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Editors' Message  |   April 2008
Counseling Adolescents About Healthy Decision Making: the Opportunity HPV Vaccine Offers
Article Information
Pediatrics / Preventive Medicine / Psychiatry
Editors' Message   |   April 2008
Counseling Adolescents About Healthy Decision Making: the Opportunity HPV Vaccine Offers
The Journal of the American Osteopathic Association, April 2008, Vol. 108, S1. doi:
The Journal of the American Osteopathic Association, April 2008, Vol. 108, S1. doi:
Advances in public health historically have been made through the application of knowledge to policy and practice. Sanitation and immunization have spared countless millions from pain, disability, and death. The recent introduction of the human papillomavirus (HPV) vaccines presents a wonderful opportunity to continue in this tradition. However, it also brings new challenges to healthcare providers. Unlike previous infectious diseases, the latency period between exposure to the infectious agent and clinical disease is measured not in days, weeks, or months, but in years. 
The fear that gripped parents during the polio epidemics 50 years ago propelled them to clinics for the then newly developed Salk and Sabin vaccines. Cervical cancer, condylomata acuminata, and other serious manifestations of HPV infection can be prevented only by the timely administration of the recently developed quadrivalent HPV L1 capsid protein virus-like particle vaccine. But the fear of immediate disease is not present in the minds of parents of early adolescents or the patients themselves—the primary target group for this immunization. Thus, a new challenge or perhaps an opportunity is presented to primary care physicians. Anticipatory guidance for adolescents should always touch on healthy decision making. The important health decisions for young people revolve around drugs, sexuality, and other high-risk behaviors. 
The recommendation to administer the quadrivalent HPV vaccine universally to 11-year-old girls provides primary care physicians with the perfect invitation to approach the discussion of healthy choices, values, and sexuality. This topic can be a great educational opportunity for our young patients and their parents. Despite hopes to the contrary, the majority of adolescents have engaged in some risky sexual experiences before graduating from high school. Primary prevention—a core tenet of osteopathic medicine—means that specific immunoprophylaxis be administered before the inception of intimate sexual behaviors. The articles in this supplement to JAOA—The Journal of the American Osteopathic Association clearly demonstrate the increased risk of contracting HPV infection with increasing time and numbers of partners, the potentially fatal subsequent outcomes, and most importantly—the safety and efficacy of HPV vaccines. 
The time is now. Carpe diem! Every adolescent female patient and her parents deserve to hear about and receive HPV vaccine before the inception of sexual activity. The long-term benefit clearly makes the case for this conversation! 
 Dr Marino, a member of the JAOA's Editorial Advisory Board, is a clinical professor of pediatrics at the New York College of Osteopathic Medicine of New York Institute of Technology in Old Westbury; a clinical professor of pediatrics at State University of New York Medical School in Stony Brook; and associate chairman of pediatrics at Winthrop University Hospital in Mineola, NY.
 
 Dr Marino discloses that he has no financial conflicts of interest related to the topic of this supplement.