MONTREAL — Canadian youth are woefully underinformed about human papillomavirus (HPV), according to research presented at Public Health 2026, the annual meeting of the Canadian Public Health Association.

Antonella Pucci, manager of immunization initiatives at the Canadian Public Health Association and manager at Immunize Canada, moderated the session in which the research was presented. She told Medscape News Canada that HPV infections are the most common sexually transmitted infections (STIs) in the world. More than 100 types of papilloma viruses infect humans, with 40 of those types affecting the anus and genitals.

While most HPV infections will go away on their own and not cause any symptoms, infection can sometimes lead to genital warts and cancers. “Around 75% of sexually active Canadians who have not been immunized against HPV will have an HPV infection at some point in their lives,” said Pucci. “Therefore, it is important that people get vaccinated to protect themselves.”

Important Knowledge Gaps

To better understand the knowledge, attitudes, and beliefs about HPV among young adults in Canada, Caitlin Ford and colleagues conducted a survey based on Health Belief Model of Behavior Change constructs, with sections on HPV knowledge and awareness; HPV vaccine awareness, attitudes, and beliefs; message testing; and demographics. Ford is manager of health promotion and outreach at the Calgary-based nonprofit Praxus Health.

“Because young adults are within that high-risk group for transmitting HPV, we wanted to understand which messaging strategies and interventions would work to nudge them toward vaccination and HPV prevention,” Ford told Medscape News Canada. “Before going down that path with those interventions and community strategies, we wanted to understand their current attitudes, knowledge gaps, and perspectives related to HPV and the vaccine.”

Thousand participants were recruited by Abacus Data, a national research firm. Participants were eligible if they were 18-30 years of age and resided in Canada. Quotas were set for gender, region, and language in alignment with census data from 2021. The survey was conducted online, and participants received honoraria.

Participants’ median age was 25 years, 50.0% were women, 48.5% were men, and 1.5% were other or preferred not to say. The greatest proportion lived in Ontario (38.5%), followed by the Western provinces (32.5%), Quebec (22.0%), and the Atlantic provinces (7%).

While 60.8% of participants affirmed that their understanding of HPV was strong, most (60.1%) considered themselves not very or not at all likely to contract it. This is in stark contrast with the reality that HPV is the single most common STI. Similarly, only 64.7% expressed worry about the serious health outcomes of HPV, despite its causative role in six cancers, Ford said.

Some of the most concerning knowledge gaps regarding HPV and vaccination were the following:

• About one quarter of respondents were unaware that or unsure of whether HPV is an STI.
• About one quarter were unaware that or unsure of whether men can contract and spread HPV.
• About one third were unaware that or unsure of whether there is a vaccine for HPV.
• About 40% were unaware that or unsure of whether HPV can cause warts on the genitals.
• Only about half were aware that HPV can cause cancer.
• Only about half were aware that HPV can be spread via saliva.
• Over one quarter believed that there might be or there is an effective cure for HPV.

Regarding the types of cancer caused by HPV, 47.4% of participants correctly identified cervical cancer, 45.1% vaginal, 31.2% anal, 30.6% penile, 24.7% vulvar, and 11.7% head and neck. Cancers that were incorrectly associated with HPV infection by at least 10% of participants included prostate, colon, and skin.

“The level of knowledge was definitely below what we thought was going to be the case,” said Ford. “What was most surprising was awareness gaps as far as cancer risk related to HPV.”

Pucci was not surprised, however. “As someone who works in the vaccine communication space, we often hear that youth have limited knowledge about HPV and the HPV vaccine,” she told Medscape News Canada. “The topic is not given as much attention in the education system [as it should] and can often be contentious. Some parents may be reluctant for their children to learn about or receive the vaccine due to apathy, perceptions that they are too young, or stigma associated with it being viewed as a ‘sex vaccine.’”

Vaccine Coverage Gaps

Only 41.2% of participants had received the HPV vaccine. Among the rest, 40.9% were sure they had not received it, and 17.9% were unsure. The most common reasons for not vaccinating were lack of awareness the vaccine existed (37.6%), no recommendation from a healthcare provider (30.3%), and lack of concern about HPV infections (24.9%). Over half of the participants believed the HPV vaccine was only appropriate for women and girls, and only 61.0% would know where to go to get an HPV vaccine if they wanted one.

For most respondents, vaccine safety was not a concern, although nearly 6% perceived it to be not very safe or not safe at all. In addition, while 51.7% thought the vaccine was effective or extremely effective, just over one quarter thought it was only somewhat effective, not very effective, or not at all effective.

A major barrier to vaccination was willingness to pay. The largest proportion of participants would be willing to pay up to $100 CDN for the full vaccine series, an amount that is far outstripped by the actual cost in most provinces.

Participants were most likely to report that they wanted to hear about HPV vaccination from their doctor, which most viewed as a trusted source. Interestingly, while 28.6% said they would prefer to learn about it from social media, this was not considered to be a trusted source by most participants.

Working Toward Change

Praxus Health is engaging with young adults about HPV via partnerships with postsecondary institutions and by launching a national awareness campaign. The organization is also partnering with multiple stakeholders in Alberta to increase awareness about HPV among gender-diverse communities using inclusive language. At Public Health 2026, Madison Fullerton, a PhD candidate at the University of Calgary, Calgary, and vice president of operations and community partnerships at Praxus Health, described this initiative, which also offers resources for healthcare professionals.

“Praxus Health is making strong strides in addressing HPV awareness among youth,” said Pucci. “Additionally, it is important that they are working to address gaps among 2SLGBTQI+ communities, who have traditionally been missing from these conversations. I am interested to see how this work can be leveraged to support behavior-change interventions.”

In addition to these efforts, she would like to see the HPV vaccine publicly funded beyond age 17 across Canada, greater outreach in postsecondary institutions, and the expansion of prescriptive authority for the vaccine to pharmacists. She shared some resources on HPV for patients and for healthcare professionals.

The research was supported by the Canadian Partnership Against Cancer and Praxus Health. Ford, Fullerton, and Pucci reported having no conflicts of interest.