↵a Significantly different from vaccination requirements only (P < .05).
↵b HPV was assessed among adolescent girls only; because of sample size, education requirement group includes the 1 state that had a vaccine requirement for this vaccine.
↵c One vaccination requirement for HPV vaccine combined with 5 education requirements to ensure adequate sample size.
↵d UTD Overall was defined for males as receiving ≥1 MenACWY and ≥1 Td/TdaP and among adolescent girls as receiving ≥1 MenACWY, ≥1 Td/TdaP, and ≥1 HPV.
↵e Vaccination requirements only defined as states with ≥1 vaccination requirement for Td/TdaP, MenACWY, and/or HPV vaccines; education requirements only defined as states with no vaccination requirements and ≥1 educational requirement.
Average Percentage Point Change in Coverage From 2008 to 2009 by Timing of Implementation of Middle School Requirement