Last fall, California passed a law, AB 499, that would allow adolescents 12 years of age and older to provide their own consent in obtaining health care for the prevention of sexually transmitted infections (STIs). As a nurse, I was thrilled. The law would make it easier for teens to get preventive STI services, including the human papillomavirus (HPV) vaccine.
HPV is the most common STI in the United States and the primary cause of cervical cancer. Each year, more than 12,000 women in the United States are diagnosed with cervical cancer and 4,000 women die from it.
The new law ignited controversy. News reports quoted parents who were concerned that their rights were being taken away. Ever since the Advisory Committee on Immunization Practices (ACIP) recommended the HPV vaccine for girls in 2007, the vaccine has conjured fears ranging from the idea that the vaccine is a green light for children to have sex to the worry that it can cause intellectual disabilities. Though there's no evidence to support either idea, media coverage may have contributed to the slow uptake in HPV vaccination rates. Recent U.S. data showed that only 49% of adolescents ages 13 to 17 started the HPV series (three doses) and an even smaller percentage (32%) completed it.
According to 2009 data from the Youth Risk Behavior Surveillance System, 62% of 12th graders have had sexual intercourse. If we don't give the vaccine until we think a teen will have sex, it may be too late. The Centers for Disease Control and Prevention reported that at least 50% of sexually active people in the United States will contract HPV, and each year, 6 million Americans are infected with HPV.
Given the vaccine's potential to save lives and reduce the burden of disease, the ACIP now recommends it for both sexes (males, 11 to 21; females, 11 to 26). The recommendation has been endorsed by the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the American Academy of Family Physicians. In 2011 a study in the Lancet found that a nationwide HPV vaccine program in Australia had in its first several years reduced the incidence of precancerous cervical abnormalities by nearly half among girls ages 17 and younger, whereas the benefit was not significant for women older than 18, emphasizing the importance of giving the vaccine during the teen years.
Requiring teens to get parental permission for the HPV vaccine may discourage some from getting it. Not every teen is able—or willing—to talk to her or his parents about sex. Research and anecdotal evidence strongly suggest that teens are more likely to obtain information about sex from their peers and the media than from their parents.
In addition, vulnerable teens such as homeless youth do not have regular contact with their parents. A significant percentage of homeless youth experience parental abuse. As a volunteer public health nurse at a community agency for homeless youth, I see firsthand the health risks they face. They are significantly more likely to engage in risky sexual behaviors and to have higher rates of STIs, and forcing them to obtain parental consent for preventive health care against STIs can cause them to forgo care altogether.
Another potential benefit of the California law is that a teen who desires the HPV vaccine must interact with a health care professional, most likely a nurse or a physician, who can educate the teen about STIs and reproductive health and also assess the teen's understanding and ability to provide consent for the vaccine.
Nurses have a responsibility to counter misinformation with up-to-date, evidence-based information. With time, the public may view the HPV vaccine as another routine vaccine, like the hepatitis B vaccine, that prevents a serious health issue—in this case, cancer.