Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors

Abstract

BACKGROUND: Despite preventive health benefits of the human papillomavirus (HPV) vaccination, uptake in the United States remains low. Twenty-four states have enacted legislation regarding HPV vaccination and education. One reason these policies have been controversial is because of concerns that they encourage risky adolescent sexual behaviors. Our aim in this study is to determine if state HPV legislation is associated with changes in adolescent sexual behaviors. METHODS: This is a difference-in-difference study in which we use data on adolescent sexual behaviors from the school-based state Youth Risk Behavior Surveillance System from 2001 to 2015. Sexual behaviors included ever having sexual intercourse in the last 3 months and condom use during last sexual intercourse. We compared changes in sexual behaviors among high school students before and after HPV legislation to changes among high school students in states without legislation. RESULTS: A total of 715 338 participants reported ever having sexual intercourse in the last 3 months, and 217 077 sexually active participants reported recent condom use. We found no substantive or statistically significant associations between HPV legislation and adolescent sexual behaviors. Recent sexual intercourse decreased by 0.90 percentage points (P = .21), and recent condom use increased by 0.96 percentage points (P = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses. CONCLUSIONS: Implementation of HPV legislation was not associated with changes in adolescent sexual behaviors in the United States. Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation.

State statutes and regulations related to human papillomavirus vaccination

“…11 While helpful, some of this research focuses exclusively on legislative activity. 25,26 Additionally, much of the existing HPV vaccination law literature relies on data generated by NCSL. 8,9,11,21,26,27 While this information is incredibly valuable for strategic planning, developing policy priorities, and giving an idea of the existing landscape of laws, it cannot be relied on for scientific studies.…”

Human Papillomavirus Vaccines: Successes and Future Challenges

“…These controversies and challenges have arisen from misinformation and disregard of scientific evidence, stemming from distrust of institutions, the pharmaceutical industry, and biomedical technologies [138,139,140]. One such controversy was that of risk compensation, which is no longer a valid argument to prevent HPV legislation [105], and appears to be less and less of a concern among most parents. Nonetheless, continued concerns about the safety of the HPV vaccine linger.…”

“…Furthermore, a recent difference-in-difference study that examined the concept of risk compensation at the policy level found that US state HPV legislation was not associated with any increased or significant changes in riskier US adolescent sexual behaviors [105]. In fact, the authors found the reverse: sexual intercourse decreased by 0.90 percentage points (P = 0.21) and recent condom use increased by 0.96 percentage points (P = 0.32) among adolescents in states that had enacted HPV vaccine legislation compared with states that had not [105], highlighting that HPV legislation could be protective to encourage positive safe-sex behaviors.…”

Access to HPV vaccination for boys in the United Kingdom

“…[39][40][41] However, these concerns appear misguided, as evidence to date suggests that vaccinated cohorts exhibit no increase in sexual activity, relative to their unvaccinated peers. 42,43 Further evidence indicates that abstinence approaches are themselves ineffective, with teens subjected to such education commencing sexual activity at the same stage as their peers, 44,45 but being less likely to use contraception or condoms. 46 Outside of the United States, safety concerns rather than the moral ones have proved a far greater barrier to implementation of HPV vaccination programmes.…”