Pediatricians in Appalachia less likely to recommend HPV vaccine

Pediatricians in Appalachia are less likely than doctors in other areas to encourage parents to have their children receive the human papillomavirus (HPV) vaccine, according to a new study.

The results are alarming because HPV infection is the most important risk factor for cervical cancer – and studies show that Appalachian women are more likely to get cervical cancer and to die from it than women living elsewhere.

"We found that pediatricians in Appalachia were less likely than others to think their patients were even susceptible to HPV," said Janice Krieger, lead author of the study and assistant professor of communication at Ohio State University.

"That's a huge problem. If pediatricians in Appalachia don't think HPV infection is an issue for their patients – when we know that it is – it is going to be difficult to convince women to get the HPV vaccine for themselves or their children."

HPV is the most common sexually transmitted infection and will infect about half of sexually active people in the United States during their lifetimes. HPV causes about 70 percent of cervical cancer cases, which can be deadly, especially in Appalachia. The cervical cancer mortality rates for women living in Appalachia Ohio were 41.7 percent greater than non-Appalachia Ohio from 2000 to 2004.

If Appalachian women are not getting the information they need about HPV from pediatricians, they aren't getting it from their local newspapers either. In a separate study, Krieger and her colleagues found that newspapers published in Appalachia contained fewer articles than papers outside the region about the threat of cervical cancer and the efficacy of the HPV vaccine.

"The results of these two studies suggest that women in Appalachia, who are at higher risk for cervical cancer, are less likely than others to have the information they need to make informed decisions about the HPV vaccine," Krieger said.

The study of pediatricians appears online in the journal Women's Health Issues and will be published in a future print edition.

In this study, Krieger and her colleagues surveyed 334 pediatricians in Appalachian and non-Appalachian areas of Kentucky and West Virginia.

The results showed that those pediatricians serving Appalachian areas were less likely to say they encouraged their patients to receive the vaccine, and were less likely to say their patients were susceptible to HPV.

One key reason may be the pediatricians in Appalachia were less likely than others to say that they would be comfortable talking to the parents of their patients about the importance of the HPV vaccine, Krieger said.

"The fact that HPV is sexually transmitted makes it a difficult subject to bring up. Other studies have shown that is especially true in small towns and rural areas where parents may be concerned about community gossip," she said.