Skip to main content

HPV Vaccination Communication Messages, Messengers, and Messaging Strategies


Human papillomavirus (HPV) causes over 39,000 cancers annually in the US. The HPV vaccine is safe and effective but underutilized to prevent cancer. In the US, only 37% of adolescents ages 13–17 have received the full vaccine series. Ineffective messages and misinformation about the vaccine have negatively impacted its uptake in the US. It was initially only approved for girls and early marketing focused on cervical cancer prevention and prevention of HPV as a sexually transmitted infection. Understanding effective messages and methods of dissemination is critical to address suboptimal vaccine uptake. Qualitative interviews were conducted with 34 participants to identify best practices for HPV vaccination messaging in SC. Participants included state leaders representing public health, medical associations, K-12 public schools, universities, insurers, and cancer advocacy organizations. Recommended HPV vaccine messages included focusing on cancer prevention rather than sexual transmission, routinizing the vaccine, and highlighting risks/costs of HPV. Targeting messages to specific demographics and utilizing multiple media platforms to disseminate consistent, scientifically accurate messages were recommended. Strategies such as appealing to parents’ moral responsibility to protect their children against cancer and addressing the ubiquity of HPV and sharing growing evidence that HPV may be transmitted independent of sexual activity were also recommended. Suggested HPV vaccine messengers included trusted peers, medical professionals, and health associations. Culture-centered narratives to raise the voices of cancer survivors and parents were also recommended. This study provides an array of HPV vaccination messages and dissemination strategies for optimizing HPV vaccination rates.

This is a preview of subscription content, access via your institution.


  1. 1.

    McQuillan G, Kruszon-Moran D, Markowitz LE, Unger ER, Paulose-Ram R Prevalence of HPV in adults aged 18–69: United States, 2011–2014. NCHS Data Brief 2017(280):1–8

  2. 2.

    American Cancer Society. What are the key statistics about cervical cancer? About cervical cancer 2017; Accessed November 1, 2017

  3. 3.

    CDC. Number of HPV-attributable cancers per year. HPV and Cancer 2017; Accessed October 31 2017

  4. 4.

    Walker TYE-E, Laurie D, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SL, Stokley S (2017) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years — United States, 2016. MMWR 66:874–882

    PubMed  Google Scholar 

  5. 5.

    Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S (2014) Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 168(1):76–82

    Article  Google Scholar 

  6. 6.

    Daley EM, Vamos CA, Thompson EL, Zimet GD, Rosberger Z, Merrell L, Kline NS (2017) The feminization of HPV: how science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. Papillomavirus Res 3:142–148

    Article  Google Scholar 

  7. 7.

    Gottlieb SD (2013) The patient-consumer-advocate nexus: the marketing and dissemination of gardasil, the human papillomavirus vaccine, in the United States. Med Anthropol Q 27(3):330–347

    Article  Google Scholar 

  8. 8.

    Viens LJ, Henley SJ, Watson M, Markowitz LE, Thomas CC, Thompson TD, Razzaghi H, Saraiya M (2016) Human papillomavirus-associated cancers - United States, 2008–2012. MMWR Morb Mortal Wkly Rep 65(26):661–666

    Article  Google Scholar 

  9. 9.

    CDC. HPV vaccines: vaccinating your preteen or teen. 2017; Accessed November 7, 2017

  10. 10.

    National Cancer Institute. HPV vaccine uptake in cancer centers. Healthcare delivery research program 2017; Accessed November 27, 2017

  11. 11.

    Bernard HR, Wutich A, Ryan GW (2017) Analyzing qualitative data: systematic approaches, Second edn. Los Angeles, SAGE

    Google Scholar 

  12. 12.

    CDC. Partner spotlight. Human papillomavirus (HPV) 2017;

  13. 13.

    Hopfer S, Clippard JR (2011) College women's HPV vaccine decision narratives. Qual Health Res 21(2):262–277

    Article  Google Scholar 

  14. 14.

    Hopfer S (2012) Effects of a narrative HPV vaccination intervention aimed at reaching college women: a randomized controlled trial. Prev Sci 13(2):173–182

    Article  Google Scholar 

  15. 15.

    Amin AB, Bednarczyk RA, Ray CE, Melchiori KJ, Graham J, Huntsinger JR, Omer SB (2017) Association of moral values with vaccine hesitancy. Nature Hum Behav 1(12):873–880

    Article  Google Scholar 

  16. 16.

    Liu Z, Nyitray AG, Hwang LY, Swartz MD, Abrahamsen M, Lazcano-Ponce E, Villa LL, Giuliano AR (2018) Acquisition, persistence, and clearance of human papillomavirus infection among male virgins residing in Brazil, Mexico, and the United States. J Infect Dis 217(5):767–776

    Article  Google Scholar 

  17. 17.

    Mills LA, Head KJ, Vanderpool RC (2013) HPV vaccination among young adult women: a perspective from Appalachian Kentucky. Prev Chronic Dis 10:E17

    Article  Google Scholar 

  18. 18.

    Cohen EL, Head KJ (2013) Identifying knowledge-attitude-practice gaps to enhance HPV vaccine diffusion. J Health Commun 18(10):1221–1234

    Article  Google Scholar 

  19. 19.

    Donadiki EM, Jimenez-Garcia R, Hernandez-Barrera V et al (2014) Health belief model applied to non-compliance with HPV vaccine among female university students. Public Health 128(3):268–273

    CAS  Article  Google Scholar 

  20. 20.

    National Cancer Institute (2005) Theory at a glance: a guide for health promotion practice. National Cancer Institute, Bethesda

    Google Scholar 

  21. 21.

    Krieger JL, Coveleski S, Hecht ML, Miller-Day M, Graham JW, Pettigrew J, Kootsikas A (2013) From kids, through kids, to kids: examining the social influence strategies used by adolescents to promote prevention among peers. Health Commun 28(7):683–695

    Article  Google Scholar 

  22. 22.

    Bynum SA, Brandt HM, Annang L, Friedman DB, Tanner A, Sharpe PA (2012) Do health beliefs, health care system distrust, and racial pride influence HPV vaccine acceptability among African American college females? J Health Psychol 17(2):217–226

    Article  Google Scholar 

  23. 23.

    Vanderpool RC, Cohen E, Crosby RA et al (2013) “1-2-3 pap” intervention improves HPV vaccine series completion among Appalachian women. J Commun 63(1):95–115

    Article  Google Scholar 

  24. 24.

    Blasi PR, King D, Henrikson NB (2015) HPV vaccine public awareness campaigns: an environmental scan. Health Promot Pract 16(6):897–905

    Article  Google Scholar 

  25. 25.

    Corcoran B, Clarke A, Barrett T (2018) Rapid response to HPV vaccination crisis in Ireland. Lancet 391(10135):2103

    Article  Google Scholar 

Download references


The authors would like to thank the leaders across the state of South Carolina who generously gave of their time to participate in interviews.


This project was funded by the National Cancer Institute through grant no. 3P30CA138313-06S2.

Author information



Corresponding author

Correspondence to Kathleen B. Cartmell.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cartmell, K.B., Mzik, C.R., Sundstrom, B.L. et al. HPV Vaccination Communication Messages, Messengers, and Messaging Strategies. J Canc Educ 34, 1014–1023 (2019).

Download citation


  • HPV vaccination
  • HPV-related cancers
  • Communication
  • Environmental scan
  • Evaluation
  • Implementation