Association Between Human Papillomavirus Vaccination School-Entry Requirements and Vaccination Initiation

Abstract

IMPORTANCE Human papillomavirus (HPV) vaccination coverage is suboptimal in the US. The association between HPV vaccination requirements for school entry and HPV vaccination coverage remains to be studied.OBJECTIVE To examine the association between HPV vaccination school-entry requirements and vaccination initiation in jurisdictions with such vaccination policies (ie, Virginia, the District of Columbia, and Rhode Island) compared with other regions of the US, as determined by the National Center for Chronic Disease Prevention and Health Promotion. DESIGN, SETTING, AND PARTICIPANTS In a population-based, cross-sectional study, 2017 data from the National Immunization Survey-Teen database were used to determine HPV vaccination initiation. Data from 2008 to 2017 were then examined to assess the association between HPV vaccination school-entry policies and vaccination initiation. Data were obtained for adolescents aged 13 to 17 years in the US with health care professional-reported HPV vaccination histories (cross-sectional study, n = 4784; pre-post policy comparisons, n = 42 431). This study was conducted from May 1, 2019, to March 31, 2020. EXPOSURES State-level HPV vaccination school-entry requirements from 2008 to 2017. MAIN OUTCOMES AND MEASURES Health care professional-confirmed HPV vaccination initiation. RESULTS The 2017 cross-sectional study included 4784 adolescents aged 13 to 17 years (2228 [46.6%] girls; 2556 [53.4%] boys; mean [SD] age, 15.0 [1.4] years; interquartile range, 14-16 years). Compared with nonpolicy jurisdictions within the same region, Rhode Island and the District of Columbia, which have HPV immunization school-entry requirements, had higher levels of HPV vaccination initiation (Rhode Island: adjusted odds ratio [aOR], 4.34; 95% CI, 2.16-10.00; District of Columbia: aOR, 2.35; 95% CI, 1.39-4.19). However, compared with regional nonpolicy states, Virginia's HPV vaccination initiation did not differ significantly (aOR, 1.01; 95% CI, 0.72-1.42). The 2008-2017 pre-post policy comparisons involved 42 431 adolescents aged 13-17 years (22 362 [52.7%] girls; 20 069 [47.3%] boys; mean [SD] age, 15.0 [ 1.4] years; interquartile range, 14-16 years). Postpolicy levels of HPV vaccination initiation in girls was significantly higher in Rhode Island (aOR, 3.12; 95% CI, 1.92-5.07) than prepolicy values. Similar changes were noted for postpolicy HPV vaccination initiation in boys in the District of Columbia (aOR, 6.36; 95% CI, 4.27-9.46) and Rhode Island (aOR, 5.84; 95% CI, 3.92-8.69) compared with prepolicy measures. With respect to regional nonpolicy states during the same period, both girls and boys in Rhode Island and boys in the District of Columbia experienced larger increases in HPV vaccination initiation. For example, in Rhode Island, boys aged 16 to 17 years had 7.32 (95% CI, 3.56-15.06) times the change in pre-post policy HPV vaccination initiation, while girls aged 16 to 17 years had 1.28 (95% CI, 0.60-2.73) times the change. In the District of Columbia, boys had 6.36 (95% CI, 4.27-9.46) times...

Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico

“…On the other hand, suboptimal UTD vaccine coverage rates found in our study could be explained by the design and the way the requirement was implemented; at the moment this study was conducted, only one dose of HPV was required for school-entry [46]. However, all HPV vaccine coverage rates showed an improvement after the implementation of the policy, which provides additional evidence that school-entry policies can be an effective tool for increasing childhood vaccination rates [14,25,26].…”

“…In general, school-entry-policies have shown to be an effective tool for increasing childhood vaccination rates [14,25,26]. However, only a handful of studies have measured their impact on HPV vaccination uptake, with mixed results [14,[27][28][29][30].…”

Assessment of human papillomavirus vaccination rates of adolescents in California, 2018–2019

“…( People, 2030 ) While the gap is narrowing between male and female HPV initiation and completion rates according to both NIS-Teen and CAIR findings, there remain missed opportunities for vaccination with the NIS-Teen estimates of HPV vaccination series completion peaking at 51.4 % and 61.5 %, respectively, for the study years. ( Walker et al, 2019 ) While this study did not investigate contributing factors in California’s HPV vaccination patterns, decreased awareness of the HPV vaccine 41–43 , lack of school entry requirements, ( Ko et al, 2020 ) parental refusal based on informational, social, or cultural factors, ( Wong et al, 2021 , Hirth et al, 2019 , Brewer et al, 2017 , Szilagyi et al, 2020 ) and lack of standard provider recommendations ( Kashani et al, 2019 , Dempsey and O’Leary, 2018 ) have been noted as influences in decreased uptake across the United States. Future studies should elucidate patterns for HPV vaccine hesitancy and refusal in California, by region and population, to improve both initiation and completion rates.…”

Assessment of Human Papillomavirus Vaccination Rates of Adolescents in California, 2018-2019

“…(People, 2030) While the gap is narrowing between male and female HPV initiation and completion rates according to both NIS-Teen and CAIR findings, there remain missed opportunities for vaccination with the NIS-Teen estimates of HPV vaccination series completion peaking at 51.4 % and 61.5 %, respectively, for the study years. (Walker et al, 2019) While this study did not investigate contributing factors in California's HPV vaccination patterns, decreased awareness of the HPV vaccine [41][42][43] , lack of school entry requirements, (Ko et al, 2020) parental refusal based on informational, social, or cultural factors, (Wong et al, 2021;Hirth et al, 2019;Brewer et al, 2017;Szilagyi et al, 2020) and lack of standard provider recommendations (Kashani et al, 2019;Dempsey and O'Leary, 2018) have been noted as influences in decreased uptake across the United States. Future studies should elucidate patterns for HPV vaccine hesitancy and refusal in California, by region and population, to improve both initiation and completion rates.…”