Florida’s vaccination rate for a virus that can take hold early and cause cancer later in life is among the nation’s lowest, and its rate of those cancers is among the nation’s highest. Eleven North Central Florida rural counties have even higher rates.
Stephanie Staras, M.S.P.H., Ph.D., a UF Health researcher in the University of Florida College of Medicine, aims to reduce this risk by addressing multiple barriers to vaccination in rural areas with the help of a $4 million, five-year National Institutes of Health grant that began in September. The project will give clinicians clear strategies and help parents understand the HPV vaccine. It also will provide rural residents help with transportation, health insurance navigation and vaccine access through UF Clinical and Translational Science Institute mobile clinics.
Human papillomavirus, or HPV, is the cause of six forms of cancer, including almost all cervical cancers, as well as cancers of the anus, vulva, vagina, penis and the back of the throat. Health officials say the virus causes more than 37,000 cancer diagnoses each year.
Despite the availability of effective vaccines that can prevent HPV infection and its associated cancer risks, low vaccination rates continue.
The low vaccination rate combined with the high number of HPV-related cancer diagnoses is a national concern, especially in Florida. Florida currently ranks 47th among the states for vaccine initiation (administering the first of two doses), and 48th in receiving both recommended vaccinations. In Florida, 20,186 new cases of HPV-related cancers were diagnosed between 2015-2019.
Staras’ targeted area — Bradford, Columbia, Dixie, Hamilton, Lafayette, Levy, Madison, Putnam, Suwannee, Taylor and Union counties — has lower vaccination rates than the state and higher HPV-related cancer rates for both men and women.
For example, just 13% of 9- to 12-year-olds in Lafayette County have started the two-part vaccine series, while only 5% have completed it. Meanwhile, HPV-related cancers in the county occur at higher rates than both the state and nation, with 17.6 cases per 100,000 women and 19.2 cases per 100,000 men. These low vaccination rates can be attributed to barriers, such as lack of public transportation and the sheer distance to local clinics, as well as hesitancy from parents concerned about the vaccine’s overall safety.
A parent as well as a researcher, Staras understands these concerns.
“I understand that it is scary,” Staras said. “As a parent it’s tough to watch your child get medical care like vaccines, so I understand the hesitancy. I want families to understand the impact the vaccines can have on the life of their children. I want clinicians to be able to make sense of the research and to be able to communicate to parents and caregivers accurate and reliable information surrounding the vaccine.”
HPV vaccines were approved in the U.S. in 2006 for girls and in 2011 for boys. Experts suggest that all children between 11 and 12 years old should receive the vaccine, with vaccination starting as young as age 9 and up to age 45. The HPV vaccine is safe, with typically minor side effects like pain and redness at the injection site. And it is 99% effective at protecting recipients from the nine targeted HPV strains and 92% effective at preventing HPV-related cancers.
Staras has specialized in HPV vaccine implementation research since the vaccine’s release. She is an associate professor and the director of the UF Clinical and Translational Science Institute’s Precision Public Health Program, a collaborative team of scientists and health professionals dedicated to finding ways to improve health outcomes for underserved groups. The success of her work mostly has been due to her focus on improving parents’ confidence in the vaccines and helping clinicians make better recommendations. However, Staras’ new initiative takes things a step further by increasing vaccine accessibility in rural communities.
As part of its commitment to improving health outcomes across the state of Florida and beyond, the UF CTSI will provide the support of its mobile health fleet of seven vehicles to assist with community outreach. This fleet previously has been used to help offer free vaccinations and health screenings during the COVID-19 pandemic. Now the vehicles will be used to supply HPV vaccines to the areas of greatest need in North Central Florida.
The UF Health Cancer Center, where Staras is a member of the Cancer Control & Population Sciences research program, provides support through its Office of Community Outreach and Engagement and Community Advisory Board. She is supported, in part, through the UF Health Cancer Center by the Casey DeSantis Cancer Research Act (Fla. Stat. § 381.915). Additionally, the OneFlorida Clinical Research Consortium, jointly funded by the CTSI and the UF Health Cancer Center, is partnering with Staras to help identify participating primary care clinics. The existing collaborative relationships between UF Health Cancer Center investigators and community partners helped Staras gain the support of multiple institutes for this important collaborative project: UF Institute of Food and Agricultural Sciences Extension Suwannee River Area Health Education Center, CommunityHealth IT, a federally designated Rural Health Network (Rural Health Partnership), and the Florida Department of Health.