Impact of the Affordable Care Act on human papillomavirus vaccination initiation among lesbian, bisexual, and heterosexual U.S. women

Objective To examine the effect of the 2010 Affordable Care Act (ACA) extended dependent coverage and no cost‐sharing provisions on human papillomavirus (HPV) vaccination in relation to sexual orientation identity among U.S. women. Data Sources 2006‐2010 and 2011‐2015 National Survey of Family Growth. Study Design We used an interrupted time series design and multivariable Poisson regression to assess differences in HPV vaccination initiation before (2007‐2010) and after (2011‐2015) the 2010 ACA provisions among heterosexual, bisexual, and lesbian U.S. women aged 15‐25 years (N = 7033), adjusting for temporal trends and demographic factors. Data Collection Computer‐assisted personal interview and audio computer‐assisted self‐interview questionnaires. Principal Findings The adjusted prevalence of HPV vaccination initiation was significantly higher among lesbian and bisexual women after compared to before the 2010 ACA—at 19.1 (95% confidence interval [CI]: 5.4, 32.9) and 15.7 (95% CI: 4.4, 27.1) percentage points in 2015 compared to 2007‐2010, respectively. We observed no association between the 2010 ACA provisions and HPV vaccination initiation among heterosexual women after adjusting for temporal trends and demographic factors. Conclusions The 2010 ACA provisions may have improved HPV vaccination initiation among lesbian and bisexual women. Policies and programs that increase access to health insurance and provide HPV vaccines at no cost to patients may facilitate HPV vaccine uptake in these marginalized populations.