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Human papillomavirus (HPV) vaccination uptake has increased in the United States yet continues to fall short of the Healthy People 2030 goal. Cost of care is a known barrier. The Affordable Care Act (ACA) aimed to enhance access to preventive healthcare services, including HPV vaccination. Our study examined the association between the ACA and known vaccination-enabling factors in the United States. We analyzed data from 29,216 adults aged 18–26 in the National Health Interview Survey from 2011 to 2017. Changes in vaccination-enabling factors (regular physician visitation and changes in health insurance status) and HPV vaccination status pre- (2011–2013; n = 13,494) to post-ACA (2014–2017; n = 15,722) were assessed using logistic regression models adjusted for poverty, education, marital status, comorbidities, sex, and geography. A total of 13,494 and 15,722 eligible individuals were identified pre- and post-ACA, respectively. Post-ACA, the proportion of individuals reporting receipt of one dose of the HPV vaccine increased by 43 % (3.9 % to 5.5 %; OR 1.45, 95 % CI 1.24, 1.70; p < .001), with significant gains among non-Hispanic White (OR 1.55, 95 % CI 1.24, 1.94) and Black individuals (OR 1.59, 95 % CI 1.12, 2.29). Completion of ≥2 doses rose from 12.5 % to 17.8 % (OR 1.62, 95 % CI 1.47, 1.79), notably among Hispanic individuals (7.6 % to 14.7 %, ORinteraction = 1.36, 95 % CI 1.05, 1.77; p = .020). Post-ACA, there was a significant decrease in uninsured rates and an increase in vaccination completion odds among individuals privately insured (OR 1.36, 95 % CI 1.22, 1.52; p < .001) and those insured by Medicaid (OR 1.81, 95 % CI 1.35, 2.43; p < .001). Regular physician visits also rose pre- to post-ACA (53.1 % to 57.1 %, OR 1.17, 95 % CI 1.09, 1.25; p < .001). The ACA has been associated with increased HPV vaccination uptake, especially among racial/ethnic minorities, gains likely driven by an increase in vaccination-enabling factors such as decreased uninsurance and increased access to physician visits. •The Affordable Care Act (ACA) increased HPV vaccination rates among 18–26 year-olds in the U.S.•Post-ACA, vaccine uptake rose significantly in racial/ethnic minority groups.•Insurance coverage and regular physician visits improved post-ACA.•The ACA reduced vaccine cost barriers and expanded healthcare access.•Persistent racial disparities in HPV vaccine uptake remain despite ACA gains.

The Oxford Cognitive Screen (OCS) is a screening tool to assess stroke patients for deficits in attention, executive functions, language, praxis, numeric cognition, and memory. In this study, the OCS was culturally and linguistically adapted to Tamil, for use in India (OCS TA), considering the differences between formal and spoken versions of Tamil and consideration of its phonetic complexity. We adopted two-parallel form versions of the OCS and generated normative data for them. We recruited 181 healthy controls (Mean = 39.27 years, SD 16.52) (141 completed version A, 40 completed version B, 33 completed version A and B) and compared the data with the original UK normative sample. In addition, 28 native Tamil-speaking patients who had a stroke in the past three years (Mean = 62.76 years, SD 9.14) were assessed. Convergent validity was assessed with subtasks from Addenbrooke's Cognitive Examination III (ACE-III). We found significant differences between the UK normative group and the OCS TA normative group in age and education. Tamil-specific norms were used to adapt the cutoffs for the memory, gesture imitation, and executive function tasks. When domain-specific scores on the ACE-III were compared, OCS TA exhibited strong convergent validity. The OCS TA has shown the potential to be a useful screening tool for stroke survivors among Tamil speakers with the two-parallel forms demonstrating good equivalence. Further empirical evidence from larger studies is required to establish their psychometric performance and clinical validity.