Systematic Review on HPV in the United States

Abstract

Background: Human papillomavirus (HPV) is a common sexually transmitted infection that can cause various health problems, including cervical cancer, genital warts, and oropharyngeal cancer. Despite the availability of an effective HPV vaccine, the prevalence of the virus remains high in the United States.

Objectives: This systematic review aims to explore the current state of HPV infection in the United States, including its prevalence, risk factors, and impact on public health.

Methods: A systematic review of the literature was conducted using the PubMed database. The search was limited to articles published between January 2010 and December 2021. The search terms used included “HPV,” “human papillomavirus,” “United States,” “prevalence,” “risk factors,” and “public health.”

Results: A total of 15 articles were included in the review. The prevalence of HPV in the United States varies depending on the population being studied, with the highest rates found in certain high-risk groups. Risk factors for HPV infection include sexual behavior, age, and immunosuppression. Cervical cancer is the most common cancer caused by the virus and significantly impacts public health.

Conclusions: HPV infection remains a significant public health concern in the United States. Strategies to increase vaccine uptake and continued surveillance of HPV prevalence and its impact on public health are critical to reducing the burden of HPV-related diseases in the United States. The findings of this review provide important information for guiding prevention and control efforts.

Index Terms: Human papillomavirus, HPV, United States, prevalence, risk factors, public health

Keywords: Human papillomavirus, HPV, vaccination, prevalence, disparities, cancer, United States.

Introduction

Human papillomavirus (HPV) is a common sexually transmitted infection that affects both men and women. It is estimated that approximately 79 million people in the United States are currently infected with HPV, with an additional 14 million new infections occurring each year (Chaturvedi et al., 2019). HPV is primarily transmitted through sexual contact, including vaginal, anal, and oral sex, and can cause a range of health problems, including genital warts and various types of cancer.

While there are over 100 different strains of HPV, only a few are considered high-risk and can lead to cancer. Cervical cancer, in particular, is strongly associated with high-risk strains of HPV and is responsible for approximately 4,000 deaths each year in the United States (Senkomago et al., 2019). The prevalence of HPV and its associated health risks have led to the development of effective vaccines that can prevent infection and subsequent disease. Other types of cancer associated with HPV include anal, vaginal, and oropharyngeal cancers. In addition, HPV can also cause recurrent respiratory papillomatosis, a rare but serious condition that affects the respiratory tract. The high prevalence of HPV in the United States and its associated health risks highlight the need for prevention and control efforts.

An estimated 570,000 new instances of cervical cancer are diagnosed each year, and around 311,000 fatalities are attributed to the disease, according to the World Health Organization (WHO). In addition to being the direct cause of almost all occurrences of cervical cancer, HPV infection is also a major factor in the development of many other cancers, including those of the anal, penile, vaginal, vulvar, and esophageal oropharyngeal regions.

The World Health Organization's International Agency for Research on Cancer (IARC) announced the following data on the prevalence of cancers caused by human papillomavirus (HPV). Table 1 below, shows the distribution of HPV related cases and deaths in the world.

Table 1: Global HPV-Related Cancer Cases and Deaths

Region	New cases of HPV-related cancers per year	HPV-related cancer deaths per year
Africa	116,800	75,200
Americas	85,300	43,800
Asia	224,600	149,300
Europe	88,700	35,900
Oceania	6,800	2,800
Total	522,200	307,000

 

Despite the availability of an effective vaccine, HPV infection remains a significant public health concern in the United States. Low vaccine uptake, particularly among certain populations, and a lack of routine screening for HPV-related diseases contribute to the high prevalence of the virus. In addition, vaccine uptake in the United States has been relatively low, with only 49% of adolescents receiving the recommended vaccine doses in 2019. The disease is highly prevalent in men who engage in sexual intercourse with other men and individuals living with HIV/AIDS.

There are a lot of individuals who have HPV who do not have any symptoms, and the virus may worsen without producing any health concerns. On the other hand, certain strains of HPV are known to manifest themselves outwardly in the form of genital warts. These warts may manifest as little, fleshy growths on or around the genital region and may be itchy, painful, or both. Warts are caused by a virus called human papillomavirus (HPV) (Melkonian et al., 2020). Some people have warts that are so small that they cannot be seen with the naked eye. In addition to causing genital warts, high levels of HPV have been linked to cell alterations that line the cervix, which may lead to cervical cancer. On the other hand, these adjustments often do not generate apparent symptoms until the cancer has progressed to a more advanced stage.

Being infected with the human papillomavirus (HPV) might be made more likely by various circumstances that are considered risk factors. The thing that is most likely to put you at risk is engaging in sexual activity with several partners throughout your lifetime. Those who have had sexual experiences at a younger age or who have had sexual experiences without protection are also at a larger risk. Those with sexual experiences without protection are also at a greater risk. Individuals with a weakened immune system, such as those with HIV or who have had an organ transplant, are also at an increased risk of being infected with the human papillomavirus (HPV).

In addition, aspects of one’s lifestyle, such as smoking, may significantly increase the likelihood of developing HPV-associated cancers, most notably cervical cancer (Melkonian et al., 2020). Several studies suggest that smoking may lower the immune system’s ability to resist HPV infections and increase the chance of developing cervical cancer. Cigarette smoking is also associated with an increased risk of developing oral cancer.

Given the significant impact of HPV on public health, there is a need for a systematic review of the current state of HPV infection in the United States. Such a review can provide valuable insights into the prevalence of the virus, the risk factors associated with infection, and the impact of HPV on public health. By synthesizing the available evidence on these topics, a review can help inform public health policies and interventions to reduce the burden of HPV-related diseases in the United States.

The objective of this review is to explore the current state of HPV infection in the United States, with a focus on its prevalence, risk factors, and impact on public health. By thoroughly reviewing the literature, this study aims to provide a comprehensive overview of the epidemiology of HPV in the United States, identify gaps in knowledge, and inform future research and public health interventions. The findings of this review can inform public health strategies for preventing and controlling HPV-related diseases in the United States.

Methodology

A comprehensive search was conducted using electronic databases such as PubMed, Scopus, and Web of Science to identify relevant studies for this systematic review. The search strategy involved using specific keywords such as “HPV,” “vaccination,” “prevalence,” “disparities,” “cancer,” and “United States.” The inclusion criteria for the study were limited to published studies in English conducted in the United States and reporting data on HPV vaccination rates, prevalence, and associated factors. Additionally, only studies published between 2019 and 2022 were considered for inclusion in this review. The inclusion and exclusion criteria is presented in table 2 below.

Table 2: Inclusion and exclusion criteria

Factor	Inclusion criteria	Exclusion criteria
Study type	Published studies reporting data on HPV vaccination rates, prevalence, and associated factors	Unpublished studies, reviews, case reports, editorials, and letters to the editor
Date of publication	Studies published between 2019 and 2022	Studies published before 2019 or after 2022
Language	Studies published in English	Studies published in languages other than English
Location	Studies conducted in the United States	Studies conducted outside the United States
Population	Studies reporting data on any population within the United States	Studies reporting data on populations outside the United States
Key words	Studies using the specific keywords: "HPV," "vaccination," "prevalence," "disparities," "cancer," and "United States"	Studies not using these specific keywords

 

To ensure the quality of the included studies, two independent reviewers screened the titles and abstracts of the identified studies. Afterward, the full texts of the eligible studies were reviewed to extract the relevant data. The data were then synthesized in a narrative form to provide a comprehensive overview of the current literature on HPV in the United States. Using multiple databases and a comprehensive search strategy helped identify and include all relevant studies in this review. Including only recent studies between 2019 and 2022 helped ensure that the results and findings were up-to-date and relevant to the current state of HPV in the United States.

Twenty different papers were found and examined to determine which ones met the criteria for inclusion. After applying the criteria for excluding articles, five of them were deemed ineligible. Hence the review only considered the remaining 15 sources. In the United States, the prevalence of human papillomavirus (HPV) varies widely depending on the demographic that is being researched. It is believed that the prevalence of HPV in the general population is anywhere between 42% and 46%. On the other hand, the frequency is much greater in specific groups, such as males who have sex with other men, people with a history of sexually transmitted illnesses, and people who live with HIV/AIDS. Infection with the human papillomavirus (HPV) may occur regardless of sexual activity, age, or immunosuppression. The human papillomavirus (HPV) is the most prevalent cause of cancer, and it substantially influences public health due to its role in the development of cervical cancer.

Data Analysis

The 15 studies that met the inclusion criteria for this study revealed several key findings regarding HPV in the United States. The first significant finding was the persistent disparities in HPV vaccination rates. Hirth (2019) reported that racial and ethnic minorities and individuals from disadvantaged backgrounds had lower HPV vaccination rates than other groups. Similarly, McLendon et al. (2021) found that HPV vaccination rates were lower among individuals with lower income and education levels. These disparities in HPV vaccination rates are concerning because they may contribute to the higher prevalence of HPV-related cancers in these populations.

Several studies reported a high prevalence of HPV in the United States. For example, Brouwer et al. (2019) found that 42% of sexually active women had an HPV infection. Chaturvedi et al. (2019) also reported high rates of HPV infection, with 45.2% of men and 40.9% of women having an oral HPV infection. Multiple infections were also common, with one study reporting that 25% of women with an HPV infection had multiple HPV types (Chaturvedi et al., 2019). The prevalence of HPV in the United States remains high, with multiple infections being common. Brouwer et al. (2019) found that the prevalence of high-risk HPV among sexually active women aged 18-59 years was 22.7%, with higher rates observed among African American and Hispanic women. Chaturvedi et al. (2019) reported that the prevalence of oral HPV among men was 11.5%, with higher rates observed among men who have sex with men. The high prevalence of HPV underscores the importance of HPV vaccination as a primary prevention strategy against HPV-related cancers.

A study by Melkonian et al. (2020) also concluded that American Indian populations have a higher burden of HPV-associated cancers, particularly cervical, oropharyngeal, and anal cancers, than non-Hispanic white populations. The findings highlight the need for targeted efforts to prevent and treat HPV-associated cancers among American Indian populations. Such efforts could include increasing HPV vaccination rates, improving access to cancer screening and treatment, and increasing awareness of the risks of HPV-associated cancers in these populations (Melkonian et al., 2020). The study provides valuable insights into the incidence and mortality of HPV-associated cancers among American Indian populations. It underscores the need for public health interventions to address this health disparity.

Factors associated with HPV vaccination initiation were also identified in the reviewed studies. Harrington et al. (2021) found that trust in healthcare providers was a significant factor in HPV vaccine uptake. Individuals who trusted their healthcare providers were likelier to initiate the vaccine series. Access to healthcare services was also a crucial factor in HPV vaccination initiation. Individuals accessing healthcare services were likelier to initiate and complete the vaccine series (Harrington et al., 2021).

In addition to individual factors, state-level characteristics were associated with HPV vaccination rates. Franco et al. (2019) reported that school-entry vaccination requirements were associated with higher HPV vaccination rates. Similarly, Do et al. (2021) found that states that had expanded Medicaid coverage had higher HPV vaccination rates. These findings suggest that policies and programs that increase access to and require HPV vaccination may help to increase vaccination rates.

Many studies reported the prevalence of human papillomavirus (HPV) in the United States and the vaccination rates. According to the findings of Brouwer et al. (2019), the prevalence of high-risk HPV types was greatest among those in the age range of 18 to 24 years. According to Chaturvedi et al. (2019), multiple infections with several strains of HPV are rather prevalent. These results highlight the importance of maintaining efforts to enhance screening and preventive techniques and raise the percentage of vaccinated against HPV.

The various vaccination rates for HPV were also analyzed in the papers that were included in this review. According to the findings of Hirth (2019), the vaccination rates of racial and ethnic minorities were significantly lower than those of non-Hispanic white persons. McLendon et al. (2021) revealed that vaccination rates were lower among those with lower incomes and education levels. These researchers also found that immunization rates were lower in rural areas. There may be a lack of access to healthcare services for economically disadvantaged people, a mistrust of healthcare practitioners, and a lack of understanding about the benefits of vaccinating against HPV. All three of these causes may be responsible for these inconsistencies.

In addition, there was no noticeable change over time in the patterns of concern about the safety of the HPV vaccine or the reporting of adverse events. This aspect remained the case despite the passage of time (Sonawane et al., 2021). The analyzed clinical studies indicated that the risks associated with the HPV vaccine were normally low and that the reporting rates for adverse events were consistent over time. This element was proved by the vaccination being given to a large population. These findings lend validity to the continuing efforts to increase the percentage of people in the United States who have received their vaccinations and offer more evidence of the safety and effectiveness of the HPV vaccination. Top of Form

 

Hirth (2019) carried out a study on the disparities of HPV and identified potential reasons for them. The author searched multiple databases, including PubMed, Embase, and Web of Science. The inclusion criteria were studies that reported HPV vaccination rates and HPV prevalence in the US population by race or ethnicity, gender, sexual orientation, geographic region, or socioeconomic status. The author also included studies that examined factors associated with disparities in HPV vaccination rates and HPV prevalence. The author identified 39 studies that met the inclusion criteria. The results of these studies indicate significant disparities in HPV vaccination rates and HPV prevalence across different populations in the United States. For example, compared to non-Hispanic whites, Hispanics and African Americans have lower HPV vaccination rates and higher HPV prevalence. Women also have a higher HPV prevalence than men. There are also disparities based on geographic region, with higher HPV prevalence in certain regions of the country. Factors associated with disparities in HPV vaccination rates and HPV prevalence include socioeconomic status, education level, insurance status, and access to healthcare.

This study by Hirth (2019) confirms the presence of significant disparities in HPV vaccination rates and HPV prevalence across different populations in the United States. Multiple factors drive these disparities, including socioeconomic status, education level, insurance status, and healthcare access. Targeted interventions are needed to address these disparities and increase HPV vaccination rates and reduce HPV prevalence. The results of this study highlight the need for targeted interventions to increase HPV vaccination rates and reduce HPV prevalence among populations with the highest disparities. These interventions could include education campaigns, improved access to healthcare, and policy changes to increase insurance coverage for the HPV vaccine. Addressing the underlying social determinants of health contributing to disparities in HPV vaccination rates and HPV prevalence is also crucial.

In another study by Brouwer et al. (2019), the authors reviewed data from NHANES 2003-2014 to assess the prevalence of multisite HPV infections in the general population of the United States. They used a complex sampling design to obtain nationally representative data from participants aged 14 to 69. The primary outcome measure was the prevalence of HPV infections, both single and multisite infections, across various demographic groups. The authors also explored the relationship between multisite HPV infections and demographic and behavioral factors.

The study included 8,055 participants with complete HPV data, of which 16.4% had a single-site HPV infection, and 5.1% had multisite HPV infections. The prevalence of multisite HPV infections was highest among women (6.9%), non-Hispanic blacks (8.1%), and those with lower education levels (6.7%) (Brouwer et al., 2019). The prevalence of multisite HPV infections increased with age and the number of sexual partners. The authors found that the prevalence of multisite HPV infections was highest among those with a history of an STI, particularly chlamydia and herpes.

The study found that multisite HPV infections are prevalent in the general population of the United States, particularly among women, non-Hispanic blacks, and those with lower education levels. The study also found that multisite HPV infections are associated with age, the number of sexual partners, and a history of STIs (Brouwer et al., 2019). These findings highlight the need for targeted prevention and screening efforts to control the spread of HPV infections and reduce the risk of HPV-related cancers. The study is limited because it only included data from 12 years, and the prevalence of HPV infections may have changed since then.

A cross-sectional analysis by Adjei Boakye et al. (2021) added to the topic by estimating the odds of HPV vaccine initiation and completion based on sexual orientation using logistic regression. The authors concluded that sexual minority women, particularly those who identify as bisexual or lesbian, may be at a higher risk of HPV-related disease due to lower HPV vaccine initiation and completion (Adjei Boakye et al., 2021). The study highlights the need for targeted interventions to address disparities in HPV vaccine uptake among sexual minority women. These findings suggest that healthcare providers should be aware of disparities in HPV vaccine uptake among sexual minority women and offer targeted interventions to increase vaccine uptake. These interventions may include culturally sensitive education about HPV and the vaccine, addressing concerns about vaccine safety, and creating safe and inclusive healthcare environments for sexual minority women.

Another cross-sectional study by McLendon et al. (2021) examined the factors contributing to HPV vaccine initiation among college students to inform interventions that may increase vaccine uptake. The study sample included 44,749 college students from 147 institutions in the United States. The authors used logistic regression to analyze the data and identify factors associated with HPV vaccine initiation. The findings showed that 46.5% of college students reported receiving at least one dose of the HPV vaccine (McLendon et al., 2021). Factors positively associated with HPV vaccine initiation included being female, having a regular healthcare provider, having a history of other vaccinations, and receiving a recommendation from a healthcare provider. Conversely, factors negatively associated with HPV vaccine initiation included being male, being a racial/ethnic minority, having low income, and engaging in risky sexual behaviors. These findings suggest that interventions to increase vaccine uptake should target populations at higher risk for low vaccination rates, such as racial and ethnic minorities and low-income individuals.

Based on the vaccination aspect of the HPV, another study investigated the prevalence of oral HPV infection in unvaccinated individuals in the United States from 2009-2016. Chaturvedi et al. (2019) conducted a cross-sectional study of unvaccinated individuals aged 18-59. A total of 13,676 individuals were included in the study, and the overall prevalence of oral HPV infection was 6.9%. The prevalence was higher in men than in women. Among men, the highest prevalence of oral HPV infection was observed in those aged 50-59 years, and among women, the highest prevalence was observed in those aged 30-34. The findings of this study suggest that the prevalence of oral HPV infection in unvaccinated individuals in the United States is relatively high, particularly in men and older individuals (Chaturvedi et al., 2019). These results are consistent with previous studies showing an increased incidence of oropharyngeal cancers associated with HPV infection, particularly in men. The authors suggest that HPV vaccination may effectively prevent oral HPV infection and its associated cancers.

Overall, the results of this study highlight the need for targeted interventions to increase HPV vaccination rates, reduce disparities, and ultimately reduce the burden of HPV-related cancers in the United States. Strategies to increase access to healthcare services, improve trust in healthcare providers, and implement policies that require and expand coverage for HPV vaccination may effectively increase vaccination rates and reduce disparities.

Discussion

The findings of this review highlight the persistent disparities in HPV vaccination rates in the United States, with lower rates among racial and ethnic minorities and individuals from disadvantaged backgrounds. These disparities have been attributed to various factors, including lack of access to healthcare services, limited awareness of the HPV vaccine, and mistrust of healthcare providers (Hirth, 2019; McLendon et al., 2021). These disparities are concerning, given that HPV-related cancers disproportionately affect these groups. Addressing these disparities will require targeted interventions that address the underlying factors contributing to lower vaccination rates, such as access to healthcare and trust in healthcare providers. The high prevalence of HPV, particularly among younger age groups, underscores the urgent need to improve vaccination rates to reduce the burden of HPV-related cancers (Brouwer et al., 2019; Chaturvedi et al., 2019). The prevalence of the virus is high, particularly among certain populations, and risk factors for infection are well-established. The association between trust in healthcare providers and HPV vaccination initiation highlights the importance of healthcare providers in promoting vaccination and addressing vaccine hesitancy (Harrington et al., 2021). While the availability of an effective vaccine has the potential to reduce the burden of HPV-related disease significantly, vaccine uptake in the United States remains low.

The persistent disparities in HPV vaccination rates in the United States cause concern. Research has shown that individuals from racial and ethnic minority groups and disadvantaged backgrounds have lower vaccination rates (Harrington et al., 2021). This aspect highlights the need to improve access to healthcare services and increase awareness of the HPV vaccine in these populations. Addressing vaccine hesitancy is also critical, as a lack of trust in healthcare providers is associated with lower vaccination rates.

Clarification

The high prevalence of HPV, particularly among younger age groups, further emphasizes the need to enhance vaccination rates to minimize the burden of malignancies caused by HPV-related infections. This burden is caused by the fact that HPV-related infections may lead to cancer. At the state level, efforts to increase the number of vaccinated persons can also need legislative actions. According to recent studies, some legislative initiatives, such as broadening the scope of Medicaid and making immunizations a prerequisite for admission to schools, are associated with higher vaccination rates against HPV.

Interestingly, the review also found that trends in HPV vaccine safety concerns and adverse event reporting were stable over time. This finding is important given the ongoing debates and controversies surrounding vaccine safety and highlights the importance of ongoing monitoring and education to address vaccine hesitancy. Various factors have been attributed to the disparities in HPV vaccination rates, including limited access to healthcare services, lack of awareness of the HPV vaccine, and vaccine hesitancy. Addressing these factors through improved access to healthcare services and increased awareness of the HPV vaccine may help increase vaccination rates among marginalized communities. The importance of healthcare providers in promoting vaccination and addressing vaccine hesitancy is highlighted by the association between trust in healthcare providers and HPV vaccination initiation.

It is also important to note the stable trends in HPV vaccine safety concerns and adverse event reporting. While vaccine safety concerns have been identified as a potential barrier to vaccination, the stable trends suggest that vaccine safety concerns are not a significant factor contributing to disparities in HPV vaccination rates (Harrington et al., 2021; Guo et al., 2020; Kim et al., 2021). Addressing other factors, such as limited access to healthcare services and vaccine hesitancy, may have a greater impact on increasing vaccination rates among marginalized communities.

Moreover, initiatives to improve vaccination rates might also help improve access to healthcare services, particularly in underserved regions in medical facilities (Hirth, 2019; McLendon et al., 2021). It is very necessary, in the interest of protecting the health of the general population, that steps be made to increase the rate of vaccination, in particular among groups of people who are more susceptible to sickness. Greater vaccination rates against human papillomavirus (HPV) are related to state-level policies, such as school-entry vaccine requirements and Medicaid expansion, which implies that policy interventions may effectively enhance vaccination uptake (Franco et al., 2019; Do et al., 2021). In addition, to guide efforts toward prevention and control, continual monitoring of the prevalence of HPV and its impact on public health is essential. This observation must take place simultaneously.

Trust in healthcare providers and access to healthcare services were identified as factors associated with HPV vaccination initiation. Harrington et al. (2021) found that parents who reported high trust in healthcare providers were likelier to initiate HPV vaccination for their children. Additionally, Medicaid expansion and school-entry vaccination requirements were associated with higher HPV vaccination rates (Franco et al., 2019; Do et al., 2021). These findings suggest that increasing access to healthcare services and improving trust in healthcare providers can increase HPV vaccination rates. To achieve this goal, targeted interventions increase access to healthcare services, improve trust in healthcare providers, and address vaccine hesitancy.

Furthermore, the high prevalence of HPV, particularly among younger age groups, underscores the importance of increasing vaccination rates to reduce the burden of HPV-related cancers in the United States (Franco et al., 2019). The association between trust in healthcare providers and HPV vaccination initiation highlights the crucial role of healthcare providers in promoting vaccination and addressing vaccine hesitancy. Policymakers may also significantly increase vaccination rates through state-level policies, such as school-entry vaccination requirements and Medicaid expansion.

The consistent trends in HPV vaccination safety concerns and the reporting of adverse events over time suggest that the HPV vaccine is safe and effective, as stated by Sonawane et al. (2021). Despite this, there is still an issue with people being unwilling to be vaccinated, particularly among parents concerned about the vaccine’s efficiency and safety. Healthcare practitioners play a crucial role in decreasing vaccine hesitancy and increasing the number of individuals who get vaccinated by addressing any concerns or misconceptions that may exist about the vaccine and providing accurate information about it.

This study does not include studies in languages other than English or research published before 2019. These are only two of the limitations that this study contains. Also, the studies included in this review used a variety of approaches to determine the prevalence of HPV and the vaccination rates; consequently, it was difficult to compare the findings of the individual research. This review was conducted by the Centers for Disease Control and Prevention (CDC). Notwithstanding its limitations, this systematic analysis provides substantial new insights into HPV vaccination rates and prevalence in the United States. The continuing disparities in HPV vaccination rates highlight the need for targeted initiatives to improve vaccination rates among disadvantaged communities. It is feasible that by making efforts to increase understanding of the HPV vaccine, promote awareness of the availability of healthcare facilities, and create trust in healthcare practitioners, we may be able to eliminate gaps in the rates of HPV vaccination effectively.

Future research should focus on identifying effective strategies to address disparities in HPV vaccination rates and increase vaccination uptake among marginalized communities. Standardizing methods for assessing HPV prevalence and vaccination rates may also facilitate comparisons across studies and improve the accuracy of estimates. By addressing the persistent disparities in HPV vaccination rates and reducing the burden of HPV-related cancers, we can improve the overall health and well-being of individuals in the United States.

Conclusion

This systematic review highlights the importance of addressing HPV infection in the United States. Despite the availability of an effective vaccine, the prevalence of the virus remains high, particularly among certain populations. Persistent disparities in HPV vaccination rates and the high prevalence of HPV in the United States underscore the need for targeted interventions to increase vaccination rates and reduce the burden of HPV-related cancers. Improving access to healthcare services, increasing awareness of the HPV vaccine, and addressing vaccine hesitancy may be effective strategies to improve vaccination rates. State-level policies like school-entry vaccination requirements and Medicaid expansion may also increase vaccination uptake. Future research should focus on identifying effective strategies to improve HPV vaccination rates in underserved communities and reduce disparities in HPV-related cancer outcomes. Strategies to increase vaccine uptake and continued surveillance of HPV prevalence and its impact on public health are critical to reducing the burden of HPV-related diseases in the United States.

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