Presented to the Faculty of the Graduate School of The University of Texas at Arlington in Partial Fulfillment Of the Requirements For the Degree of Master of Arts in Communication, The University of Texas at Arlington

Katherine Egan Bennett
Publication Date
December 6, 2016

University of Texas at Arlington

"...themes were uncovered in this analysis that may help public health researchers and health care providers better talk to reporters, patients, and parents about the HPV vaccine."

The goal of the research conducted as part of this Masters thesis was to examine portrayals of gender roles and expectations related to the human papillomavirus (HPV) vaccine for men and boys in United States (US) newspapers within the theoretical framework of feminist theory, feminist media theory, hegemonic masculinity, and heteronormativity (the presumption that heterosexuality is the dominant and only preferred sexual orientation). Research questions include: How do US newspapers portray the HPV vaccine for heterosexual boys and men with regard to gender roles and expectations? Does the news information on the HPV vaccine for boys and men reinforce heteronormative gender norms? Does news information on the HPV vaccine for boys and men discuss men who have sex with men (MSM), and if so, how?

The first sections of the thesis provide context for the problem, which centres around the fact that vaccine rates remain very low, despite the fact that the US Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for all adolescent boys and girls, and the US Health and Human Services' "Healthy People 2020" campaign has a goal of 80% uptake of 3 doses of the HPV vaccine for both sexes by 2020. In 2014, the CDC reported that only 38% of girls and 14% of boys receive all 3 doses. After the Gardasil vaccine was approved for girls and women in 2006, state legislators (with lobbying help from Merck) across the nation attempted to mandate that adolescent girls receive the vaccine. All the legislative activity led to news articles on the issue debating the HPV vaccine's benefits and possible concerns surrounding it. As the debate began, politicians, health professionals, religious groups, women's health activists, and public health researchers jockeyed to have their views represented to the public and in the news. In general, news coverage of the vaccine has been quite gendered, as the thesis demonstrates, with most news focusing mainly, if not exclusively, on girls and women, even when the science and public health recommendations became more expansive.

Chapter 2 looks at the theories used as a framework for the research in this thesis. Chapter 3 reviews previous academic literature to examine what researchers have already identified about the media and the HPV vaccine for males. Chapter 4 then lays out the methodology used in this research. In short, the research examined print newspaper articles between 2011, when the US Advisory Council on Immunizations Practices (ACIP) first recommended the HPV vaccine for routine vaccination in boys and men ages 9 to 21 in addition to women and girls 9 to 26, through to June 2016, after the ACIP expanded its recommendation to also include men ages 21 to 26. In chapter 5, the media narratives for the vaccine and males are reported and explored. In brief, every article in the sample of 124 articles contained some level of information about the HPV vaccine for boys and men. However, boys and men are still treated as an afterthought, with much of the discussion still focused on cervical cancer. Other themes include an increased focus on oral cancer (12.9% of articles), acceptance of riskier sexual behaviour for men (4%), vaccine mandate focused on civil liberties (4%), the overlooking of side effects of the HPV vaccine on men and boys (25.8%), and the idea that men should receive the HPV vaccine as a way to protect their female partners (3.2%). There also remains a heteronormative emphasis in the newspaper portrayals, with only 4.8% of articles mentioning that MSM are at significantly higher risk of developing some HPV-related cancers.

The final chapter explores conclusions to be gleaned from this research. Overall, "[t]he articles show that reporters are still not making the connection that the human papillomavirus women contract that can lead to genital warts and cervical cancer is the same virus that can cause oral, genital, and anal cancers in both men and women....This is a missed opportunity for public health officials as there are significantly more oral cancers related to HPV diagnosed each year than cervical cancers." The thesis presents a real-world case study of the different way in which the media discussed actor Michael Douglas, when he explained that his diagnosis of HPV-linked oral cancer was likely caused by having oral sex with women (he was praised for his honesty and ability to raise awareness), as compared to the coverage of New York City Councilwoman Melissa Mark-Viverito's revelation that she had been diagnosed with a strain of HPV that often leads to cancer (she was publicly criticised for revealing she had a sexually transmitted infection, or STI). "This is also a good example of what feminist media theorists point out when explaining how power and gender come together in mass communication to reinforce common beliefs" - e.g., moral judgments about women and their sexuality. "One of the main arguments against the HPV vaccine for girls and women has been that the virus can only be contracted through sexual activity and giving females the vaccine implies we as a society think any partner other than her husband is acceptable for women."

The heteronormative assumptions unearthed by the research are also examined in more depth. For instance, there is a heteronormative assumption in the dialogue that while women may suffer, men are expected to be tougher and just handle the vaccine's side effects. Feminist media theory highlights how the news is reflecting the traditional cultural idea that men need to protect women, ignoring the fact that men are just as vulnerable to HPV-related cancers as women.

After examining limitations of the study, this final chapter identifies areas for future research. For example, some regions of the world are considering offering the HPV vaccine only for MSM. These are often regions with government-run health care where the country aims to save money by only providing the US$375 vaccine to girls, which leaves MSM unprotected. "However, as MSM is a marginalized group in today's heteronormative culture, it would be interesting to see the news articles in these countries to see the debate, possibly looking to see if HPV gets labeled as a 'gay' disease, similar to HIV. It would also be interesting to look at the awareness of HPV and the vaccine in the LGBT [lesbian, gay, bisexual, and transgender] community to see what efforts have been made to encourage MSM to receive the vaccine in lieu of mandates by looking in specific LGBT publications."

The thesis concludes with some ideas for public health advisors and healthcare providers hoping to educate the public on the HPV vaccine for boys and men in order to raise vaccination rates. For example, campaigns seeking to communicate to the public about the HPV vaccine could focus instead on the fact that to date more than 90 million doses of the vaccine have been safely administered (CDC, 2016) - data that is available on the CDC websites (so providers could include links for additional information on side effects). Another recommendation is to focus communications on oral cancer instead of cervical cancer. Oral cancer is not only found in both sexes, but it also has a higher incidence rate (48,500 cases diagnosed per year versus 13,000 cases of cervical cancer). "When public health experts and physicians are asked for comments on stories for cancer screening, that would be a good opportunity to educate reporters on cancer prevention instead of cancer diagnosis."


Image credit: Matthew Busch/The Washington Post/Getty Images