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HPV Vaccine: A License to Thrill?

While some debate the political wisdom of mandating HPV vaccination of young girls, the science is clear. The vaccines are safe, reduce the burden of a disease that infects 6 million women annually, and do not promote promiscuity.

Human papilloma virus (HPV), the virus that causes cervical cancer, infects 6.2 million women each year.  Nearly 25 percent of girls ages 14-19 and nearly 45 percent of young women ages 20-24 are infected with HPV.  HPV types 16 and 18 cause 70 percent of cervical cancers worldwide; types 6 and 11 cause genital warts.  In 2006 and 2009, two FDA-approved vaccines were licensed for use in females ages 9-26 years to protect against HPV infection.

This study explores whether sexual behavior and demographics correlate with the initiation of HPV vaccination.  Data were obtained from the National Survey of Family Growth (NSFG) 2006-2008, representing a sample of the US household population aged 15-44 years. From June 2006 to December 2008, a total of 7356 women were interviewed. The response rate was 76 percent.

All females  were asked if they had ever heard of HPV and the HPV vaccine, while those under 25-years-old were asked if they had received at least one dose of the vaccine.  Statistical analysis was based on the 4283 females aged 15-24 who were asked these questions. For questions regarding receipt of the HPV vaccine, analyses were limited to 1243 females who were actaully aware of the vaccine’s existence. A separate analysis was run for girls aged 15-19 due to potential influence by the federally-funded Vaccines For Children (VFC) program .

Differences were examined with regards to receipt of the HPV vaccine by demographic factors (marital status, race/ethnicity, religion, education, and poverty income level), parental communication about sexual health (talks about STDs, birth control, how to say no, how to use a condom), and whether the respondent ever engaged in vaginal sex.

To observe differences in sexual behaviors by receipt of HPV vaccine, only those reported having vaginal sex (n=833) were analyzed.  Data from an earlier analysis of sexual activity and condom use among teens were also examined.  Receipt of a Pap test or an STD service was used as a general measure of access to reproductive health care.

Of females aged 15-24 years, 23 percent reported at least one dose of HPV vaccine. HPV vaccination was significantly higher in those aged 15-19 (30.3 percent) versus those aged 20-24 (15.9 percent).  Of those in the younger age group, there was no difference in receipt of HPV vaccine by race, education, or poverty level.  Report of vaginal sex, parental communication variables, and receiving reproductive health services were all unrelated to receipt of the HPV vaccine. Insured  and Catholic respondents were more likely to receive the vaccine than their counterparts.

In the sexually active 15-19 age cohort, no demographic variables were related to receipt of HPV vaccine.  HPV vaccination was higher in those who used condoms (either  “always” or “inconsistently”, >40 percent) than those who never used condoms (18 percent). Demographic differences were, however, noted in women aged 20-24. Non-Hispanic blacks were significantly less likely than white women to receive HPV vaccine. (95% CI= 0.1,0.5).   Never married women were 3 times more likely to be vaccinated than women of other marital statuses.  Unlike the younger age group, there were no differences in HPV vaccination by religion and poverty.  Finally, there were no differences in vaccination with having had sex or having received reproductive services.

Commentary

Texas Governor Rick Perry was chastised due to his 2007 executive order to vaccinate all girls in the 6th grade with the HPV vaccine.  Perry has since removed the order; however, his actions bring to question the role of public health on health policy.  While criticism of Perry’s order was based largely on his administration’s conflict of interest with the manufacturer of the Gardasil HPV vaccine, criticism did not end there.

The notion that the HPV vaccine might encourage young girls to initiate sexual activity or to engage in high-risk sexual behaviors exists.  This study clearly demonstrates that young girls receiving the vaccine are no more likely to report having sex.  Among women who were sexually active, those who engaged in safer sexual practices (i.e. condom use) were also more likely to be vaccinated than those who participated in unsafe sex..

Sadly, the idea that the HPV vaccine might actually prevent cervical cancer has been lost.  Fifty years ago, cervical cancer was the leading cause of cancer death in females; after the introduction of the Pap test it is now number fourteen.  Instead of embracing another tool that will lessen the morbidity and mortality of cervical cancer,  myths continue to surface like Michelle Bachmann’s recent insinuation that the vaccine causes mental retardation.  Criticism of the HPV vaccine raises a series of important questions.  Despite efforts to “find a cure,” will legislators serve as obstacles to the prevention of diseases that are sexually-transmitted?  If a vaccine or a cure for HIV existed, would this also be labeled as a green light to engage in high-risk sexual behaviors or would the priority be to decrease premature deaths from preventable diseases?  Law makers need to strongly consider how their opinions and decisions potentially affect their constituents’ health.

Liddon, NC, et al. Human papillomavirus vaccine and sexual behavior among adolescent and young women. Am J Prev Med. 2012 Jan; 42(1):44-52.

 by
Renee Volny, DO, MBA
About Renée Volny Darko, DO, MBA

Dr. Volny is an OB/GYN for the UPMC Altoona Regional Health System. She recently served as interim associate director of the Health Policy Leadership Fellowship at the Morehouse School of Medicine’s Satcher Health Leadership Institute under the direction of the 16th U.S. Surgeon General, Dr. David Satcher. She is, herself, a 2011 graduate of that fellowship. She earned her medical degree from Kansas City University of Medicine and Biosciences and her Masters in Business Administration in Health Care Leadership from Rockhurst University. She completed her residency in Obstetrics and Gynecology at the UMDNJ – Robert Wood Johnson Medical School in 2010. Contact: Facebook | Twitter | More Posts

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