BILL ANALYSIS Ó
AB 499
Page 1
ASSEMBLY THIRD READING
AB 499 (Atkins)
As Introduced February 15, 2011
Majority vote
HEALTH 13-5 JUDICIARY 7-2
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Feuer, Atkins, Dickinson, |
| |Bonilla, Eng, Gordon, | |Huber, Huffman, Monning, |
| |Hayashi, | |Wieckowski |
| |Roger Hernández, Bonnie | | |
| |Lowenthal, Mitchell, Pan, | | |
| |Silva, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Wagner, Jones |
| |Nestande, Knight | | |
| | | | |
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SUMMARY : Permits a minor who is 12 years of age or older to
consent to medical care related to the prevention of a sexually
transmitted disease. Makes a technical, conforming change to
existing law.
EXISTING LAW permits a minor who is 12 years of age or older and
who may have come into contact with an infectious, contagious,
or communicable disease to consent to medical care related to
the diagnosis or treatment of the disease, if the disease or
condition is one that is required by law or regulation adopted
pursuant to law to be reported to the local health officer, or
is a related sexually transmitted disease (STD), as may be
determined by the State Director of Health Services (now the
State Public Health Officer).
FISCAL EFFECT : None
COMMENTS : According to the author, there is a gap in the law
relative to prevention of STDs because existing law only
specifies the ability of minors to consent to diagnosis and
treatment. The author states that the omission of consent for
preventative services creates a barrier to time-critical
preventive services. The author asserts that at the time the
existing law was passed, the preventive options we have today
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did not exist and there are now time-critical prevention
services for diseases that are sexually transmitted, such as
prophylactic post-exposure HIV medications (which must be given
within 72 hours of exposure) and the human papillomavirus (HPV)
vaccine (which, if given before exposure, can significantly
reduce the risk of certain cancers and abnormal, precancerous
cervical cell changes and genital warts). The author states
that these diseases can be life-long and are only treatable, not
curable. The author further states that while physicians
encourage their minor patients to involve parents, in the past
the Legislature has recognized, by enacting minor consent laws,
that involvement is not always practical and what is paramount
is that teens receive timely, necessary medical care. The
author states that this bill is needed since some adolescents,
from difficult family situations, will either delay or simply
fail to obtain services if confronted with a legal requirement
of parental consent.
According to the Centers for Disease Control and Prevention
(CDC), compared to older adults, sexually-active adolescents 15
to 19 years of age and young adults 20 to 24 years of age are at
higher risk for acquiring STDs for a combination of behavioral,
biological, and cultural reasons. For some STDs, such as
chlamydia, adolescent women may have a physiologically increased
susceptibility to infection due to increased cervical ectopy
(the condition when certain cells are present on the outer
surface of the cervix). The higher prevalence of STDs among
adolescents may also reflect multiple barriers to accessing
quality STD prevention services, including lack of insurance or
other ability to pay, lack of transportation, discomfort with
facilities and services designed for adults, and concerns about
confidentiality. Estimates suggest that while representing 25%
of the sexually experienced population, 15- to 24-year-olds
acquire nearly half of all new STDs. According to a July 2010
report of the California Adolescent Sexual Health Work Group, in
2008 there were 517 California children ages 10 through 17 who
were infected with HIV/AIDS, 18,901 who were infected with
chlamydia, 2,581 who were infected with gonorrhea, and 22 who
were infected with syphilis. While adolescent rates are lower
than young adult rates, these cases are of great concern to
public health officials because chlamydia and gonorrhea are the
leading causes of preventable infertility in California,
affecting all women, but particularly women who are just
entering their reproductive years.
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According to a 2008 report by the California Cancer Registry
(CCR), cervical cancer is the eleventh most frequently diagnosed
cancer among California women, with approximately 1,500 cases,
including 400 deaths, per year. CCR reports that cervical
cancer incidence has declined 29% in California since 1988.
However, Hispanic women are more than twice as likely to be
diagnosed with cervical cancer as non-Hispanic women. Hispanic
and non-Hispanic black women are also more likely to die from
cervical cancer than non-Hispanic white and Asian/Pacific
Islander women. Nearly all cervical cancer is caused by HPV
infection, with two types of HPV accounting for approximately
70% of cervical cancer. HPV also causes 90% of anal cancers;
40% of vulvar, vaginal, and penile cancers; and, smaller
proportions of oral and throat cancers.
In 2006, the federal Food and Drug Administration (FDA) approved
Gardasil, a quadrivalent vaccine (prevents four types of HPV)
manufactured by Merck, for use in females nine through 26 years
of age. The vaccine is injected as three separate doses; the
second dose should be administered two months after the first
dose and the third dose six months after the first dose. The
cost of a three-dose vaccination is estimated at $468, including
the cost of administration, for those covered by private
insurance. In October 2009, the FDA approved Cervarix, a
vaccine that prevents two types of HPV by GlaxoSmithKline, for
use in females 10 through 25 years of age. Non-vaccine
strategies to prevent HPV infection include the use of physical
barriers, such as condoms, reducing the number of sexual
partners, and abstinence from sexual contact.
According to a 2007 article in the journal Disease Markers,
adolescents who are sexually active have the highest rates of
prevalent and incident HPV infection rates, with over 50 to 80%
having infections within two to three years of initiating
intercourse. According to the article, most infections are
transient in nature and will clear. However, a small number of
adolescents will not clear the infection, and persistence of HPV
is strongly linked to the development of invasive cancer. The
author stated that association between age of first intercourse
and invasive cancer cannot be ignored. Consequently, initiating
screening at appropriate times in this group is essential. In
addition, HPV vaccination prior to the onset of sexual activity
is critical since most infections occur within a short time
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frame post initiation.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0000370