This is the first study of HPV vaccination practices among juvenile justice facilities. We had a 100% response rate from states and found that most states currently offer the HPV vaccine to adolescent females residing in juvenile justice facilities. However, in many of these states the HPV vaccine is offered only to committed youth and is not offered or inconsistently offered to detained youth. The primary reason given by respondents for not vaccinating detained youth was the short length of stay. Given the approximately 25,000 adolescents who pass through detention facilities annually [6
] and their increased risk for HPV, vaccinating these individuals should be a priority. Providing at least the first HPV vaccine dose to detained youth, and for those released, linking them to community-based providers after release for the second and third vaccine doses, has the potential to significantly improve HPV vaccination rates among this population.
In most states that provide the vaccine, protocols allow the state or facility superintendent to consent for HPV vaccination with the adolescent’s agreement. To increase uptake of the HPV vaccine it may be beneficial for states that require parental consent or seek parental consent initially to move to more liberal consent protocols.
One of the primary barriers cited in this study was a general lack of education regarding HPV vaccination among adolescents. It is important to increase HPV vaccine educational efforts for adolescents in juvenile justice facilities.
Cost was also cited as a barrier in some states. The HPV vaccine is provided through the Center for Disease Control’s Vaccines for Children (VFC) program, as long as the juvenile justice facility is enrolled as a VFC provider [7
]. Many juvenile justice facilities are enrolled as VFC providers and have access to vaccine through this program. Further research is necessary to examine reasons for non-VFC provider status among juvenile justice facilities.
One of the limitations of this study is that state immunization program managers were relied upon for accurate information regarding policy in their state and true practices of all individual facilities were not confirmed. However, state immunization program managers are in a position to be most knowledgeable about state policy. In addition, this study did not account for any adolescents residing in either adult correctional facilities or privately operated juvenile justice facilities.
The juvenile justice setting provides an important opportunity to administer the HPV vaccine to a high-risk, hard-to-reach population that might not otherwise receive the benefits of the vaccine. To maximize vaccine uptake, all states should make the HPV vaccine available, offer the vaccine universally to both detained and committed youth, and optimize consent protocols to allow for efficient vaccine delivery.