Addressing HPV Vaccination and Cancer Prevention and Control through Data and Dialogue in the 99 Counties Project   

By Whitney Zahnd, PhD

The state of Iowa has the second highest rate of new cancers in the country and is one of only two states that is experiencing an increase in new cancers. To address this important challenge, the Iowa Cancer Registry and University of Iowa College of Public Health in partnership with the Holden Comprehensive Cancer Center, Iowa Cancer Consortium, Iowa Rural Health Association, and the Iowa Department of Health and Human Services launched the 99 Counties Project. The 99 Counties Project is focused on community engagement and information dissemination with presentations to each of Iowa’s 99 counties, seventy-seven of which are classified as non-metropolitan (rural) by the Office of Management and Budget. As of mid-February 2026, the team has presented to 52 Iowa counties.

The project team works with each county’s local health department to identify a time and venue that works best to hold the presentation to optimize community participation. Presentations are typically 45 minutes, with an additional 15 minutes allocated for questions from the audience. All presentations include a virtual component to allow folks to join from anywhere. Many presentations include an in-person component for those who wish to be in community and to improve accessibility to the material. The presentations include county-specific data on their top five cancers by incidence and recommendations for evidence-based steps one can take to reduce their individual risk and collective policy solutions one can support to address those risk factors that are outside of their control. Additionally, the presentations include myriad resources that individuals and communities can access for more information about cancer risk, prevention, partnerships, and advocacy. These resources are available in a resource guide linked on the project's website, and all presentation slides are made available for people to revisit at any time.

While the presentations focus on the leading cancers by incidence in each county, HPV-associated cancers are an important part of the discussion, especially as Iowa has the highest rate of oropharyngeal cancers in the country. Each presentation includes a discussion of county-level HPV vaccination rates compared to the state and national rates as well as a comparison to the vaccination rate goal in the Iowa Cancer Plan. Additional information is provided about HPV vaccination recommendations and its safety and efficacy to prevent six cancer types. If local health departments are part of the Vaccines for Children program, information about that program is provided as part of the presentation as well. Further, each presentation provides information about the Iowa “Care for Yourself” Breast and Cervical Cancer Early Detection Program, Iowa’s version of the National Breast and Cervical Cancer Program, which provides free or low-cost breast and cervical cancer screening to eligible women.

A comprehensive approach is needed to address cancer prevention and control challenges in a state with high cancer rates. Sharing evidence-based HPV vaccination information alongside smoking prevention, radon testing, cancer screening, and other evidence-based activities is critical. Additionally, pairing data with dialogue is key. The goal of this project is not only to provide information, but also to listen to the questions and concerns of community members who participate in presentations. The Project partners’ goals of being a trusted source of information and an ongoing partner are key to reducing Iowa’s cancer rates.

About the author

Whitney Zahnd, PhD, is a tenure-track assistant professor in the Department of Health Management and Policy in the College of Public Health and a full member of the Holden Comprehensive Cancer Center at the University of Iowa. Her research employs health services research and social epidemiological approaches to address rural cancer disparities across the continuum and to ameliorate disparities in access to health care services. Currently, she serves as the deputy director of the RUPRI Center for Rural Health Policy Analysis, past-president of the Iowa Rural Health Association board, and chair of the Journal of Rural Health editorial board.