Results |The data set included 81 899 adolescents aged 13 to 17 years, with 38 942 girls (49.0%) and a mean (SD) age of 15.0 (1.4) years. Sociodemographic characteristics of the overall cohort and by permission to consent to HPV vaccination are shown in Table 1.Initiation of the HPV vaccine series was 67.9% for adolescents permitted to consent (n = 6470), compared with 61.4% for those not permitted to consent (n = 44 846; adjusted odds ratio, 1.16 [95% CI, 1.01-1.34]). Vaccine series completion was 53.7% among adolescents permitted to consent (n = 5161) compared with 47.9% among those not permitted to consent (n = 35 473; adjusted odds ratio, 1.06 [95% CI, 0.94-1.21]) (Table 2). In the sensitivity analysis, initiation of the vaccine series remained significantly associated with the ability to consent (adjusted odds ratio, 1.16 [1.01-1.34]).Discussion | Laws that permit adolescents to consent to HPV vaccination are either in a scope of laws allowing adolescents to make independent decisions on sexual health, or less commonly, in a more general scope of preventive health inclusive of vaccines. 2 Our analysis showed a significant positive association between adolescents being permitted to consent to HPV vaccination by state laws in their location of residence and increased rates of initiation of the vaccine series. This suggests that policies that permit adolescents to consent to HPV vaccination could be an important strategy toward improving vaccine initiation among young adolescents, when the vaccine is likely to be most effective. Given the cross-sectional nature of these analyses, we are unable to establish causality. States with certain characteristics that are associated with immunization rates may also be more or less likely to pass laws permitting adolescents to give consent. However, it is notable that states permitting adolescent consent to HPV vaccinations are highly diverse with respect to geography, population, and demographic variables. Further work is needed to better understand the associations between policies permitting adolescent consent to vaccinations and immunization rates.

Cit a tio n fo r fin al p u blis h e d ve r sio n: R a n u , Ja s mi n, Kal e bi c, N a t a s h a , M el e n d e z-Tor r e s , G.J. a n d Taylor, P a m el a ORCID: h t t p s ://o r ci d.

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