Minor Consent Laws Research Articles

Minor Consent for Vaccination: Ethically Justified, Politically Fraught.

Policies allowing some minors to consent to receive recommended vaccines are ethically defensible. However, a policy change at the federal level expanding minor consent for vaccinations nationwide risks triggering a political backlash. Such a move may be perceived as infringing on the rights of parents to make decisions about their children's health care. In the current post-COVID environment of heightened anti-vaccination activism, changes to minor consent laws may be unadvisable, and policy makers should proceed with caution.

Minor Consent Laws for Sexually Transmitted Infection and Human Immunodeficiency Virus Services in the United States: A Comprehensive, Longitudinal Survey of US State Laws.

Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397-407. https://doi.org/10.2105/AJPH.2022.307199).

Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics.

Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.

Minor Consent Laws for Sexually Transmitted Infection and HIV Services

This study examines current minor consent laws for sexually transmitted infection/HIV services and related confidentiality protections in all 50 states and the District of Columbia.

Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act.

Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act.

Are State-Level HIV Testing Policies for Minors Associated With HIV Testing Behavior and Awareness of Home-Based HIV Testing in Young Men Who Have Sex With Men?

PurposeThe objective of this study was to determine whether state-level policies that restrict minors' access to confidential HIV testing without parental consent may suppress HIV testing in young men who have sex with men (YMSM) in the United States. MethodsSecondary data from a national HIV prevention trial among YMSM aged 13–17 years (N= 612) were analyzed to evaluate the association between living in a state with restrictive HIV testing policies for minors and HIV testing behavior, awareness of home-based HIV testing, and confidential interactions with a physician. Multilevel logistic regression models were adjusted for age, parents' education level, race, ethnicity, sexual orientation, being sexually experienced, and health literacy of medical forms and controlled for clustering by state. Age-stratified models by state-level age of consent for HIV testing and a subanalysis (including only sexually experienced participants) were also conducted. ResultsResiding in a state with restrictive HIV testing policies was associated with the lack of awareness of home-based HIV testing (adjusted odds ratio [aOR]: 3.06; 95% confidence intervals [CI]: 1.49, 6.28). No significant associations were found for HIV testing behavior (aOR: 1.81; 95% CI: 0.85, 3.84), speaking privately with a physician (aOR: 1.00; 95% CI: 0.56, 1.79), or discussing confidentiality with a physician (aOR: 0.95; 95% CI: 0.52, 1.71) and HIV testing policies for minors. These results were consistent in both the age-stratified models and subanalysis. DiscussionHIV testing proportions among YMSM did not differ by state-level minor consent laws. However, YMSM living in states with restrictive policies on HIV testing for minors were less likely to be aware of home-based HIV testing.

Consent for HIV Testing Among Adolescent Sexual Minority Males: Legal Status, Youth Perceptions, and Associations with Actual Testing and Sexual Risk Behavior.

This brief report presents a preliminary investigation of the relations between minor consent laws for HIV testing/treatment and testing behavior among adolescent sexual minority males (ASMM; N = 127; ages 14-17). Most participants had legal capacity to consent without parental/guardian permission (HIV testing: 79%; HIV testing/treatment: 65%). Despite having this legal right, few (15%) had ever tested. Capacity to consent was not associated with HIV testing in this sample; nevertheless, those who had not disclosed their sexual activity to parents/guardians were less likely to have tested. Confidentiality concerns may be a barrier to testing for these youth despite laws intended to enable independent testing.

Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients

Study ObjectiveProviding adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices. DesignParticipating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality. SettingNine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites. ParticipantsForty-four physicians. InterventionsProvider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions. Main Outcome MeasuresImprovement in confidentiality standards met during minor adolescent well visits. ResultsParticipating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001). ConclusionsA medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.

Challenges to Adolescent Confidentiality in a Children's Hospital.

Protecting confidentiality for hospitalized adolescents can be challenging and may interfere with optimal adolescent-friendly care. The goal of this study was to explore physician trainees' experience with adolescent confidentiality at an academic children's hospital. A total of 175 trainees were invited to complete an online survey about knowledge, attitudes, and experiences with confidential adolescent concerns in the inpatient setting. A total of 133 (76%) responded: 78% female; 65% pediatric or family medicine residents; and 35% medical students. In the past year, 56 (42%) of 133 trainees cared for a hospitalized adolescent whose confidentiality had been breached. Barriers to ensuring confidentiality included: patient/family not knowledgeable about minor consent law (50%); trainees not knowledgeable about minor consent law (47%); and hospital discharge summary requiring parental signature (47%). On patient- and family-centered rounds (PFCR), respondents reported that minor adolescents (aged <18 years) compared with young adults (aged ≥18 years) were more likely to have social history discussed away from the bedside (91% vs 84%; P < .001) and less likely to have confidential time with the medical team (28% vs 47%; P < .001). Barriers to participation in PFCR included the following: patient was sleeping (61%), patient declined to participate (51%), and confidentiality concerns (32%). Breaches in confidentiality for hospitalized adolescents are a common trainee experience. On PFCR, adolescents are less likely to have confidential time with the medical team than young adults. In trainees' experience, hospital systems such as PFCR and discharge procedures pose inherent challenges to confidentiality for minor adolescent patients, as do lack of knowledge of minor consent laws by both clinicians and families.

Legal Barriers to Adolescent Participation in Research About HIV and Other Sexually Transmitted Infections.

Whether adolescents can participate in clinical trials of pharmacologic therapies for HIV prevention, such as preexposure prophylaxis, without parental permission hinges on state minor consent laws. Very few of these laws explicitly authorize adolescents to consent to preventive services for HIV and other sexually transmitted infections. Unclear state laws may lead to research cessation. We have summarized legal, ethical, and policy considerations related to adolescents' participation in HIV and sexually transmitted infection prevention research in the United States, and we have explored strategies for facilitating adolescents' access.

Physician Knowledge and Attitudes around Confidential Care for Minor Patients

Study ObjectiveMinor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. DesignAn anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. ResultsResponse rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. ConclusionsPhysicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services.

Adolescents' Perceptions of Their Consent to Psychiatric Mental Health Treatment

The purpose of this paper is to present the findings of a small-scale study in which the decision-making process of adolescents who consent to psychiatric mental health treatment was examined. Sixteen (16) adolescents were interviewed about their decisions related to initial and continued treatment, along with their understanding of minor consent laws. Interviews were audio-recorded, and transcripts were analyzed through concept analysis. Findings are presented in the context of the decision-making steps and research questions. Most adolescents did not recognize consequences related to psychiatric mental health treatment and did not assimilate and integrate information provided to them about treatment choices. Adolescents disagreed with current minor consent laws that allow minors to consent to certain healthcare treatments without the required consent of the parent. Further, adolescents reported that a collaborative approach in making decisions about the adolescent's psychiatric mental health treatment was most facilitative of achieving the goals of treatment.

Retail Pharmacies and Adolescent Vaccination—An Exploration of Current Issues

To describe adolescent immunization practices prevalent in retail pharmacies in the United States, where little is known about their potential for increasing adolescent immunizations. State pharmacy association spokespersons with knowledge of statewide pharmacy practices were interviewed to assess pharmacy practices and vaccine-related attitudes. Descriptive frequencies and score-tested differences in attitudes, using the generalized estimating equation, are presented. A total of 24 respondents from 24 states completed the interviews. Of these , 14 respondents reported that pharmacists vaccinate adolescents and in these states more than 40% of adolescents presenting for vaccines without a parent would receive vaccines some of the time. Knowledge of minor consent laws was found to be limited. Vaccines were routinely available in <50% of the retail pharmacies. Most of the respondents strongly agreed with Advisory Committee on Immunization Practices' recommendations for tetanus, diphtheria, and pertussis vaccine (83%), human papillomavirus vaccine (58%), and influenza (71%) vaccine. The percentage of the respondents who believed that financial barriers make it difficult for adolescents to obtain human papillomavirus vaccine (96%) and tetanus, diphtheria, and pertussis vaccine (78%) was significantly higher as compared with those who had the same belief regarding influenza (35%) (p < .001). Nineteen respondents (79%) believed that adolescent immunization services in retail pharmacies will likely expand in the next 5 years. If pharmacists want to expand their adolescent immunization roles, they should ensure the availability of adolescent vaccine and address clarification related to consent for vaccines in case of minors.

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Private Physicians and the Provision of Contraceptives to Adolescents

Data from a national sample of private physicians show that 86 percent of obstetrician-gynecologists, general practitioners and pediatricians are willing to prescribe contraceptive methods to adolescent women. However, only 59 percent are willing to serve unmarried minors without parental consent. The obstetrician-gynecologists are more likely to provide contraceptives than the other two specialists, and are likely to have fewer policy restrictions. Although pediatricians are the least willing to prescribe contraceptives (only 32 percent say they would do so for a 15-year-old patient), they are the most likely to refer such patients to other sources of care (61 percent of those who will not provide primary contraceptive care do so). The parental consent requirements that physicians set for contraceptive services are somewhat related to state policies. Seventy-five percent of physicians who provide contraceptive care for adolescents and who practice in states that clearly authorize minors to give their own consent for family planning services will serve unmarried minors on their own consent, compared with 62 percent in states without explicit minor consent laws. Physicians practicing in the Southwest are the most likely to provide contraceptive services to unmarried patients younger than 18, while those in the North are least likely to do so (88 and 67 percent, respectively). Ninety percent of private physicians who prescribe contraceptives for adolescent women will prescribe the pill, but smaller proportions will make the diaphragm or IUD available (61 and 23 percent, respectively). Among the physicians surveyed, the average fee that an adolescent would have to pay for an initial contraceptive visit, including laboratory tests, is $37. Of those who accept teenage contraceptive patients, only 53 percent will accept Medicaid reimbursement and only one percent indicate that they will instead provide free services to adolescents who cannot afford to pay the fee.