THE IMPLEMENTATION OF HPV MANDATES FOR SCHOOL ENTRY IN RHODE ISLAND AND HAWAII AND THE IMPACT ON HPV VACCINE COVERAGE AMONG ADOLESCENTS

ABSTRACTAlyssa Schatz: The Implementation of HPV Mandates for School Entry in Rhode Island and Hawaii and the Impact on HPV Vaccine Coverage Among Adolescents(Under the direction of Lisa Spees) Human Papillomavirus (HPV) is the most common sexually transmitted infection and has been linked to six known cancer types including cervical, anal, oropharyngeal, penile, vaginal, and vulvar. Annually, an estimated 37,800 cases of all cancers in the US are estimated to be caused by HPV, and HPV vaccination is estimated to prevent up to 90% of HPV related cancers. HPV vaccination is well established as effective at reducing HPV incidence and transmission. Despite demonstrated efficacy and largely mild associated side-effects, rates of uptake of the HPV vaccine in the US lag well behind other childhood immunizations.In an effort to improve HPV vaccine coverage, a handful of jurisdictions enacted HPV vaccine requirements for middle school entry from 2008 to 2020. However, it is unclear how effective these policies have been to date. Additionally, while implementation supports are established as playing a role in policy effectiveness, it is unknown what implementation supports have been used in states with HPV vaccination school-entry requirements.This study explored the implementation supports used by Rhode Island (RI) and Hawaii (HI), two states that have enacted and implemented HPV immunization requirements for school entry over the last decade. The study sought to identify and understand promising practices that could improve uptake of the HPV vaccine among adolescents nationally. The study gathered data through a literature review, secondary data analysis of HPV vaccination rates in RI and HI, a qualitative document review, and key informant interviews (KIIs) with individuals involved in or impacted by the implementation of these policies. The study concluded that the school-entry policies in HI and RI were effective in improving HPV vaccination uptake, particularly for females. However, key informants (KIs) attributed this success in part to the state having existing high rates of vaccine acceptance. The study also found that these states used robust implementation support strategies in their policy rollout and identifies the most promising practices as identified by KIs and supported by the existing literature. This study concluded that HPV vaccination requirements for school entry may be a useful intervention for some states with existing high rates of vaccine acceptance and offers insights into promising practices for states seeking to improve their HPV vaccination coverage.