Cervical cancer mortality rates are 45 percent higher in Eastern and southeastern Kentucky than in the rest of the country, according to statistics from the Centers for Disease Control.
One in five women in Eastern and southeastern Kentucky has not had a Pap test during the past three years, and Pap tests are key to revealing cervical changes that can lead to cancer.
For those women, the three-shot HPV vaccine Gardasil, which became available several years ago and fights the virus linked with cervical cancer, should have been sending young women flocking to health care providers.
So why didn't it?
University of Kentucky health behavior researchers Elisia Cohen, an associate professor of communication, and Robin C. Vanderpool, an assistant professor in the department of public health, decided to look in to why women 18-26 weren't getting the full series of shots. Their findings were included in an article in the academic publication Journal of Communication in February.
When the vaccine was introduced in 2006, it was targeted at younger teens, who often would be brought to physicians and clinics by their parents.
The researchers asked themselves: What kind of incentive would it take to get young women older than 18 to commit to getting three shots within six months, knowing it could save their lives?
They knew that simply providing the full series of three shots at no cost did not work. They recruited 246 women in 2010-11 from rural health clinics with vouchers for the full series of shots. Only 45 percent took the first shot; 14 percent of those who took the first shot returned for the second, and only 5 percent received the third.
So researchers tried again: They gave the first dose of medication free to 344 young women at health departments, medical clinics, community colleges, outdoor festivals, Wal-Mart stores, businesses and homes.
Then, they asked those women if they'd like to take part in a study. This time, though, they'd make it personal: Women getting their first shot would watch a video in which area medical providers and women who had received the shots would talk about the importance of taking charge of their health. The video team used interviews and focus groups to design the DVD.
It was theorized that women who saw other young women like themselves talking positively about the vaccine's effect would be more willing to get all the shots.
"Really, half the battle is getting them in for dose one," Vanderpool said. "But there's also getting them in for dose two or three."
One of the young women in the video talked about losing her grandmother to cervical cancer. Another addressed questions young women have about why they should get the shots when they're in a monogamous relationship, and whether young men should feel threatened by having a girlfriend who takes care of her body and health.
"The (video) messages were more salient," Vanderpool said. "People look like them, talk like them ... so it resonates with the young women. ... It was also about changing social norms, how people talk about this — that it's OK to get the HPV vaccine."
Plans are being made for videos to urge younger teenagers to be vaccinated — and young men as well.
And while the videos are helping, legislation might, too. A bill sponsored by Rep. David Watkins, D-Henderson, requiring that young boys and girls be immunized against HPV was approved 54-40 by the House on Feb. 26. The bill, now in the Senate, would provide the ability to opt out for parents who do not want their children — girls 9-16 and boys 10-16 — immunized.
Vanderpool, assistant professor in the Department of Health Behavior in the UK College of Public Health, led the study about how the DVD helped increase the number of women who took the entire course of shots.
She called it "one part research, one part community outreach."
"Now that we have the vaccine and regular Pap testing, we have two ways that we can fight this cancer," she said.