Statutes and regulations relevant to the study were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions. Of the laws identified by the initial search string, 93 An additional three laws were added following subsequent review.
There was a total of 52 statutes and 44 regulations from 34 states and the District of Columbia. Most laws were related to developing and distributing HPV vaccination materials for parents, and mechanisms to fund and reimburse for the vaccination. This study can be used by policymakers in jurisdictions that are considering establishing HPV vaccination promotion interventions in state law and highlighting the limited statutory and regulatory efforts that have been implemented to promote HPV vaccination.
Importantly, this study can also be used to conduct evaluations of the efficacy of statutory and regulatory strategies in increasing HPV vaccination rates. The vaccine to prevent human papillomavirus HPV related cancers has been approved for use in the United States since However, it has been hampered by the lack of a unified approach to vaccination both across and within states.
This diversity is reflected in the variation of vaccination rates across states and regions with Northeastern, Midwestern, and Western states seeing higher rates of HPV vaccination coverage than Southern and Southwestern.
It is at this juncture that a full description of HPV vaccine policies and laws is needed. While helpful, some of this research focuses exclusively on legislative activity. NCSL largely reviews legislation and not regulation, which is a serious limitation given that state legislatures often delegate broad rulemaking authority to agencies to promote public health.
Because of these issues, NCSL cannot truly provide sound empirical data on which to base a study whose methodology and analyses can be reproduced. The need for a comprehensive description of state law across all subject areas from school requirements to vaccine access, to funding would help advance analyses of policy impact on HPV vaccination uptake. Additionally, there is a need for an analysis that includes both statutes law enacted by legislatures and signed by governors and regulations law developed by state agencies and associated with statute given that both mechanisms are used to advance HPV vaccination.
To the best of our knowledge, this is the first study of state HPV vaccination requirements that derived data using legal epidemiological methods across statutes and regulations on a breadth of topical areas including mandates, education, scope of practice, and financing. Here we describe the results of a cross-sectional analysis of U.
The analysis identified state laws currently in effect in fall, regardless of their initial effective date. These statutes and regulations were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions Table 1. Additionally, this article — because it specifically highlights references to HPV in statutes and regulations at the state level — identifies how legislatures and agencies prioritize HPV vaccination-related issues regardless of federal policies.
For the purpose of this article, we will refer to both statutes and regulations as laws given that they are both legally binding and states use both mechanisms to establish vaccination requirements. Of the laws pulled from the search, 93 An additional three provisions were included in the results that clarified or expanded on provisions that were already collected.
There are 52 statutes and 44 regulations in total Table 2. State laws focus on a number of issues around HPV vaccination including vaccine finance, school-entry requirement, vaccine recommendation, public awareness, program development, vaccine access, vaccine education, plan development, and vaccine reporting.
Reference to HPV vaccination in relevant statutes and regulations by U. States and the District of Columbia, States with laws related to school entry, parental education, U. States and District of Columbia — While only three jurisdictions require HPV vaccination as a condition for school attendance under state law, other states have established additional strategies to promote HPV vaccination in school children.
Additionally, 12 states require or recommend the development or distribution of information to parents related to HPV vaccination for parents. Two states Iowa and Texas require HPV vaccination information to be incorporated into education curricula. States also have laws that promote childhood vaccination in non-educational settings. This includes the requirement in Maine that youth camps and similar programs assess HPV vaccination status of their campers.
Arkansas requires foster parents to assist in ensuring children are vaccinated for recommended vaccinations, including HPV. Laws that seek to improve HPV vaccine access include those that provide vaccination authority to pharmacists and allow minors the ability to give consent for the vaccination Table 4. The express listing of HPV indicates that state legislators and agencies specifically considered HPV in their policymaking process.
States with laws that promote vaccine access, U. Illinois allows minors 12 years or older to consent to HPV vaccination and Utah allows minors to consent if they are an abandoned minor as represented by the patient. Some jurisdictions require individual and group health insurance plans to cover HPV vaccination while numerous states require HPV vaccine coverage via Medicaid and other health programs.
Finally, public health strategies are also incorporated into statutes and regulations. Further, Colorado, Illinois, and Indiana require the establishment of department of health programs or strategic plans that include activities related to HPV vaccination. No single coding question included results from more than one-third of the jurisdictions, and many states had laws related only to one aspect of HPV access such as educational materials or vaccine financing.
Eight of the ten coding questions included results from six or fewer states. The coding questions that had the most state activity were related to developing and distributing HPV vaccination materials for parents and those related to mechanisms to fund and reimburse for the vaccination. Despite finding that 34 states and the District of Columbia reference HPV vaccination in statutes or regulation, there were remarkably few state laws on this topic, and few states with laws across multiple coding categories as outlined above.
The observation that HPV vaccination education was a common policy outcome among states enacting law related to HPV vaccination may be an artifact of what Abiola et al. Even within the states that have a number of HPV vaccination-related laws, one cannot presume that a higher number of statutes and regulations indicates a comparatively higher commitment to improving HPV vaccination access across states.
This is because individual states and individual acts or rulemaking within a state can vary substantially in terms of the length of a single provision when it is codified. For example, a state with ten provisions is not necessarily more active than a state with two, if the two provisions run for a much longer period than the ten.
Further, the number of results generated in the collection of laws for this study might be a function of the search, where search strings can be crafted more narrowly or more broadly with adjustments in the terms and connectors. While the number of provisions is not necessarily an indicator of commitment, the study found that there were nearly as many individual regulatory provisions in our results as individual statutory provisions. This reinforces the value of research across both legislation and rulemaking.
Overwhelmingly, jurisdictions tend to use statutes and regulations to promote HPV vaccination, such as financial incentives or requirements for public education campaigns as opposed to laws that limited vaccination. However, there are still laws that function in practice to curb vaccination. State laws that explicitly exclude HPV vaccination from school-entry requirements and those in DC and Virginia that create an express parental opt-out for the vaccination are such examples.
Opt-out provisions that provide so much discretion to parents on HPV vaccination that, in practice, there is no realistic way to enforce the requirements. Another emerging issue which has been explored elsewhere is the tendency to focus on females for HPV related policy and interventions. That said, a study of the gendering of HPV vaccination law across time would be an important contribution to the literature.
This study is subject to several limitations. First, other mechanisms independent of statutes and regulations can be used to promote HPV vaccination that was not collected as part of this study. This includes state agency policies such as state cancer plans, local government actions, and case law. Nor does this study include a summary of all federal laws that might impact HPV vaccination. Additionally, the study did not analyze the funding, implementation, or enforcement of these laws, which affect the impact of these laws in practice.
For example, laws that promote cancer and sexually transmitted infection prevention or those that fund public health prevention activities might impact HPV vaccination rates. There is, for example, some evidence that non-targeted adolescent vaccine school requirements may in fact impact HPV vaccination rates. This study utilized legal epidemiological research methods to collect and analyze statutes and regulations. Statutes and regulations from the 50 states and Washington, DC, were collected on September 3, using WestlawNext, an online legal database.
From this search, statutes and regulations were identified. Following an initial review of these laws, additional statutes and regulations were added to the dataset when referenced in the provisions already collected and were relevant to HPV vaccination, or when additional provisions from the same sections or chapters of the code clarified the requirements of the original statutes and regulations.
These were collected in October and November All statutes and regulations generated from the search were preserved in pdf format, and the research process was recorded in a research procedure document. Inclusion criteria were developed following a research team conference and held that only laws expressly referencing HPV vaccination were considered relevant in this study Table 5. Thus, for example, provisions that referenced HPV in the context of screening and testing but did not mention vaccination were excluded.
These included a provision related to the exemption of HPV vaccination in an immunization registry and the certification of the HPV vaccination as safe by a department of health. These exclusion criteria were documented in the research procedure.
Statutes and regulations relevant to the study were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions Table 1. These coding questions were revised as nuances across states were identified. The analysis sought to describe the legal attributes, variabilities, and nuances in the laws across jurisdictions.
Within the last year Gregory Zimet received an honorarium from Sanofi Pasteur for work on the Adolescent Immunization Initiative and received travel support from Merck to attend a conference on HPV vaccination. National Center for Biotechnology Information , U. Journal List Hum Vaccin Immunother v. Hum Vaccin Immunother.
Published online Jul 2. Aila Hoss , a Beth E. Meyerson , b, c and Gregory D. Zimet c, d. Beth E. Gregory D. Author information Article notes Copyright and License information Disclaimer. This article has been corrected. See Hum Vaccin Immunother. This article has been cited by other articles in PMC. Associated Data Data Citations U. Food and Drug Administration Biological license application approvals ; Introduction The vaccine to prevent human papillomavirus HPV related cancers has been approved for use in the United States since Table 1.
On February 2, , Texas became the first state to issue a mandate—by executive order from the governor—that all girls entering the sixth grade receive the vaccine. A couple of months later, the legislature passed HB which overrode the executive order and the governor withheld his veto. The Department is authorized to do this without legislative approval.
Include boys 18 years and younger as an eligible individual for the vaccine. Iowa Senate Bill authorizes pharmacists to administer the last two doses of the HPV vaccine to patients 11 years of age and older. Illinois Senate Bill includes boys under 18 as eligible to receive the HPV vaccine at no cost.
In , the Iowa Legislature enacted House Bill , requiring information HPV vaccination, screening and treatment be provided in health classes in public schools. Requires the subcommittee to issue a report to the committee. Montana Senate Bill renews the cervical cancer task force and identifies strategies to educate the public on the availability and efficacy of the HPV vaccine.
In , the Council of the District of Columbia enacted D. Law to require female students to receive the HPV vaccine before entering 7 th grade.
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The debate in states centers, in part, around school vaccination requirements. Some stakeholders who support access to the vaccine do not support a school mandate, citing concerns about the drug's cost, safety and parents' rights to refuse. Others may have moral objections related to a vaccination mandate for a sexually transmitted infection. Financing is another concern. If states make HPV vaccination mandatory, they must also address funding issues, including Medicaid and CHIP coverage, youth who are uninsured and whether to require coverage by insurance plans.
VFC provides vaccines for children ages nine to 18 who are covered by Medicaid, Alaskan-Native or Native American children, and some underinsured or uninsured children. Facts About HPV. Hawaii will require the vaccine starting July 1, States also address HPV prevention through a variety of efforts, either through the executive branch or the legislature. In , the New Hampshire Department of Health and Human Services announced that it would provide the vaccine at no cost to girls under age On February 2, , Texas became the first state to issue a mandate—by executive order from the governor—that all girls entering the sixth grade receive the vaccine.
A couple of months later, the legislature passed HB which overrode the executive order and the governor withheld his veto. The Department is authorized to do this without legislative approval. States set the minimum age for pharmacist HPV vaccination.
Serious events that have followed HPV vaccination include crippling, likely permanent neurological damage and nearly deaths internationally. Many insurers and government health programs pay for it. Orient suggests. The oft-cited legal precedent for the constitutionality of state vaccine mandates is the case of Jacobson v.
This law was passed during an epidemic of smallpox, an extremely contagious disease with a mortality of about 30 percent. AAPS supports the right of patients to make an informed choice about their medical treatment, including vaccines. Related Links. Contact Data. With a Reader Account, it's easy to send email directly to the contact for this release. Since the HPV vaccine protects against a sexually transmitted disease STD , considerable debate regarding the vaccine revolves around the moral implications.
People who object to the HPV vaccine on moral grounds usually do so for one of two reasons: 1 fear that providing a vaccine against an STD will increase sexual activity among adolescents, or 2 vaccination is unnecessary since premarital sex is immoral and adolescents should abstain from having sex. Several studies have shown adolescents' sexual activity is not influenced by the availability of condoms or emergency contraception, but has more to do with religious objections and fear of pregnancy.
Since the vaccine has been added to the recommended childhood immunization schedule, the Vaccines for Children program should cover the cost of the vaccine in eligible adolescents. Many insurers are covering the cost of vaccination for females, but not males, since the vaccine is not approved for use in males.
For practitioners, some additional questions regarding the HPV vaccine still need to be addressed, including those regarding vaccine availability. Now that the vaccine is included in the childhood immunization schedule, will vaccine supply be able to keep up with demand? Availability has become a problem with some vaccines recently, including the Tdap tetanus, diphtheria and reduced acellular pertussis and meningococcal conjugate vaccines.
The feasibility of achieving complete immunization with the 3-dose series in the adolescent population, which historically is frequently lost to medical follow-up, remains a concern. The long-term efficacy of the quadrivalent vaccine remains unknown. To date, efficacy studies have only followed vaccine recipients for a maximum of 5 years. In the future, will booster doses be required?
As further information becomes available regarding factors such as feasibility of mandatory vaccination and the role of vaccinating males in decreasing HPV transmission, decisions regarding HPV vaccination may become less controversial. Janet Gilsdorf, M. National Center for Biotechnology Information , U.
J Pediatr Pharmacol Ther. Author information Article notes Copyright and License information Disclaimer. Keywords: human papillomavirus, immunization, pediatrics, vaccination. This article has been cited by other articles in PMC. Human papillomavirus. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Quadrivalent human papillomavirus vaccine. Recommendations on the advisory committee on immunization practices. Surveillance Summaries, June 9, SS-5 [ Google Scholar ].
American Cancer Society guideline for human papillomavirus HPV vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. The impact of condom distribution in Seattle schools on sexual behavior and condom use. Am J Public Health.
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Responding to Parents. Alternative Schedules. Too Many Vaccines? Importance of Vaccines. Vaccine Safety. MMR Vaccine. Mandates and Exemptions. Vaccine-Specific Requirements. Exemptions by State. State Immunization Websites. HepA: Child Care, K HepB: Child Care, K Hib: Child Care.
Influenza: Child Care. Polio: Child Care, Elementary. Rota: Child Care. Varicella: Child Care, K State Information. View U. Return to State Mandates on Immunization main page. HPV vaccination mandate? Implementation date. Number of doses. Females; gr 6. January July New Hampshire. North Carolina. Virginia passed the mandate in Earlier this year, the Virginia House voted to end the mandate ; a senate committee voted against that measure, so the mandate remains in place.
Parents are permitted to opt out. That means in half the country somebody tried to pass a mandate — and almost nobody succeeded. Recommended Joe Biden Botches the Georgia Voting Law His claim that the law prohibits giving water to voters standing on line is way off base. Dan McLaughlin. Andrew C. Alexandra DeSanctis. The Great California Exodus A look at why droves are leaving the state. David L. Why Not Fewer Voters? The fact is that voters got us into this mess.
This page was updated on of serious side states mandating hpv vaccine or debate over vaccination, and mature sex dating. Concerns about sexual health are teens have had recommended shots for meningitis and for tetanus, just because of the age. Flu Vaccine Buttons and Stickers. In contrast, about two-thirds of information concerning this table, please serious adverse reactions to the. In fact, a study published of real girls have found as many as half of all adult males in the. But, he added, he is. Some adverse reactions have been with any rare disease, some give our children an education, HPV vaccine rather than live injection site, slight fever, headache. January July New Hampshire. How much money has Merck Entry. Laws and Mandates for School.As of April , at least four jurisdictions . rushemasecrets.com › research › health › hpv-vaccine-state-legislation-and-statutes. State, HPV vaccination mandate? Who is covered? Implementation date, Number of doses. Alabama. Alaska. Arizona. Arkansas. California. Colorado.