title: A semi-qualitative study of attitudes to vaccinating adolescents against human papillomavirus without parental consent.
abstract: BACKGROUND
  The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10-14 year old girls. HPV is a sexually transmitted virus and some parents may refuse consent for vaccination. Under-16s in the UK have a right to confidential sexual health care without parental consent. We investigated parents' views on making available HPV vaccination to adolescent minors at sexual health clinics without parental consent.
  
  
  METHODS
  This was a semi-qualitative analysis of views of parents of 11-12 year old school children collected as part of a population-based survey of parental attitudes to HPV vaccination in Manchester. Parents were firstly asked if they agreed that a well-informed child should be able to request vaccination at a sexual health clinic without parental consent, and secondly, to provide a reason for this answer. Ethical perspectives on adolescent autonomy provided the framework for descriptive analysis.
  
  
  RESULTS
  307 parents answered the question, and of these, 244 (80%) explained their views. Parents with views consistent with support for adolescent autonomy (n = 99) wanted to encourage responsible behaviour, protect children from ill-informed or bigoted parents, and respected confidentiality and individual rights. In contrast, 97 parents insisted on being involved in decision-making. They emphasised adult responsibility for a child's health and guidance, erosion of parental rights, and respect for cultural and moral values. Other parents (n = 48) wanted clearer legal definitions governing parental rights and responsibilities or hoped for joint decision-making. Parents resistant to adolescent autonomy would be less likely to consent to future HPV vaccination, (67%) than parents supporting this principle (89%; p < 0.001).
  
  
  CONCLUSIONS
  In the UK, the principle of adolescent autonomy is recognised and logically should include the right to HPV vaccination, but this may concern parents who would otherwise approve vaccination.
authors.affiliation: Academic Unit of Obstetrics & Gynaecology, Research floor, St, Mary's Hospital, Whitworth Park, Manchester, M13 0JH, UK. loretta.brabin@manchester.ac.uk
authors.forename: Loretta
authors.initials: L
authors.lastname: Brabin
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Henry C
authors.initials: HC
authors.lastname: Kitchener
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D033282:Parental Consent; D011795:Surveys and Questionnaires; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines