1. Sydney Z. Spiesel, PhD MD Yale University School of Medicine

2. warts 2

3. cervical cancer incidence 3

4. prevention of HPV transmission abstinence condom use immunization 4

5. HPV vaccines 5

6. HPV viruses and virus-like particles HPV viruses HPV virus-like particles 6

7. Main cancer-causing HPV strains 7

8. HPV vaccine requirements  contain at least HPV 16 and 18 VLPs (cancer)  may also contain HPV 6 and 8 (genital warts)  administered as 3 shots over 6 months  must be given before exposure for effectiveness … not effective if given after exposure to vaccine strains of HPV  for that reason, especially important to be started early in adolescence 8

9. adolescent vaccination rates 9

10. parental reluctance 10

11. reasons for not immunizing 11

12. underlying issues  mistrust of authority and data  especially medical authority  reliance on Internet  Times New Roman effect  (note that this list is in Times New Roman)  ostensible issues …  not needed (vaccine worthless; never at risk)  too young  questionable safety or side-effects  promotes sexual activity 12

13. the facts about HPV vaccination  immunization can prevent many cancers  incredibly effective if given early  boys as well as girls are at risk  the vaccines are very safe  fear-mongering is very common  especially on the internet  many postings completely false 13

14. practitioner non-advocating issues  need for time-consuming explanations  dislike of raising issues around sexuality  fear of parent reaction  personal disapproval …“It's almost an assault on their innocence to be talking about those things when they do not even know what I'm talking about” -- David Castellan, a Lewisburg, Pa., pediatrician. 14

15. unconscious issues in HPV shots  how can it be that my young teen – almost a baby – will soon/someday be having sex?  if I agree to HPV immunization will it be taken as tacit approval of sex?  will taking the vaccine decrease the perception of danger in sex and encourage experimentation?  will taking the vaccine damage my child’s innocence? 15

16. innocence  a time of …  “simplicity”  “wonder”  “openness”  “a magic time”  “free of ….”  “corruption”  “lying”  “cheating”  asexual “tranquility and serenity” 16

17. issues I address with parents …  need for early administration  HPV vaccine largely ineffective after exposure  HPV as a cause of cancer  cervical  oropharyngeal  HPV vaccine is well-tested, safe, effective  valuable for both boys and girls  importance of skepticism toward what one hears or reads (especially on the internet) 17