NUMBER 26

Preventing Cancer through Increased Human Papillomavirus (HPV) Vaccine Uptake 

The President’s Cancer Panel recently released a report describing 

the underuse of the human papillomavirus (HPV) vaccine as a 

“serious, but correctable threat to our progress against cancer.” 

Almost all cervical cancer cases result from persistent HPV 

infection, making it one of the most preventable forms of cancer, 

yet only one third of girls aged 13–17 have received all three 

recommended doses of the vaccine. This falls far short of the 

Healthy People 2020 goal of having 80 percent of girls aged 13–15 

fully vaccinated. A recommendation for vaccinating boys was not 

made until 2011, and uptake has been slow. In 2012, less than 

7 percent of boys aged 13–17 were fully vaccinated.

Not all types of HPV cause cancer, and the HPV vaccine does not 

protect against all types of HPV. Most high-risk HPV infections occur 

without any symptoms and go away on their own within one to two 

years. In some cases, these high-risk HPV infections persist and, if 

left untreated, progress to cancer. Discussions are needed between 

health care providers, parents, and adolescents to clearly convey the 

importance and benefits of HPV vaccination for cancer prevention. 

The vaccines are recommended for adolescents aged 11–12, and are 

most effective prior to the advent of sexual activity. Many parents of 

young adolescents are not prepared for or comfortable discussing 

HPV vaccination, and many health care providers sometimes delay 

or avoid making vaccine recommendations. 

Despite these challenges, since the HPV vaccine became available 

in 2006, awareness of HPV has increased significantly, but remains 

lower than desired. In 2013, equal proportions (68 percent) of the 

general adult population reported having heard of HPV and the 

HPV vaccine. Prior to the vaccine’s release, only 38 percent of 

women were familiar with HPV, and awareness among all adults 

was likely lower. 

Familiarity with HPV does not necessarily translate into knowledge 

of the potential health consequences of the infection. Data from 

HINTS 4, cycle 3 collected in late 2013 indicate that about two 

thirds of HPV-aware adults in the United States knew of the link 

between HPV and cervical cancer (62 percent), and 64 percent 

were unaware that HPV infections will often go away on their 

own without treatment. While knowledge and awareness alone 

do not lead to action, they are critical components of any health 

promotion strategy. 

Do you think HPV can 

cause cervical cancer?

2013 Estimated U.S. Population 

Among Aware of HPV.

Yes

No

Not Sure

62%

34%

4%

Do you think that HPV 

will often go away on its 

own without treatment?

2013 Estimated U.S. Population 

Among Aware of HPV. 64%

31%

5%

Yes

No

Not Sure

Quick Facts • 

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Nearly 80 million people in the United States are infected with 

at least one strain of HPV. 

HPVs are a group of more than 150 related viruses, and 40 of 

these can easily be spread through direct skin-to-skin contact. 

About 12 high-risk virus types have been identified as cancer 

causing, and the two most virulent types (HPV 16 and 18) 

account for 70 percent of the cases of cervical cancer as well as 

cancers of the vulva, vagina, anus, and penis. 

In 2006, the Food and Drug Administration (FDA) approved 

two HPV vaccines that collectively have proven highly effective 

in preventing infections with HPV types 16 and 18, resulting in 

substantially reduced rates of cervical and other cancers. 

If current vaccination levels increased to 80 percent, an 

additional 53,000 future cases of cervical cancer would be 

prevented among girls who are now 12 years old and younger 

over the course of their lifetimes.

HPV vaccines are effective. Despite lower than expected 

vaccination rates, the rate of HPV infection from the four strains 

targeted by the vaccines decreased 56 percent among girls 

aged 15–19 from 2007 to 2010. 

In this HINTS Brief, we explore the sociodemographic factors associated with awareness and knowledge 

of HPV and the HPV vaccine in the United States.
Sociodemographic Differences in HPV Knowledge and Awareness

Comprehensive communication strategies and tools are needed that promote opportunities for in-depth discussion about HPV 

vaccination among adolescents, their parents or caregivers, and health care providers. Women with children under age 18 are significantly 

less likely than women without children under 18 to have heard of HPV or the vaccine, according to a recent analysis of HINTS 4 data 

collected in late 2013. This finding is concerning given that mothers are often the decision makers for their families on health-related 

issues. The same study looked at other sociodemographic differences in HPV knowledge and awareness. 

Heard of HPV

Sixty-eight percent of Americans have heard of HPV. Those with 

a high school degree are less likely than those with a college 

education to have heard of HPV. Males are about 75 percent less 

likely than females to have heard of HPV. Age is a primary driver 

of awareness, with those aged 18–34 being five times more likely 

than those over 65 to have heard of HPV.

Heard of HPV Vaccine

Sixty-eight percent of Americans have heard of the cervical cancer 

vaccine, or HPV shot. Those with a high school degree are less 

likely than those with a college education to have heard of the 

HPV vaccine, and males are about 75 percent less likely than 

females to have heard of the vaccine. Hispanics are half as likely as 

whites to have heard of the vaccine. Younger age is also a driver of 

vaccine awareness, with those aged 18–34 being three times more 

likely than those over 65 to have heard of the vaccine.

Knowledge That HPV Causes Cervical Cancer

Sixty-two percent of Americans know that HPV causes cervical 

cancer, 34 percent are unsure of that fact, and 4 percent 

inaccurately think that HPV does not cause cervical cancer. People 

in rural areas are significantly less likely than those in urban areas 

to know that HPV causes cervical cancer. People with less than 

high school education, high school graduates, and people with 

some college are significantly less likely than college graduates to 

know that HPV causes cervical cancer. Males are significantly less 

likely than females to think that HPV causes cervical cancer, and 

those aged 18–34 are twice as likely to know about the HPVcancer link as those over 65.

How Can This Inform Your Work? • 

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• Missed clinical opportunities are the most important reason 

why the United States has not achieved high rates of HPV 

vaccine uptake. According to the Centers for Disease Control 

and Prevention (CDC), if all missed opportunities during 

health care visits had been eliminated between 2007 and 2012, 

93 percent of girls aged 13–17 would have received at least 

their first dose of the vaccine by 2012. Targeted efforts should 

be made to address factors that keep health care providers 

from strongly recommending HPV vaccines. 

Most parents believe that vaccines protect their children from 

potentially life threatening diseases. Work is still needed to 

improve parents’, caregivers’, and adolescents’ understanding of 

HPV vaccines as a protective measure against cancer.

Cancer prevention messages should incorporate the importance 

of early vaccination, reinforce the vaccine’s safety and 

effectiveness, and emphasize the necessity of vaccinating both 

girls and boys.

As public awareness of HPV and the importance of vaccination 

for girls and boys becomes more widely known, convenient 

access is imperative for ensuring the HPV vaccine series can be 

initiated and completed. About HINTS

hints.cancer.gov

facebook.com/ncihints

twitter.com/NCIHINTS HINTS was created to monitor changes in the rapidly evolving field of health communication. The survey data 

can be used to understand how adults use different communication channels to obtain health information 

for themselves and their loved ones. It can also help to create more effective health communication strategies across populations. 

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002–2003, surveying 

6,369 Americans. Subsequent surveys followed in 2005 (5,586 Americans surveyed), 2008 (7,674 Americans surveyed), 2011–2012 

(3,959 Americans surveyed), 2012–2013 (3,630 Americans surveyed), and 2013 (3,185 Americans surveyed). 

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings. They introduce population-level estimates for specific 

questions in the survey and summarize significant research findings that are a result of analyzing how certain demographic characteristics 

influence specific outcomes. Many Briefs summarize research findings from recent peer-reviewed journal articles using HINTS data.

For More Information on Cancer

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Call the NCI Cancer Information Service at 1-800-4-CANCER

Visit http://cancer.gov

Order NCI publications at https://pubs.cancer.gov/

Visit Facebook.com/cancer.gov and http://www.youtube.com/ncigov

References Used in This HINTS Brief

Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer. A Report to the 

President of the United States from the President’s Cancer Panel. Bethesda, MD: National 

Cancer Institute; 2014. A web-based version of this report is available at http://deainfo.nci.nih.gov/

advisory/pcp/annualReports/HPV/index.htm.

Blake KD, Ottenbacher AJ, Rutten LF, Grady M, Kobrin S, Jacobson R, and Hesse B. 

Sociodemographic predictors of HPV knowledge and awareness in 2013: identifying gaps and 

opportunities for targeted communication strategies. 2014 (manuscript in preparation).

HPV and Cancer, NCI fact sheet. 2012; http://cancer.gov/cancertopics/factsheet/Risk/HPV.

Markowitz LE, Hariri S, Lin, Carol, Dunne EF, Steinau M, McQuillan G, and Unger ER. Reduction 

in human papillomavirus (HPV) prevalence among young women following HPV vaccine 

introduction in the United States, national health and nutrition examination surveys, 2003–2010. 

Journal of Infectious Diseases. 2013; 208(3):385-393.

Tiro JA, Meissner HI, and Kobrin S. What do women in the U.S. know about human papillomavirus 

(HPV) and cervical cancer? Cancer Epidemiology, Biomarkers & Prevention. 2007; 16:288-294.

May 2014