Addressing Disparities in HPV Vaccination for Head and Neck Cancer Prevention in Adults (2025-2026)

Background

Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S., affecting 85% of sexually active individuals. While many HPV infections clear spontaneously, persistent infections can lead to serious health issues like cervical, oropharyngeal and other cancers. Alarmingly, HPV-associated oropharyngeal cancer rates have increased over the past 40 years, likely due to limited early detection, making vaccination the most effective prevention strategy.

In response to the need for broader HPV protection, the U.S. Food and Drug Administration expanded the recommended age for vaccination up to 45 years in 2018. While overall HPV vaccine uptake increased after this recommendation, notable disparities exist. Specifically, vaccine uptake remains lower among Black and Hispanic individuals, individuals with less than a high school education, and individuals who are uninsured.

A physician’s recommendation of the HPV vaccine is one of the most important predictors of vaccine uptake. Increasing physicians’ communication about the HPV vaccine, along with targeted public information campaigns, has the potential to increase vaccine uptake among underrepresented populations and ultimately reduce their risk of HPV-associated cancers.

Project Description

This project team will seek to address and reduce racial and ethnic disparities in HPV vaccine uptake among adults aged 27-45 in the United States, with a focus on HPV-related head and neck cancers. The team will include three subteams, each focused on a specific project aim:

• Aim 1: Conduct a scoping review of existing literature on physician communication strategies that successfully promote HPV vaccine uptake.
• Aim 2: Leverage Duke Health’s data systems to analyze current vaccination rates among adults in the target age range and evaluate the effectiveness of a recent media campaign at Duke aimed at increasing HPV vaccine awareness and uptake, with particular attention to underrepresented groups.
• Aim 3: Conduct a qualitative study with both vaccinated and unvaccinated individuals to explore the factors influencing individuals’ vaccination decisions, emphasizing the barriers encountered by racial and ethnic minorities.

The insights generated by the project will guide the development of targeted interventions and recommendations, ultimately helping to bridge the disparity gap in HPV vaccination rates and enhancing HPV-associated cancer prevention in minority populations.

Anticipated Outputs

Peer-reviewed publications, abstracts and grand rounds presentations on HPV vaccine–related health disparities; evidence-based guidelines to improve HPV vaccine communication and patient-provider interactions; robust dataset to support future research

Student Opportunities

Ideally, this project team will include 3 graduate students and 3 undergraduate students. Interested graduate students may come from such fields as public policy, epidemiology, medicine or public health. Undergraduate students may come from such fields as sociology, public health, health policy, psychology or pre-medical subjects. All applicants should demonstrate interest in health equity research and a passion for improving health outcomes for underserved populations. Cultural competency and strong communication skills are also necessary. Applicants with experience conducting surveys and qualitative interviews or analyzing qualitative and quantitative data are especially desirable.

This team will combine clinical insight with health disparities research, allowing students to connect with mentors from various backgrounds. Students will engage in literature review; perform data collection, extraction and interpretation; help develop surveys and recruit for prospective studies; gain interview and qualitative data coding experience; and deepen their understanding of health disparities. All students will have ample opportunities to disseminate their work by co-authoring abstracts and publications. Some may be selected to present at professional conferences.

In Fall 2025, this team will meet on Tuesdays from 4-5 p.m.

An optional summer component will take place over a 10-week period from early June to mid-August, with students expected to work approximately 10 hours per week. Participants will engage in initial training and work on literature review.

Timing

Summer 2025 – Spring 2026

• Summer 2025 (optional): Finalize study protocol; obtain IRB approval; begin literature review for Aim 1
• Fall 2025: Continue literature review; extract and analyze data for Aim 2; begin participant recruitment for Aim 3
• Spring 2026: Complete qualitative data collection for Aim 3; analyze qualitative and quantitative data; draft manuscripts and conference abstracts; finalize recommendations

Crediting

Academic credit available for fall and spring semesters; summer funding available