these discussions and join forces with the St. Jude HPV Cancer Prevention Program to advance the rural priority actions and identify opportunities to collectively increase vaccine uptake in our communities.

About the Author:

Sarah Edward is a Master of Public Health student at Baylor University, concentrating in epidemiology. With degrees in biology and psychology from Dallas Baptist University, she brings a multidisciplinary lens to public health work and a deep commitment to reducing health disparities across underserved communities. Sarah has a deep personal passion for women's health, believing that everyone deserves access to quality, compassionate care regardless of their background. This commitment was reflected throughout her experience as a former medical assistant at Women First OBGYN, where she provided hands-on support in patient counselling, reproductive health procedures, and care coordination for a diverse patient population. Sarah is particularly drawn to the St. Jude HPV Cancer Prevention Program's efforts to prevent HPV cancers in rural communities. She is passionate about the power of community-based outreach and education in driving meaningful prevention efforts and believes that lasting change comes from meeting people where they are and building trust at the grassroots level. Through her internship at St. Jude, Sarah hopes to contribute to work that bridges the gap between epidemiological research and community-centered action, ultimately helping build a future where equitable access to cancer prevention is a reality for everyone.