Cook Erin E, Venkataramani Atheendar S, Kim Jane J, Tamimi Rulla M, Holmes Michelle D
Departments of Epidemiology and
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2018-0458. Epub 2018 Aug 13.
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.
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.
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 ( = .21), and recent condom use increased by 0.96 percentage points ( = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses.
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.
尽管人乳头瘤病毒（HPV）疫苗接种对健康有预防益处，但在美国的接种率仍然很低。24个州已经颁布了关于HPV疫苗接种和教育的立法。这些政策引发争议的一个原因是担心它们会鼓励青少年的危险性行为。我们这项研究的目的是确定州HPV立法是否与青少年性行为的变化有关。
这是一项双重差分研究，我们使用了2001年至2015年基于学校的州青少年风险行为监测系统中关于青少年性行为的数据。性行为包括在过去3个月内是否有过性交以及上次性交时是否使用避孕套。我们将HPV立法前后高中生性行为的变化与没有立法的州的高中生性行为变化进行了比较。
共有715338名参与者报告在过去3个月内有过性交，217077名性活跃参与者报告了近期使用避孕套的情况。我们发现HPV立法与青少年性行为之间没有实质性的或统计学上显著的关联。与未颁布立法的州相比，颁布立法的州的青少年中，近期性交减少了0.90个百分点（P = 0.21），近期避孕套使用增加了0.96个百分点（P = 0.32）。多项敏感性分析的结果很稳健。
在美国，HPV立法的实施与青少年性行为的变化无关。在决定是否通过HPV立法时，不应担心立法会增加青少年的危险性行为。
