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      The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico

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          Abstract

          Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico’s HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews ( n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations’ leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza’s case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

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          Most cited references 7

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          How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability

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            Agendas, Alternatives, and Public Policies

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              Theories of the policy process

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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Qualitative Health Research
                Qual Health Res
                SAGE Publications
                1049-7323
                1552-7557
                April 2021
                March 18 2021
                April 2021
                : 31
                : 5
                : 859-870
                Affiliations
                [1 ]Harvard T.H. Chan School of Public Health and Dana-Farber Cancer Institute, Boston, Massachusetts, USA
                [2 ]University of South Florida, Tampa, Florida, USA
                Article
                10.1177/1049732321991507
                © 2021

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