Focus on STD, not cancer prevention, to promote HPV vaccine use

These results go against the conventional wisdom that scaring women about the possibility of cancer is the best way to get them vaccinated.

The failure of that cancer-threat message may be one reason that fewer than 20 percent of adolescent girls in the United States have received the HPV vaccine, said Janice Krieger, lead author of the study and assistant professor of communication at The Ohio State University.

"Young women don't respond strongly to the threat of cervical cancer," Krieger said.

"They seem to be more worried about getting an STD. That's the way we should try to encourage them to get the HPV vaccine."

The vaccine -- most commonly sold under the brand name Gardasil -- prevents the types of HPV, or human papillomavirus, that cause most cases of cervical cancer and most cases of genital warts, a sexually transmitted disease.

Krieger conducted the study with Melanie Sarge of Texas Tech University. It appears in a recent issue of the journal Health Communication.

Many early studies of how to sell the benefits of the HPV vaccine found that the message that it prevents cancer was effective. But these studies often involved women of all ages, from adolescence to old age. The problem, though, is that the vaccine is targeted to women under the age of 26.

"Cancer is something people start to worry about later in life, not when they're in high school and college. We decided to do a clean study that compared what message worked best with college-aged women versus what worked with their mothers," Krieger said.

Participants in the study included 188 female college students (average age of 22) and 115 of their mothers (average age of 50).

The mothers and students both received a packet of materials that included a questionnaire and a pro-vaccine message. The student message recommended talking to a doctor about the HPV vaccine, and the parent message recommended encouraging their daughter to talk to a doctor.

Two different messages were created. Half of the mothers and students received a message sheet about the vaccine with a large headline that read, "Prevent cervical cancer." The other half received a similar message, but with the headline declaring, "Prevent genital warts." A text box on the sheet also re-emphasized either the cancer or the genital warts message.

Participants then filled out the questionnaire, which asked a variety of questions that included how they felt about the threat of HPV and whether they felt they (or their daughter) could talk to a doctor about receiving the vaccine.

Results showed that the message emphasizing the vaccine's effectiveness at preventing genital warts was a clear winner with the young women.

Compared to those who received the cancer prevention message, young women who read that the vaccine prevented genital warts were more likely to say they intended to talk to their doctor about the vaccine. They also said they felt more comfortable talking to their doctor about the vaccine.

"Preventing cancer was not a big motivator," Krieger said.

Overall, the findings showed that scaring young women into getting the vaccine doesn't seem to be a good strategy.

Young women who perceived HPV as a bigger threat to their health than others, or who thought they were more likely to get the virus, were not consequently more likely to say they would get the vaccine or talk to their doctor.

"Our results suggest it is more important to get women to feel comfortable talking to their doctor about the vaccine," she said. "Fear doesn't work. They need to feel it is not difficult or embarrassing to discuss the vaccine with their doctor. That's the best way to encourage them to be vaccinated."

The researchers expected that the mothers in the study would be more likely to talk to their daughters about getting the HPV vaccine if they read the cancer prevention message rather than the STD prevention message.

Part of their reasoning was that the mothers, being older, were at a stage in their life when cancer was a bigger issue for them, Krieger said. But they also thought mothers would not feel comfortable about an STD message that assumes that their daughters were sexually active.

However, it turned out that the mothers weren't affected by which of the messages they received.

"We believed that mothers would react negatively to the message about preventing genital warts, but that wasn't supported. Mothers reacted similarly to the genital warts and cancer prevention messages. It suggests that if we focus on the prevention of genital warts in our messages to daughters, it may not mean we have lost the mothers."

Krieger said the results should encourage policymakers, doctors and others to shift their messages to young women concerning the HPV vaccine.

"Cancer may seem to be the more serious issue to some older adults, but it is not the top concern for young women," she said.