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Clinical Preventive Services for Adolescents: Position Paper of the Society for Adolescent Medicine

Published online by Cambridge University Press:  06 January 2021

Abigail English ,
Carol A. Ford  and
John S. Santelli
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Extract

Over the past several years, new vaccines have become available to prevent serious illnesses and conditions in the adolescent population. Several have already been approved by the FDA for use in this age group; others are still in development. Recently, significant public attention has been focused on the availability of vaccines for several strains of HPV, to prevent both cervical cancer and genital warts. Prior to that, the vaccine for Hepatitis B was approved and recommended for the adolescent age group. Others currently available and recommended include vaccines for pertussis, meningitis, and influenza. In the future, additional vaccines are expected to become available for sexually transmitted and communicable diseases such as herpes simplex virus and HIV. Unfortunately, financial limitations and consent requirements can impede adolescents’ access to the vaccines that are recommended for their age group. However, a variety of policy options exist for overcoming the barriers and expanding access. These policy options are grounded both in international principles of human rights and in the existing framework of laws in the United States, and can be enhanced by attending to variations in age and developmental status among adolescents.

Type
Article
Information
American Journal of Law & Medicine , Volume 35 , Issue 2-3 , June 2009 , pp. 351 - 364
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2009

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References

1 David S. Rosen et al., Clinical Preventive Services for Adolescents: Position Paper, 21 J. Adolescent Health 203, 203 (1997).

2 See Elizabeth M. Ozer et al., America's Adolescents: Are They Healthy?, 2003 Nat’l Adolescent Health Info. Ctr. 14-37, available at http://nahic.ucsf.edu//downloads/AA_2003.pdf.

3 Abigail English, Madlyn Morreale, & Amy Stinnett, Adolescents in Public Health Insurance Programs: Medicaid and CHIP 20-22 (Ctr. for Adolescent Health & the Law ed., 1999).

4 Id.

5 See Park, M. Jane et al., The Health Status of Young Adults in the United States, 39 J. Adolescent Health 305, 305 (2006)CrossRefGoogle ScholarPubMed.

6 See Arthur Elster et al., Racial and Ethnic Disparities in Health Care for Adolescents: A Systematic Review of the Literature, 157 Archives Pediatrics & Adolescent Med. 867, 867 (2003), available at http://archpedi.ama-assn.org/cgi/reprint/157/9/867.

7 English et al., supra note 3, at 20-22; see also Harriette B. Fox et al., Early Assessments of SCHIP's Effect on Access to Care for Adolescents, 32 J. Adolescent Health 40, 41 (Supp. 2003).

8 See Am. Acad. of Pediatrics, Guidelines for Health Supervision III (3d ed. 2002); Am. Med. Ass’n, Guidelines for Adolescent Preventive Services (1997), available at http://www.ama-assn.org/ama/upload/mm/39/gapsmono.pdf; Nat’l Ctr. for Educ. in Maternal and Child Health, Georgetown University, Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (Morris Green & Judith S. Palfrey eds., 2d ed. 2002), available at http://brightfutures.org/bf2/pdf; M. Jane Park et al., Nat’l Adolescent Health Info. Ctr., Investing in Clinical Preventive Health Services for Adolescents (2001), available at http://nahic.ucsf.edu/downloads/CPHS.pdf; Am. Acad. of Pediatrics, Scope of Health Care Benefits for Children From Birth Through Age 21, 117 Pediatrics 979 (2006).

9 See Am. Acad. of Pediatrics, supra note 8, at 980-81; see also Claire D. Brindis et al., The Unique Health Care Needs of Adolescents: Assuring Access to Care, 13 The Future of Children 117, 127-30 (2003), available at http://www.futureofchildren.org/usr_doc/tfoc13-1_nophoto.pdf; English et al., supra note 3, at 60-71.

10 See Daniel B. Fishbein et al., New, and Some Not-so-New, Vaccines for Adolescents and Diseases They Prevent, 121 Pediatrics S5, S6-S12 (2008).

11 Id. at S5; Ctrs. for Disease Control and Prevention, Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2009, 57 Morbidity and Mortality Weekly Report Q-1, Q-1-Q-4 (2009), available at http://www.cdc.gov/mmwr/PDF/wk/mm5751.pdf.

12 Lauri Markowitz et al., Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 56 Morbidity and Mortality Weekly RR-2, 1 (2007), available at http://www.cdc.gov/mmwr/PDF/rr/rr5602.pdf.

13 Gregory D. Zimet, Potential Barriers to HPV Vaccine: From Public Health to Personal Choice, 35 Am. J. Law & Med. 389, 390 (2009). The vaccine licensed in 2006, which protects against two strains of cervical cancer and two strains of genital warts, was developed by Merck & Co., Inc., and a second HPV vaccine, which protects against two strains of cervical cancer, was developed by GlaxoSmithKline and is under review by the FDA. Id.

14 Markowitz et al., supra note 12, at 16.

15 Brindis, supra note 9, at 123; Abigail English & Madlyn Morreale, A Legal & Policy Framework for Adolescent Health Care: Past Present & Future, 1 Hous. J. Health L. & Pol’y 63, 68-69 (2001).

16 Brindis, supra note 9, at 123, 126, 130.

17 Carol A. Ford et al., Increasing Adolescent Vaccination: Barriers and Strategies in the Context of Policy, Legal, and Financial Issues, 44 J. Adolescent Health 568, 569 (2009).

18 Id.

19 Id. at 570-72.

20 See Sally H. Adams et al., Health Insurance Across Vulnerable Ages: Patterns and Disparities from Adolescence to the Early 30’s, 119 Pediatrics e1033, e1035-37 (2007); see also Paul W. Newacheck et al., Trends in Private and Public Health Insurance for Adolescents, 291 J. Am. Med. Assoc. 1231, 1233-36 (2004).

21 Newacheck et al., supra note 20, at 1231-33.

22 Adams et al., supra note 20, at e1034.

23 Brindis, supra note 9, at 118.

24 Harriette B. Fox et al., Private Health Insurance for Adolescents: Is It Adequate?, 32 J. Adolescent Health 12, 22 (Supp. 2003).

25 See Ford et al., supra note 17, at 571-72.

26 See id. at 572.

27 Abigail English et al., Legal Basis of Consent for Health Care and Vaccination for Adolescents, 121 Pediatrics S85, S85 (Supp. 2008).

28 Id.

29 Id.; see generally Abigail English & Kirsten E. Kenney, State Minor Consent Laws: A Summary (2d ed. 2003) (summarizing consent laws from all fifty states and the District of Columbia).

30 English et al., supra note 27.

31 Ford et al., supra note 17, at 570-71.

32 Id. at 570.

33 Id.

34 Id.

35 Id.

36 Id.

37 U.N. Convention on the Rights of the Child, G.A. Res. 44/25, U.N. Doc. A/RES/44/25 (Nov. 20, 1989) [hereinafter Convention].

38 See Lynn P. Freedman, Censorship and Manipulation of Reproductive Health Information, in The Right to Know: Human Rights and Access to Reproductive Health Information 3-4 (Sandra Coliver ed., 1995).

39 Universal Declaration of Human Rights, G.A. Res. 217A, at Art. 25.1, U.N. GAOR, 3d Sess., 1st plen. mtg., U.N. Doc. A/810 (Dec. 10, 1948) [hereinafter Universal].

40 Convention, supra note 37, at Art. 24.

41 International Conference on Population and Development, Sept. 5-13, 1994, Report of the International Conference on Population and Development, U.N. A/Conf.171/13 (Oct. 18, 1994) [hereinafter Conference], available at http://www.un.org/popin/icpd/conference/offeng/poa.html.

42 See id.; Convention, supra note 37, at Art. 24; Universal, supra note 39, at Art. 25.1.

43 Peter McIntyre, World Health Organization, Adolescent Friendly Health Services: An Agenda for Change 19 (2002).

44 Convention, supra note 37, at Art. 24.1.

45 U.N. Committee on the Rights of the Child, General Comment No. 4: Adolescent Health and Development in the Context of the Convention on the Rights of the Child, ¶ 1, CRC/GC/2003/4 (July 1, 2003).

46 Id. at ¶ 7.

47 Id. at Part IV.

48 Id. at ¶ 7.

49 Id.

50 Id. at Part I.

51 Id. at ¶ 6.

52 Id. at ¶ 28.

53 Id. at ¶ 41.

54 42 U.S.C. §§ 1396-1397jj (2000).

55 42 U.S.C. §§ 1397aa-1397jj (2000).

56 42 U.S.C. § 1396s(e) (2000).

57 42 U.S.C. § 247b (2000).

58 Fox et al., supra note 7, at 40.

59 Newacheck et al., supra note 20, at 1233.

60 Id. at 1234; see generally Madlyn C. Morreale & Abigail English, Eligibility and Enrollment of Adolescents in Medicaid and SCHIP: Recent Progress, Current Challenges, 32 J. Adolescent Health 25, 36 (Supp. 2003) (noting Census Bureau data suggesting a large portion of uninsured children in low income families would be eligible for Medicaid or SCHIP).

61 Morreale & English, supra note 60, at 26-27.

62 See id. at 28; see also Judith Wooldridge et al., Congressionally Mandated Evaluation of the States Children's Health Insurance Program: Final Report to Congress 3 (2005), available at http://www.mathematicampr.com/publications/pdfs/schipcongress.pdf.

63 Morreale & English, supra note 60, at 26.

64 Id.

65 Id.

66 Id.

67 Id.

68 Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111-3 (Feb. 4, 2009).

69 Morreale & English, supra note 60, at 28.

70 Id.

71 Id. at 38.

72 Id.

73 Id. at 36; Donna C. Ross et al., Resuming the Path to Health Coverage for Children and Parents: A 50 State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2006, Kaiser Commission on Medicaid and the Uninsured 1 (2007), available at http://www.kff.org/medicaid/upload/7608.pdf.

74 42 U.S.C.S. § 1396s(b)(2)(A)(i) (LexisNexis 2009).

75 Newacheck et al., supra note 20, at 1231-32.

76 Fox et al., supra note 24, at 12.

77 See id. at 22 (noting that among private health insurance plans HMOs were more likely to cover preventative services and immunizations than PPOs).

78 Sara Rosenbaum et al., Ctr. for Health Services Research & Pol’y, The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws 14-15 (2003), available at http://www.gwumc.edu/sphhs/departments/healthpolicy/immunization/epidemiology_of_US_immunization_law.pdf.

79 See Ford et al., supra note 17, at 571-72.

80 Id. at 571.

81 See 42 U.S.C.S. § 1396s(e) (LexisNexis 2009).

82 “The Secretary shall provide under subsection (d) for the purchase and delivery on behalf of each State meeting the requirement of section 1902(a)(62) … without charge to the State, of such quantities of qualified pediatric vaccines as may be necessary for the administration of such vaccines to all federally vaccine-eligible children in the State … .” 42 U.S.C.S. § 1396s(a)(2)(A) (LexisNexis 2009).

83 Id.

84 § 1396s(d)(5).

85 Letter from Theresa A. Eagleson, Administrator, Div. of Med. Programs, Ill. Dept. of Healthcare and Fam. Services, to Enrolled Physicians, Advanced Practice Nurses, and Local Health Departments, http://www.hfs.illinois.gov/assets/061507_hpv.pdf (June 15, 2007).

86 42 U.S.C.S. § 1396s(b)(2)(A)(i) (LexisNexis 2009).

87 § 1396s(b)(2)(A)(ii).

88 § 1396s(b)(2)(A)(iii).

89 § 1396s(b)(2)(A)(iv).

90 § 1396s(c)(2)(C)(ii).

91 States are authorized to purchase vaccines for children who are not federally vaccine-eligible through VFC at the same price negotiated by the Secretary for federally vaccine-eligible children. § 1396s(d)(4)(B).

92 42 U.S.C. § 247b (2006).

93 § 247b; Ctrs. for Disease Control, Immunization Grant Program (Section 317): What is the Public Health Issue 1-2 (2007), http://www.cdc.gov/ncird/progbriefs/downloads/grant-317.pdf.

94 Kevin M. Malone & Alan R. Hinman, Vaccination Mandates: The Public Health Imperative and Individual Rights, in Law in Public Health Practice 262-84 (Goodman R.A. et al., eds., 2003), available at http://www.cdc.gov/vaccines/vacgen/policies/downloads/vacc_mandates_chptr13.pdf.

95 Ctrs. for Disease Control, supra note 93, at 1-2.

96 See Ford et al., supra note 17, at 3-5.

97 English & Kenney, supra note 29, at v.

98 E.g., D.C. Mun. Regs. Tit. 22, § 600.7; N.C. Gen. Stat. § 90-21.5 (2009); Okla. Stat. Ann. Tit. 63, §§ 2601 and 2602.

99 See generally English et al., supra note 29.

100 Minn. Stat. Ann. § 144.3441 (West 2009).

101 English et al., supra note 27, at S86.

102 Id.

103 Id.

104 Researchers at the Center for Adolescent Health & the Law are currently conducting such an analysis. Results of the analysis will be released during 2009.

105 Vaccine Information Statements are information sheets produced by the Centers for Disease Control and Prevention that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. CDC, Vaccine Information Statements: What You Need to Know (2005), http://www.cdc.gov/vaccines/Pubs/vis/default.htm.

106 English et al., supra note 27, at S86.

107 Researchers at the Center for Adolescent Health & the Law and the University of North Carolina, Chapel Hill are currently collaborating on a survey of key informants in all 50 states and the District of Columbia to learn more about the extent of knowledge of minor consent laws and their use in the context of vaccination of adolescents. Results of the survey will be released in late 2009 or early 2010.