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A 13-Minute DVD Increases HPV Vaccination

It may be possible to curb cervical cancer in rural Appalachian Kentucky. Researchers from the University of Kentucky Prevention Research Center (PRC) have been leading efforts to understand and address cancer-related disparities in this underserved region. Specifically, women in this region have higher rates of cervical cancer and lower rates of HPV vaccination when compared with women in the rest of the country. While the issues behind low HPV vaccination rates may be complex, a strategy may be as simple as showing a tailored 13-minute DVD at a shopping center.

three female friends standingWhat is HPV?

Almost all cervical cancers are caused by human papillomavirus (HPV), which is a common virus that can be passed from one person to another during sex. It usually causes no symptoms, but certain types of HPV can lead to genital warts or changes in a woman’s cervix that can lead to cervical cancer over time. Fortunately, there is now a HPV vaccine that is widely available to prevent the spread of HPV, genital warts, and cervical cancer among girls and women. It is given in three doses over the course of a 6-month period. Learn more about HPV.

Why are HPV vaccination rates low in certain communities?

Researchers from the University of Kentucky PRC began studying HPV vaccination rates in local communities by offering the vaccine for free to young women aged 18–26 years through a rural clinic, a rural community college, and an urban clinic. More than 700 women were recruited, and the results showed lower vaccination rates in rural locations—less than 5% of the rural participants received all 3 doses of the vaccine, but 28% of the urban participants received all 3 doses.

Researchers conducted follow-up interviews on the topic of HPV vaccination to learn more from both rural health care providers and rural young women aged 18–26 years. The following are some examples of the most commonly reported reasons for not getting vaccinated:

  • Anticipated pain of injection.
  • Limited communication from the clinic.
  • Lack of information about cervical cancer, HPV, and the HPV vaccine.
  • Barriers such as limited transportation and child care.

Both the health care providers and the young women offered suggestions for improving vaccination rates and one major theme was the need for tailored, age-appropriate and region-specific educational campaigns.

Can a strategy to increase HPV vaccination rates be as simple as a 13-minute DVD?

Disc and laptopTo increase HPV vaccination rates in their area, researchers from the University of Kentucky PRC developed a video called "1-2-3 Pap," a 13-minute educational and motivational DVD that features women and health care providers from Appalachian Kentucky. To test the video, researchers recruited 344 young women in community settings such as local health departments, outdoor festivals, and shopping centers. All of the participants received the first dose of the vaccine at the time of enrollment. Half of the women then watched the DVD on individual laptops, and the other half received an informational pamphlet. All the participants then received phone call reminders to complete doses 2 and 3 of the vaccine series.

Researchers found positive results—the women who watched the DVD were more than twice as likely to complete the HPV vaccine series as the women who received the pamphlet. This simple approach can easily be adapted and repeated in other underserved areas with high rates of cervical cancer, such as other rural communities or minority populations. The video footage could also be re-filmed for use with males, because the HPV vaccine is recommended for men as well to prevent genital warts, throat cancer, and anal cancer caused by HPV. Further, this DVD can be delivered in a variety of non-clinic settings, which may be easier and quicker for women with limited transportation and time constraints.

Want to use this video or create a similar one for another underserved group?

The University of Kentucky PRC has partnered with the National Coordinating Center for Public Health Services and Systems Research to make the "1-2-3 Pap" video available on YouTube. If you are interested in learning more about the process of adapting and using the video, please visit the University of Kentucky PRC website or contact Robin Vanderpool at

What is the Prevention Research Centers Program?

The Prevention Research Centers Program is a network of academic, community, and public health partners that conducts applied public health research to promote health and prevent disease. Congress authorized the program in 1984, and the first 3 centers were funded 2 years later. Today, 37 centers, including 5 in a developmental stage, are located in 27 states, and they reach nearly 30 million people in 103 partner communities. PRCs work with vulnerable communities where the mean per capita income is one-third lower than the U.S. average. Information about their achievements and work in progress is available on the program's website.


Acosta AM, Bonney LE, Fost M, Green VL, del Rio C. HPV knowledge among a marginalized population [Letter]. Prev Chronic Dis. 2013;10:130088. doi:

Crosby RA, Casey BR, Vanderpool R, Collins T, Moore GR. Uptake of free HPV vaccination among young women: a comparison of rural versus urban rates. J Rural Health. 2011;27(4):380-4.

Head KJ, Vanderpool RC, Mils LA. Health care providers’ perspectives on low HPV vaccine uptake and adherence in Appalachian Kentucky. Pub Health Nurs. 2013. doi: 10.1111/phn.12044.

Mills LA, Head KJ, Vanderpool RC. HPV vaccination among young adult women: a perspective from Appalachian Kentucky. Prev Chronic Dis. 2013;10:E17. doi: 10.5888/pcd10.120183.

Vanderpool RC, Cohen EL, Crosby RA, et al. "1-2-3 Pap" Intervention improves HPV vaccine series completion among Appalachian women. Journal of Communication. 2013;63(1):95-115.