Attitude Adjustments
For decades, most parents have accepted the use of childhood immunizations
in the war on measles, rubella, polio, diphtheria, tetanus and mumps.
In recent years, a new class of vaccine weapons has been under development
to defend against sexually transmitted diseases.
Sexually active adolescents comprise one of the leading target
groups who could benefit most from STD vaccines. Researchers in
the Section of Adolescent Medicine in the IU School of Medicine's
Department of Pediatrics are at work to gauge perceptions and attitudes
of the public and medical community about the use of such immunizations.
"Given the potential of immunizations to ward off STDs, some
believe that current behavioral approaches to control infections
simply are stop-gap measures as new technologies are developed,"
says Gregory D. Zimet, PhD, professor of pediatrics and clinical
psychology.
"Vaccine developments on the STD front involve at least two
major issues," says Dr. Zimet. "First, a vaccine must
be accepted by a large number of the at-risk population, taking
into account their perceptions of personal risk, parental attitudes,
sexual behavior and overall effectiveness of a vaccine. The second
issue involves post-immunization behavior."
If, for example, HIV immunization leads to a perception of low
risk of HIV infection and a perception that other STDs are inconsequential,
there could be increases in behavior that lead to contracting other
sexually transmitted infections, Dr. Zimet speculates.
As indicated earlier, progress in STD prevention among teens has
as much to do with attitude and behavior as the development of vaccines.
In a study published in the Journal of Adolescent Health in 1999,
Dr. Zimet and his colleagues surveyed youth at Indianapolis adolescent
health clinics to measure how a hypothetical HIV vaccine that is
ninety percent effective might influence behavior of teens. Although
most of the participants thought an effective vaccine would be acceptable
to their peers, most indicated that such a vaccine would pave the
way for more risky sexual behaviors.
Gauging the attitudes of both adolescents and their parents is
paramount in the use of future vaccines. And for good reason: of
adolescents who have been successfully treated for an STD, forty
percent will contract a second sexually related infection within
two months, according to the Centers for Disease Control and Prevention
The preliminary findings of an interview study conducted by Dr.
Zimet and his colleagues indicate that acceptability of STD vaccines
among some parents might be on the upswing. In an interview of parents
of adolescents in the Indianapolis area, a larger number were adamantly
in favor of STD vaccination of their children; only a handful were
reluctant about STD vaccines or rejected their use outright.
"We were a bit surprised the acceptance level was as high
as it was," Dr. Zimet notes. "There seems to be a parallel,
too, that the farther away from the urban area, the more parents
did not see their children as being at risk. Certainly, there are
morality and religious issues of concern to parents and caregivers
since sexually transmitted diseases are behavior related.
"The bottom line is that the development of a vaccine does
not guarantee its use and it may go unused for years," Dr.
Zimet adds. For example, he says that many sexually active adolescents
remain susceptible to hepatitis B - the only available STD vaccine
- nearly two decades after it was introduced. "Even those who
support vaccinations - and this includes health care providers -
are not always able to deal comfortably with the issues at stake
and this could be a factor in the effectiveness of any STD immunization
program or campaign."
Ongoing studies by Dr. Zimet and his colleagues no doubt will contribute
significantly on both the recommended use of new vaccines and how
they are implemented.
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