Background:
Most sexually active people acquire genital human papillomavirus (HPV) sometime in their lives. Yet there have been few national efforts to educate the public about HPV and its link to cervical cancer or genital warts.

Objective:
Develop audience-centered HPV awareness messages, which are appropriate for/ relevant to English and Spanish-speaking men and women.

Method:
Between 2003-2005, CDC conducted formative, concept testing and message testing research through three phases of focus groups (FGs) across the United States with 18-45 year-old White, African-American and Latino men and women. Phase1: 35 FGs (N=315) assessed HPV-related awareness and information needs. This guided the development of headlines, framing approaches, and tones for HPV communications, which were tested in Phase2 with 14 FGs (N=117) in English and Spanish. Messages and designs were then developed and tested for understandability, appropriateness & effectiveness through 15 FGs (N=134) in English and Spanish (Phase3).

Result:
Phase1 demonstrated low HPV awareness across groups. It identified the need for public information about HPV transmission, prevention, treatment and prevalence. Phase2 demonstrated that women <30yrs, Latinas, and men preferred an STD approach for its personal and shared relevance. Women >30yrs preferred a cervical cancer approach, but this approach was seen as irrelevant to men and Latinas worried it would place the burden on women. Phase3 identified audience preferences for messages that were serious, eye-catching, emphasized the indiscriminant nature of HPV, and minimized shame and blame.

Conclusion:
Research culminated in the development of English and Spanish posters and booklets, which approach HPV as a common but generally harmless sexually transmitted virus, and highlight the importance of preventing its most serious consequence, cervical cancer.

Implications:
The research identified barriers and facilitators to effective HPV communications, which have important implications for future HPV education programs.