title: The Role of Physician Recommendations and Public Policy in Human Papillomavirus Vaccinations.
abstract: BACKGROUND
  Immunization rates for human papillomavirus (HPV) infections remain low among teenagers despite strong evidence of the effectiveness of vaccines. Physician recommendations of the vaccine are far from universal. Several states have enacted policies that mandate HPV vaccination or distribute educational materials.
  
  
  OBJECTIVE
  To provide policy makers, physicians, and researchers information on the relative importance of physician recommendations and early state-level policies to promote HPV vaccinations among targeted age groups.
  
  
  METHODS
  We first use probit models to determine the strongest correlates of immunization in a nationally representative US sample of teenagers. We then use instrumental variable probit models to determine the direct role that physician recommendations play in vaccination using plausibly exogenous physician encounters that are likely not the result of more health-conscious parents seeking out information on the vaccine.
  
  
  RESULTS
  We show that children in the targeted age range who are more likely to encounter physicians for reasons other than seeking out the vaccine, such as through mandatory wellness exams or previous asthma diagnoses, are significantly more likely to get the vaccine. There is no consistent evidence that the state policies we analyze have been effective.
  
  
  CONCLUSIONS
  Encouraging recommendations by physicians may be the most effective path toward increasing HPV vaccination. State-level mandates and policies are yet to exhibit effectiveness.
authors.affiliation: School of Medicine and Health Science, George Washington University, Washington, DC, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Moghtaderi
authors.affiliation: Department of Economics, University of Wisconsin-Milwaukee, Bolton Hall 802, 3210 N. Maryland Ave., Milwaukee, WI, 53201, USA. sjadams@uwm.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000191:economics / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D007342:Insurance Benefits / Q000191:economics / Q000592:standards / Q000639:trends; D007348:Insurance, Health / Q000191:economics / Q000592:standards* / Q000639:trends; D016015:Logistic Models; D015233:Models, Statistical; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010290:Parents / Q000193:education; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012572:School Health Services; D013219:State Government; D014481:United States; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines