SUNDAY, May 4 (HealthDay News) -- New research shows that only half of American mothers intend to have their teenaged daughters vaccinated against human papillomavirus (HPV) if the girls are under the age of 13, despite government guidelines that suggest the opposite.

HPV, which is sexually transmitted, is the primary cause of cervical cancer. The first vaccine against the virus, Gardasil, was approved in 2006. The U.S. Centers for Disease Control and Prevention currently recommends that 11- and 12-year-old girls be targeted for this vaccine, as most girls of this age are not yet sexually active, have not yet been exposed to HPV, and will therefore achieve maximum protection.

However, this study suggests that many mothers aren't willing to follow those recommendations.

"Mothers had a lower intention to vaccinate [younger] daughters," said study author Dr. Jessica Kahn, an associate professor of pediatrics at Cincinnati Children's Hospital Medical Center. "This presents a challenge, and provides us with an opportunity to educate mothers about the importance of vaccinating girls under 13 years of age because the vaccine will have a greater health impact if given before 13."

Kahn will present the findings Sunday at the Pediatric Academic Societies' annual meeting in Honolulu.

About 10,000 new cases of cervical cancer are diagnosed in the United States each year, with about 4,000 women dying of the disease annually.

Three-quarters of U.S. women will be exposed to HPV at some point in their lifetime and, at any one time, one-quarter have been infected.

According to one estimate, giving the vaccine universally would eliminate about 70 percent of cervical cancer cases. Gardasil protects against most, but not all, types of HPV that cause cervical cancer.

This study is the first national survey of its kind and also the first to measure attitudes towards the vaccine since it was approved by the U.S. Food and Drug Administration in 2006.

Forty-nine percent of almost 10,000 respondents intended to vaccinate a daughter if she were 9 to 12 years old; 68 percent intended to vaccinate if the daughter was 13 to 15 years old; and 86 percent said they would vaccinate if the daughter was 16 to 18 years of age.

Specific beliefs about HPV vaccine were the most powerful predictor of one's intention to vaccinate one's 9-to-12-year-old daughter.

The belief that really stood out was that the vaccine would protect the daughter against cervical cancer. "That was not at all surprising to me," Kahn said. "[Other] studies have shown that the most powerful factor driving mothers' decisions is the desire to protect a child from harm."

The next most powerful predictor were beliefs that the vaccinations would not cause a child to engage in riskier sexual behaviors.

"That implies we need some studies to prove or disprove this concern," Kahn said. "It also is going to be important for clinicians to address that head on with parents."

If a clinician recommended the vaccine, the mom was more likely to decide to vaccinate her daughter.

Mothers were also more likely to go for the vaccine if they thought their daughter was at risk for HPV.

All of these factors could be incorporated into messages, including those seen in brochures and posters about HPV and the vaccine, Kahn said. She was also lead author of a paper appearing in the May issue of Obstetrics & Gynecology that found that interventions which address personal beliefs about the HPV vaccine as well as system-wide barriers to vaccination could lead to higher vaccination rates.

"This shows that there's a difficulty in having mothers recognize that their children will become sexually active at a relatively young age," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "It's a process and it's an attitudinal change that has to occur."

More information

The U.S. National Cancer Institute has more on HPV and cervical cancer.

WEDNESDAY, April 30 (HealthDay News) -- There's a big difference between "secure" high self-esteem and "fragile" self-esteem, according to University of Georgia researchers, who found that those with the secure form are less likely to be verbally defensive.

"There are many kinds of high self-esteem, and in this study, we found that for those in which it is fragile and shallow, it's no better than having low self-esteem," Michael Kernis, a professor of psychology, said in a prepared statement. "People with fragile self-esteem compensate for their self doubts by engaging in exaggerated tendencies to defend, protect and enhance their feelings of self-worth."

Kernis and his colleagues studied 100 undergraduate students to determine how they responded to perceived challenges to their self-esteem.

"Individuals with low self-esteem or fragile high self-esteem were more verbally defensive than individuals with secure high self-esteem. One reason for this is that potential threats are, in fact, more threatening to people with low or fragile high self-esteem than those with secure high self-esteem, and so they work harder to counteract them," Kernis said.

But people with secure high self-esteem are better able to accept themselves, "warts and all." Because they feel less threatened, they're less likely to be defensive by blaming others or providing excuses when they discuss past transgressions or threatening experiences.

The study was published in the current issue of the Journal of Personality.

The findings are important, because they show that greater verbal defensiveness is associated with lower psychological well-being and life satisfaction, according to Kernis.

"These findings support the view that heightened defensiveness reflects insecurity, fragility and less-than-optimal functioning rather than a healthy psychological outlook," he said.

"We aren't suggesting there's something wrong with people when they want to feel good about themselves," the researchers wrote. "What we are saying is that when feeling good about themselves becomes a prime directive, for these people, excessive defensiveness and self-promotion are likely to follow, the self-esteem is likely to be fragile rather than secure, and any psychological benefits will be very limited."

More information

The American Psychological Association has more about self-esteem  .

THURSDAY, April 24 (HealthDay News) -- Decisions on switching to a second-line series of drugs for HIV/AIDS patients who are failing the first-line regimen are often made on the basis of sophisticated and expensive lab tests.

But a new study shows that survival is only slightly affected if these decisions are based instead on the appearance of clinical symptoms.

Researchers still need to develop less expensive versions of laboratory tests currently used, but lack of test availability shouldn't affect access to highly effective drugs in poorer nations, said the authors of a study in this week's issue of The Lancet.

"I hope that the findings will reassure health policy makers and clinicians that they should continue to make every effort to widen access to ART and not allow any concerns over lack of laboratory monitoring to inhibit this," said study author Andrew Phillips, a professor of epidemiology at Royal Free and University Medical School in London.

The World Health Organization (WHO) recommends that, in lower-income areas, decisions regarding drug treatment for HIV be based on symptoms and, when available, CD4 cell count, rather than viral load.

With viral load, switches to second-line treatment occur when the viral load exceeds 500 copies per millileter.

CD4 cells are a type of immune system cell. Patients generally switch to the second-line drugs when CD4 counts in the blood drop 50 percent from their highest.

WHO-recommended first-line treatment consists of the antiretroviral drugs Zerit (stavudine), Epivir (lamivudine) and Viramune (nevirapine).

Using a computer simulation model to analyze how antiretroviral therapy influences HIV infection, the researchers compared survival rates, switch of second-line medication regimens and development of resistance for three different strategies: monitoring viral load and CD4 cell count or clinical observation.

Over a period of five years, 83 percent of patients using the viral load monitoring strategy, 82 percent using CD4 cell count monitoring, and 82 percent using clinical monitoring survived.

After a period of 20 years, survival rates were 67 percent, 64 percent and 64 percent, respectively. Viral load monitoring showed a slightly longer survival but was not the most cost-effective avenue (at a cost of around $3,500 per life-year gained).

Other experts were concerned that the results might be construed to mean viral load monitoring and CD4 cell count should be abandoned in the developed world.

"It's a great study, but it has no application to First World countries," said Dr. Michael Horberg, director of HIV/AIDS policy at Kaiser Permanente Health Plan in Santa Clara, Calif. "There is wide availability of these tests, and there should be funds to support such monitoring.

"Having said that, it has to be well-acknowledged that in resource-limited nations, CD4 count and viral load monitoring are expensive and have limited availability, and clinical decisions have to be made on the basis of clinical impressions," Horberg continued. "Health-care infrastructures must be sent to resource-limited nations. However, in the interim, clinicians should at least be reassured that their clinical practices are not doing undue harm.

"Infectivity seems to be increased with increased viral load. Not monitoring viral load could mean that highly infectious patients are passing the virus to new people and, indeed, a virus which is already resistant to drugs."

More information

The World Health Organization   has more on antiretroviral therapy for HIV infection.

MONDAY, April 7 (HealthDay News) -- Babies born to women who use cocaine, alcohol or tobacco during pregnancy may have brain structure changes that persist into early adolescence, a new U.S. study says.

Researchers at Children's Hospital Boston and the Boston Medical Center used MRI scans to study the brains of 35 children, average age 12, who were exposed to the substances while in the womb.

"We found that reductions in cortical gray matter and total brain volumes were associated with prenatal exposure to cocaine, alcohol or cigarettes," study first author Dr. Michael Rivkin, a neurologist at Children's Hospital Boston, said in a prepared statement.

The more substances a child was exposed to, the greater the reduction in brain volume.

The study, published in the April issue of the journal Pediatrics, is the first to document joint long-term effects of prenatal cocaine, alcohol and tobacco exposure on brain structure, Rivkin said.

Previous studies that documented brain effects of prenatal alcohol exposure were mostly limited to children with fetal alcohol syndrome. Children with that condition were excluded from this new study.

Rivkin noted that his study was too small to find statistically significant effects of single substances after factoring in exposure to other substances, and was also too small to document the effects of different levels of prenatal exposure.

However, Rivkin said the overall findings are highly suggestive, and he and his colleagues would like to continue their research into this important public health matter. It's estimated that more than one million babies born each year in the United States have been exposed to at least one of these substance while in the womb.

Health-care providers should offer pregnant women comprehensive care to help them reduce the use of all harmful substances. And public health campaigns shouldn't ignore the risks of some substances while focusing on others, since the greater the number of total prenatal exposures, the more likely there will be harmful and lasting effects on a baby's developing brain, the study authors said.

More information

The American Pregnancy Association has more about pregnancy wellness  .