Background: The HPV vaccine represents a significant advancement in cancer prevention, but vaccination against a sexually transmitted infection and possible vaccine mandates have received negative publicity. Media coverage can influence attitudes toward vaccination and cancer prevention, and controversy can negatively affect vaccine acceptance. This study explored sources of conflict in media messages about HPV vaccination.

Methods: In manuscript 1 we quantitatively analyzed 447 articles published in 13 U.S. newspapers (2005-2009). Multivariate models were used to analyze relationships between conflict and article characteristics. In manuscript 2, quantitative and qualitative analyses were used to analyze a subset of articles (n=169) published in 3 geographic locations that passed compulsory HPV vaccine legislation. In manuscript 3 we qualitatively explored messages about sexual behaviors in a sample of articles (n=49) Results : We deemed 66% of all stories conflict-containing. Quantitative analyses revealed significant positive relationships between conflict and article topics addressing government/state activities and social influences/reactions/attitudes toward vaccination; discussions of abstinence; discussions of vaccination encouraging risky sexual behaviors; and articles published in 2007 compared to other years.

Qualitative analyses in Manuscript 2 revealed that articles generally failed to give context to the burden of cervical cancer compared to other diseases, or to discuss screening as an alternative to vaccination to prevent cervical cancer. Messages around vaccine mandates reflected distrust, skepticism and parental autonomy concerns.

Analysis of health behavior messages in Manuscript 3 revealed that articles generally dismissed concerns that vaccination would encourage sexual behavior but may have overstated the impact of HPV and the vaccine on cervical cancer in the U.S. Conclusions: Media messages about the vaccine were generally positive but the majority of articles contained conflict. Messages about vaccine mandates suggested compulsory vaccine legislation was premature and generated controversy. Articles focused on legislative controversy may mean a missed opportunity for education about vaccination and cancer prevention. Messages about sexual behaviors also revealed conflict but tended to provide support for HPV vaccination. To achieve public health objectives of reducing cervical cancer morbidity and mortality, media messages should more clearly communicate the role of cervical cancer screening, in addition to HPV vaccination in cancer prevention.