Nearly all U.S. states offer the human papillomavirus (HPV) vaccine to adolescent girls who have been arrested or detained, according to a new report from The Miriam Hospital and Brown University. The study, published in the May issue of the Journal of Adolescent Health, offers the first nationwide review of HPV vaccination practices among juvenile justice facilities.
HPV is the most common sexually transmitted disease in the United States. Approximately 20 million Americans are currently infected with HPV, and another six million people become infected each year. At least half of all sexually active men and women will get it at some point in their lives. There are more than 40 types of genital HPV, which is passed to others through sexual contact. Although HPV is usually harmless, some types are associated with genital warts and certain cancers -- particularly cervical cancer, which strikes more than 12,000 American women each year.
Several FDA-approved vaccines have been found to be effective in protecting women against the types of HPV that can cause cervical cancer. Vaccines are recommended for females between the ages of 11 and 26.
"Juvenile offenders may be at particularly high risk for HPV because they tend to become sexually active at a younger age and have more sexual partners than their peers," says Courtney E. Henderson, MPH, the study's lead author and administrative director for the Center for Clinical and Translational Sciences at Brown University. "Also, these girls often do not receive consistent health care, meaning they might not otherwise receive the HPV vaccine on their own."
Henderson, along with co-investigators Michelle A. Lally, MD, MSc, and Josiah D. Rich, MD, MPH, both from The Miriam Hospital, surveyed state immunization program managers or juvenile justice medical personnel from all 50 states. They found that 39 states -- including Rhode Island -- currently offer the HPV vaccine to adolescents residing in juvenile justice facilities. Ten of these states only administer the vaccine to juvenile offenders who are incarcerated, but do not make it available to detainees due to their short length of stay.
"Given that approximately 25,000 adolescent girls pass through detention facilities annually, and their increased risk for HPV, vaccinating these teens should be a priority," says Lally, who along with Rich, are also affiliated with The Warren Alpert Medical School of Brown University and are physicians with University Medicine.
"The health of this high risk population could be significantly improved with health care programs based in the juvenile justice setting."
In most states that offer the HPV vaccine, the state or facility superintendent is authorized to consent for vaccination with the adolescent's agreement. Other states initially seek out or require some form of parental consent in order to administer the vaccine.
Researchers also identified several barriers to HPV vaccine administration. A general lack of education among adolescents about the HPV vaccine and its benefits was most commonly reported, followed by parental consent requirements, a lack of adequate and consistent health care staff to administer the vaccine, adolescents' fear of needles, and cost.
To increase the uptake of the HPV vaccine in the juvenile justice system, the authors recommend all states make the vaccine available to juvenile offenders, offer the vaccine universally to both detained and incarcerated adolescents, and adopt more liberal vaccine consent protocols. They also call for additional educational outreach for adolescents in juvenile justice facilities.
"Young girls in juvenile justice facilities will eventually become part of the general population again," says Henderson. "Any opportunity we have to improve their health will ultimately lead to improvements in the overall health of our communities."
The study was supported by grants from the National Institute of Health's National Institute on Drug Abuse (NIDA/NIH) and Center for AIDS Research (CFAR).
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