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Education Level, Race, and Ethnicity May Affect Human Papillomavirus Awareness

In a recent study published in JAMA, HPV awareness varied by education level and by race and ethnicity. Inequitable dissemination of information and a need to tailor messages regarding HPV -related information may be the cause of differences in HPV awareness and knowledge.

Researchers conducted a cross-sectional study of US individuals, 18 years and older. Data was sourced from the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 between January 26, 2017, and June 15, 2020. The primary outcome was to assess differences in HPV awareness, vaccine awareness, and knowledge that HPV causes cancer. The interaction between educational attainment and race and ethnicity was assessed using a Wald test.


Almost half of the participants (N=15,637) were female (51.2% [95% CI, 51.0%-51.4%]).Most of these individuals identified as heterosexual (93.6% [95% CI, 92.7%-94.4%]) and had health insurance (91.6% [95% CI, 91.4%-91.7%]). The median age was 58 (IQR, 44-69) years, which increased with decreasing levels of educational attainment.


Most of the participants with race and ethnicity information were white (62.6% [95% CI, 64.0%- 64.7%]) , followed by hispanic (15.3% [95% CI, 16.1%-16.6%])  and black (13.9% [95% CI, 10.6%-11.2%]). A higher proportion of Black individuals had a household income of $34 999 or less (46.1% [95% CI, 41.9%-50.3%]) compared with other racial and ethnic groups (range, 21.3% [95% CI, 16.1%-27.5%] for Asian to 33.8% [95% CI, 30.5%-37.4%] for Hispanic).


Awareness of HPV decreased with decreasing educational attainment from those with less than high school to those with a college degree or higher (40.4% vs 78.2%).  Participants with a college degree were more likely to be aware that HPV causes cancer than participants without a high school degree (51.7% vs 84.7%).  Participants with a college degree or higher were more aware of HPV vaccines than those without a high school degree (34.7% vs 74.7%). White participants were more aware of HPV than Asian participants (46.9% vs 70.2%, respectively).Asian participants were less aware of HPV vaccines than white participants (48.4% vs 68.2%, respectively). 

Limitations of this study include low survey response rates.Language in questionnaires on gender identity may have led to inconsistency in surveys.


According to the researchers, “Despite the well-established scientific literature on HPV, the general US public lacks knowledge regarding HPV and its causality in cancers, as well as awareness of the HPV vaccine.”


Stephens, Erica S, et al. “Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity.” JAMA Network Open, vol. 6, no. 11, 14 Nov. 2023, pp. e2343325–e2343325,

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