evidence: - Vaccination against human papillomavirus (HPV) nearly eliminates the risk of cervical cancer, vulvar cancers, and penile or anus cancers caused by HPV. [...] Thanks to the development of the HPV vaccine nearly two decades ago, those who receive the vaccine as children nearly eliminate their risk of developing HPV-associated cancers. The HPV vaccine is approved for males and females ages 9 to 45, with recommendations for the first doses beginning at age 11 to 12 (see Sidebar 16). Despite clear evidence showing that the HPV vaccine reduces cervical cancer incidence, the uptake of the vaccine has been suboptimal in the United States (382)Mix JM, et al. (2021) Cancer Epidemiol Biomarkers Prev, 30: 30.. This is partly because there is no national mandate in the United States requiring HPV vaccination to attend school. However, some states have implemented their own vaccine requirements. As of 2024, four US states (Hawaii, Rhode Island, Virginia, and the District of Columbia) require the vaccine for entry into secondary schools. Rural areas have very low rates of HPV vaccination among teens, necessitating culturally tailored interventions to increase vaccination in these populations (383)Swiecki-Sikora AL, et al. (2019) J Rural Health, 35: 506. DOI: 10.1111/jrh.12353..