{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:28:26Z","timestamp":1792200506711,"version":"4.4.0"},"reference-count":28,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,6,12]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe school-level and area-level factors that influence coverage of the school-delivered human papillomavirus (HPV) and meningococcal A, C, W and Y (MenACWY) programmes among adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Ecological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>Aggregated 2016\/2017 data from year 9 pupils were received from 1407 schools for HPV and 1432 schools for MenACWY. The unit of analysis was the school.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Outcome measures were percentage point (pp) difference in vaccine coverage by schools\u2019 religious affiliation, school type, urban\/rural, single sex\/mixed and region. A subanalysis of mixed-sex, state-funded secondary schools also included deprivation, proportion of population from black and ethnic minorities, and school size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Muslim and Jewish schools had significantly lower coverage than schools of no religious character for HPV (24.0 (95% CI \u221238.2 to \u22129.8) and 20.5 (95% CI \u221230.7 to \u221210.4) pp lower, respectively) but not for MenACWY. Independent, special schools and pupil referral units had increasingly lower vaccine coverage compared with state-funded secondary schools for both HPV and MenACWY. For both vaccines, coverage was 2 pp higher in rural schools than in urban schools and lowest in London. Compared with mixed schools, HPV coverage was higher in male-only (3.7 pp, 95%\u2009CI 0.2 to 7.2) and female-only (4.8 pp, 95%\u2009CI 2 to 7.6) schools. In the subanalysis, schools located in least deprived areas had the highest coverage for both vaccines (3.8 (95% CI 0.9 to 6.8) and 10.4 (95% CI 7.0 to 13.8) pp for HPV and MenACWY, respectively), and the smallest schools had the lowest coverage (\u221210.4 (95% CI \u221214.1 to \u22126.8) and \u22127.9 (95% CI \u221212 to \u22123.8) for HPV and MenACWY, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tailored approaches are required to improve HPV vaccine coverage in Muslim and Jewish schools. In addition, better ways of reaching pupils in smaller specialist schools are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029087","type":"journal-article","created":{"date-parts":[[2019,7,12]],"date-time":"2019-07-12T05:34:38Z","timestamp":1562909678000},"page":"e029087","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["What school-level and area-level factors influenced HPV and MenACWY vaccine coverage in England in 2016\/2017? 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