The State of HPV Vaccination in Rhode Island: Qualifying Outcomes of a School Entry Vaccine Mandate [17A

Abstract

INTRODUCTION: In 2015, RI became one of two states and Washington, DC to mandate HPV vaccination for school entry and RI's is the only mandate to include boys. Previous studies have described longitudinal trends in HPV vaccination rates in RI but no studies to date have evaluated factors predictive of vaccine series completion. The goal of this project was to identify factors predictive of up-to-date HPV vaccination status in RI and evaluate how factors change in the face of an implemented mandate. METHODS: Data were extracted from the National Immunization Survey-Teen for years 2012–2017 and then transformed and analyzed in Julia. Binomial logistic regression modeling was applied to evaluate predictive factors related to up-to-date vaccination status for RI teens surrounding implementation of the school mandate. RESULTS: In the pre-mandate period, maternal education level and income level were predictive (p less than 0.05) of up-to-date vaccine status for girls. In the post-mandate period, maternal education level and income level remained predictive in addition to patient-reported provider recommendation for girls (p less than 0.05). No factors in the pre- or post-mandate period were predictive of up-to-date status for boys. CONCLUSION: Parent-reported provider recommendation was predictive of up-to-date HPV vaccination status for girls in RI in the setting of a vaccine mandate. Qualifying significant predictors of HPV vaccine series completion and effectiveness of provider recommendation is important at the individual and policy level for implementing, evaluating, and improving the efficacy of an opt-in versus opt-out structure of HPV vaccination.