State Policies Linked to Uptake of HPV Vaccine

State policies play a significant role in the usage of vaccinations to prevent human papilloma virus (HPV), the most common sexually transmitted infection in the U.S.  Wayne Psek, MD, PhD, of the George Washington University Milken Institute School of Public Health served as an author on a study that identified a combination of state policies that are associated with high uptake of the vaccine in children, which the U.S. Centers for Disease Control and Prevention recommends beginning when they are 11 or 12 years old.

Each year, persistent HPV infections lead to more than 26 000 cases of HPV-associated cancers. Dr. Psek was approached by the study’s lead author, Megan Roberts of the U.S. National Cancer Institute (NCI), to participate in the study because of his expertise with qualitative comparative analysis (QCA). The group’s analysis of the combinations of state policies determined which ones may be necessary or sufficient for high state-level HPV vaccination uptake. His colleagues also included Taylor Murphy, an undergraduate student at GW who worked on the project to complete her internship requirement, and other researchers at the NCI.

The research team found a combination of state policies linked to consistently high uptake of HPV vaccination. The combination includes Medicaid expansion, permitting HPV vaccination in pharmacies, school-entry requirements for the vaccine, classroom sex education mandates, and the absence of parental education mandates.

“The effect of Medicaid expansion on vaccine uptake is unclear,” Dr. Psek explains. “Medicaid expansion may increase adolescents’ access to care, including preventive vaccines,” he says. However, he adds that “adolescents who were uninsured or underinsured may already have been eligible for vaccines through other programs such as Vaccines for Children, which is associated with increased HPV vaccine uptake.”

Because the researchers were looking at combinations of policies, the finding that the absence of parental education mandates was associated with high HPV vaccine uptake “does not suggest that parental education campaigns are not effective or that they decrease vaccine uptake,” Dr. Psek his coauthors stress. Policymakers should continue to consider the value of parental education campaigns for improving HPV vaccine uptake in combination with other policies, they say.

Dr. Psek says he is interested to see if Virginia’s recent decision to expand Medicaid, which took place after the study data was collected, will make a difference. “Virginia is one of only three states with school-entry requirements for HPV, along with Rhode Island and Washington, DC,” he explains. However, the researchers found that although DC and RI had high uptake of HPV vaccination, Virginia did not. “Rhode Island and Washington, DC expanded Medicaid previously, so Virginia’s decision to expand Medicaid might have an impact,” he says. “It is important to consider that Medicaid expansion works in combination with Virginia’s other policies and programs.”

Dr. Psek also lauds Murphy, who earned her BS from the Milken Institute School of Public Health and is now working towards her Masters of Health Administration at Columbia University’s Mailman School of Public Health, for taking the initiative to reach out to him. She contributed to the analysis of the state policy data and drafted portions of the article. “She is a great example of a student who is engaged and motivated to find opportunities,” he says.

A Qualitative Comparative Analysis of Combined State Health Policies Related to Human Papillomavirus Vaccine Uptake in the United States” is published in the American Journal of Public Health.