title: Impact of Virginia's School-Entry Vaccine Mandate on Human Papillomavirus Vaccination Among 13-17-Year-Old Females.
abstract: The link between human papillomavirus (HPV) and anogenital cancers is well established in the literature. Many states have passed laws requiring funding for HPV education or vaccination. Mandatory HPV vaccination policies have been considered and passed in several states; yet their effectiveness has not been evaluated. This study sought to assess the impact of Virginia's HPV vaccine mandate for school-entry on HPV vaccine uptake among females aged 13-17 years.
  
  
  
  Data from the National Immunization Survey-Teen for the 2008-2012 period were used, and 3,203 adolescent females were included in the analysis. We performed difference-in-differences estimation and logistic regression with a policy and period interaction term. Virginia was considered the treatment state, and South Carolina and Tennessee were the comparison states to account for nonpolicy factors that may have affected vaccination rates during the time period considered in the analysis.
  
  
  
  There was no evidence of an effect of Virginia's HPV vaccine mandate for school-entry on vaccination rates or on physician vaccination recommendation using either the difference-by-differences analysis or the policy and period interaction term in the logistic regression. Physician recommendation was the factor most strongly associated with vaccination in the Virginia-South Carolina analysis (adjusted odds ratio [aOR] = 9.33; 95% confidence interval [CI]: 6.11-14.3) and in the Virginia-Tennessee analysis (aOR = 9.33; 95% CI: 6.11-14.3).
  
  
  
  Study findings suggest that Virginia's HPV vaccine mandate for school-entry did not lead to a significant increase in HPV vaccination among adolescent females or physician recommendations. However, physician recommendation was the factor most strongly associated with vaccination.
authors.affiliation: 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida.
authors.forename: Dudith
authors.initials: D
authors.lastname: Pierre-Victor
authors.affiliation: 2 Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Page
authors.affiliation: 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
authors.affiliation: 3 Department of Psychology, College of Arts and Science, Florida International University, Miami, Florida.
authors.forename: Dionne P
authors.initials: DP
authors.lastname: Stephens
authors.affiliation: 4 Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida.
authors.forename: Tan
authors.initials: T
authors.lastname: Li
authors.affiliation: 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida.|5 Public Health Research Institute of India, Karnataka, India .
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D037141:Mandatory Programs; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D010819:Physician's Role; D012574:Schools; D013022:South Carolina; D013714:Tennessee; D014611:Vaccination / Q000706:statistics & numerical data*; D014768:Virginia
chemical_list: D053918:Papillomavirus Vaccines
keywords: effectiveness; human papillomavirus; mandate; school-entry; vaccination