Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods.

Methods: We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students’ knowledge on the SCP topics, HPV knowledge, tobacco usage, and factors that reduced cancer development.

Results: 87% agreed that tobacco products are associated with cancer, and 81% did not agree that E-cigarettes are scientifically proven to be safer than cigarettes. Although we do not have pre-evaluation data about these students’ HPV knowledge, our evaluation survey shows that 80% of students correctly identified HPV as the most common STI, and 84% of students correctly identified the factors that decrease their risk of developing cancer.:

Conclusion:Through this initiative, students learned essential health concepts and HPV-related risk factors.

Keywords: Human papilloma virus, Rural health, Cancer prevention, Schooling cancer program, Healthy lifestyle, Vaccination


[1] Braverman PK. HPV Vaccine in Adolescents. Pediatr Ann. 2019 Feb 1;48(2):e71-e77. doi: 10.3928/19382359-20190118-02.

[2] Amerivan Cancer Society. Cancer Facts & Figures 2021. [ cited 2023 Jan]. Available from https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html

[3] Thomas TL. Cancer Prevention: HPV Vaccination. Semin Oncol Nurs. 2016 Aug;32(3):273-80. doi: 10.1016/j.soncn.2016.05.007.

[4] Shapiro GK. HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol. 2022 May 23;29(5):3780-3792. doi: 10.3390/curroncol29050303.

[5] Cox DS, Cox AD, Sturm L, Zimet G. Behavioral interventions to increase HPV vaccination acceptability among mothers of young girls. Health Psychol. 2010 Jan;29(1):29-39. doi: 10.1037/a0016942.

[6] Griffiths AJ, Diamond EL, Alsip J, Furlong M, Morrison G, Do B. School-wide implementation of positive behavioral interventions and supports in an alternative school setting: A case study. J Community Psychol. 2019 Jul;47(6):1493-1513. doi: 10.1002/jcop.22203.

[7] Basu P, Bhatla N, Ngoma T, Sankaranarayanan R. Less than 3 doses of the HPV vaccine - Review of efficacy against virological and disease end points. Hum Vaccin Immunother. 2016 Jun 2;12(6):1394-402. doi: 10.1080/21645515.2016.1146429

[8] Donken R, Dobson SRM, Marty KD, Cook D, Sauvageau C, Gilca V, et al. Immunogenicity of 2 and 3 Doses of the Quadrivalent Human Papillomavirus Vaccine up to 120 Months Postvaccination: Follow-up of a Randomized Clinical Trial. Clin Infect Dis. 2020 Aug 14;71(4):1022-1029. doi: 10.1093/cid/ciz887.

[9] Henry KA, Swiecki-Sikora AL, Stroup AM, Warner EL, Kepka D. Area-based socioeconomic factors and Human Papillomavirus (HPV) vaccination among teen boys in the United States. BMC Public Health. 2017 Jul 14;18(1):19. doi: 10.1186/s12889-017-4567-2. Erratum in: BMC Public Health. 2017 Sep 22;17 (1):736.

[10] Thanasas I, Lavranos G, Gkogkou P, Paraskevis D. Understanding of Young Adolescents About HPV Infection: How Health Education Can Improve Vaccination Rate. J Cancer Educ. 2020 Oct;35(5):850-859. doi: 10.1007/s13187-019-01681-5.

[11] Dell DL, Chen H, Ahmad F, Stewart DE. Knowledge about human papillomavirus among adolescents. Obstet Gynecol. 2000 Nov;96(5 Pt 1):653-6. doi: 10.1016/s0029-7844(00)01009-7.

[12] Liu CR, Liang H, Zhang X, Pu C, Li Q, Li QL, et al. Effect of an educational intervention on HPV knowledge and attitudes towards HPV and its vaccines among junior middle school students in Chengdu, China. BMC Public Health. 2019 May 2;19(1):488. doi: 10.1186/s12889-019-6823-0.

[13] Skinner SR, Davies C, Cooper S, Stoney T, Marshall H, Jones J, et al. HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents. BMC Public Health. 2015 Sep 15;15:896. doi: 10.1186/s12889-015-2168-5.

[14] Makadia LD, Roper PJ, Andrews JO, Tingen MS. Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes. Curr Allergy Asthma Rep. 2017 Aug;17(8):55. doi: 10.1007/s11882-017-0723-0.

[15] Tarney CM, Beltran TA, Klaric J, Han JJ. Tobacco Use and Prevalence of Human Papillomavirus in Self-Collected Cervicovaginal Swabs Between 2009 and 2014. Obstet Gynecol. 2018 Jul;132(1):45-51. doi: 10.1097/AOG.0000000000002681.

[16] Athanasiou A, Bowden S, Paraskevaidi M, Fotopoulou C, Martin-Hirsch P, Paraskevaidis E, Kyrgiou M. HPV vaccination and cancer prevention. Best Pract Res Clin Obstet Gynaecol. 2020 May;65:109-124. doi: 10.1016/j.bpobgyn.2020.02.009.

[17] Davies C, Stoney T, Hutton H, Parrella A, Kang M, Macartney K, et al. School-based HPV vaccination positively impacts parents' attitudes toward adolescent vaccination. Vaccine. 2021 Jul 5;39(30):4190-4198. doi: 10.1016/j.vaccine.2021.05.051.

[18] Koskan AM, Dominick LN, Helitzer DL. Rural Caregivers' Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children. J Cancer Educ. 2021 Feb;36(1):189-198. doi: 10.1007/s13187-019-01617-z.

[19] Thomas TL, Strickland OL, DiClemente R, Higgins M, Haber M. Rural African American parents' knowledge and decisions about human papillomavirus vaccination. J Nurs Scholarsh. 2012 Dec;44(4):358-67. doi: 10.1111/j.1547-5069.2012.01479.x. Epub 2012 Nov 5. Erratum in: J Nurs Scholarsh. 2013 Jun;45(2):219.