Human papillomavirus (HPV) vaccine uptake: Does HPV vaccine legislation work?

Background Prophylactic vaccination against HPV is undoubtedly beneficial to the public's health, as it can largely reduce the incidence of HPV-associated cancers in the population, yet general awareness of both the disease and vaccine remain low. Currently, 23 states have introduced legislation to require the vaccine, increase insurance-coverage requirements, or educate the public to increase voluntary, informed vaccination uptake. Our objective was to assess awareness of HPV and the vaccine, and examine the potential effectiveness of legislation in achieving higher rates of vaccine uptake. Methods Using pooled data from the 2008-2010 National Health Interview Survey, we ranked prevalence of awareness of HPV and the vaccine in young adults (18-26 year old) in all 50 U.S. states and D.C. Multivariable models were used to determine the predictors of HPV vaccine uptake in states with and without HPV vaccine legislation. Results There was substantial inter-state variation in awareness of HPV and the vaccine, with young adults in Maine having the highest (91.2%) and North Dakota having the lowest (40.6%) prevalence of HPV awareness. Prevalence of HPV vaccine awareness was highest in New Hampshire (83.4%) and lowest in Montana (27.6%). In multivariable analyses, there was no significant difference in HPV vaccination uptake in young adults living in states with HPV vaccine legislation compared with those in states without legislation. Conclusion HPV vaccination varied considerably in states with vaccine legislation. Evaluation of current policy and development of more effective interventions are needed to improve awareness of HPV and vaccine uptake rates across the U.S.