By Heather Owens, PhD, MPH and Nicole Rhodes, CHES

The rural United States (U.S.) experiences higher rates of HPV cancers, including oropharyngeal cancer, compared to urban areas and also has fewer adolescents who are up-to-date with HPV vaccination. Five of the bottom 10 ranked states for up-to-date HPV vaccination have one third or more of their population living in a rural area. There are unique challenges that come with vaccination in rural areas, including increased vaccine hesitancy, lower HPV and HPV vaccination knowledge and awareness, and increased value of personal choice in decisions.

The primary age group for on-time HPV vaccination is initiation at ages 9-12. Starting HPV vaccination at age 9 has several benefits including being most effective when given before exposure, providing more time to complete the required doses, and flexibility for providers and parents in discussing the vaccine. Additionally, some parents are concerned about giving too many vaccines at once, so starting the HPV vaccine at age 9 separates it from the other routinely recommended 11–12-year-old vaccines for whooping cough (Tdap) and meningitis (MenACYW). Given the rapid rise in the number of oropharyngeal cancers attributed to HPV, dental providers play an increasingly important role in HPV vaccination, especially in rural communities where dental providers can be key messengers who discuss, educate, and recommend HPV vaccination.

As of 2026, seven states allow dentists to vaccinate for HPV – Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, Oregon. Research by Naavaal et al. and Barrientos et al. indicates that patients who understand the link between HPV and oropharyngeal cancer tend to hold more positive perceptions of dental providers’ involvement in HPV vaccination efforts and are generally comfortable discussing the HPV vaccine with their dental providers, yet few report actually receiving a recommendation from a dental provider. From the provider perspective, research from Askelson et al. showed dentists consider HPV vaccine discussions to fall within their scope of practice and are willing to recommend the vaccine and provide referrals but expressed a need for more education, training, and practical tools to prepare for and guide these discussions. There are limited materials available specifically for dental settings, and the current age 9 materials are not specific for rural or dental settings.

As part of our experience as Emerging Leaders Fellows in the American Cancer Society National HPV Vaccination Roundtable, we developed a toolkit to leverage dental providers in rural communities for HPV vaccination starting at age 9. The toolkit guide includes instructions for using and editing each component, background information on HPV and the link to oropharyngeal cancer, common questions and answers about the vaccine, and additional resources.

The toolkit components include a birthday card that can be sent to patients on their 9^th birthday to initiate the conversation about HPV vaccination. Additionally, there are scripts for a radio campaign and reminders that can be used as a phone call or email. For clinics with texting or patient portal abilities, we developed a shortened version of the reminder that can be texted to patients. The radio campaign is built to focus on HPV vaccination as cancer prevention, including oral cancer, and encourages the clinic to tailor the campaign with a common HPV vaccine or general vaccine myth or misperception in the community. All materials have two versions available: a version for states where dentists cannot vaccinate for HPV/clinics that do not to offer HPV vaccination and a version for states that allow dentists to vaccinate.

It is our hope that the toolkit provides easy-to-use, low-resource materials that can be easily incorporated into the day-to-day operations of rural dental offices.

The Dental HPV Resources: A Toolkit for Rural Dental Offices will be available soon through the American Cancer Society. In the meantime, sign up here to be notified when it becomes available.

Heather Owens, PhD, MPH, is an Assistant Professor at the West Virginia University (WVU) School of Pharmacy and WVU Cancer Institute and 2025 fellow with the American Cancer Society National HPV Vaccination Roundtable Emerging Leaders Fellowship. She received her PhD in Public Health from the University of South Florida and completed a postdoctoral fellowship in the T32 Behavioral Oncology Training Program at Moffitt Cancer Center. Her research focuses on the development of interventions to increase HPV vaccine and cervical cancer screening utilization in rural communities.

Nicole Rhodes, CHES, is an MPH student at Oregon State University and 2025 fellow with the American Cancer Society National HPV Vaccination Roundtable Emerging Leaders Fellowship. Her work includes supporting Washington state with the “HPV at Nine” initiative, creating a dedicated “HPV at Nine” website, and expanding language access to HPV educational materials.