PO.PS01.12 · 人群科学
通过政策推进癌症预防：美国各州 HPV 疫苗强制接种规定的差异
Advancing cancer prevention through policy: State-level variation in HPV vaccine mandate in the United States
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摘要 Abstract
中文摘要
目的：人乳头瘤病毒（HPV）疫苗接种仍是癌症预防的基石，但美国青少年的接种覆盖率并不一致。根据全国州立法会议（NCSL）的数据，有五个辖区——夏威夷、波多黎各、罗德岛、弗吉尼亚和哥伦比亚特区——要求接种 HPV 疫苗方可入学，尽管强制规定的范围和执行力度各不相同。本研究考察了影响强制规定采纳的政策决定因素，以为公平的癌症预防策略提供依据。
方法：以 Kingdon 的多源流框架和政策扩散理论为指导，对八个有目的选取的州进行了比较性定性政策分析，这些州代表了 HPV 疫苗强制规定状况和覆盖率的差异。数据来源包括州法规、立法记录、卫生部门文件和 CDC 免疫接种数据。理论驱动的编码及州-变量矩阵识别出强制规定设计、豁免结构、扩散机制和实施障碍中的模式。
结果：具有 HPV 疫苗强制规定的辖区相比无强制规定的州实现了更高的青少年疫苗接种覆盖率。有效性受强制规定范围、执行机制以及医学和非医学豁免可获得性的影响。接种率高的无强制规定州通过健全的公共卫生基础设施、医务人员参与和校本教育举措，展现出可比的结果。由于意识形态阻力、青少年疫苗的政治化以及缺乏协调的联邦或州际激励，强制规定的政策扩散仍然有限。
结论：当 HPV 疫苗强制规定在设计上具有明确的执行条款、有限的豁免和有力的公众沟通时，能够提高覆盖率。通过加强医务人员参与和社区外展的强制等效政策，也可能取得可比的进展。研究结果凸显了可供决策者、护理领导者和癌症预防倡导者采取的可行策略，以加速 HPV 疫苗接种并减少全美各州 HPV 相关癌症差异。
查看英文原文 English abstract
Purpose: Human papillomavirus (HPV) vaccination remains a cornerstone of cancer prevention, yet adolescent coverage in the United States is inconsistent. According to the National Conference of State Legislatures (NCSL), five jurisdictions - Hawaii, Puerto Rico, Rhode Island, Virginia, and the District of Columbia - require the HPV vaccine for school attendance, although mandate scope and enforcement vary. This study examined policy determinants influencing mandate adoption to inform equitable cancer prevention strategies.
Methods: Guided by Kingdon's Multiple Streams Framework and Policy Diffusion Theory, a comparative qualitative policy analysis was conducted across eight purposively selected states representing variation in HPV vaccine mandate status and coverage. Data sources included state statutes, legislative records, health department documents, and CDC immunization data. A theory-driven coding and state-by-variable matrix identified patterns in mandate design, exemption structures, diffusion mechanisms, and implementation barriers.
Results: Jurisdictions with HPV vaccine mandates achieved higher adolescent vaccination coverage compared with non-mandate states. Effectiveness was influenced by the scope of mandates, enforcement mechanisms, and availability of medical and nonmedical exemptions. Non-mandate states with high vaccination rates demonstrated comparable outcomes through robust public health infrastructure, provider engagement, and school-based education initiatives. Policy diffusion of mandates remains limited due to ideological resistance, politicization of adolescent vaccines, and the absence of coordinated federal or interstate incentives.
Conclusions: HPV vaccine mandates can increase coverage when designed with clear enforcement provisions, limited exemptions, and strong public communication. Comparable progress may also be achieved through mandate-equivalent policies that strengthen provider engagement and community outreach. Findings highlight actionable strategies for policymakers, nursing leaders, and cancer prevention advocates to accelerate HPV vaccination and reduce HPV-related cancer disparities across U.S. states.
利益披露 Disclosure
G. K. Kyei, None..
E. Nana Kwaning, None..
E. F. Kyei, None.