title: School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines.
abstract: Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination.
  
  
  
  We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models.
  
  
  
  States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05).
  
  
  
  Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions.
authors.affiliation: Departments of Health Behavior and jennifer.moss@nih.gov.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Reiter
authors.affiliation: Biostatistics, Gillings School of Global Public Health, and.
authors.forename: Young K
authors.initials: YK
authors.lastname: Truong
authors.affiliation: Departments of Health Behavior and.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.affiliation: Departments of Health Behavior and.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012570:School Admission Criteria / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines