Objectives. To assess changes in human papillomavirus (HPV) vaccine initiation for adolescent girls and boys in Rhode Island compared with all other states.

Methods. We estimated the gender-specific effects of Rhode Island’s school-entry HPV vaccination policy on self-reported HPV vaccination initiation by using a difference-in-differences design with the National Immunization Survey–Teen from 2010 through 2016.

Results. Compared with boys in other states, boys in Rhode Island increased their HPV vaccine initiation rate by 11% (b = 0.11; 95% confidence interval [CI] = 0.05, 0.18) after enactment of the requirement. No difference was seen in the probability of HPV vaccine initiation among girls in Rhode Island compared with girls in the multistate control (b = −0.01; 95% CI = −0.08, 0.05).

Conclusions. Our analysis identified an 11% increase in HPV vaccine initiation rate among boys in Rhode Island after the school-entry requirement was enacted, whereas no significant change was observed for girls.

Public Health Implications. Given suboptimal vaccine uptake rates in the United States, continued pursuit of state-level public policy to improve HPV vaccination is needed. School-entry requirements for HPV vaccination may be a strategy for closing the gap in HPV vaccine uptake for boys and girls.


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Erika L. Thompson, PhD, MPH, Melvin D. Livingston III, PhD, Ellen M. Daley, PhD, MPH, and Gregory D. Zimet, PhDErika L. Thompson is with the Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth. Melvin D. Livingston III, is with the Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center. Ellen M. Daley is with the Department of Community and Family Health, College of Public Health, University of South Florida, Tampa. Gregory D. Zimet is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. “Human Papillomavirus Vaccine Initiation for Adolescents Following Rhode Island’s School-Entry Requirement, 2010–2016”, American Journal of Public Health 108, no. 10 (October 1, 2018): pp. 1421-1423.


PMID: 30024803