Effects of School-Entry Vaccination Mandates on Adolescent Human Papillomavirus Vaccination Uptake: United States, 2008-2023.

Abstract

<b>Objectives.</b> To evaluate the association between school-entry vaccination mandates and adolescent human papillomavirus (HPV) vaccination uptake in the United States. <b>Methods.</b> We conducted a quasi-experimental study using a difference-in-differences approach comparing HPV vaccination uptake (≥ 1 dose) in mandate (n = 4) versus nonmandate (n = 47) states and territories by sex. We used provider-verified vaccination records from the 2008-2023 National Immunization Survey-Teen (n = 240 616) for adolescents aged 13 to 17 years. Models accounted for staggered policy implementation and adjusted for demographic and socioeconomic covariates. <b>Results.</b> School-entry mandates were associated with 6.4 percentage-points (95% confidence interval [CI] = 3.6, 9.1) higher HPV vaccination uptake among girls and 3.4 percentage points (95% CI = 1.8, 5.0) higher uptake among boys. Associations with HPV vaccination uptake increased over time for girls, whereas for boys, associations were concentrated in the first few years following implementation and attenuated thereafter. <b>Conclusions.</b> School-entry mandates are associated with higher HPV vaccination uptake among adolescents. <b>Public Health Implications.</b> Although mandates alone are unlikely to achieve national HPV vaccination targets, they may serve as an important component of comprehensive state efforts to increase uptake and prevent HPV-related cancers. (<i>Am J Public Health</i>. Published online ahead of print August 20, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308635).