Effect of School HPV Vaccination Requirements on Pediatricians' Recommendations.

: Pediatrician recommendations are highly influential in parents' decisions to vaccinate their children against HPV. Unqualified, presumptive, and bundled recommendations (UPBRs) are associated with increased HPV vaccine uptake and are considered best practice. This study analyzes pediatricians' self-reported data to assess changes in UPBR use and the psychosocial determinants of UPBR use as a result of the implementation of a multi-level intervention, the Adolescent Vaccination Program (AVP). : We surveyed pediatricians across 51 clinics in the Houston area. Baseline surveys ( = 137) were distributed in 2015, and follow-ups ( = 120) in 2019. : Pediatrician UPBR use significantly increased as a result of AVP implementation. Change in the provider belief that it is necessary to tell parents that HPV vaccination is not required for public school attendance significantly predicted UPBR use at follow up. This belief was also a significant mediator of increased use of UPBRs at follow-up. : AVP was successful in increasing pediatricians' use of UPBRs. Change in UPBR use is related to one critical psychosocial determinant: beliefs about communication regarding the non-mandatory nature of HPV vaccination for school enrollment. HPV vaccine promotion efforts should devote focus to changing pediatricians' beliefs about the necessity of disclosing the non-mandatory nature of HPV vaccination for school attendance.